No abstract

To help curb excessive radiography, we developed a protocol for selecting patients with injured extremities who need x-ray examination, and we tested the protocol prospectively in 848 patients to determine its safety and effectiveness. Strict adherence to the protocol would have reduced x-ray usage by 12 per cent for upper extremities and 19 per cent for lower extremities. The actual reductions were 5 per cent and 16 per cent, respectively, since further reductions were limited by patient's demands for x-ray examinations. One fracture in 287 were missed, but the treatment was appropriate and the outcome satisfactory. By eliminating superfluous x-ray procedures, the protocol could reduce charges by $79 million to $139 million nationwide, without compromising quality of care or increasing malpractice liability. Nevertheless, even the best protocol cannot eliminate all negative x-ray studies. These results should serve as a stimulus for judicious use of radiography, but also as a warning to avoid overzealous cost-containment strategies that would reduce x-ray usage to below a safe threshold.

Chondral

No abstract

Acrylic spacers and cubes of cortical bone of known dimensions were placed in predetermined locations in cadaver hip joints, which were then studied with plain radiography and linear, hypocycloidal, and computed tomography (CT). Joint space widening was not measurable on plain radiographs of the pelvis when 2-mm spacers were placed anywhere within the hip joint. When 4-mm spacers were used, widening measured 2 mm in the axis of measurement corresponding to the location of the spacer. Linear tomography did not permit identification of the 2-mm cubes; however, hypocycloidal tomography and CT consistently showed them anywhere within the hip joint. Radiation dose and clinical recommendations are discussed.