In message <[log in to unmask]>,
Rowley Cottingham <[log in to unmask]> writes
>I believe that we should abandon plain film radiography in the management of
>My view is that we should CT scan or nothing, as the pick up rate on plain film
>ludicrously low, and if you do see a fracture you are obliged to scan anyway.
>[log in to unmask]
In my current post, we are fortunate enough to have a very liberal head
CT policy. All sorts of injuries get scanned and I am frequently
surprised at the number of abnormalities that we find. A lot of them
have no discernable fracture.
I qualify the above with the observation that we do a lot of scans that
Plain films of the skull are now rarely performed. I know because I
review all the reports and have to screen the SHO requests.
I agree that skull fractures mandate a scan. Early recognition and
transfer of patients with an intracranial collection leads to better
outcomes. If they deteriorate, you can always re-scan them.
In our institution, we are lucky enough to have a scanner in the
department and a radiology department that is supportative. Elsewhere
its commonly a different story. I suspect that where radiologists are
not supportative, scan only between 9am and 5pm and are reluctant to
come in, then the good old plain skull xray will remain the
(inappropriate) passport to getting a CT.