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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

What does a Nuclear Radiologist specialize in?

Dz requiring use of radioactive isotopes or as an aid in Dx and/or therapy