Frequently Asked Questions (FAQs)

Who can order the VirtuOst test?
As an FDA-registered Class-II medical device, the VirtuOst test must be ordered by a physician or healthcare provider. For more information, refer to Order VirtuOst.

How can I get the VirtuOst test?
Physicians can order VirtuOst directly from the O.N. Diagnostics Medicare-enrolled IDTF, or, from select healthcare providers (hospitals, imaging facilities) who partner with O.N. Diagnostics.

Are the BCT and BCT with VFA tests reimbursed?
Yes. Both tests are reimbursed by Medicare if considered reasonable and necessary for the patient’s care. Coverage by private insurance will depend on the patient's plan. For further details, refer to Coding and Reimbursement and Order Instructions.

What format is needed for the CT scans?
Standard DICOM formatted scans, not de-identified or altered.

How should the CT scans be sent to O.N. Diagnostics?
For IDTF orders, the CT scan can be mailed directly to O.N. Diagnostics, or, O.N. Diagnostics can arrange to retrieve it from your Radiology Facility. For partnering healthcare providers, the CT scan is sent electronically. For the latter, our staff can work with partners to customize a HIPAA-compliant transfer protocol or to use third-party scan-transfer solutions such as PowerShare. O.N. Diagnostics meets all state and federal regulations for handling of PHI (Protected Health Information).

What is the format of the results?
For the IDTF, the VirtuOst Results report can be returned via encrypted email in PDF format or secure fax. For partnering healthcare providers, results can also be returned directly to PACS. For PACS, other formats include DICOM encapsulated PDF, DICOM structured report (HL7), and DICOM secondary capture image.

What types of CT scan can be analyzed?
Most pelvic, abdomen, spine, and chest scans, and even whole-body scans, can be analyzed. An external calibration phantom is not required.

For Hip BCT, the scan needs to include one femur from just below the lesser trochanter to just above the top of the femoral head. Slice thickness of the scan must be 5.0 mm or less; intravenous contrast is not a problem.

For Spine BCT, the scan needs to include one complete lumbar or thoracic vertebral body (T1–L5). Diagnostic classifications are provided only between T12–L3, but measurements can be provided for any level. Slice thickness of the scan must be 3.0 mm or less and the scan cannot have intravenous contrast.

For VFA, any vertebra between T4–L4 is analyzed. Slice thickness of the scan must be 3.0 mm or less; intravenous contrast is not a problem. For more information, see VirtuOst CT Scan Selection.

What types of scan cannot be analyzed?
In addition to the restrictions noted above regarding slice thickness and intravenous contrast, scans cannot be analyzed if metal implants reside at the same transverse cross-section as the bone to be analyzed, or if the scan does not cover the proximal femur or a complete vertebral body. Streaking artifacts or poor image quality can disqualify an analysis. If you send us a scan that we cannot analyze, you will not be charged.

What if I want to order a dedicated CT scan specifically for the VirtuOst test?
There are various scan acquisition options to consider for a dedicated scan. For more information, see VirtuOst CT Scan Selection.

Can scans with intravenous (IV) contrast be analyzed?
For images enhanced with IV contrast, BCT can only be performed at the hip and VFA is not affected. For CT scans taken with IV contrast, the radio-opaque contrast agent can permeate the porous bone, making the bone appear denser and stronger than it actually is. This effect is typically negligible for the hip but for the spine can be appreciable and highly variable, depending on the CT machine, IV contrast agent, and scan protocols. Thus, BCT at the spine is not reliable and therefore is not performed. VFA can be performed on scans with IV contrast since the morphology of the vertebrae is not affected by the contrast agent.

What scan settings should be used?
The VirtuOst test is quite robust so most typical current clinical settings will work. For more information, see VirtuOst CT Scan Selection.

Can the VirtuOst test be used to monitor treatments?
Yes, VirtuOst has outstanding repeatability precision. As with any clinical densitometry, optimal precision for monitoring with BCT requires the same CT machine and imaging protocol to be used at both time points.

What if I have trouble sending the scans or receiving the results?
Please don't hesitate to Contact Us. We are available by phone between 9 am to 5 pm PST Monday–Friday.