Excellence in REMS Scans since 2018
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.
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.
If you have had a fracture fixed with screws or a nail into the thigh bone, you can 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.
Although wheelchair access is possible at almost all external Osteoscan UK Ltd 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 Bragborough 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 Bragborough, where they have the equipment needed for more complex transfers.
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.
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 be scanned.
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.
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 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.
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. In younger people, REMS scans are possible by labelling the patient as “21 years old” following which the Z scores and Fragility Scores can be adjusted using international tables that allow age matched estimates of bone density and bone toughness to be produced.
Absolutely! 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.
Yes. Your REMS scan results are available immediately.
Once the REMS scan has been completed, the person conducting your scan, either Dr Nick Birch or Alison Johnson, will sit down with you and go through your results. They will explain the findings, what they mean and the appropriate guidance. Alison follows the same thorough report-review process as Dr Birch.
Your results will be emailed to you following your appointment. If further consultant input is required, a separate Zoom consultation with Dr Birch can be arranged for an additional fee.
We email you the reports for your hips and spine (4 pages for each hip and 5 for the spine) for your own use but we do not send them to your GP. If you wish your GP to see your results you need to forward them to the practice yourself.
You can book a Zoom appointment with Mr Birch. These should be booked via his PA, Kathy (07534 609934). His Zoom fees are £150 for 30 minutes and £300 for 60 minutes. An alternative option, if you have a complex past history and have lots to go through, is to book a double appointment at a clinic.
This can be done on an ad hoc basis. There is an additional cost of £150 per letter.
If you cannot wait until one of the regional clinics and you can travel to Mr Birch’s full- time consulting rooms in Braunston (NN11 7JG), you will get in far sooner than waiting for a regional clinic. The Braunston clinic runs on most Mondays and Wednesdays as well as Thursday mornings. Contact his PA, Kathy (07534 609934) to book the appointment.
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.
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. 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.
We would highly recommend you visit our webpage: How to Prepare for Your REMS Scan: A Step-by-Step Patient Guide
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.
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.
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 mineral density and increased fragility is really only 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.
No, REMS does not visualise bones in the same way that DXA does. DXA is an X-ray modality that directly images the spine and hips. This means that it can detect old and new fractures. REMS uses the information from ultrasound signals to measure the density and toughness of the hip and spine, but it cannot visualise the bones to see whether there is a fracture or not. Therefore, if a person has had a fracture and has no symptoms, which most commonly occurs in the spine, REMS would not pick up such a fracture, whereas DXA would. However, DXA cannot determine how old that fracture is, and comparison with previous X-rays is needed to try to understand when the fracture might have occurred, especially if it has not caused any symptoms
Commonly, people have fractures that are detected on X-rays, or CT / MRI / DXA scans which may not have been symptomatic. It is obvious if somebody causes damage to their spine and they then get pain that they may have fractured, and a scan or X-ray would show that to be the case. However, many fractures occur without pain or any other symptoms and are detected coincidentally on subsequent scans or X-rays. These give an indication that the underlying structure of the bone might not be as good as it would have been in the past and are an indication that ongoing preventative measures or treatment would be appropriate.
Even after doing the very best that they can, a person with low bone density and partially degraded bone toughness can still fracture. Both FRAX and REMS give fracture risk estimates which indicate how likely it is that these fractures can occur. For REMS, the fracture risk estimate looks at both the density and the toughness of the spine and hips and provides a risk level which gives an understanding of the likelihood of sustaining a future fracture. The risk levels 1,2 and 3 (called “R1”, “R2”, “R3”) are considered low risk. Risk levels 4 and 5 are medium risk, and risk levels 6 and 7 high risk. Therefore, a woman with R6 in both hips and R4 in the spine with very low bone density (osteoporosis) can still fracture and often might fracture without getting symptoms despite taking all of the preventative measures that she possibly can. This doesn’t however mean that she should give up trying to prevent fractures and particularly she should continue to be mindful of not falling. If she gives up, then the situation will get worse
OsteoscanUK has a comprehensive Cancellation policy which can be read here
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