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The following examinee appeals process section shall be added to the ACRRT Rules and Regulations. Please contact the ACRRT administration if you would like to comment on this addition. ACRRT member comments will be accepted until June 30, 2012.

 

ARTICLE II

            EXAMINATION OF APPLICANTS 

F:  Appeals:  An examinee may appeal the scoring and results of the examination.  Appeals are to be written and sent to the ACRRT address.  Appeals will be accepted on a case by case basis, if received within 30 days of mailing of the results.  ACRRT will only communicate with the examinee. Hand grading of tests may be performed for a $35.00 fee.  The examinee must submit support to their arguments to a specific question via references from appropriate texts or referenced journal articles.  Tests or copies of  the examination cannot and will not be released due to confidentiality and test material security.  Results of the ACRRT appeal process are final.

About 700,000 cases of compression fracture due to osteoporosis occur yearly in the United States. In this article, we will take a close look at this common fracture - which causes the bones - vertebrae - to collapse in height.

 

ANATOMY

The human spine consists of 24 bones called vertebrae. They are built just like a square egg - outer shell (cortex) and an inner yolk portion - the medullary cavity. Compression fractures cause the outer shell to collapse. A simple compression fracture involves the vertebral body only however the spinal cord is at risk with severe fractures because of its proximity to the posterior part of the vertebral body.

 

CAUSES

An injury, such as a fall on the buttocks or a car accident where the person’s head hits the steering wheel (restrained by the seat belt) can cause a vertebra to fracture. Compression fractures occur when the forces are too great for the spine to withstand or the bones of the spine are weakened (osteoporosis).

 

Fractures from osteoporosis usually occur in the front part (anterior) portion of the vertebra.
The worse the osteoporosis, the less trauma will be required for a compression fracture to occur.

 

SYMPTOMS

What does the patient feel ? Symptoms may include immediate and sharp back pain, decreased range of motion, and reduced sensation to the lower limbs if severe.

 

DIAGNOSIS

A doctor of chiropractic will usually perform a complete history and physical examination. Pressure (palpation) over the vertebra or striking the spinous process with a reflex hammer will almost take their breath away. If the doctor feels a compression fracture is present, x-rays will be ordered which can be performed by ACRRT personnel.

Additional imaging such as CT or MRI studies may be required if the compression fracture shows multiple small fragments or if there is possible spinal cord involvement.
SURGERY

 

VERTEBROPLASTY

A surgeon uses a needle guided by a special x-ray TV (fluoroscope) to fill the compressed vertebra with bone cement. A reaction in the cement causes it to harden quickly. Approximately 80% of patients feel almost immediate pain relief from this procedure.

 

KYPHOPLASTY

Two long needles are inserted along side of the vertebra. Two holes are drilled into the sides of the vertebra. The surgeon then slides a hollow tube with a deflated balloon on the end through each drill hole. Inflating the balloons restores the height of the vertebra. Bone cement is injected into the hollow space formed by the balloon. This fixes the bone in its proper size and position.

 

OSTEOPOROSIS PREVENTION

I have been performing peripheral DXA bone scans for 6 years on DC’s, their patients, and health store patrons in the Midwest. Generally, 47% of the women and 72% of the men have low scores on their bone scans. I am fond of saying, “Osteoporosis is NOT caused from a deficiency of biphosphonates” rather a lack of proper nutrition especially minerals i.e., calcium, magnesium, and other nutrients including vitamins D3 and K2.

A daily vitamin mixture that provides calcium (1200 mgs), magnesium (500 mgs), and enough vitamin D3 to bring the blood levels to 60+ ng/mls (as much as 10,000 IU’s/day) has been documented to produce higher bone density on follow-up scans.

Calcium alone or only with vitamin D may not be sufficient. Sunlight helps create vitamin D when it strikes a cholesterol molecule. People who live “north” of a line from Atlanta to San Diego will need more sun than others. Twenty minutes daily during the summer may fall far short of what is needed according to recent articles. Imagine how much sun exposure is needed over the winter months!

Exercise is helpful. Young women (30‘s) are osteopenic (birthing 3 children in 5 years) and 70+ year-old men are having compression fractures that needed Vertebro/Kyphoplasty. I diagnosed a 34-year-old (birthing 4 children in 7 years) with a compression fracture.

Good quality x-rays are needed as is careful review of the films. A patient on Fosamax had me examine her cheek and I felt the hole created in her jaw (ONJ) ! No minerals or vitamin D were suggested by her physician when she was given the prescription.

Osteoporosis is wide-spread and I suggest a base-line scan be obtained for many prior to 40 years of age should bone loss be detected. Proper nutrition has been shown to be effective in preventing and reversing the painful and damaging effects of low bone density that has been documented to lead to early death.

