This is a challenging film precisely because it looks superficially
normal. You are right, the radiologists also missed the abnormality.
PACS does allow one to spot lots of abnormalities because of the ability
to manipulate the image so much more; I have worked before at somewhere
with PACS (and ours is coming soon too) and I found that it was
particularly useful with carpus and facial bones. On a traditional film
you see the maxillary sinus full of blood and hunt for the #; with PACS
you can often see that too.
> *From:* Adrian Fogarty <[log in to unmask]>
> *To:* [log in to unmask]
> *Date:* Fri, 6 Jan 2006 20:57:58 -0000
>
> I agree with Tim and Peter on this one: I'm not convinced the junior
> has done anything wrong. I get the impression your radiologists didn't
> spot the abnormality either Rowley; all the more reason why I'd hardly
> mention it to the junior, whether or not any harm resulted, as the
> latter is not directly relevant to the "error" of misinterpretation.
>
> I've only just looked at the image this evening but found the
> abnormality difficult to see until I saw your answer. That may relate
> to looking at the 3 x 6 image on my computer screen - something I'm not
> used to compared with traditional films - or it may relate to my
> impatience as your answer was already sitting in my inbox! The former's
> a bit of a concern to me, however, as we go live with PACS on Monday! I
> think I'm going to have to retrain my "eye" from scratch with the new
> technology; we'll see.
>
> But pretty much no-one on the list got the correct answer, with perhaps
> Tony coming closest, but then he did identify 6 possible abnormalities,
> 5 of which were incorrect, so this hardly counts as a confident
> identification, does it?
>
> One other point not mentioned so far is to consider getting a
> radiologist's opinion "live" whenever you have a challenging plain film
> like this. After all, they're paid to provide this service so you might
> as well use them. Then, if they can't confidently clear the film it
> becomes an automatic CT, as the radiologist himself has to go for a
> scan if he can't clear the film, saving you the argument!
>
> AF
>
> ----- Original Message -----
> From: "Rowley Cottingham" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Wednesday, January 04, 2006 10:11 AM
> Subject: The cervical spine xray - my answer.
>
>
> > Now, a further question. How would you deal with a junior who missed
> > this
> > abnormality?
> >
> > /Rowley./
>
>
/Rowley./
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