Radiology


Digital X-ray Solutions for Chiropractic
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Radiology
Written by Ryan Everhart   
Sunday, 22 July 2012 21:05
X
-rays play an important role in determining the exact cause for many health complications in patients. The advancements in radiography are allowing physicians to pinpoint the exact cause of complications through high quality output in a matter of seconds. As a chiropractor, it is important to determine what part of the body is causing the trouble, and you can do that easily with digital radiography. You can choose one of three digital X-ray options to set up in your chiropractic clinic. 

Computed Radiography

digxraysolutionComputed radiography (CR) is the closest process to traditional radiography because it still includes the use of X-ray cassettes and films, albeit in a different form. Instead of the traditional X-ray film, computed radiography makes use of a reusable phosphor plate. After taking each image, the plate will be processed through a scanner that then erases the image so that the plate can be used again. As the process of obtaining imaging is very similar to traditional radiography, computed radiography also takes the same time to finish one cycle.

As the images are now digitized, the need for chemicals, X-ray films and a darkroom does not exist. Computed radiography equipment requires regular maintenance and replacement as the moving parts tend to wear out after prolonged use.

Charge-Coupled Device

The charge-coupled device is the closest arrangement to flat panel digital X-rays. They produce fairly high quality imaging using an extensive setup of cameras and mirrors. Some elaborate arrangements are known to contain almost 192 cameras. Charge-coupled device (CCD) systems were extremely popular a while back because they produced results closest to those from flat panel detectors for a fraction of the cost. CCDs are still highly preferred among physicians and clinics because they are cost effective. By choosing the right model, you will get high quality imagery with lower maintenance costs than computed radiography.

Although they are much cheaper, charge-coupled devices are bulky and occupy a lot of space. They also require high frequency generators to produce high quality images. The hundreds of cameras attached to the device need to be recalibrated every few weeks to ensure that there are no blank spaces in the output. A huge advantage CCD has over computed radiography is the response time. Each image can be captured and digitized in just about five seconds.

Flat Panel Digital X-ray

Although flat panel digital X-ray detectors were considered to be too pricy a few years ago, they are now more affordable and popular than ever. Most hospitals are switching to flat panel detectors because they produce the best results in the shortest amount of time. These detectors are also the safest for patients as they emit the least amount of radiation. Flat panel detectors (FPDs) are known to produce the most detailed images, which help chiropractors detect even the smallest inconsistencies in the body. As they contain no moving parts, FPDs are long-lasting with an average lifespan of at least one million exposures. Unlike CCDs, flat panel detectors do not require high frequency generators to achieve excellent image quality. Taking only two to five seconds for each image, an FPD’s only drawback is its slightly higher price than CR or CCD. However, a flat panel upgrade is the most economical long-term digital X-ray solution in my opinion.

Ryan has been involved in the X-Ray business for 15 years. He started doing X-Ray service and is now a top sales producer at Viztek based in Garner NC. The evolution of Digital X-Ray imaging has created numerous opportunities for streamlining medical practices throughout the country. Ryan specializes in converting Analog customers to a completely Digital Imaging solutions.www.Viztek.net

 
Melorheostosis
Radiology
Written by Terry R. Yochum, D.C., D.A.C.B.R., Fellow, A.C.C.R., and Alicia M. Yochum, D.C., R.N., BSN   
Saturday, 02 June 2012 02:31
melorheostosis[Case History]

This male patient has a history of multiple traumas to his humerus.  Are these radiopacities exuberant callous formation from hematoma?

Diagnosis:  The answer is no!! This is a rare sclerotic skeletal dysplasia referred to as “MELORHEOSTOSIS”.

General Considerations

Melorheostosis is a rare, sclerosing bone dysplasia that was first described in 1922 by Leri and Joanny.  Synonyms include Leri type of osteopetrosis, osteosis eberneizzante monomelica, and flowing hyperostosis.  The name melorheostosis is of Greek derivation, meaning limb, flow, and bone, and aptly describes the hyperostotic appearance that has been likened to wax flowing down a lighted candle.

