midterm Flashcards
What are the roles of report writing
- record of findings
- medicolegal documentation
- permanent record
- inter- professional communication
- provides important indications and contraindications
- assisting in auditing radiographic quality
- database for retrospective research and data collection
the radiology report is part of the _____
- medical report/ record
reports are the result of a radiographic test
The C’s of a report
- clear
- correct
- confidence
- concise
- complete
name the most common reason for malpractice suits against chiropractors
- failure to communicate results clearly and effectively
- failure to diagnose
what is in the preliminary report information
- letterhead information of the report writer
- date of the report
- name and address of the referring clinician
- patint information
- radiographic exams performed (dates and locations)
- clinical information
- chief complaint
- key clinical findings
- reason for the study- differential dx
what is In the report
- technical factors- kVp, mA,FFD
- radiologic findings - ABC
- Conclusion
- recommendations ( additional imaging
- Signature and qualifications
Film Interpretation
- turn off lights to all unused box spaces
- hot light exam
- cover- up emxam - cover up 1/2 of film
- film tilt - detect scratches
Optimum environments
- suboptimal viewing conditions
- time allocation
- demographic details
How to have clarity of content and report structure
- concise reporting
- correct english
- avoid jargon
- avoid abbreviations
- quantifying terminology
- standardized format
- measurements
- proofreading
When to get a second opinion radiology review
- complicating history - red flags
- abnormal clinical findings
- failure to respond to therapy
- unexplained deterioration of the condition
- confirming the practicionar’s interoperation
- establish a dx
- improving interpratation skill
- interpreting equivocal findings
- use of complex multi modality imaging
- medicolegal support
- Describe how the reporting flow chart should be in order
- orientation and placement of films
- patient identification
- systematic review
- ABCs
- Conclusion/ impression and recommendations
ABCs means what?
- A= alignment
- B= Bone
- C= cartilage
- S = soft tissue
What is recorded in the alignment part of the report
- evaluate spinal curve
- evaluate scoliosis
- evaluate leg length inequality
- evaluate alignment of joints
- use of lines of measurements
What is recorded in the Bone part of the report
- evaluate bone density
- evaluate cortical and cancellous bone for fractures and osseous destruction
- evaluate size, shape and configuration of all osseous structures
What is recorded in the Cartilage in the part of the report
- cartilage is not visualized on x- rays
- this category is about the joints
- evaluate width of joint cavity between opposing articular surfaces
- widening of joints
- loss of mint space
- osteophytes
What is recorded in the soft tissue report
- overall thickness and density of the soft tissues ( retotracheal air spaces)
- evaluate skin , fat pads , deposits, tendons, organs , blood vessels , ligaments
What goes under Impressions of the report
- point by point summary of the most important radiological findings ( conclusion)
- categorize the pathological process ( CATBITES)
C- congenital
A- arthritis
T- trauma
B- blood
I- infection
T- tumor
E- endocrine
S- soft tissue
What goes into the recommendations report
- plan of actions based on impression
- recommend further studies like MRI
- provide specific clinical or therapeutic advice, like chiropractic adjustments
- suggestions to improve radiographic quality
what is required at the end of all radiology reports
- signature and credentials
list some general guidelines
- all reports should be typed , not written
- be brief
- use complete sentences
- use present tense for what is seen on the film
- quantify all measurements
- proof read the report
With acute neck injury name some that may be x-ray indicated
- over 65
- paraesthesias in extremities
- not a simple rear end collision
- immediate cervical pain onset
- presence of milline cervical tenderness
- patient unable to actively turn to 45 degrees in both direction
in acute neck injury x-rays are not indicate when all of the following CCSR criteria is met
- simple rear and collision
- delayed cervical pain onset
- absence of midline cervical tenderness
T/F
x-rays are indicated in acute uncomplicated neck pain
fasle
uncomplicated means non traumatic without underlying neurological findings or red flags
X- rays are indicated with complicated ( red flags) neck pain
- patient ( 20 and > 50 , particularly with S&S suggesting systemic disease