In summary:

700, 000 cases of compression fracture/yr in US.
Osteoporotic fractures usually involve anterior part of vertebra.
Radiographs determine severity of compression fracture.
Uncomplicated cases respond well to conservative care. Nutrition should be included.

 


 

References:

  1. About.Com: Orthopedics Sept. 28, 2008
  2. eorthopod.com: Spinal Compression Fractures
  3. wisegeek.com: What is a compression fracture?
  4. spineuniverse: Kyphoplasty and Vertebroplasty: Treatment for Spinal Compression fractures
  5. www.nof.org/osteoporosisdiseasefacts.html: Fast Facts On Osteoporosis

For those offices using digital technology, whether Computed Radiography (CR) or Direct Radiography (DR), the following points should be considered:

  1. PART CENTERING - the body part being radiographed should be in the center of the cassette of the CR plate or DR detector. If the body part is at the periphery of the image receptor (IR) the image cannot be adequately formed by the computer.
  2. SPLIT CASSETTES - if a CR plate is split into 2 parts, the side not receiving the exposure should be covered by a lead shield. Storage phosphors in the CR plate are extremely sensitive to low levels of exposure and may cause a “pixilated” effect.
  3. COLLIMATION - in digital systems, the computer software becomes inundated with information from the phosphor crystals at the edges of the image receptor as well as the area of the central ray. At the very least, the collimated field should be placed so that all four margins are placed on the IR.
  4. OPEN CASSETTES - with CR plate technology, the latent image is stored in the phosphor crystal and accidentally opening the cassette starts the erasure process, but a lag time of 15 seconds is normal.
  5. GRIDS - Image Receptors are more sensitive to scatter radiation.

 


References:

  1. Merrill’s Atlas of Radiographic Positioning & Procedures 11 Ed. 2007

 

Professionals x-raying children either love it, or actively avoid it.

  1. Asking a 4-year-old child NOT to move is like trying to hold back a tsunami.
  2. Hoping to get the perfect hand series for a 2-year-old, who’s frightened and doesn’t understand what you are trying to achieve, is unrealistic. 

 

The following tips are complements of Children’s Hospital — Oakland, CA.

 

Introduce yourself.

Become a real person to the patient and family, not just a rad tech. Children associate scrubs with pain and the technologist must get past that as soon as possible.

 

Create trust. 

Let the child know right away what you are going to do and that it will not hurt.

 

Specific ways to develop trust include:

 

Use a demonstration doll.

With young children, use a doll to show them exactly what will happen and how the x-ray will take place. Kids think this is great and can’t wait to take the place of the doll.

 

Rehearse.

Show the patient what the procedure will entail and let the child act it out first. Make it a game and it will seem like a fun challenge.

 

Be fast.

There is a short window of opportunity to get the examination done as quickly as possible to reduce potential trauma for the child.

 

Prepare in advance.

Have everything set up before you bring the child into the x-ray room. Be especially cognizant of gonadal shielding.

 

Distract the child.

Use age–appropriate creative sounds and objects to distract younger children when they are on the table.

 

Sing songs.

Even small children respond because they enjoy music.

 

Wear funny things.

Funny headgear can make the procedure and environment less hostile. Be aware that some masks can traumatize the little patient.

 

Be the example.

Use yourself as the demonstration doll showing the slightly older child with your armor foot exactly what you need them to do.

 

Count down.

Enlist the slightly older child into the procedure by making a game of how long it will take. See how high or low you will have to count to complete the exam.

 

Smile a lot and laugh when possible.

Make light of a tough situation to help the child feel that the process is going to be OK.

 

Have patience.

Remember that children may be in pain, yet unable to communicate it the ways we adults do.

 

Working with children can be very rewarding if you can handle the pressure of speed combined with patience. The rewards come when you have talked a child through a fearful situation or shown the child that he or she can have fun.

What does an S-value represent and how is it monitored?

S-values or “sensitivity” values represent the numeric value of exposure received by the receptors in the digital system. This represents a key value in monitoring that a quality radiograph is obtained with the least amount of dose to the patient.

The S-value is automatically recorded by the software for every exposure taken on a particular digital system.

The illustration on the right shows that an optimal CXR in this office has an S-value of 200.

Your X-ray service company versed in digital technology can ensure that YOUR exposures fall within acceptable ranges.

 


 References:

  1. http://www.sprawls.org/

Contact ACRRT

American Chiropractic Registry
of
Radiologic Technologists

52 W. Colfax Street
Palatine, Illinois
60067

Telephone: 847.705.1178
Fax: 847.705.1178

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