This article was submitted by Dr Deborah Sambo and Assoc Prof Jane Smith of the RACGP Queensland Research Support Committee.
The number and the complexity of choices a GP has to make when deciding on an imaging test has become increasingly sophisticated and far more of a challenge. Interpreting the results can be complex and depends on a written report, possibly influencing us to stop looking at the images of our patients as much as in the past.
However, herein lies a folly; it may benefit us, and our patients, to analyse the images and the reports, especially focusing on lateral chest x-rays. Many GPs have looked at countless x-rays over the years, but some of us prefer not to spend time reading the images for ourselves. You may find that patients feel much more connected when their images are shown and explained to them, rather than having the radiologist report read out in abstract terms.
We need to be mindful that a radiologist may not comment on findings irrelevant to the initial request. It has been found that 1.4% of women admitted to hospital over the age of 50 years had vertebral fractures found on chest x-ray, but these were only included in reports 59% of the time and discharge summaries 16% of the time.1
Another smaller study of 145 men and women with an average age of 67.5 years found a vertebral fracture rate on lateral CXR at 12.4%, but only 11% were included in reports.2
Vertebral crush fractures on CXR from osteoporosis can be observed by GPs just from studying the lateral views. The report may not refer to these, because the CXR was ordered for another totally unrelated condition. For you and the patient this means an earlier diagnosis, intervention and treatment.
Unless you look you will never know.
References
- Morris CA, Carrino JA, Lang P, Solomon DH. Incidental vertebral fractures on chest radiographs. Recognition, documentation, and treatment. J Gen Intern Med. 2006;21(4):352–6.
- Cataldi V, Laporta T, Sverzellati N, De Filippo M, Zompatori M. Detection of incidental vertebral fractures on routine lateral chest radiographs. Radiol Med. 2008;113(7):968–77.
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