Radiologic Findings 

Cortical thickening in a streaked or wavy pattern is the most marked roentgen feature.  In children the hyperostosis is primarily endosteal; in adulthood, periosteal bone deposition is more dramatic. (1) The radiographic findings appear to reflect developmental errors at the sites of intramembranous and enchondral bone formation. (1) The hyperostotic bone protrudes under the periosteum and usually follows along one side of a long bone.   Endosteal involvement may encroach upon the medullary space.   Bony masses resembling osteochondromas extend into adjacent articulations.  

Bone scintigraphy shows increased tracer uptake in the involved area.


Involvement of the carpal and tarsal bones resembles the multiple bone islands that are seen in osteopoikilosis.  In the pelvis and scapulae (flat bones) the sclerotic bone may be in the form of dense radiations from the joint.  Heterotopic bone formation and soft tissue calcification are encountered and may lead to joint ankylosis.  Bone scintigraphy shows increased tracer uptake in the involved area.  A number of other disorders have been found in association with melorheostosis.  These include linear scleroderma, osteopoikilosis, osteopathia striata, neurofibromatosis, tuberous sclerosis, and hemangiomas. (1)

Dr. Terry R. Yochum is a second generation chiropractor and a Cum Laude Graduate of National College of Chi-ropractic, where he subsequently completed his radiology residency. He is currently Director of the Rocky Mountain Chiropractic Radiological Center in Denver, Colorado, and Adjunct Professor of Radiology at the Southern California University of Health Sciences, as well as an instructor of skeletal radiology at the University of Colorado School of Medicine, Denver, CO. Dr. Yochum can be reached at 1-303-940-9400 or by e-mail at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Dr. Alicia M. Yochum is a third generation chiropractor and 2011 Suma Cum Laude Graduate of Logan College of Chiropractic, as well as a Registered Nurse.  She is starting her Radiology Residency at Logan College in April 2012.   She can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Reference: 1.Yochum TR, Rowe LJ:  Essentials of Skeletal Radiology, 3rd ed., Williams & Wilkins, Baltimore, Maryland, 2005.
 
Fractures of the Pubis and Ischium
Radiology
Written by Terry R. Yochum, D.C., D.A.C.B.R., Fellow, A.C.C.R. Alicia M. Yochum, D.C., R.N., B.S.N.    
Tuesday, 01 May 2012 17:23
pubisandischium[Case History]
This patient presents following severe trauma to the pelvic region after a motorcycle accident.
 
Diagnosis:  This patient has bilateral fractures of the superior and inferior pubic rami which has been referred to as a STRADDLE FRACTURE. Fortunately, this patient had no injury to the bladder, as bladder trauma is often present with fractures such as this. Of incidental notation is a bilateral transitional segment at the lumbosacral junction with a unilateral accessory joint articulation.
 
Straddle Fractures
The straddle fracture or comminuted fracture of the pubic arches is the most common type of unstable fracture of the pelvis. This double vertical fracture involves both superior pubic rami and ischiopubic junctions bilaterally. The central fracture fragment is usually displaced posterosuperiorly, placing pressure upon the ventral surface of the bladder. Twenty percent of these patients have bladder rupture and urethral tear which may require diagnosis via urethrography and cystography.1
 
Bucket-Handle Fracture
The bucket-handle fracture represents a fracture through the superior pubic ramus and ischiopubic junction on the side opposite the oblique force of impact to the pelvis. A fracture or dislocation of the sacroiliac joint on the side of impact is part of the injury. This fracture is usually the result of an automobile or auto/pedestrian accident. The pubic component of the fracture is usually displaced inward and superiorly. Associated injuries to the abdominal viscera, head and thorax may be present.1
 
Avulsion Fractures
Symphysis Pubis.  Severe injuries of the major adductor muscles cause a tearing of bone from the superior or inferior pubic rami near the pubic articulation. This injury is common in soccer players.
 
