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Lesion location Lesion size Status of the Physis – Physeal Patency

X-RAY CRITERIA. Lesion location Lesion size Status of the Physis – Physeal Patency Characteristics of Parent Bone Sclerosis Characteristics of Progeny Bone – Static Non-Comparison Measurements Visualization Fragmentation Displacement Radio-density of the Center of the Progeny Bone

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Lesion location Lesion size Status of the Physis – Physeal Patency

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  1. X-RAY CRITERIA • Lesion location • Lesion size • Status of the Physis – Physeal Patency • Characteristics of Parent Bone • Sclerosis • Characteristics of Progeny Bone – Static Non-Comparison Measurements • Visualization • Fragmentation • Displacement • Radio-density of the Center of the Progeny Bone • Radio-density of the Rim of the Progeny Bone • Boundary (primary variable to assess healing) • Shape • Characteristics of Progeny Bone – Dynamic Comparison Measurements • Radio-density • Boundary

  2. Standing AP – bilateral knees Lateral – bilateral knees Merchant – bilateral knees Notch/Tunnel – bilateral knees Left hand (for skeletal age) X-ray Technique Protocol for these studies – Radiologist input? X-RAY PROTOCOL

  3. CRITERION 3 – STATUS OF THE PHYSIS / PHYSEAL PATENCY Open Closing Closed 1 – Open 2 – Closing 3 – Closed 1 – Open 2 – Closing 3 – Closed 1 – Open 2 – Closing 3 – Closed Assessment should consider only the femoral physis. Closing’ Definition: - Must be able to see both some areas of the physis that appear to be ‘closed’ and some areas that are clearly still ‘open’.

  4. CRITERION 1 – LOCATION OF THE LESION AP Lateral Pat T Post A 1 – Medial femoral condyle 2 – Lateral femoral condyle 3 – Patella 4 – Trochlea 1 – Anterior Condyle 2 – Posterior Condyle 3 – Patella 4 – Trochlea LATERAL VIEW: Project line off posterior femoral shaft. If posterior to line = Posterior. If between posterior femoral line and Blumenstadts line then =Anterior. If anterior to Blumenstadts then=Trochlear. Pick center of lesion surface predominant compartment

  5. CRITERION 2 – SIZE OF THE LESION AP Lateral Notch 2 2 3 2 3 1 3 Need image Need image 1 1 1 – Width of OCD lesion 2 – Width of knee 3 – Max. depth of lesion 1 – Length of OCD lesion 2 – Length of condyle 3 – Max. depth of lesion 1 – Width of OCD lesion 2 – Width of knee 3 – Max. depth of lesion AP 1 – Width/Length OCD = normal parent bone to normal parent bone margin 2 – Width = inter-epicondylar distance Length = maximal AP dimension measure parallel to joint 3 – Max Depth = in unossified, complete the arc of the parent bone contour and measure the longest perpendicular line to the rim of parent bone and depth of the crater

  6. CRITERION 2 – SIZE OF THE LESION AP Lateral Notch 2 2 3 2 3 1 3 Need image Need image 1 1 1 – Width of OCD lesion 2 – Width of knee 3 – Max. depth of lesion 1 – Length of OCD lesion 2 – Length of condyle 3 – Max. depth of lesion 1 – Width of OCD lesion 2 – Width of knee 3 – Max. depth of lesion Lateral 1 – Length of OCD lesion – normal parent bone to normal parent bone margin. 2 – Length of condyle (anterior-to-posterior). Measure the involved condyle. Measure parallel to physis 3 – Maximum depth of lesion (if unossified, complete the arc of the parent bone contour, and measure the longest perpendicular line to the rim of parent bone in the depth of the crater)

  7. CRITERION 2 – SIZE OF THE LESION AP Lateral Notch 2 2 3 2 3 1 3 Need image Need image 1 1 1 – Width of OCD lesion 2 – Width of knee 3 – Max. depth of lesion 1 – Length of OCD lesion 2 – Length of condyle 3 – Max. depth of lesion 1 – Width of OCD lesion 2 – Width of knee 3 – Max. depth of lesion Notch 1 – Width of OCD lesion – normal parent bone to normal parent bone margin 2 – Width of knee (inter-epicondylar distance) – Select the maximum distance parallel to joint surface 3 – Maximum depth of lesion (if unossified, complete the arc of the parent bone contour, and measure the longest perpendicular line to the rim of parent bone in the depth of the crater)

