Post on 20-Jan-2016
ABCs and Bone FormationBy: Jeff Binder
Performed first (usually by the tech) ABCs
• Anatomy: Is entire region of anatomy on the film
• Bone: Search for signs of patient motion. Big white lines and small white lines.
• Cartilage: Check joint spaces are not obscured by positioning errors
• Soft Tissues: Evaluate technique of the soft tissues
Performed by a Doctor ABCs
• Anatomy: sub inventory of all anatomical parts (pedicles, Tp’s, sp’s, etc)
• Bone: Cortical and trabecular bone. Look for an increase or absence of either
• Cartilage: Signs of arthritis, injury, or anomaly
• Soft tissue: Regional inspection of soft tissue for pathology
Imaging is for documentation NOT education
Every xray must be interpreted to reach a diagnosis or conclusion
ALWAYS do an exam prior to taking xrays
A written interpretation of the study Part of the patients permanent record Signed and dated by the individual
doing the interpretation All radiographic studies must be
interpreted to reach a diagnosis or conclusion
Verbal rendition of visual image Medico legal communication
• Insurance company, work comp, attorneys Provide a standard for comparison Part of a patient’s permanent record
• A report may replace lost films Professional communication Expedite treatment by highlighting indications
and contraindications for treatment
1. Stationary2. Patient Information3. Radiology Information4. Technique (optional)5. Body (also called Findings)6. Impression (also called Conclusion) 7. Recommendations (when applicable)
Name and address of the clinic or individual who is creating the report
Joe Bob’s MRI clinic15 s. main streetChesterfield, MO 63017
Patient’s full name Address Date of birth (sometimes patient age
is listed also) Sex Medical record number (or patient
number)
All views performed for interpretation must be listed here • Ex: cervical 3 view would state “AP, Lateral
and AP open mouth” Location and dates films were taken Patient’s clinical history and reason
for taking the films can be listed here as well
This is optional. If the interpreting Doctor is supplied with the technique for each film he/she can list them in this area.
Some doctors list these on special views in case they need to be repeated at a later date.
This is where the doctor will list everything he finds through the ABCs method.
This is the description of findings. There is no diagnosis here. Basic facts about the film and findings are listed.
EX: “A geographic lucency is seen in the proximal right tibia measuring 2.1 centimeters in diameter.”
A short, concise list of important radiologic finding and diagnoses based on previous narrative descriptions (body).
List them from most importance to least Avoid long lists Medical diagnoses and terminology should
be used Very critical as a percentage of Doctors will
not read the full report.EX: “Condroblastoma in right proximal
tibia”
Optional Basically anything the Radiologist
wants the Doctor to pay attention to Contraindications
• “Low force technique recommended due to fracture”
Additional exams that may need performed• “Recommend MRI to further evaluate
surrounding soft tissues.”
Intramembranous: Adding bricks to a house
Enchondral: Framework of a house
Throughout life Adding layers of bone Initiated by proliferation of
mesenchymal cells Flat bones developed by this (skull,
pelvis) No preformed cartilage Used for BONE REPAIR Increases WIDTH of bone
Formed by primary ossification centers
Use non-ossified matrix as framework Osteoblasts and osteoclasts form and
become embedded Cell death is followed by ossification Increases LENGTH of bone
Epiphysis: articular surface, produces and supports articular cartilage
Apophysis: attachment site for ligaments and tendons (trochanters, tuberosities, tubercles)
Metaphysis: Most metabolically active, focus for disease and trauma, indolent blood flow (very slow, stagnant blood)
Diaphysis: Shaft of long bones, act as lever, 50/50 cortical and medullary bone
Physis: Growth plate, epiphyseal plate, bone growth center
Growth arrest line: line formed by growth plate showing end of bone growth. White on xray
ZPC (zone of provisional calcification): Most mature layer of the growth plate. Least Mature layer of the metaphysis
Periosteum: Part of intramembranous formation, mediates repair, sensitive to Gh, • Sharpe’s fibers anchor periosteum to bone in
adults. Periosteal lifting in adults is SERIOUS
Calcium Regulators• Parathormone, 1,25-dihydroxy vit D, Calcitonin
Maturation hormones• Glucocorticoids, insulin, t3/t4, androgen,
estrogen, Gh Growth factors
• Somatomedin, epidermal gf, platelet-derived gf
Local Factors• Prostaglandin E2, interleukins
Ions• Calcium and Phosphorus (2:1 ratio, inverse)
Increase blood Ca+ Bone
• Softens bone to allow osteoclasts to work more efficiently
• NO RECEPTORS ON OSTEOCLASTS Kidney
• Increase Ca+ reabsorption at the DCT Gut
• Activation of Vit D3 to increase absorption in the small intestine
Decreases blood Ca+ Stimulates osteoblasts
• ACTS ON RECEPTORS
Considerable effect on growth plates Hyper or hypo = stunted growth
• Opposite mechanisms Estrogens more responsible for
growth plate closure