Ischial Tuberosity (Rider’s Bone).  This type of fracture represents an avulsion of the secondary growth center (apophysis) for the ischial tuberosity as a result of a forceful contraction of the hamstring group of muscles. With healing, an unexplained overgrowth of the avulsed apophysis occurs, often leaving a wide radiolucent gap between the avulsed fragment and the parent ischium.  
 
This overgrowth may be the effect of hyperemia upon the ischial apophysis. Occasionally, the avulsed ischial apophysis may assume a size larger than the parent ischium. This large overgrowth should not be confused with an extraosseous neoplasm. Usually, the patient’s history of a previous severe hamstring injury and the fact that the lesion is asymptomatic secures the proper diagnosis.  
 
These fractures are seen most commonly in cheerleaders and hurdlers. The residual bony fragment has been called “rider’s bone,” because a high percentage of these lesions occur in horseback riders as a result of chronic stress.
 
Dr. Terry R. Yochum is a second generation chiropractor and a Cum Laude Graduate of National College of Chi­ropractic, where he subsequently completed his radiology residency. He is currently Director of the Rocky Mountain Chiropractic Radiological Center in Denver, Colorado, and Adjunct Professor of Radiology at the Southern California University of Health Sciences, as well as an instructor of skeletal radiology at the University of Colorado School of Medicine, Denver, CO. Dr. Yochum can be reached at 1-303-940-9400 or by e-mail at This e-mail address is being protected from spambots. You need JavaScript enabled to view it
 
Dr. Alicia M. Yochum is a third generation chiropractor and 2011 Suma Cum Laude Graduate of Logan College of Chiropractic, as well as a Registered Nurse.  She is starting her Radiology Residency at Logan College in April 2012.   She can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
 
Reference: 1.Yochum TR, Rowe LJ:  Essentials of Skeletal Radiology, 3rd ed., Williams & Wilkins, Baltimore, Maryland, 2005.
 
 
Digital X-ray: Do I Need One in My Office?
Radiology
Written by Andrew Cheesman   
Friday, 16 March 2012 18:49
S
o, you are considering “transforming” your practice? Or maybe starting a brand new or satellite office? What are some of the things you should keep in mind in making decisions on just what your practice will offer? What should it look like? What kind of vibe would you like it to put out? And how does the decision of installing digital x-ray (DXR) affect your practice? 
 
As they say, there are “many ways to skin a cat.” Each practice is a reflection of its doctor; there is no one right way to operate a practice. That being said, generally speaking, most “successful” practices today should seek to: 
  1. medicalrecordsfilesAppear modern, cutting edge, and up-to-speed with other health care practices. Patients are turned off when walking into a practice that appears to be circa 1975. They simply don’t feel comfortable with a “tired” atmosphere, complete with old adjustment tables with torn padding. 
  2. Offer technology that provides convenience to the patient, in terms of comfort, functionality and time savings. As “Larry the Cable Guy” would say, “Git er done.” More than ever before, people are busy and don’t have the luxury of taking an inordinate amount of time for an office visit. If an appointment takes too long, they will stop coming, period. 
  3. Give a patient confidence that the technology employed is state-of-the-art. No one wants to be treated by any health care professional if they think there are better protocols and/or technologies that could be utilized.  Is your patient education a VCR tape on an old, low resolution TV? That probably won’t cut it.
  4. Take advice and follow models of other successful practices. Once the wheel was invented, you could pretty much assume that the wheel was a great idea and should be utilized. If you see a true (with the same type of practice in the same type of neighborhood) peer of yours successfully implementing a new technology or protocol, you don’t need to be a “doubting Thomas” – you can jump-start your own advancement by learning from the successful model of others. 
How does this apply to DXR?
As you are making decisions regarding your new or “re-invented” office, you would be well-advised to consider whether incorporating DXR is a quality fit for you and your practice. And I will say that DXR is not a fit for every doctor, so I am in no way asserting that DXR is a no-brainer for all chiropractors, because it simply isn’t. However, for those practices that fit the profile, DXR offers great benefits to not only the doctor, but to the patient as well. 
 
