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