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10 Commandments of Accident and Emergency Radiology


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Teaching in Accident and Emergency Medicine:
10 Commandments of Accident and Emergency Radiology
BMJ 1995;310:642-5

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10 Commandments of Accident and Emergency Radiology

  1. 1. The 10 Commandments of<br />Accident and Emergency Radiology<br />Adapted from BMJ 1995;310:642-5<br /><br />
  2. 2. Treat the patient, not the radiograph<br />If the condition is immediately life threatening treatment should be started straight away without waiting for a radiograph to confirm the clinical diagnosis.<br />tension pneumothorax<br />severely displaced fractured ankle<br />
  3. 3. Take a history and examine the patient before requesting a radiograph<br />Establish the mechanism and force of injury and use this information to deduce which resultant abnormalities are likely.<br />
  4. 4. Request a radiograph only when necessary<br />A useful investigation is one whose result (positive or negative) will alter the patient's management; <br />many requested investigations do not.<br />
  5. 5. Never look at a radiograph without seeing the patient, and never see the patient without the looking at the radiograph<br />The doctor can correlate the radiological findings with the clinical examination, which helps to reduce the chances of missing an abnormality or perpetuating an error. <br />If a patient re-attends, always look at any radiographs taken previously, or at the least obtain the radiologist's report. <br />Do not accept the accident and emergency radiological interpretation written on the medical record.<br />
  6. 6. Look at every radiograph, the whole radiograph, and the radiograph as a whole<br />A common mistake is to focus immediately on severe abnormalities or on particular areas of the film. <br />This may lead you to fail to inspect the whole film and consequently to miss additional abnormalities.<br />
  7. 7. ABCs for Interpreting Radiographs<br />A. Adequacy<br />A. Alignment<br />B. Bones<br />C. Cartilage and Joints<br />S. Soft tissues<br />
  8. 8. Re-examine the patient when there is an incongruity between the radiograph and the expected findings<br />
  9. 9. The rule of twos<br />Two views at right angles<br />Two joints include either end of the long bones<br />Two sides to compare the normal and injured side<br />Two occasions to repeat radiographs at a later date to show the abnormality (early callus or rarefaction)<br />Two radiographs to compare with a known normal film<br />
  10. 10. Take radiographs before and after procedures<br />Removal of foreign body<br />Reduction of dislocation or fracture<br />
  11. 11. If a radiograph does not look quite right ask and listen: there is probably something wrong<br />The final responsibility lies with the doctor, and not the radiographer, therefore never accept poor quality or inadequate films.<br />It is important to seek senior advice and also to listen to the radiographer.<br />
  12. 12. Ensure you are protected by fail safe mechanisms<br />Quality control system for interpreting radiographs<br />On reviewing the films, the doctor records the radiological diagnosis on the request (or return) card<br />All emergency radiographs must be reviewed by a radiologist, and the report returned, within 3 working days. Many would now advocate immediate (within 24 hours) reporting as a good standard of practice<br />The radiologist's report should state clearly whether he agrees or disagrees with the radiological diagnosis of the emergency doctor<br />All radiographs must be reviewed if the report states disagree. The radiologist must contact the department at once if a serious injury has been missed<br />