Mr. Green Jeans
Obviously, we live in a world that is increasingly focused on being “green” and that trend is only going to intensify as time passes. Young people are more aware of acting in a planet-friendly manner, more so than baby boomers, etc. so “being green” is not a fad that will ever disappear. It is not a “pet rock,” so to speak, but a lasting trend that will be ever-increasing. (If you aren’t old enough to understand the “pet rock” analogy, my apologies.) 
 

An office utilizing flat-screen monitors and the like generally will give the impression of a more cutting-edge practice.

One of the features that DXR contributes is the fact that it eliminates the toxic odor of chemicals present when you are using a film x-ray unit. People are more sensitive than ever to things like a chemical odor and going digital completely eliminates that negative presence.
 
Less radiation exposure for everyone
Using DXR reduces the exposure to harmful radiation, which the public is more aware of than ever. With cancer on virtually everyone’s minds, the patients are generally very leery of exposure to radiation and will appreciate having digital technology as opposed to exposure to traditional x-rays.  
 
Time is money
Not only does going with DXR save time for the doctor, but it also saves the patient’s time as well, and they will appreciate that. You get your images instantly, as opposed to waiting for film to develop, or, of course, sending the x-rays off to another party. Also, if you need a re-take, you also know that immediately and without additional costs, as you are not using film or chemicals in the first place. Additional x-rays cost virtually nothing. You can take them until you get what you need, in terms of images that display the needed elements. 
 
Additionally, if your patient wants a copy of the x-ray, you can easily hand him a computer disk or email the image, while you have your copy of the image forever. When using film, you typically have only one copy, so you can’t give out a copy to your patient without risking your own image. 
 
digitalxrayvsfilmPatient education, compliance and retention
Giving your patient an image of their spine helps with patient education, compliance and retention – all at no additional cost with each image you hand out. This allows the patient to more fully understand, and retain, the reality of their condition. And a better educated patient is a more likely retained patient. 
 
Expert analysis on-hand
You will have to check with each individual DXR vendor, but some offer a radiologist on-hand to help analyze images, which you can easily email. When in doubt, the guidance of a radiologist to interpret digital images can be invaluable, and, in some cases, costs you no additional charges. When in doubt, check with your radiologist, at no additional expense. 
 
Developing a high-end image
In practice, you are not only competing with other chiropractors, but you are also being compared to all other health care practices in general. We know that MDs, etc. generally have offices that reflect an upper-scale, high-end image. If patients visit a chiropractor and the office is full of antiquated technologies – including a film-based x-ray unit, it will cause the patients to conjure a poor image of the practice.  An office utilizing flat-screen monitors and the like generally will give the impression of a more cutting-edge practice. Yes, it is true that chiropractors encourage an image of being non-surgical and have an aversion to using drugs — unless absolutely necessary – but the two are not mutually exclusive. In other words, you still want a practice that appears somewhat sleek and modern while not advocating allopathic medicine in general. 
 
Extra room to roam
Eliminating your film-based x-ray equipment will allow for additional space in your office. Most doctors of chiropractic struggle to make do with the square footage of their office space; there is a fine line between paying for space and having enough room for not only a waiting room, treatment rooms, etc., but also some space for retail products such as pillows, topicals, in-home rehab, etc. When you convert to DXR, you free up space otherwise used for storing images, film, chemicals and the like. Most chiropractic offices need every square inch they can find and going DXR gives you that little bit of extra space that might make a difference. 

Andrew Cheesman is Sr. VP Marketing and Sales for RF System Lab North America, based in Lincoln, Nebraska. Their head office is based in Nagano, Japan. They have over 2,000 users in the US and several thousands worldwide. They are now the largest digital retrofit company in the world. You can reach them at 800-905-1554 or visit www.rfamerica.com or email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
 
Anomalies of the C-1 Posterior Arch
Radiology
Written by Terry R. Yochum, D.C., D.A.C.B.R., Fellow, A.C.C.R. Alicia M. Yochum, D.C., R.N., B.S.N.   
Wednesday, 29 February 2012 16:30

c1posarch[Case History]

This young adult was in a car accident and has suboccipital pain. Do you see a fracture?

