Flashcards in X ray Considerations Deck (52)
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1
What does the global fee consist of?
Technical and professional component
tech --> 2/3 of global fee
Pro --> 1/3 of fee
2
What is NOT a part of teh global fee?
Time spent making the films and/or discussing the findings
3
What is the technical component?
-production of radiograph
-equipment costs, time to position pt, time to create image
4
What is the professional component?
Full typed report in ABCS format
5
What things can alter liability even if films are sent out for review?
Bad quality
lack of opposing views
failure to follow through on radiologist's recommendations
6
What are reasons to get a 2nd opinion on an xray?
Red flags
Complicated Hx or Exam (not like everybody else)
Failure to respond to care as expected
Unexplained deterioration of condition
Confirm the DCs Interpretation
Medicolegal support (ex. Personal injury/ worker's comp case confirmation)
7
How are digital transmissions made?
Through the receiver's VPN
8
Components of a Radd Report
Biographical info
Hx
Body of report
Conclusions/ Impressions
Recommendations
Signature
9
"Acute" Span
1-4 weeks
10
"Subacute" Span
5-12 weeks
11
"Chronic" Span
>12 weeks
12
Acute Neck Injury: Are X-rays indicated?
Over 65
Yes
13
Acute Neck Injury: Are X-rays indicated?
Paraesthesias in extremities
Yes
14
Acute Neck injury --> When are X-rays NOT indicated?
*All 3 criteria must be met
-Simple rear end collision
-Delayed cervical pain onset
-Absence of midline cervical tenderness
15
Acute Neck Injury: Are X-rays indicated?
Immediate Cervical pain onset
Yes
16
Are x rays indicated in nontraumatic neck pain AND arm pain and paraesthesia
Yes
17
Acute Neck Injury: Are X-rays indicated?
Pt unable to turn head 45 degrees in both directions
Yes
18
Acute Neck Injury: Are X-rays indicated?
Presence of midline cervical tenderness
Yes
19
Are x rays indicated in Uncomplicated Subacture or chronic neck pain with or without radicular symptoms?
Yes, but must be present for 4 weeks or longer
20
Are x rays indicated in Acute uncomplicated neck pain?
No
*uncomplicated means nontraumatic w/o underlying neuro findings or red flags
21
What are the special circumstances under which x-rays are indicated in acute uncomplicated neck pain?
-If prior to seeing you, the pt has had Tx with no success
-absence of expected response to care or worsening of symptoms
22
When are X-rays indicated with complicated (red flags) neck pain?
Pt 50, particularly w/ S&S suggesting systemic Dz
Intractable pain, constant or progressive S&S
Significant activity restriction >4 weeks
No response to care after 4 weeks
Neck rigidity in sagittal plane w/ no trauma
Dysphagia
Impaired Consciousness
Cranial N. signs, Path reflexes, long tract signs
Arm or leg pain w/ movement
Suspected Neoplasm
Suspected infection
Suspected failed surgical fusion
Progressive painful or structural deformity
Elevated lab exam and positive S&S
23
When are x rays indicated with recent acute T, L, or TL trauma?
*WIth ANY of the following present
-Moderate to severe localized back pain
-Midline tenderness upon palpation
-Neuro Deficits
-MVA >50 MPH
-Fall of 10 ft. or more
24
When are x rays NOT indicated with recent acute T, L, or TL trauma?
-Absence of pain
-Normal ROM
-Absence of neuro deficits
25
Are x rays indicated in acute pt. with uncomplicated LBP, T pain?
No
26
Are x rays initially indicated with Subacute or Chronic LBP, T pain and no previous Tx trial?
No
*No prior tx --> trial period of 4-6 weeks is recommended
*Absence of expected response or worsening after 4-6 weeks --> take films
27
Pt. has nontraumatic acute LBP and Sciatica (suspicion of disc herniation). You shouldn't take films unless...
pt is >50
progressive neuro deficits
unexpected response to care 4-6 weeks
worsens with care
*MRI would be of value
28
What are the signs of disc herniation?
