In March 2015, Dr. Renne did a Grand Rounds lecture on soft tissue neck radiographs, which offers a great review of normal anatomy and systematic approach to reading films (“CHESS”). Yet, in my small, informal (not scientific at all) poll of some of our residents, none had ever ordered a soft tissue neck film. Are soft tissue neck radiographs useful? You be the judge.Read More
Ever have a patient present with foot or ankle pain? In case you have, here is a refresher on the radiographic anatomy of the foot as well as the test characteristics and viability of the use of the Ottawa Rules in the ED setting by Dr. Golden.Read More
You knew that you'd see at least one patient with a FOOSH (Fall On Outstretched Hand) while working in Minor Care. A nice, thin layer of ice laid down by the "Snow-pocalypse" snow storm that came through last night had already caused several patients to slip and fall.
John, your first patient of the day, a 24 year old rushing to work this morning, slipped coming down the steps outside his house. He tells you he landed on his right hand with his arm extended at the elbow and wrist. He is complaining of pain in the dorsal and radial right wrist. You go to examine him, noticing no obvious deformities, lacerations, or abrasions. On palpation, he has tenderness to palpation in the anatomic snuff box and pain with axial loading of the thumb. Suspecting a scaphoid fracture, you order a wrist x-ray.
While waiting for the film to be developed, you look for a refresher on how to interpret these challenging films.Read More
Utility of the imaging modality aside, abdominal radiographs can be a bit of a challenge to interpret. With a number of possible techniques (cross table laterals, left lateral decubitus, AP, upright, or supine) and a lot of structures to evaluate (is that small bowel or large bowel?, is that a kidney stone or an infamous phlebolith?), it's pretty easy to stare at a film and zone out as you eye moves from one shade of gray to another.
In the embedded video below, PGY-1 resident, Dr. Julie Teuber goes through a standardized approach to reading the abdominal x-ray that hopefully help keep your eyes from going cross-eyed next time you need to interpret an acute abdominal series.Read More