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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 l.jpg

DxImg 1

Midterm information

By: Jeff Binder


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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


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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


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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


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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


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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


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Report Format

Stationary

Patient Information

Radiology Information

Technique (optional)

Body (also called Findings)

Impression (also called Conclusion)

Recommendations (when applicable)


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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


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Patient Information

Patient’s full name

Address

Date of birth (sometimes patient age is listed also)

Sex

Medical record number (or patient number)


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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


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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.


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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.”


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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”


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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”


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Bone Formation

Intramembranous: Adding bricks to a house

Enchondral: Framework of a house


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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


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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


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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


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  • 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