when to order imaging Flashcards
True/False
In general, imaging should confirm a suspicion.
True
Good or bad consult
18 year old male with cough, please advise
Bad
Good or bad consult
18 year old male non-smoker with fever, cough, dullness to percussion at left lower lobe, course crackles. Please evaluate for pneumonia.
Good
Ottawa Rules ankle
Ankle series is indicated if:
(a) Has pain in the “malleolar” zone AND
(b) Has bone tenderness at the posterior edge (6cm) of the lateral or medial malleolus
OR
(c) Inability to bear weight both immediately after the injury and for four steps in the
evaluation room.
1) If the patient can transfer weight twice to each foot, the patient can bear weight.
2) If the patient limps, the patient can bear weight.
under Ottawa rules should you order an Xray for a limping patient
If the patient limps, the patient can bear weight.
Xray yes or no
Inability to bear weight both immediately after the injury and for four steps in the evaluation room.
YES
Ankle series is indicated if
(a) Has pain in the “malleolar” zone AND
(b) Has bone tenderness at the posterior edge (6cm) of the lateral or medial malleolus
OR
(c) Inability to bear weight both immediately after the injury and for four steps in the
evaluation room.
True/false
the patient can transfer weight twice to each foot, the patient can’t bear weight
False
the patient can bear weight
Foot series is indicated if:
(a) Has pain in the “midfoot” region
AND
(b) Has bone tenderness at the base of the 5th metatarsal or the navicular
OR
(c) Inability to bear weight both immediately after the injury and for four steps in the
evaluation room.
For suspicion of stress fractures if X-rays are normal initially
Bone scan can show abnormalities before X-ray findings
Consider CT or MRI
If plain radiographs are negative and you still suspect bony fracture what should you do?
Consider CT
Knee series is indicated if:
(a) Age >55 year old
(b) Isolated tenderness of the patella (with no other bony tenderness to the knee).
(c) Tenderness at the head of the fibula.
(d) Inability to flex the knee to 90 degrees.
(e) Inability to bear weight both immediately after the injury and for four steps in the evaluation room (limping is allowed).
If you suspect ligamentous injury, what is the preferred imaging
MRI
True/False
You should Immobilize a knee while awaiting further evaluation
True
When is shoulder imaging warranted?
1) Traumatic cause
(2) Presence of pain
(3) Loss of range of motion
Shoulder plain films will be able to identify what?
Fractures Dislocations Arthritis Acromioclavicular (AC) joint or Sternoclavicular (SC) joint injuries.
Shoulder
What is preferred for labral, ligamentous or rotator cuff injuries?
MRI
True/ False
A radiograph of the injured part of the hand should be obtained. The type of radiograph depends on the clinical assessment and suspected injuries, based on the physical examination and mechanism of injury. Consultation with a radiologist is often helpful.
True
If a fracture of the phalanx is suspected, an anteroposterior (AP) and true lateral views are obtained of what?
The individual digit
When the fracture involves or is close to the joint, what view is helpful?
Oblique view
Finger Xray
If the fracture cannot be delineated because of superimposed digits, such as the base of the proximal phalanx what is done?
radiograph of the entire hand must be obtained
All metacarpal fractures require what views?
AP, lateral, and oblique views
A suspected scaphoid fracture should be evaluated with a ______
scaphoid series…………………………
True/False
Special views may be required for assessment of specific injuries.
True
Intra-articular fractures refer to fractures involving what?
the joint
Tuft fractures refer specifically to fractures involving what?
head of the distal phalanx.
True lateral views show the pisiform projected over the scaphoid tubercle.
scapholunate angle greater than 60 degrees suggests _________________
An angle of less than 30 degrees suggests __________
- A scapholunate angle greater than 60 degrees suggests possible scapholunate instability.
- An angle of less than 30 degrees suggests ulnar-sided wrist instability.
In the PA wrist view, the wrist is held in neutral, with _____ of rotation to evaluate the relative lengths of the radius and ulna.
0 degrees
Scaphoid view (wrist in ulnar deviation) to check for _____
scaphoid fractures……………..
Clenched fist view to check for ___________ seen with ligament disruptions.
scapholunate joint space widening
_______ view is used to check for hook of the hamate fractures.
Hook view….
_____________________ of the radiocarpal joint is characterized by narrowing of the joint space and sclerosis of the articular surfaces.
Osteoarthritis
Imaging is not indicated in the first 4-6 weeks unless back pain is present with:
(a) Progressive neurological findings or cauda equina symptoms
(b) Constitutional findings (fever, weight loss)
(c) Traumatic cause
(d) Current or history of malignancy
(e) Elderly
(f) Infectious risk (IV drug use, immunosuppression)
(g) Chronic steroid use
(h) Failed conservative management with signs of nerve root irritation
(i) At risk for osteoporosis
For back pain
______ is helpful for fractures or joint degeneration
______ is preferred for serious trauma
______ is imaging of choice for back pain with prior surgery, suspected infection, spinal cord injury, tumor, or cord compression.
- X-ray
- CT
- MRI
headache
____ is preferred for trauma, to rule out hemorrhage, bone abnormalities, or prior to lumbar punctures.
CT
For headache
____ is preferred for soft tissue causes such as tumors, or vascular.
MRI
For a headache with one or more of these issues what should you consider?
(a) Associated with head/neck trauma
(b) New, worse or new features, or abrupt onset headache
(c) Focal neurologic signs or symptoms
(d) Thunderclap headache (sudden, severe)
(e) Headache radiating to the neck
(f) Persistent positional headache
(g) Temporal headache in older than 55 years of age
(h) Suspect infection
1) Associated with cough, exertion, or sexual activity
imaging…..
