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Radd Report Writing > X ray Considerations > Flashcards

X ray Considerations Flashcards

1
Q

What does the global fee consist of?

A

Technical and professional component
tech –> 2/3 of global fee
Pro –> 1/3 of fee

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2
Q

What is NOT a part of teh global fee?

A

Time spent making the films and/or discussing the findings

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3
Q

What is the technical component?

A
  • production of radiograph

- equipment costs, time to position pt, time to create image

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4
Q

What is the professional component?

A

Full typed report in ABCS format

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5
Q

What things can alter liability even if films are sent out for review?

A

Bad quality
lack of opposing views
failure to follow through on radiologist’s recommendations

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6
Q

What are reasons to get a 2nd opinion on an xray?

A

Red flags
Complicated Hx or Exam (not like everybody else)
Failure to respond to care as expected
Unexplained deterioration of condition
Confirm the DCs Interpretation
Medicolegal support (ex. Personal injury/ worker’s comp case confirmation)

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7
Q

How are digital transmissions made?

A

Through the receiver’s VPN

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8
Q

Components of a Radd Report

A 
Biographical info
Hx
Body of report
Conclusions/ Impressions
Recommendations
Signature
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9
Q

“Acute” Span

A

1-4 weeks

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10
Q

“Subacute” Span

A

5-12 weeks

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11
Q

“Chronic” Span

A

> 12 weeks

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12
Q

Acute Neck Injury: Are X-rays indicated?

Over 65

A

Yes

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13
Q

Acute Neck Injury: Are X-rays indicated?

Paraesthesias in extremities

A

Yes

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14
Q

Acute Neck injury –> When are X-rays NOT indicated?

A
  • All 3 criteria must be met
  • Simple rear end collision
  • Delayed cervical pain onset
  • Absence of midline cervical tenderness
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15
Q

Acute Neck Injury: Are X-rays indicated?

Immediate Cervical pain onset

A

Yes

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16
Q

Are x rays indicated in nontraumatic neck pain AND arm pain and paraesthesia

A

Yes

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17
Q

Acute Neck Injury: Are X-rays indicated?

Pt unable to turn head 45 degrees in both directions

A

Yes

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18
Q

Acute Neck Injury: Are X-rays indicated?

Presence of midline cervical tenderness

A

Yes

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19
Q

Are x rays indicated in Uncomplicated Subacture or chronic neck pain with or without radicular symptoms?

A

Yes, but must be present for 4 weeks or longer

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20
Q

Are x rays indicated in Acute uncomplicated neck pain?

A

No

*uncomplicated means nontraumatic w/o underlying neuro findings or red flags

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21
Q

What are the special circumstances under which x-rays are indicated in acute uncomplicated neck pain?

A
  • If prior to seeing you, the pt has had Tx with no success

- absence of expected response to care or worsening of symptoms

22
Q

When are X-rays indicated with complicated (red flags) neck pain?

A

Pt 50, particularly w/ S&S suggesting systemic Dz
Intractable pain, constant or progressive S&S
Significant activity restriction >4 weeks
No response to care after 4 weeks
Neck rigidity in sagittal plane w/ no trauma
Dysphagia
Impaired Consciousness
Cranial N. signs, Path reflexes, long tract signs
Arm or leg pain w/ movement
Suspected Neoplasm
Suspected infection
Suspected failed surgical fusion
Progressive painful or structural deformity
Elevated lab exam and positive S&S

23
Q

When are x rays indicated with recent acute T, L, or TL trauma?

A
  • WIth ANY of the following present
  • Moderate to severe localized back pain
  • Midline tenderness upon palpation
  • Neuro Deficits
  • MVA >50 MPH
  • Fall of 10 ft. or more
24
Q

When are x rays NOT indicated with recent acute T, L, or TL trauma?

A
  • Absence of pain
  • Normal ROM
  • Absence of neuro deficits
25
Q

Are x rays indicated in acute pt. with uncomplicated LBP, T pain?

A

No

26
Q

Are x rays initially indicated with Subacute or Chronic LBP, T pain and no previous Tx trial?

A

No

  • No prior tx –> trial period of 4-6 weeks is recommended
  • Absence of expected response or worsening after 4-6 weeks –> take films
27
Q

Pt. has nontraumatic acute LBP and Sciatica (suspicion of disc herniation). You shouldn’t take films unless…

A 
pt is >50
progressive neuro deficits
unexpected response to care 4-6 weeks
worsens with care
*MRI would be of value
28
Q

What are the signs of disc herniation?