- significant activity restriction > 4 weeks
- intractablle pain, constant or progressive
- neck rigidty in the sagital plain in the absence of trauma
- Dysphagia
- impaired consciousness
- cranial n signs
- high risk log laxity
- arm or leg pain with movement
Signs of disc herniation ( need 3 out of 5 )
- primarily leg pain
- leg pain confined to dermatome
- neural stretch tests recreate or exacerbate the leg pain
- at least 2 of 4 neurologic findings consistent with dermatome
- MR or CT correlating to dermatome
Signs of degenerative spondylolisthesis in the lumbar spine
- primarily scleratogenous leg pain
- comes and goes
- often reduced by leaning forward or sitting down
- no nerologic findings
- very common
- 4 F’s : Fat, female, forty and Lfour
Criteria for inflammatory Back Pain
- morning stiffness for > 30 minutes
- improvement of back pain with exercise but not rest
- awakening in the second half of the night due to back pain
- alternating in the second half of the night due to back pain
- alternating buttock pain
What is a global fee
- record findings
- documentation in me- legal circumstances
- provide a permanent record in case films lost or damaged
- provide communication with other health care professionals
- assist with indications, contra- indications, and prognosis for care
Technical component
- represents the productions of the radiograph
- includes equipment costs, time to position the patient, and time to create the image
Professional component
- is a full written typed report in the ABCs format a
-
Failure to have a written report when using the global fee constitutes what
fraud
what is referred as a local defense
the idea that you will only be held to the same standard as another DC in your locale
Describe what malpractice is
- an action brought by the patient against the practitioner for a crime of omission or commission
- may result in punitive damage but is not a board issue
- covered by malpractice insurance
Describe what is board action
- any complaint to the board MUST be invesitaged
- may or may not also have a malpractice claim
- often board complaints are not covered by malpractice insurance
- adverse decisions lead to liscensue penalties to include revocation of license
what would go under body of a chest x-ray report
- inspiratoory effort (10 ICS normal) this is optional
- lung fields : infiltrate, mass, abnormal markings, cavitations
- Diaphragm : height, shape, calcification
- any pleural fluid or thickening
- size of heart ( should be less than 50% of thorax)
list the accessory views for the cervical spine
- flexion/extension - looking for motion, ligament laxity, aid integrity
- obliques- looking at pedicles, pillars, IVF
name the accessory views for the lumbar spine
- obliques- pars,lamina, soft tissue
- Post obliques: anterior structures move farther from spine and posterior structures move closer to the spine versus the AP
- Ant obliques: posterior structures move farther from spine and antterior structures move closer to the spine versus the AP
name the accessory views of the knee
-Tunnel
See intercondylar notch
-Sunrise
See patella femoral joint
name the accessory views for the shoulder
Accessory
Baby Arm
Helps with HADD, more of a true lateral
Y View
Good for dislocations and scapular assessment
which view is helpful with scaphoid fracture assessment and to assess integrity of certain ligaments
Ulnar deviation of the wrist
reporting soft tissues findings should include
- organ enlaargement or displacement
- displacement of normal structures like the tracheal air shadow
- abnormal accumulation of bowel gas
- abnormal soft tissue calcifications
- soft tissue swelling
- masses
- displacement or blurring of fascial planes
- foreign bodies
Impressions should include:
- a conclusion
- use diagnostic terminology
- label the conditions described
- list in order of severity
Recommendations should include
- (optinional)
- give specific flow up procedure
additional x rays
advanced imaging
lab evaluation
refer
explain why
Signs of suspected Neoplasm
- considerable Low back pain > 50 HX of Ca - unexplained weight loss - failure of conservative care - intractable pain - ESR > 50 - systemically unwell - Lymphadenopathy
Special Circumstance for X- ray
- pt unable to give a relaible HX
- Crippling cancer phobia
- need for immediate decision about career or athletic future or legal evaluation
- Hx of sig radiographic abnormalities elsewhere
- Hx of finding from outside story that requires spine evaluation
T/F
in a skeletally mature patient scoliosis is > 10 degrees with non painful , non progressive , it is indicated to take X- rays
false
