Indications For Radiography Research Articles

Imaging after trauma in clinics and practice for children and adolescents : Part 1 of the results of a nationwide online survey of the Pediatric Traumatology Section of the German Trauma Society

The indication for radiography should strictly follow the ALARA (as low as reasonably achievable) principle in pediatric and adolescent trauma patients. The effect of radiation on the growing sensitive tissue of these patients should not be disregarded. The Pediatric Traumatology Section (SKT) of the German Trauma Society (DGU) wanted to clarify how the principle is followed in trauma care. An online survey was open for 10 weeks. Target groups were trauma surgeons, pediatric surgeons, general surgeons, and orthopedic surgeons. From Nov. 15, 2019, to Feb. 29, 2020, 788 physicians participated: branch office 20.56%, MVZ 4.31%, hospital 75.13%; resident 16.62%, senior 38.07%, chief 22.59%. By specialist qualification, the distribution was: 38.34% surgery, 33.16% trauma surgery, 36.66% special trauma surgery, 70.34% orthopedics and trauma surgery, 18.78% pediatric surgery. Frequency of contact with fractures in the above age group was reported as 37% < 10/month, 27% < 20/M, 36% > 20/M. About 52% always request radiographs in 2 planes after acute trauma. X-ray of the opposite side for unclear findings was rejected by 70%. 23% use sonography regularly in fracture diagnosis. In polytrauma children and adolescents, whole-body CT is never used in 18%, rarely in 50%, and standard in 14%. The analysis shows that there is no uniform radiological management of children and adolescents with fractures among the respondents. Comparing the results of the survey with the consensus findings of the SKT recently published in this journal, persuasion is still needed to change the use of radiography in primary diagnosis.

Comparison of the NOF and NOGG guidelines for spinal radiographic examination in postmenopausal Chinese women.

To compare the National Osteoporosis Foundation (NOF) and the UK National Osteoporosis Guideline Group (NOGG) guidelines for the detection of vertebral fractures in postmenopausal Chinese women. A cross-sectional study on 255 community-dwelling postmenopausal women was conducted in Hunan province in 2017. Demographic and clinical characteristics and risk factors were recorded through questionnaires. Height and weight were measured using standard methods, and bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry. Vertebral fractures were diagnosed by radiography using semi-quantitative morphometry. The prevalence of vertebral fractures was 9.4%. Women with vertebral fractures were significantly older and shorter, had higher years-since menopause and height loss values and lower BMD and T-scores at the femoral neck and total hip, and were more likely to have a history of previous fractures. The sensitivity and specificity of the NOF guidelines were 91.7% and 39.8%, respectively, while the NOGG guidelines had lower sensitivity (87.5%) and specificity (32.5%). However, a higher percentage had indications for radiography in the 50-64 years age group according to the NOGG guidelines, while a higher percentage had indications for radiography in the ≥ 65 year group according to the NOF guidelines. The NOF guidelines were better than the NOGG guidelines for spinal radiography examination in the Chinese postmenopausal women.

Clinical diagnosis of rigid flatfооt in children

Flatfeet are divided into rigid and mobile forms. Rigid flatfeet usually lead to the development of pain. The most common reason of rigid flatfeet is a tarsal coalition. Mobility of the tarsal joints is checked by specific clinical tests. The study investigated the sensitivity and specificity of foot mobility tests - the “tip toes test”, Jack test, manual examination of passive and eversion and inversion. The study found the following parameters: the sensitivity of the “tip toes test”, Jack test was 87% and 85%, specificity - 65% and 64%. The sensitivity of the manual examination of passive and eversion and inversion was - 80%, specificity - 88%. The last test has a high specificity compared to the “tip toes test” and Jack test. Detection limits the mobility of the tarsal joints can be an indication for radiography for the detection of tarsal coalitions.

Radiography for head trauma in children: what guidelines should we use?

OBJECTIVE: To audit the appropriateness of skill radiography in children attending an accident and emergency (A&E) department with head injuries. METHODS: 569 children presenting to a large teaching hospital A&E...

The role of plain radiography in the management of suspected orbital blow-out fractures.

We reviewed the indications for radiography and its impact on management in 100 consecutive patients referred to the Radiology Department from the Accident and Emergency Department of a large eye hospital in order to assess the utility of orbital plain radiographs in patients suspected of having blow-out fractures. We assessed whether administration of antibiotics or referral for surgical or orthoptic treatment was influenced by clinical features, radiographic findings or both. Ophthalmologists interpreting the radiographs appeared to be guided by the presence or absence of physical signs. No patient in whom they overlooked a fracture which was not evident clinically was subsequently referred for surgery. All patients who did have surgery for complications of a blow-out fracture underwent pre-operative computed tomography. Neither referral for orthoptic treatment nor administration of systemic antibiotics was consistently influenced by the presence or absence of a fracture. Given these findings, and the observation that the decision to operate was guided exclusively by clinical rather than radiological criteria, we recommend that only patients with well-defined indications for surgery (enophthalmos of more than 2 mm at any time within the first 6 weeks following the injury, and/or diplopia in the primary and/or downgaze reading positions not showing evidence of resolving within 2 weeks of the injury) should undergo radiography.

