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DxImg 1

DxImg 1. Midterm information By: Jeff Binder. Quality Control. Performed first (usually by the tech) ABCs Anatomy: Is entire region of anatomy on the film Bone: Search for signs of patient motion. Big white lines and small white lines.

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DxImg 1

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  1. DxImg 1 Midterm information By: Jeff Binder

  2. Quality Control • Performed first (usually by the tech) • ABCs • Anatomy: Is entire region of anatomy on the film • Bone: Search for signs of patient motion. Big white lines and small white lines. • Cartilage: Check joint spaces are not obscured by positioning errors • Soft Tissues: Evaluate technique of the soft tissues

  3. Interpretation • Performed by a Doctor • ABCs • Anatomy: sub inventory of all anatomical parts (pedicles, Tp’s, sp’s, etc) • Bone: Cortical and trabecular bone. Look for an increase or absence of either • Cartilage: Signs of arthritis, injury, or anomaly • Soft tissue: Regional inspection of soft tissue for pathology

  4. Diagnostic Imperatives • Imaging is for documentation NOT education • Every xray must be interpreted to reach a diagnosis or conclusion • ALWAYS do an exam prior to taking xrays

  5. Xray report • A written interpretation of the study • Part of the patients permanent record • Signed and dated by the individual doing the interpretation • All radiographic studies must be interpreted to reach a diagnosis or conclusion

  6. Xray Report Role • Verbal rendition of visual image • Medico legal communication • Insurance company, work comp, attourneys • Provide a standard for comparison • Part of a patient’s permanent record • A report may replace lost films • Professional communication • Expedite treatment by highlighting indications and contraindications for treatment

  7. Report Format • Stationary • Patient Information • Radiology Information • Technique (optional) • Body (also called Findings) • Impression (also called Conclusion) • Recommendations (when applicable)

  8. Stationary Name and address of the clinic or individual who is creating the report Joe Bob’s MRI clinic 15 s. main street Chesterfield, MO 63017

  9. Patient Information • Patient’s full name • Address • Date of birth (sometimes patient age is listed also) • Sex • Medical record number (or patient number)

  10. Radiology Information • All views performed for interpretation must be listed here • Ex: cervical 3 view would state “AP, Lateral and AP open mouth” • Location and dates films were taken • Patient’s clinical history and reason for taking the films can be listed here as well

  11. Technique This is optional. If the interpreting Doctor is supplied with the technique for each film he/she can list them in this area. Some doctors list these on special views in case they need to be repeated at a later date.

  12. Body (Findings) This is where the doctor will list everything he finds through the ABCs method. This is the description of findings. There is no diagnosis here. Basic facts about the film and findings are listed. EX: “A geographic lucency is seen in the proximal right tibia measuring 2.1 centimeters in diameter.”

  13. Impression (conclusion) • A short, concise list of important radiologic finding and diagnoses based on previous narrative descriptions (body). • List them from most importance to least • Avoid long lists • Medical diagnoses and terminology should be used • Very critical as a percentage of Doctors will not read the full report. EX: “Condroblastoma in right proximal tibia”

  14. Recommendations • Optional • Basically anything the Radiologist wants the Doctor to pay attention to • Contraindications • “Low force technique recommended due to fracture” • Additional exams that may need performed • “Recommend MRI to further evaluate joint space”

  15. Bone Formation • Intramembranous: Adding bricks to a house • Enchondral: Framework of a house

  16. Intramembranous • Throughout life • Adding layers of bone • Initiated by proliferation of mesenchymal cells • Flat bones developed by this (skull, pelvis) • No preformed cartilage • Used for BONE REPAIR • Increases WIDTH of bone

  17. Enchondral • Formed by primary ossification centers • Use non-ossified matrix as framework • Osteoblasts and osteoclasts form and become embedded • Cell death is followed by ossification • Increases LENGTH of bone

  18. Parts of Long bones • Epiphysis: articular surface, produces and supports articular cartilage • Apophysis: attachment site for ligaments and tendons (trochanters, tuberosities, tubercles) • Metaphysis: Most metabolically active, focus for disease and trauma, indolent blood flow (very slow, stagnant blood) • Diaphysis: Shaft of long bones, act as lever, 50/50 cortical and medullary bone

  19. Physis: Growth plate, epiphyseal plate, bone growth center • Growth arrest line: line formed by growth plate showing end of bone growth. White on xray • ZPC (zone of provisional calcification): Most mature layer of the growth plate. Least Mature layer of the metaphysis • Periosteum: Part of intramembranous formation, mediates repair, sensitive to Gh, • Sharpe’s fibers anchor periosteum to bone in adults. Periosteal lifting in adults is SERIOUS

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