Agenesis of the Atlas Posterior Arch

Synonyms. Aplasia or congenital absence of the posterior arch.

Description. Lack of ossification of the posterior arch of the atlas may be complete and bilateral, may be purely unilateral, or may manifest as small clefts (i.e., spina bifida).  Dense fibrous connective tissue remains at the site devoid of ossification.  Ossification of the posterior arch of the atlas is normally present at birth, with union visible by 6 years of age.

Clinical Features. Pain or neurological complications are rare.  Atlantoaxial instability has been described.  There is occasional association with C2-C4 block vertebrae and Klippel-Feil syndrome.  Spinal stenosis may also occur.   Absence of the posterior arch needs to be differentiated from occipitalization, osteolytic metastases, aneurysmal bone cyst and osteoblastoma.  Differentiation from fractures, aggressive bone destruction, and occipitalization must be made with confidence, which may require CT or even MRI investigations.

Radiologic Features. The lateral view is the best projection for identifying the various forms of aplasia.  Oblique views are also of assistance in determining unilateral aplasias and clefts.  Thin-section CT is the technique of choice for determining the extent of aplasia and providing accurate differential diagnosis.  MRI is indicated if a neurological deficit is present.

Bilateral Posterior Arch Agenesis. The characteristic triad of findings with bilateral posterior arch agenesis is absence of the atlas posterior arch, union of the posterior tubercle to the axis spinous process (axis megaspinous sign), and compensatory enlargement and sclerosis of the anterior arch.  Occasionally the posterior tubercle will remain visible in normal position (Keller type aplasia).   Hypertrophy of the posterior atlantoaxial ligaments may produce spinal canal stenosis and be a factor for cord injury after trauma.

Unilateral Posterior Arch Agenesis (Hemi-Atlas). With unilateral posterior arch agenesis, absence of half of the posterior arch is uncommon.  The condition is best determined on the AP open mouth view and CT.

Isolated Clefts of the Posterior Arch. Isolated clefts of the posterior arch are most common in the midline posteriorly (posterior rachischisis, spina bifida occulta), accounting for 97% of arch clefts, with only 3% occurring elsewhere.  The second most common site is at the junction zone of the posterior arch with the lateral mass, where the vertebral artery passes over the arch (vertebral artery sulcus cleft).  These clefts range in size from 1 to 5 mm; have smooth, corticated opposing margins; and are best seen on oblique and slightly off-lateral projections.

Hypoplasia of the Posterior Arch. Two forms of hypoplasia of the posterior arch are described: thin and short.

  • Thin posterior arch. The width of the posterior arch is thin and attenuated maximally at the vertebral artery sulcus.  An association with Turner’s syndrome and gonadal dysgenesis has been suggested.  It may be a factor for fracture at this site after trauma.
  • Short posterior arch. The atlas posterior arch is thick and bulky, and the diameter of the spinal canal is diminished.  A described tandem finding is a thick, bulky dens that may contribute to symptomatic spinal stenosis.  The incidence of symptoms increases with age or may be triggered by minor trauma.  An association with patients of Asian origin has been implicated.

 

Dr. Terry R. Yochum is a second generation chiropractor and a Cum Laude Graduate of National College of Chiropractic, where he subsequently completed his radiology residency. He is currently Director of the Rocky Mountain Chiropractic Radiological Center in Denver, Colorado, and Adjunct Professor of Radiology at the Southern California University of Health Sciences, as well as an instructor of skeletal radiology at the University of Colorado School of Medicine, Denver, CO. Dr. Yochum can be reached at 1-303-940-9400 or by e-mail at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Dr. Alicia M. Yochum is a third generation chiropractor and 2011 Suma Cum Laude Graduate of Logan College of Chiropractic, as well as a Registered Nurse.  She is starting her Radiology Residency at Logan College in April 2012.   She can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 

Reference: 1. Yochum, T.R., & Rowe, L.J. (2005).  Essentials of Skeletal Radiology, 3rd ed. Baltimore, MD: Williams & Wilkins.

 
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