I have a pacemaker / loop recorder / spinal cord stimulator (or any other implantable electronic device)
If you have been fitted with any implantable electronic medical device, you can have a REMS scan. Both you and the device will come to no harm and the presence of the device will not affect your scan results.
 

I have a hip replacement.
You cannot have a scan on the side of the hip replacement, but if the other side has not been replaced, it can be scanned.

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I broke my hip and it has been fixed

If you have had a fracture fixed with screws or a nail into the thigh bone, you can still have a REMS scan. However, if your fracture was treated with a half- or full-hip replacement then we are unable to scan that hip. If this is the case, your other hip can be scanned as is usual practice (both hips are scanned as a matter of course). If you have had both hips replaced, you will still be able to have your spine scanned.

 

I am in a wheelchair and have restricted mobility

Although wheelchair access is possible at almost all external OsteoScan UK clinics, the couch height is fixed which makes it unsuitable for most transfers from wheelchairs. However, if you can easily self-transfer to an examination couch, or transfer with minimal assistance, you can have a scan at the Braunston clinic where the couch can be raised and lowered as needed.  If you are unable to self-transfer, then arrangements can be made to have a scan at a neurological physiotherapy centre in Northamptonshire, a few miles away from Braunston, where they have the equipment needed for more complex transfers.

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I have scoliosis
Having scoliosis does not affect a REMS scan in most cases. It is very helpful to know ahead of the scan that a person has a scoliosis and if a previous x-ray or DXA scan (with the spinal images) is available that also assists the operator. However, if a person has a scoliosis and has had a fracture in the lumbar region, the combination can make it difficult, or even impossible, to visualise the spine even with REMS.
 

I have had a spinal fusion / I have implants in my back
You can have a REMS scan if you have had a fusion with metallic implants rods. In most cases, if you have had cement injected into your vertebrae following a fracture (vertebroplasty / kyphoplasty), REMS is unaffected and your spine can still be scanned.
 

What happens if I can’t lie flat for a scan?
If you can’t lie flat, but can lie reclined, then you can have a REMS scan.  There are memory foam pillows at our clinics that make it easier for someone with a painful or curved spine to lie down. Additionally, supporting the legs in a flexed position is often helpful, which is easy to do. The scan part of the appointment usually lasts for 15 – 20 minutes so patient comfort is of great importance and all efforts will be made to ensure the time spent lying is as comfortable as possible. It is very helpful for us to know about lying down difficulties ahead of the clinic appointment so please alert us when booking.

 

I have a very low (or high) BMI  If you are visiting a mobile regional clinic, a portable couch and the mobile EchoS machine is used for the scans with a weight range of 30-130kg. If you weigh less than 30 kg, the REMS device cannot screen you. If you weigh more than 130 kg, but your body mass index (BMI) is less than 40 Kg/m 2 , you will have to have a scan at the Braunston clinic where the mechanical couch has a higher weight rating.

 

Is there an age range of people who can have a scan?

There is no upper age range for a REMS scan, although the report generated by the REMS scan only provides the age-related Z scores up to 85 years of age. The T- scores and Fragility Scores are reported with higher ages. The REMS software allows the lowest age of people being scanned as 21 years. T-scores, Z-scores and Fragility Scores will be generated, but T-scores should be ignored as they are not relevant until a person is 30 or older.

 

Can I bring someone else into my appointment?
Absolutely!  We very much encourage you to bring a friend, spouse, partner or relative. Two pairs of eyes and ears are better than one pair of each. If you wish to tape/record your appointment, you can do so as well.

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Do I get my results there and then?

Your results are provided immediately after the scan has been completed. After the scan part of the appointment, you will be guided through the results and information and education on bone health, focussing on diet, exercise and lifestyle factors will be provided.  Your results will be emailed to you at the end of your appointment.

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Do you send my scan results to my GP?

We email you the reports for your hips and spine (4 pages for each hip and 5 for the spine) plus a summary report containing all the results. If you wish your GP or specialist to see your results you need to forward them yourself.
 

What if after I have had my scan I have left and then realise I have more questions or need more guidance?  

You can book a Zoom appointment with Dr Birch. These should be booked via his PA, Kathy (07534 609934). His Zoom fees are £100 for 30 minutes and £200 for 60 minutes.  

 

All the clinics I want are full. How can I get an appointment quickly?
If you cannot wait until one of the regional clinics and you can travel to Dr Birch's clinic in Braunston (NN11 7JG), you will get an appointment far sooner there rather than waiting for a regional clinic. Contact his PA, Kathy (07534 609934) to book the appointment.
 

What should I wear?  
For women, there is no need to wear any special clothing, just a loose pair of trousers and a normal top. You will not need to completely undress. For the hip scans, your trousers need to be pushed down to your knees and the dignity of your private areas will be protected with a towel.

For the spine scan, the abdomen from the ribcage to the pelvis is exposed, again with dignity carefully preserved.

For men, wearing briefs is a better option than boxer shorts as it means getting access to the front of the hips is made easier.

 

Can I eat before a scan?  
Formally fasting before a scan is not necessary, but it is sensible not to have a heavy meal in the three hours before the appointment. Fluids at any time up to the scan are fine.
If you have known intestinal problems that produce a lot of bloating with gas, it is worth keeping to a bland diet for the 24 hours ahead of the scan to try to reduce the amount of gas in the bowel. This particularly applies to pulses (beans, chickpeas, lentils etc) which are known to be very likely to produce gas; REMS uses ultrasound which is unable to visualise the spine through bowel that has gas in it. Having a significant amounts of gas in the bowel is the commonest reason not to be able to get a good result for the spine.

 

 

Can my Fragility Scores be improved?

Fragility scores can be improved but it is hard to do so. If you can keep your fragility score at or around the same level by very regular impact exercise that is a major achievement and should be the first target. Women who have had improvements tend to be those who are doing 2 + hours of impact exercise daily which is not practicable for most.

 

If my hips have low bone density and moderate Fragility Scores (in the “yellow” zone) how do I protect them? I dance and walk regularly.

Your hips will respond in the same way as the rest of your skeleton to a regular program of impact exercise - as ever starting slow with any new exercises and gradually increasing the intensity and frequency. When walking vary the pace - sometimes fast, sometimes less fast. Carry a backpack with a few bottles of water in it to increase the load on your spine and hips. When coming downstairs do so with a "heavy" tread. Vary the dancing as much as possible. Bones respond to different loads and different rates of loading so the more varied your exercise program the better it will be.

 

I had been going to Qigong/Tai Chi classes, is it okay for me continue these?  I have read that bending from the waist is not advised. Is that correct and is there anything I should be avoiding?

If you have good core muscles that support your spine in all positions including forward bending your vertebrae will not be over-stressed. The advice against forward bending for a person with reduced bone density and increased fragility is especially applicable if the bend involves a lifting action. In a slow, rhythmic exercise such as Tai Chi, this should not be an issue. As ever, if you have not been bending when doing these exercises and want to start, a little bit at a time and gradually building up the amount of bending is the right way to keep your spine safe.

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What if I need to cancel my booked scan?
OsteoscanUK has a comprehensive Cancellation policy which can be read here