![]() ![]() If orthopedic hardware is present, the entire device should be included on the film, preferably with several centimeters of normal bone on either end.Place the entire limb on the film, including the joint above and the joint below.Expose a minimum of two orthogonal views of each body part.The following points should be kept in mind when performing radiographs of orthopedic fixation hardware. One only has to look at the outside films taken at the offices of most nonradiologists to see what kind of difference we make by monitoring such mundane matters as processor chemistry, cassette cleaning, film densitometry, etc. Therefore, it must be the radiologist who monitors the imaging workup and suggests the most efficacious and cost-effective followup imaging studies for each patient.Īnother important role of the radiologists is film quality control. They are likewise on much shakier ground when it comes to understanding the underlying physics, indications, and interpretation of radionuclide bone scans, fluoroscopy, ultrasound, CT and MRI. It is the radiologist’s job to look closely for these entities. Although orthopedists as a group do a superb job of interpreting plain radiographs on trauma patients, they tend to do much less well as a group when it comes to other disorders, such as metabolic bone disease, infection, neoplasms or arthritis. However, we do know imaging better than they do. So, how can radiologists add some value to the examination? We are never going to know the history, physical findings, surgical findings and postoperative course as well as the orthopedists do. I would hate for this to happen at UW, because the great majority of my practice consists of studies ordered by orthopedist. Health plan managers and third-party payers are increasingly under the gun to reduce health care costs, and it is hard to argue that radiologists should continue to receive compensation for zero-content dictations. In some hospitals, they have been successful. ![]() In a growing number of medical centers across the country, orthopedists are pressing their hospital administrations for the right to bill for film interpretation and to cut the radiologists out of the loop completely. This tendency for radiologists to tap dance their way through orthopedic dictations has not gone unnoticed by the orthopedists. If you are going to bill for the dictation, you should say something intelligent about the film and add some value to the examination. I think that this kind of dictation is a real disservice to the patient, especially if you are charging for it. The critical role of LIPUS for fracture healing is still unknown because of the heterogeneity of results in clinical trials for fresh fractures and the lack of controlled trials for delayed unions and nonunions.For some reason, many radiologists freak out when they are faced with reading out films with orthopedic hardware, and will mumble something vague along the lines of “Orthopedic hardware is seen and surgical changes are noted….”, for fear that they will say something dumb and the orthopedists will laugh at them. LIPUS likely has the ability to enhance maturation of the callus in distraction osteogenesis and reduce the healing index. For delayed union and nonunion, the overall success rate of LIPUS therapy is approximately 67% (humerus), 90% (radius/radius-ulna), 82% (femur), and 87% (tibia/tibia-fibula). The incidence of delayed union and nonunion is 5% to 10% of all fractures. The beneficial effect of acceleration of fracture healing by LIPUS is considered to be larger in the group of patients or fractures with potentially negative factors for fracture healing. Some literature, however, has shown no positive effects. They showed that LIPUS accelerated the fracture healing rate from 24% to 42% for fresh fractures. In 19, two milestone double-blind randomized controlled trials revealed the benefits of LIPUS for the acceleration of fracture healing in the tibia and radius. It has a frequency of 1.5 MHz, a signal burst width of 200 micros, a signal repetition frequency of 1 kHz, and an intensity of 30 mW/cm2. Low-intensity pulsed ultrasound (LIPUS) is a relatively new technique for the acceleration of fracture healing in fresh fractures and nonunions. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |