Should you include the Radiologist?

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=100 BGCOLOR="#000000" TEXT="#F7F7FF" bgproperties="fixed" background="03f00640dvldtc.gif"> <div> <FONT SIZE="5" COLOR="#FFCC66" FACE="Arial" ><B>Radiographers Reporting</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="Radiographers Reporting"><U><B>home</B></U></A></div> <div> <A HREF="id37.htm" TARGET="_top" TITLE="The Report"><U>The Report</U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE="Shoulder"><U>Shoulder</U></A>   |   <A HREF="id20.htm" TARGET="_top" TITLE="Elbow"><U>Elbow</U></A>   |   <A HREF="id21.htm" TARGET="_top" TITLE="Wrist"><U>Wrist</U></A>   |   <A HREF="id22.htm" TARGET="_top" TITLE="Hand"><U>Hand</U></A>   |   <A HREF="id23.htm" TARGET="_top" TITLE="Pelvis/Hip"><U>Pelvis/Hip</U></A>   |   <A HREF="id24.htm" TARGET="_top" TITLE="Knee"><U>Knee</U></A>   |   <A HREF="id25.htm" TARGET="_top" TITLE="Ankle"><U>Ankle</U></A>   |   <A HREF="id26.htm" TARGET="_top" TITLE="Foot"><U>Foot</U></A>   |   <A HREF="id36.htm" TARGET="_top" TITLE="SalterHarris fractures"><U>Salter-Harris fractures</U></A>   |   <A HREF="id33.htm" TARGET="_top" TITLE="Paediatric arm."><U>Paediatric arm.</U></A>   |   <A HREF="id35.htm" TARGET="_top" TITLE="Paediatric leg"><U>Paediatric leg</U></A>   |   <B>Should you include the Radiologist?</B>   |   <A HREF="id31.htm" TARGET="_top" TITLE="Guest book and link sites."><U>Guest book and link sites.</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#000000" TEXT="#F7F7FF" background="040d2c00dvldtc.gif"> <div> <B>1.</B></div> <div> <B><IMG SRC="240b4790.jpg" border=0 width="180" height="121" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>2.</B></div> <div> <B><IMG SRC="362b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>3.</B></div> <div> <B><IMG SRC="242b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>4.</B></div> <div> <B><IMG SRC="244b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>5.</B></div> <div> <B><IMG SRC="246b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>6.</B></div> <div> <B><IMG SRC="248b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>7.</B></div> <div> <B><IMG SRC="24eb40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>8.</B></div> <div> <B><IMG SRC="24ab41f0.jpg" border=0 width="180" height="543" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>9.</B></div> <div> <B><IMG SRC="250b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>10.</B></div> <div> <B><IMG SRC="252b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>11.</B></div> <div> <B><IMG SRC="46ab87b0.jpg" border=0 width="184" height="123" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> </td> <td valign="top" height=380 BGCOLOR="#000000" TEXT="#F7F7FF"> <div> Should you include the Radiologist?</div> <div> Should radiographers issue final reports on everything that comes through the radiology department? The identification of bony trauma is an area where radiographers can excel. Other pathologies however, although some may be obvious in their presence, require a knowledge equal to a consultant radiologist to ascertain exactly what they are, their origin, the systemic effects they may have and what line of clinical management should be taken to effect a good outcome for the patient.</div> <bR> <div> Since putting this web site together in 2000 the scope of the reporting radiographer in the U.K. has increased immensely. Many U.K. reporting radiographers are now issuing reports on the axial as well as the appendicular skeleton and are able to report on pathologies as well as fractures. In many cases the radiologist has been relieved of his reporting duties altogether.</div> <bR> <div> However, this author left the U.K. before further training could be undertaken which obviously limits this web site to the author's scope of expertise. Also, as a world wide reference tool, this web site is used by many outside the U.K. where radiographer reporting is just becoming a reality.</div> <bR> <div> This author by no means suggests that radiographers with adequate knowledge should not report on anything and everything, however not all radiographers are trained to the same level and therefore this page highlights a few areas where maybe a radiologist's opinion would be of help.</div> <bR> <div> It also depends on the reader's local protocols and indemnity as to what they should and should not report on, but it is the author's opinion, which it is stressed is a personal opinion, that radiographers should not, without adequate training and indemnity, report on anything with a joint replacement as there may be loosening or infection, any pathological appearance or anything where there may be underlying infection.</div> <bR> <div> This is only a personal view, and it is not suggested that any radiographer with adequate knowledge and training should not report on such radiographs, but it may be wise to have a radiologist's opinion. </div> <bR> <div> However, the one thing the reporting radiographer must do, is to <FONT SIZE="4" COLOR="#FFCC66" FACE="Arial" ><B>recognize their personal limitations with regard to reporting and do not exceed them.</B></FONT></div> <bR> <div> The images on the left show examples where the radiographer should be aware that a radiologist's opinion may be of help.</div> <bR> <div> <B>Image 1 </B>is a fracture of the clavicle but it includes a fracture of the first rib. This may lead to further complications but the radiographer should be certain that they have indemnity for this area and that their legal cover is not limited to the appendicular skeleton.</div> <bR> <div> <B>Image 2</B> shows the appearance of sclerotic (lighter) metaphyses of the radius and ulna. There is also some suggestion of a similar appearance at the base of the thumb. This is most likely to be a normal variant but could equally be due to some other systemic problem or even heavy metal poisoning. </div> <bR> <div> <B>Image 3</B> is an enchondroma, a benign bone tumour, but all other possibilities of pathology should be excluded.</div> <bR> <div> <B>Image 4</B> shows an ivory epiphysis but again other pathology should be excluded.</div> <bR> <div> <B>Image 5</B> is a pathological fracture of the paediatric femur. It should be possible to see that the bone texture in the area of the fracture is not well defined. Also there is the appearance of "sun ray" periosteal reaction extending into the surrounding soft tissues. These are the appearances associated with aggressive infiltrating bone tumors and these images should only be dealt with by adequately trained radiographers or consultant radiologists. There is a very high level of responsibility here as management is often amputation.</div> <bR> <div> <B>Image 6</B> shows a fibrous cortical lesion in the femur but again other pathology should be excluded.</div> <bR> <div> <B>Image 7</B> shows a Pellegrini-Steida lesion which is calcification of the collateral ligament of the knee, probably due to frequent direct minor trauma ie. sport induced. Again, other soft tissue pathology should be excluded.</div> <bR> <div> <B>Image 8</B> shows an osteoma of the tibia. As before, with bone tumors it needs to be decided what type of tumor it may be.</div> <bR> <div> <B>Image 9 </B>shows a simple bone cyst in the calcaneum, exclude other pathology such as a lipoma.</div> <bR> <div> <B>Image 10</B> shows phleboliths in the foot. This appearance is probably due to an haemangioma but may be connected to other systemic problems and the radiologist's opinion may be useful.</div> <bR> <div> <B>Image 11</B> shows a capitate which is almost entirely bone cyst. This is almost certainly benign and of little concern apart from the fact that the bone is weakened and prone to fracture. This would be a coincidental finding and not the cause of the patient's presentation. Again it is necessary to exclude other pathology.</div> </td> </tr></table></body>