This is a very simple and obvious question and it's been annoying me
for months. I find it amazing that I have the technology in my flat to
send images around the world, but not in the A&E. Working in a centre
with Pacs x-rays, ct and digital photography, but with out of house
ortho & plastics it should be a no-brainer to put in place the
(relatively low cost) technology (although we do have image-linking to
a neurourgical centre). As Peter points out, someone is already doing
the scans so the physical presence of a radiologist isn't manditory.
The question is if the radiologist is doing more work at home, will
contracts etc. need to be updated to pay them for call from home that
involves doing the work at home as well.
Jason Carty
LAT Registrar
SVUH, Dublin
On Monday, June 28, 2004, at 04:13 PM, [log in to unmask]
wrote:
> Of course in this day and age of globilisation what's stopping us
> getting a radioGRAPHER to do the scan, be that CT/USS or limb coil MRI
> and sending the image to a hospital elsewhere in the world where it IS
> 9-5pm and then we can get 24/7 hot reporting. The legal cover could
> almost certainly be worked through.
> Perhaps we could suggest that to cover the cost of this we would
> retain some of the A&E budget that currently goes to the radiology
> dept.
> Yours (mostly but not entirely with tongue in cheek)
> Peter Cutting
>
>
> ---------- Original Message ----------------------------------
> From: "Dunn Matthew Dr. (RJC) A & E - SwarkHosp-TR"
> <[log in to unmask]>
> Reply-To: Accident and Emergency Academic List
> <[log in to unmask]>
> Date: Mon, 28 Jun 2004 13:13:11 +0100
>
>>> There is increasing interest in the use of ultrasound with
>>> this reported in the last few days:
>>>
>>> J Hand Surg [Am]. 2004 May;29(3):400-5.
>>>
>>>
>>> "Ultrasound for the early diagnosis of clinically suspected
>>> scaphoid fracture.
>>>
>>> Senall JA, Failla JM, Bouffard JA, van Holsbeeck M.
>>> One hand
>>> surgeon performed the examination, and ultrasounds were read
>>> by a musculoskeletal radiologist.
>>> RESULTS: Ultrasound
>>> identified correctly 7 of 9 cases that were eventually
>>> positive for scaphoid fracture on plain x-ray.
>>> Ultrasound was read correctly as negative in 8 of 9
>>> x-ray-negative cases; this was statistically
>>> significant. The 1 false-positive case had radioscaphoid
>>> arthrosis and radial wrist swelling.
>>> Sensitivity was 78% and specificity was 89%. The positive
>>> predictive value was 88% and negative
>>> predictive value was 80%. CONCLUSIONS: We recommend that
>>> high-frequency ultrasound be
>>> used to investigate occult suspected scaphoid fractures
>>> because of its ability to allow early
>>> diagnosis and to eliminate the need for a more invasive or
>>> expensive diagnostic test in most cases."
>>
>>
>> Missing 2 out of 9 fractures seems quite a lot, and doesn't mean you
>> can
>> avoid POP. And specificity is too low for it to be used as a "rule
>> in". An
>> important issue is that these were all read by a musculoskeletal
>> radiologist. Great if you've got one handy. As it stands we've got a
>> paper
>> showing that if you've got the resources ( and what's the chances of
>> getting a radiologist to do this either as a "one stop" clinic with a
>> clinician or by seeing the patients themselves and discharging those
>> without
>> asb tenderness), then you still don't have accurate enough
>> information to
>> safely change your clinical management. Or am I reading it wrong?
>> What I'd like to see would be a paper showing ultrasound by an EP
>> could
>> reliably exclude scaphoid fracture at initial presentation (which is
>> unlikely give the unreliability of the technique in this small
>> study). If
>> all patients could be scanned at the point of presentation (or next
>> working
>> day if there was nobody with relevant ultrasound skills in the
>> department)
>> and discharged if negative rather than getting a POP on in the first
>> place,
>> that would be useful.
>>
>> Matt Dunn
>> Warwick.
>>
>>
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