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Location: Patterns of Misdiagnosis in Plain Film Radiography
Discussion: Further views
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francispost |
Further views
Mar 21 2011, 10:30 PM EDT
Thanks for your efforts in creating this post. I often ask myself in the fast paced environment of A&E X ray if I am justified to pursue further views when not totally convinced by the standard/modified views already obtaned. This post has gave me the reassurance in my beliefs that obtaining a further view is best practice when all clinical, radiographical and physical factors are considered in favor. I know that sounds obvious but these judgements can be pressured in a busy department.
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artifact
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comorbidity
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normal variants
patella fracture
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robotpie |
1. RE: Further views
Apr 21 2011, 2:04 PM EDT
I, too, was wondering about this. I think it all depends on the doctor. Once I took it upon myself to take a Swimmer's View in addition to the standard views without letting the doctor know, but the doctor got upset at me for taking more views than what was ordered. :\
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metal-fan-666 |
2. RE: Further views
Oct 13 2011, 8:09 PM EDT
I work at 2 hospitals essentially as a lone radiographer where the only doctor in emergency more often than not is a local GP. It is essential in this role that you take the request as more of a guide than a demand. With a single doctor and a single radiographer and being in a popular toruist area, pt load can be extremely volatile fluctuating from zero patients x-rayed all day to 18 patients before lunch. Dont be afraid to perform a physical examination. If something is fractured and you poke it it will usually hurt (beware, some children have amazing pain thresholds). Scaphoids radial head fractures and 5th metatarsal fractures are perfect examples of times that a quick physical by the radiographer can find a fracture that the doctor missed. Scaphoids - palpate ther snuff box. Ask them to demonstrate their range of movement. If they geniunely appear to have normal range of movement and appear to be pain free especially after palpating the scaphoid then it is very unliekyl they have a scaphoid fracture. You can also get the patient to perform ulnar deviation "as far as they are comfortable to". Do not forcefully deviate their wrist - i have worked with a colleague who turned a minor fractured scaphoid into a complete and seperated fracture of the scaphoid through forceful deviation. If however they do have pain when palpating the snuff box and do not have a full range of movement - especially ulnar devation - then a scaphoid should be performed. If you do omit or add views/regions, have a chat to the doctor about it before getting the patient out of the room and/or document why you have chosen to perform your non standard views. Ideally, the doctor should be providing you with a question i.e. 'Fell on out stretched hand, ?distal radius fracture' to which you are trying to prove or disprove the query. Unfortunately the practice of providing history and ? on the request seems to be dying out. 1 out of 1 found this valuable. Do you? |
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francispost |
3. RE: Further views
Jan 5 2012, 7:59 PM EST
From experience and in-fact current protocol at my Hospital is to not perform scaphoid views until the healing process may take place.. This is due to a scaphoid # being very difficult to identify in the immediate post trauma views. Therefore trauma views for the wrist performed and Pt asked to return for further scaphoid views (4 shot) around 10 days later.
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