  8. CRITERION 4 – CHARACTERISTIC OF PARENT BONE - SCLEROSIS More Dense Less Dense Same Density Need image Need image Need image 1 – More Dense 2 – Less Dense 3 – Same Density 1 – More Dense 2 – Less Dense 3 – Same Density 1 – More Dense 2 – Less Dense 3 – Same Density In comparison to the unaffected parent bone, the radio-density of the rim of the parent bone is?

  9. CRITERION 5a – CHARACTERISTIC OF PROGENY BONE - VISUALIZATION Visualized Not-visualized Need image 1 – No 2 – Yes 1 – No 2 – Yes Is the progeny bone visualized ON ALL VIEWS? Evaluate all views to determine presence of ossification. If ossification not visualized on any view and appears as a “black hole”, check NO (Not-visualized)

  10. CRITERION 5b – CHARACTERISTIC OF PROGENY BONE - FRAGMENTATION Fragmented Non-fragmented Need image Need image 1 – No 2 – Yes 1 – No 2 – Yes Is the progeny bone fragmented? Need to see 2 or more pieces of progeny bone

  11. CRITERION 5c – CHARACTERISTIC OF PROGENY BONE - DISPLACEMENT Non-displaced Partially displaced Completely displaced Need image Need image 1 – Non-Displaced 2 – Partially 3 – Totally 1 – Non-displaced 2 – Partially 3 – Totally 1 – Non-displaced 2 – Partially 3 – Totally • Is the progeny bone displaced? • If any view demonstrates partial displacement, then it should be defined as such, unless any view demonstrates complete displacement, then it should be defined as complete. • Look at all views before rating.

  12. CRITERION 5d – CHARACTERISTIC OF PROGENY – DENSITY OF CENTER More Dense Less Density Same Density Need image Need image Need image 1 – More 2 – Less 3 – Same 1 – More 2 – Less 3 – Same 1 – More 2 – Less 3 – Same In comparison to the unaffected parent bone of the involved condyle, the radio-density of the Center of the progeny bone is……

  13. CRITERION 5e – CHARACTERISTIC OF PROGENY – DENSITY OF RIM More Dense Less Density Same Density Need image Need image Need image 1 – More Dense 2 – Less Dense 3 – Same Density 1 – More Dense 2 – Less Dense 3 – Same Density 1 – More Dense 2 – Less Density 3 – Same Density In comparison to the unaffected parent bone, the radio-density of the Rim of the progeny bone is? Progeny Rim is usually just beyond the Parent sclerotic rim.

  14. CRITERION 5f – CHARACTERISTIC OF PROGENY BONE - BOUNDARY Distinct Indistinct Need image Need image 1 – Distinct 2 – Indistinct 1 – Distinct 2 – Indistinct The boundary between the parent bone and progeny bone is? If “Distinct” on any view, pick “Distinct”

  15. CRITERION 5g – CHARACTERISTIC OF PROGENY BONE - SHAPE Convex Linear Concave Need image Need image 1 – Convex 2 – Linear 3 – Concave 1 – Convex 2 – Linear 3 – Concave 1 – Convex 2 – Linear 3 – Concave The predominant shape/contour of the articular side of OCD lesion is?

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  17. CRITERION 6a – DYNAMIC COMPARISON CRITERION – RADIO-DENSITY Comparison Image Current image Need image Need image Need image 1 – More dense 2 – Less dense 3 – Same density In comparison to previous radiographs, radio-density of progeny bone is?

  18. CRITERION 6b – DYNAMIC COMPARISON CRITERION – BOUNDARY Comparison Image Current image Need image Need image Need image 1 – More distinct 2 – Less distinct 3 – Equally distinct In comparison to previous radiographs, the boundary is?

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