Cervical spine radiography after blunt trauma. Is it always needed?

In trauma cases, the mere presence of a cervical immobilization device is not an indication for radiography of the cervical spine. High-yield radiographic criteria have been prospectively determined for cases of blunt trauma, and these identify individuals at low risk for cervical spine injuries. Cervical spine radiography is not required for patients who are alert, cooperative, and nonintoxicated and do not have neurologic deficits, cervical signs or symptoms, antecedent spinal mobility disorders, or distracting injuries. Cervical spine radiography alone does not ensure detection of all injuries. Adequate history taking and careful examination are always essential and may dictate additional studies.

Indications for radiography in patients with acute ankle injuries: Role of the physical examination: Auletta AG, Conway WR, Hayes CW, et al. AJR Am J Roentgenol. 1991;157: 789-91

Indications for radiography in patients with acute ankle injuries: Role of the physical examination: Auletta AG, Conway WR, Hayes CW, et al. AJR Am J Roentgenol. 1991;157: 789-91

Indications for radiography in patients with acute ankle injuries: Role of the physical examination: Auletta AG, Conway WF, Hayes CW, et al AJR 157:789–791 Oct 1991

Indications for radiography in patients with acute ankle injuries: Role of the physical examination: Auletta AG, Conway WF, Hayes CW, et al AJR 157:789–791 Oct 1991

Indications for radiography in patients with acute ankle injuries: role of the physical examination.

A prospective study was performed to test the hypothesis that a thorough physical examination can eliminate the need for a large number of radiographs obtained in patients with acute ankle trauma. Two hundred one patients were seen in the emergency department for acute ankle trauma and referred to the department of radiology for ankle radiographs. Radiology residents performed a brief but thorough physical examination of the ankle in all 201 patients. Solely on the basis of a strict set of physical examination criteria (examination for gross deformity, instability, crepitation, focal bony tenderness, severe soft-tissue tenderness, moderate or severe soft-tissue swelling, and ecchymosis), the radiologists determined whether or not the radiographs were indicated. All patients, irrespective of the physical examination, underwent ankle radiography, and the results were correlated with those of the physical examination. On the basis of the results of the physical examinations, 101 (50%) of the radiologic studies were not indicated. In only one of these patients was a fracture seen on radiographs. The radiograph in this case showed a small avulsion fracture of the dorsal aspect of the talus that was clinically insignificant (no cast or surgery was required). Our results suggest that a brief but thorough physical examination can eliminate the need for a large percentage of radiographs ordered in patients with acute ankle trauma.

Radiographic examination of the facial, nasal and paranasal sinus regions of the horse: I. Indications and procedures in 235 cases.

The radiographic procedures used for examination of the facial area and paranasal sinuses of 235 horses are reported. Clinical indications for these examinations and the diagnoses made are reviewed. Unilateral nasal discharge was the commonest reason for radiography, accounting for about one third of cases, most of which had radiological signs of paranasal sinus disease recognisable on erect lateral films. Oblique projections were required to obtain further information about the maxillary dental arcades and ventro-dorsal views demonstrated sinus expansion and extension of disease into the nasal cavity. In 24 horses with bilateral nasal discharge, the origin was usually shown to be in the lower respiratory tract and radiographic abnormalities were found in only 20 per cent of cases. Facial swelling was a feature of 25 per cent of cases; the commonest causes were premolar periapical disease, best shown on oblique views with the patient recumbent, and suture periostitis, easily demonstrated on erect lateral films. Other causes of facial swelling, which required multiple radiographic projections for evaluation, were sinus cysts and tumours and peripheral soft tissue masses. Epistaxis for which no cause could be found in the lower respiratory tract was the indication for radiography in a further 10 per cent of cases. In almost half of these a radiopaque shadow representing an ethmoid haematoma could be seen on an erect lateral film. A sinus cyst and a tumour were also recorded but most other causes of epistaxis failed to produce radiographic signs.(ABSTRACT TRUNCATED AT 250 WORDS)

Lumbar spine films in primary care: current use and effects of selective ordering criteria.

Low back pain (LBP) often prompts radiography, although the diagnostic yield of lumbar spine films is low, and many radiographic abnormalities are unrelated to symptoms. Criteria have been proposed for selective x-ray use, but their value and safety are uncertain. To evaluate these criteria, the authors prospectively studied 621 walk-in patients with LBP. The yield of explanatory x-ray findings was over three times greater among patients with indications for radiography than among those without. Furthermore, an indication for x-rays existed for all patients found to have a malignancy, and for 13 of 14 patients with an identified fracture. Actual physician ordering, however, did not correspond well with the recommended indications. Application of selective criteria appears safe and may improve the yield of useful findings. It may not, however, reduce x-ray utilization from current levels without further refinement in the criteria.