DXA
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Ethnicity (Circle one):
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Height: ________________________________
African American
Do you exercise regularly as part of a fitness or recreation program?
Asian
Yes________
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No_________
If so, explain what type of exercise: ____________________________________________________________________
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Washington Institute of Sports Medicine and Health
Preparing for the DXA Scan
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The DXA scan is the clinical gold standard for determining accurate body composition results. Its clinical accuracy
is superior to all other methods, including Bod Pod, hydrostatic weighing, bioelectrical impedance, and skin
calipers. DXA can see into the body, picturing all bodily fat accurately, including visceral fat around and inside
organ tissue. Because it profiles ALL fat (essential fat and storage fat) its accuracy may yield body fat results
higher than other less accurate methods previously performed on any given subject.
Repeat readings should be at similar times of the day.
Be normally hydrated. A low carbohydrate diet can sometimes result in dehydration.
Women should be tested during the same days of their monthly cycle as their prior tests.
Do not exercise vigorously for at least 3 hours before being tested.
Do not eat for at least 3 hours before being tested.
Do not take calcium supplements on the day of testing.
Void bladder and bowels before testing.
Wear comfortable clothing with NO METAL. Check for zippers, snaps, fasteners, grommets, belts, underwire
bras, and jewelry.
Irremovable piercings, metal plates, pins, screws, or metal prosthetic joints are okay, but need to be stated to
the technician.
DXA scan is perfectly safe and harmless. It emits extremely low dose radiation, which in fact is less than several
days of exposure from natural sources, such as working out in the yard on sunny days, or that of taking an
airplane flight from Seattle to Denver.
If you are pregnant or think that you may be pregnant, the scan will not be performed. Even though the scan
emits very low dose radiation, the risk of this is not known for an unborn fetus.
DXA should not be scheduled within a week of nuclear medicine studies such as a barium enema, contrast MRI,
CAT scan, or other contrast studies.
What to Expect During the DXA Scan
Your total appointment will take approximately one hour, including the six-minute scan and a review of the body
composition results. You will undergo a scan for body composition, in addition to the optional bone density screening.
The DXA is an open-air scanner (unlike an MRI). This involves lying still on the exam table while the x-ray arm passes over
the body. The whole-body scan (body composition) takes 6-8 minutes. The bone density scan will consist of two scans of
the hip, lower back, or arm, each lasting approximately 30 second. It will take a couple of minutes to position the body
and extremities.
What to Expect After the DXA Scan
If you have a DXA body composition scan, it will take 10-15 minutes afterward to analyze the test results and compile
reports, which will then be reviewed with you. You may take your reports with you. Reports include bone, muscle, fat
data, as well as ideal weight and metabolic calorie expenditure based on your body composition data.
Patient Initials _________________
12707 120th Avenue NE, Suite 100
Kirkland, WA 98034
Phone: 425-820-2110 Fax: 425-820-2111
Washington Institute of Sports Medicine and Health
I hereby agree to indemnify, defend, and hold harmless Washington Institute of Sports Medicine and Health, officers,
employees, owners, agents, representatives, and volunteers from and against any and all claims, injuries, liabilities, loss,
damages, expenses, costs of any kind on account of my participation (including without limitation attorney fees, costs,
and expenses of litigation, arbitration or other proceedings).
I further understand that I am free to withdraw my consent and terminate my participation at any time.
Participant’s Name (print): ___________________________________________________________________________
Participant’s Signature: _____________________________________________ Date: ____________________________
If less than 18 years old:
Parent/Guardian’s Name (print): ______________________________________________________________________
Parent/Guardian’s Signature: ________________________________________ Date: ____________________________
I, the undersigned, have been available to answer any questions regarding this consent, and witness the signature
above.
WISM Staff Signature: ______________________________________________ Date: ____________________________
12707 120th Avenue NE, Suite 100
Kirkland, WA 98034
Phone: 425-820-2110 Fax: 425-820-2111