As professional and college athletic teams start to resume practice and competition, a number of coaches, trainers, and athletes are starting to ask if it is OK to start body composition testing or monitoring of athletes.  While most athletes typically are young and healthy that does not mean they are immune from acquiring COVID-19 or similar viruses or being carriers for such diseases. Therefore, as we start to consider resuming body composition testing and monitoring of athletes we need to make sure that the environment is safe for both athletes and the staff who are administering the tests. Fortunately, dual X-ray absorptiometry (DXA) for determining body composition and bone health offers a low-risk testing environment.  However, there are still things we can do to maximize subject and staff safety.  The first thing you should do before resuming body composition testing is to check with the manufacturer of your DXA scanner to see if they have an official technical bulletin that addresses cleaning and disinfecting the DXA scanner. Often issues regarding the cleaning of your DXA scanner may also be covered in the User Guide that the manufacturer of your DXA scanner provided.  It is possible that any official documents may have been written prior to COVID-19 and may lack the necessary information.  So in this blog post, I will share some thoughts on how to create a safe environment for body composition testing using a DXA scanner. 

General Observations
In setting up a safe environment I think you need to consider a few things.  The most obvious thing to consider is subject safety. The second thing to consider is the safety of the individual(s) who are administering the DXA scan.  The final area to think about is the DXA scanner and other equipment (i.e., weight scale, stadiometer, etc.) used to administer the DXA scan.

Subject
The first area of safety for DXA scanning is the subject.  Since a number of athletic teams are now testing for COVID-19 no athlete should be scanned if they have tested positive for COVID-19.  However, even if your athlete has tested negative for COVID-19 there are some precautions that should be taken.  Most individuals come to a laboratory with personal items (i.e., cell phone, wallet, backpack, shoes, coat, etc.). In the past, you may have put them on a desk or chair prior to the athlete being scanned. These items could be carriers of the virus. So to eliminate this issue in my laboratory we have plastic laundry tubs that we give to individuals for them to place their personal items in. This keeps all of the personal items together.  Following testing of the athlete, they take their items out of the tub and the tub is disinfected and set up for the next individual to use. The next issue is to have the individual being tested wear a facemask. The science behind wearing a facemask and lowering the transmission of the COVID-19 virus is well documented.  In addition, there is no issue concerning having a mask on the face and altering the DXA scan results. This goes for either cloth or paper facemasks. The third safety issue is prior to having a subject come in contact with the DXA scanner have them wash their hands with a hand sanitizer.  Anyone who has undergone a DXA scan realizes that the subject will touch the DXA scanner and the scanner table to help in positioning themselves.  So having the subject wash their hands prior to getting on the scanner can help lower the possibility of the individual contaminating the DXA scanner.

Tester
The other area to consider during DXA scanning is the safety of the person administering the test.  Similar to the subject, no one who has tested positive for COVID-19 should be involved in DXA scanning.  Like the subject being tested, the administrator of the DXA scan should wear a facemask.  In addition, we recommend that the administrator of the DXA scan should wear exam gloves since they are going to need to touch the subject to help position them on the DXA scanner. One can also use hand sanitizer prior to positioning and following positioning of the athlete or patient, but the exam gloves will offer the administrator a better barrier between themselves and the subject.

DXA Scanner
The third safety issue to consider in resuming DXA scanning is the scanner itself.  Since individuals will be touching the DXA scanner as well as lying on the DXA scanner itself the DXA scanner must be disinfected between subjects.  When deciding how to disinfect the DXA scanner there are a couple of things you need to consider.  The first is that the agent you use needs to kill the COVID-19 virus.  There are a number of disinfectants (i.e., sprays, wipes, etc.) that can be used to kill the COVID-19 virus. The United States Environmental Protection Agency (EPA) has a list of these products that can be found here:

This website provides a comprehensive list of sprays and wipes that kill the COVID-19 virus.  Besides the brand, manufacturer, and active ingredients the list provides the surface type it works on as well as the contact time.  Below I provide you with a sample of wipes that the EPA has recommended. Again this is only an example of the EPA list and for a more comprehensive list, you should refer to the link above. 

You should pay attention to the contact time since that will determine the amount of time that needs to exist between subjects to ensure the disinfection of the surface.  You also should be careful when using any type of disinfectant to make sure that it does not stain your DXA scanner.  For instance, disinfectants that contain iodine can stain the plastic that incases a DXA scanner as well as the DXA table mat. I recommend that before you select a disinfectant you place a small amount on an inconspicuous place on both the DXA table mat and the DXA scanner housing.  Wait a day and check to make sure that no stain has been left. 
In addition to the DXA scanner, you should disinfect any other equipment that the subject comes in contact with.  This should include the weight scale you may use to weigh your subject prior to the DXA scan as well as a stadiometer which you may have used to measure your subject’s height.  The surfaces of these other pieces of equipment should be disinfected similar to the methods used to disinfect the DXA scanner.

Conclusion
I hope this blog provides you some insights into creating a safe DXA scanning environment for both the subject as well as the tester.  Given all of these changes, you will need to make adjustments in the time you normally schedule for a DXA scan.  We have doubled our DXA scan appointment times to accommodate these new changes. In addition, we have arranged our facility so subjects enter the laboratory from one door, but exit out another door.  This is done to limit contact between subjects coming to the laboratory for DXA scans. In conclusion, these are good clinical practices and even with the hopeful end of the COVID-19 virus crisis, these practices should be followed in the future to ensure a safe testing environment.

About the Author
Donald Dengel, Ph.D., is a Professor in the School of Kinesiology at the University of Minnesota and is a co-founder of Dexalytics. He serves as the Director of the Laboratory of Integrative Human Physiology, which provides clinical vascular, metabolic, exercise and body composition testing for researchers across the University of Minnesota.