-Need 3 of 5 (consistent to same N. level)
primarily leg pain
leg pain confined to dermatome
Neural stretch tests recreate or exacerbate leg pain
2 of 4 neuro findings consistent w/ dermatome
-muscle weakness
-decreased reflex
-Abnormal Pinwheel
-Atrophy
MR or CT correlating to Dermatome
29
Are x rays indicated with Suspected Degenerative spondylolisthesis/ lateral recss stenosis?
Yes
30
What are signs of Degenerative Spondylolisthesis in the Lumbar spine?
Primarily scleratogenous leg pain
comes and goes
often reduced by leaning forward or sitting down
no neuro findings
very common
4 Fs --> Fat, Female, Forty, L4
31
What are the red flags of complicated T and L pain that would indicated an x ray?
S&S of systemic disease esp 50]
Constant or progressive S&S
Absence of expected tx results or worsening after 4-6 weeks
Significant activity restriction >4 weeks
Unrelenting pain at rest
*Suspected inflammatory spondyloarthropathy
suspected compression fx
suspected neoplasm
suspected infection
suspected failed surgical fusion
Progressive or painful structural deformity
Elevated Lab and Positive S&S
32
What are the criteria for inflammatory back pain?
Morning stiffness >30 mins
Improvement of back pain w/ exercise but not rest
Awakening in the second half of nigth due to back pain
Alternating buttock pain
33
What are signs of suspected neoplasm?
Considerable LBP >50 y/o
Hx of CA
Unexplained Weight loss
Failure of conservative care
intractable pain
*ESR >50 mm/hr
Systemically unwell
Lymphadenopathy
34
What are the special sircumstances for x ray?
Pt unable to give a reliable Hx
Crippling cancer phobia
Need for immediate decision about career or athletic future or legal evaluation
HX of significant radiographic abnormalities elsewhere
HX of finding from outside study (abdomen, etc..) that requires spine evalation
35
Are x-rays indicated with non-progressive, non-painful adult scoliosis?
No
*In a skeletally mature pt, scoliosis is >10 degrees
36
Chest report is same as bone except for the __ of the report
body
37
What makes up the body of a chest x ray report?
1. Insporatory effort
2. Lung fields
3. Diaphragm
4. Any pleural fluid or thickening
5. Size of heart (normal is size, any displacement noted
9. Bones and joints ok?
10. Any surrounding soft tissue changes?
38
Cervical Spine Views and accessory views
AP, APOM, Lateral
Flexion/Extension (motion, ligament lax, ADI)
Obliques (Pedicles, Pillars, IVF)
39
Thoracic Spine Views and accessory views
AP and Lateral
Accessory views are rare, instead use special imaging
40
Lumbar Spine Views and Accessory views
AP(PA) and Lateral. Some say Sacral Tilt also.
Sacral tilt --> SI and lumbosacral junction
Obliques --> pars, lamina, soft tissue (kidney stone vs. gall stone)
*Post oblique: Ant structures move further from spine and post. structures move closer to spine
*Ant obliques: post. structures move farther from spine and ant. structures move closer to spine
41
Hip Views and Accessory views
AP and Lateral
Special Imaging preffered for accessory fields
42
Knee views and accessory views
AP and Lateral
Tunnel: See intercondylar notch
Sunrise (tangential): See patella femoral joint
43
Ankle views and accessory views
AP, lateral, oblique
Special imaging preferred for accessory fields
44
Foot views and accessory views
AP, lateral, oblique
Special imaging preferred for accessory fields
45
Shoulder Views and Accessory views
Internal and External rotation
Baby arm --> helps w/ HADD, more of a true lateral
Y view --> good for dislocations and scapular assessment
46
Elbow views and accessory views
AP and lateral
External Oblique
Tangential
47
Wrist views and accessory views
PA, lateral, Oblique
Ulnar Deviation --> Helpful with scaphoid fx assessment and to assess integrity of certain ligaments
48
Hand views and accessory views
PA, Lateral, Oblique
Special Imaging preferred for accessory fields
49
What does an internist specialize in?
All diseases and total health care of adults, usually 18 y/o and older
50
What does an oncologist specialize in?
cancer and disorders of the blood and blood-forming organs?
51
What does a Diagnostic Radiologist specialize in?
x ray, ultrasound, and other imaging techniques such as CT and MRI
52
