How to Automate Hologic Horizon DXA

The densitometer produces the one number the clinic acts on

The Horizon DXA System is a bone densitometer: a Hologic scanner that measures bone mineral density by dual-energy X-ray absorptiometry, together with the APEX software that analyses and reports on what it measured. It sits in hospital radiology departments, endocrinology and rheumatology clinics, women's health practices, fracture liaison services and standalone bone health centers.

What comes out of it is small and consequential. A patient lies on the table for a scan of the spine and hip, and a T-score comes back. That number decides whether somebody is told their bones are fine, whether they start a bisphosphonate, whether they go onto an injectable, and whether they return in a year or in five.

The same machine does more than that. Body composition, trabecular bone score, an image of the spine. But the T-score is the thing the rest of the service organises itself around.

Two years pass before the scanner sees the patient again

The scan takes minutes. The treatment it starts runs for years, and the scanner has no part in those years.

A patient leaves with a prescription for a weekly bisphosphonate. Whether they are still taking it in month seven is a question for a pharmacy, not for a densitometer. A patient on denosumab needs an injection every six months, and a missed one is not a small matter. A patient five years into a bisphosphonate is due a conversation about a drug holiday, and the date that conversation falls due lives in somebody's head. Anyone starting an antiresorptive should have dental clearance first, which means a dental practice that shares no system with the clinic.

Then the fractures. Someone breaks a wrist, is treated at a hospital, and never reaches the bone service that should have seen them.

Hologic Horizon DXA

Injections that do not slip Patients due a six-monthly denosumab dose set against what the pharmacy shows dispensed, so a late one is a call in week two.

Fractures found before the clinic hears Hospital lists read for wrist and hip fractures, so a Friday break becomes a fracture liaison referral rather than a repeat.

Rescans in date order Every patient past their interval ranked by how overdue they are, with the prior result and the reason it was set.

APEX analyses the scan and stops there

Hologic has put a great deal into the scan itself, and it is worth being clear how much.

OnePass scanning takes the image in a single sweep, which removes the beam overlap and distortion that come from stitching passes together. APEX is the software a technologist actually works in, doing the analysis and the reporting. TBS Osteo computes a Trabecular Bone Score from the same lumbar spine image, adding a measure of bone texture to the density figure. Instant vertebral assessment images the spine at the same visit, so a silent compression fracture is found while the patient is still on the table rather than years later. A FRAX ten-year fracture risk report sets the density against the patient's other risk factors. Advanced Body Composition measures fat, lean mass and bone regionally, and Physician's Viewer moves the DICOM images to whoever has to read them.

All of that concerns one scan, on one day, for the patient in the room.

The next two years are not a scanning problem, and nothing in APEX was built to follow them.

Rescans, refills and injections tracked in the gap

Give those two years an owner and most of what goes wrong in them stops going wrong.

Every patient due a denosumab injection listed against what the pharmacy shows was dispensed, so a dose running late becomes a phone call in week two rather than a fracture in month nine. Bisphosphonate refill histories read at the pharmacy portal, so the patient who stopped collecting in March is found in April. Prior authorizations for the injectables followed at each payer's own site, so an approval gets used and a denial gets appealed while the window is still open.

Fracture lists read from the hospital's system, so a wrist treated in an emergency department on Friday becomes a fracture liaison referral, which is the most reliable way anyone has of preventing the next break. Dental clearance chased at the practice that has to give it. Rescan dates assembled from the prior studies and sorted by who is furthest overdue.

Reports for scans done somewhere else collected from the imaging center that holds them, so a study from two years ago can be compared rather than repeated early. Vitamin D and renal results gathered from whichever lab ran them, because an injectable should not go ahead on a number nobody has looked at.

An agent watches the years between scans

None of that needs a radiographer. It needs somebody to look, every week, at sites the scanner has never heard of.

That looking is what WebRun does. It is an AI agent driving a real Chrome browser, signed in the way your staff are, opening the pharmacy portal, the payer's site or the hospital list and reading what is displayed.

It runs to a schedule you set, in a private environment of your own, with each workflow restricted to named domains. Collecting information happens unattended. A clinician releases every record change, every referral and every message to a patient; until then each one stays a draft.

Each workflow below states which sites it opens.