![]() ![]() While doing this, they want to preserve the blood supply to the bone and associated soft tissues by means of atraumatic surgical technique. First, they want to provide anatomic reduction of the fracture fragments and then maintain them in that position with some form of stable fixation. The orthopedists have certain goals when they contemplate surgical fixation on a patient. One should also look for problems with the fixation device, such as incorrect application of the device, device failure, or infection of the device. Specifically, one should look at the fracture position for problems of alignment, apposition and rotation. A slight overexposure may be helpful for looking at metal fixation devicesĮven though the orthopedists have already looked at the same films, the radiologist should act as a general safety net under them and carefully look for problems of fixation and fracture healing.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. ![]() 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.
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