A

-Need 3 of 5 (consistent to same N. level)
primarily leg pain
leg pain confined to dermatome
Neural stretch tests recreate or exacerbate leg pain
2 of 4 neuro findings consistent w/ dermatome
-muscle weakness
-decreased reflex
-Abnormal Pinwheel
-Atrophy
MR or CT correlating to Dermatome

29
Q

Are x rays indicated with Suspected Degenerative spondylolisthesis/ lateral recss stenosis?

A

Yes

30
Q

What are signs of Degenerative Spondylolisthesis in the Lumbar spine?

A 
Primarily scleratogenous leg pain
comes and goes
often reduced by leaning forward or sitting down
no neuro findings
very common
4 Fs --> Fat, Female, Forty, L4
31
Q

What are the red flags of complicated T and L pain that would indicated an x ray?

A

S&S of systemic disease esp 50]
Constant or progressive S&S
Absence of expected tx results or worsening after 4-6 weeks
Significant activity restriction >4 weeks
Unrelenting pain at rest
*Suspected inflammatory spondyloarthropathy
suspected compression fx
suspected neoplasm
suspected infection
suspected failed surgical fusion
Progressive or painful structural deformity
Elevated Lab and Positive S&S

32
Q

What are the criteria for inflammatory back pain?

A

Morning stiffness >30 mins
Improvement of back pain w/ exercise but not rest
Awakening in the second half of nigth due to back pain
Alternating buttock pain

33
Q

What are signs of suspected neoplasm?

A 
Considerable LBP >50 y/o
Hx of CA
Unexplained Weight loss
Failure of conservative care
intractable pain
*ESR >50 mm/hr
Systemically unwell
Lymphadenopathy
34
Q

What are the special sircumstances for x ray?

A

Pt unable to give a reliable Hx
Crippling cancer phobia
Need for immediate decision about career or athletic future or legal evaluation
HX of significant radiographic abnormalities elsewhere
HX of finding from outside study (abdomen, etc..) that requires spine evalation

35
Q

Are x-rays indicated with non-progressive, non-painful adult scoliosis?

A

No

*In a skeletally mature pt, scoliosis is >10 degrees

36
Q

Chest report is same as bone except for the __ of the report

A

body

37
Q

What makes up the body of a chest x ray report?

A
  1. Insporatory effort
  2. Lung fields
  3. Diaphragm
  4. Any pleural fluid or thickening
  5. Size of heart (normal is size, any displacement noted
  6. Bones and joints ok?
  7. Any surrounding soft tissue changes?
38
Q

Cervical Spine Views and accessory views

A

AP, APOM, Lateral

Flexion/Extension (motion, ligament lax, ADI)
Obliques (Pedicles, Pillars, IVF)

39
Q

Thoracic Spine Views and accessory views

A

AP and Lateral

Accessory views are rare, instead use special imaging

40
Q

Lumbar Spine Views and Accessory views

A

AP(PA) and Lateral. Some say Sacral Tilt also.
Sacral tilt –> SI and lumbosacral junction

Obliques –> pars, lamina, soft tissue (kidney stone vs. gall stone)

  • Post oblique: Ant structures move further from spine and post. structures move closer to spine
  • Ant obliques: post. structures move farther from spine and ant. structures move closer to spine
41
Q

Hip Views and Accessory views

A

AP and Lateral

Special Imaging preffered for accessory fields

42
Q

Knee views and accessory views

A

AP and Lateral

Tunnel: See intercondylar notch
Sunrise (tangential): See patella femoral joint

43
Q

Ankle views and accessory views

A

AP, lateral, oblique

Special imaging preferred for accessory fields

44
Q

Foot views and accessory views

A

AP, lateral, oblique

Special imaging preferred for accessory fields

45
Q

Shoulder Views and Accessory views

A

Internal and External rotation

Baby arm –> helps w/ HADD, more of a true lateral
Y view –> good for dislocations and scapular assessment

46
Q

Elbow views and accessory views

A

AP and lateral

External Oblique
Tangential

47
Q

Wrist views and accessory views

A

PA, lateral, Oblique

Ulnar Deviation –> Helpful with scaphoid fx assessment and to assess integrity of certain ligaments

48
Q

Hand views and accessory views

A

PA, Lateral, Oblique

Special Imaging preferred for accessory fields

49
Q

What does an internist specialize in?

A

All diseases and total health care of adults, usually 18 y/o and older

50
Q

What does an oncologist specialize in?

A

cancer and disorders of the blood and blood-forming organs?

51
Q

What does a Diagnostic Radiologist specialize in?

A

x ray, ultrasound, and other imaging techniques such as CT and MRI

52
Q

What does a Nuclear Radiologist specialize in?

A

Dz requiring use of radioactive isotopes or as an aid in Dx and/or therapy

Radd Report Writing (1 decks)

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