UNIT 4: Surveys Flashcards
Surveys
A comprehensive radiographic examination of the axial and appendicular skeleton for differential diagnosis of disease or fracture
Types of surveys
• Long bone Measurement
• Bone Age
• Scoliosis
• Shunt Series
• Abuse: Diagnosis of Fracture
• Metastatic survey: Diagnosis of pathologic fractures and bone tumors
LONG BONE MEASUREMENT SURVEYS
Evaluate for limb length discrepancy, most often in the lower extremities
• The patient:
• Children with unequal limb growth
• Post surgical correction of unequal limb growth
• Often have yearly surveys so radiation protection is imperative
Types of Bone Measurement Surveys:
• Orthoroentgenogram
• Scanogram
• Teleroentgenogram
-Digital stitching
Long Bone Measurement Survey Procedure
Locate hip, knee, and ankle joints accurately and mark skin with a sharpie or skin marking pencil
• Hip: 1 to 1 1⁄4in laterodistally and at a right angle to the midpoint of an imaginary line from the ASIS to the pubic symphysis
• Knee: just below the apex of the patella
• Ankle: below the depression midway bw the malleoli
• Ortho: three exposures are made on the same IR
• Scano: three exposures are made on separate IRs
• Collimate tightly
• CR must be perpendicular to joint
PROCEDURE: TELEROENTGENOGRAM
Patient upright against the wall bucky
• IR may be the 14X36 inch cassette or 3 14X17cassettes
• Radiopaque ruler placed on the vertical grid between patient limbs
• SID 72” to provide large field size
• 1 to 3 images obtained depending on patient size
• Digital post-processing “stitching” may be used to paste images together
BONE AGE STUDY allows estimation of
The maturity of a child’s skeletal system
• How fast or slow the skeleton is developing
Bone age study: how its done
PA x-ray of the LEFT hand to include wrist and fingers is obtained
• Bones are compared with those of children the same age worldwide
• Growth plate appearance is indicative of bone maturity
Bone Age is done to:
• Determine how much time the child will be growing
• When a child will enter puberty
• What the child’s ultimate height will be
• Monitor bone disease such as hypothyroidism, adrenal gland disorders, and growth hormone deficiency
• Monitor genetic growth disorders such as Turner syndrome
What is Scoliosis
lateral curvature in the normally straight vertical line of the spine
Scoliosis Survey: How it’s done
-2 views of the spine done on a 14 X 36” cassette at 72” SID and digitally stitched together
-Compensation filters may be utilized to help create uniformity of the image and provide additional radiation protection
-Standing PA of torso with arms down and slightly away from hip
-Feet should be slightly apart, flat on the floor and facing forward
-Standing lateral
-Humeri parallel to the floor with elbows bent: do not fully extend arms
-Legs and knees should be straight
-Feet slightly apart, flat on the floor
How to shield scoliosis patients
-Radiation protection is key as these individuals often get multiple x-rays series in their lifetime
-Shield when possible
-X-ray done PA instead of AP to protect breasts and gonads
-Breast shields may be used
Scoliosis: degree of severity
-Degree of lateral curvature is measured and determined for severity diagnosis
-Mild: < 10 to 15 degrees
-Moderate: 20 to 50 degrees
-Severe: > 50 degrees
-Respiratory compromise >90 degrees
SHUNT SERIES: how it works
-Patients with hydrocephalus may require placement of a ventricular peritoneal (VP) shunt to assist in drainage of excess Cerebrospinal fluid
•Proximal Tip of the shunt placed in the ventricles of the brain
• Shunt is passed through the fatty tissue just under the skin behind the ear, down
the neck and chest
• A small incision is made in the abdominal lining where the distal tip of the shunt dives down and rests in the abdominal cavity
• CSF drains from the lateral ventricle into the peritoneal cavity where it is absorbed by the body
• Occasionally, the shunt can become clogged or dislodged
• These patients will need a shunt series to determine position of tubing
SHUNT series views:
• PA and Lateral Chest
• AP and Lateral Skull
• AP and Lateral Abdomen
SHUNT images
T or F: Child abuse accounts for approximately 1200 deaths/year in the U.S. Half of those occur among children younger than one year of age
True
METASTATIC SKELETAL SURVEY: what it is used for
• Often used to determine involvement in bones with multiple myeloma
• Performed on initial dx(diagnosis) of disease
• Multiple myeloma appears as Lytic lesions which look like holes in the bones on x-rays
