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1. Lesion location
2. Lesion size
3. Status of the Physis – Physeal Patency
4. Characteristics of Parent Bone
a) Sclerosis
5. Characteristics of Progeny Bone – Static Non-Comparison Measurements
a) Visualization
b) Fragmentation
c) Displacement
d) Radio-density of the Center of the Progeny Bone
e) Radio-density of the Rim of the Progeny Bone
f) Boundary (primary variable to assess healing)
g) Shape
6. Characteristics of Progeny Bone – Dynamic Comparison Measurements
a) Radio-density
b) Boundary
X-RAY CRITERIA
1. Standing AP – bilateral knees
2. Lateral – bilateral knees
3. Merchant – bilateral knees
4. Notch/Tunnel – bilateral knees
5. Left hand (for skeletal age)
X-ray Technique Protocol for these studies – Radiologist input?
X-RAY PROTOCOL
ClosingOpen Closed
1 – Open2 – Closing3 – Closed
CRITERION 3 – STATUS OF THE PHYSIS / PHYSEAL PATENCY
1 – Open2 – Closing3 – Closed
1 – Open2 – Closing3 – Closed
Assessment should consider only the femoral physis.
Closing’ Definition: - Must be able to see both some areas of the physis that appear
to be ‘closed’ and some areas that are clearly still ‘open’.
CRITERION 1 – LOCATION OF THE LESION
1 – Medial femoral condyle2 – Lateral femoral condyle3 – Patella4 – Trochlea
AP Lateral
1 – Anterior Condyle2 – Posterior Condyle3 – Patella4 – Trochlea
APostTPat
LATERAL VIEW: Project line off posterior femoral shaft. If posterior to line = Posterior. If between posterior femoral line and Blumenstadts line then =Anterior. If anterior to Blumenstadts then=Trochlear. Pick center of lesion surface predominant compartment
LateralAP Notch
1 – Width of OCD lesion2 – Width of knee3 – Max. depth of lesion
1 – Length of OCD lesion2 – Length of condyle3 – Max. depth of lesion
1 – Width of OCD lesion2 – Width of knee3 – Max. depth of lesion
CRITERION 2 – SIZE OF THE LESION
Need image Need image
AP1 – Width/Length OCD = normal parent bone to normal parent bone margin2 – Width = inter-epicondylar distance Length = maximal AP dimension measure parallel to
joint3 – Max Depth = in unossified, complete the arc of the parent bone contour and measure the
longest perpendicular line to the rim of parent bone and depth of the crater
1
32
32
1
1
2
3
LateralAP Notch
1 – Width of OCD lesion2 – Width of knee3 – Max. depth of lesion
1 – Length of OCD lesion2 – Length of condyle3 – Max. depth of lesion
1 – Width of OCD lesion2 – Width of knee3 – Max. depth of lesion
CRITERION 2 – SIZE OF THE LESION
Need image Need image
Lateral1 – Length of OCD lesion – normal parent bone to normal parent bone margin. 2 – Length of condyle (anterior-to-posterior). Measure the involved condyle. Measure parallel to
physis3 – Maximum depth of lesion (if unossified, complete the arc of the parent bone contour, and
measure the longest perpendicular line to the rim of parent bone in the depth of the crater)
1
32
32
1
1
2
3
LateralAP Notch
1 – Width of OCD lesion2 – Width of knee3 – Max. depth of lesion
1 – Length of OCD lesion2 – Length of condyle3 – Max. depth of lesion
1 – Width of OCD lesion2 – Width of knee3 – Max. depth of lesion
CRITERION 2 – SIZE OF THE LESION
Need image Need image
Notch1 – Width of OCD lesion – normal parent bone to normal parent bone margin2 – Width of knee (inter-epicondylar distance) – Select the maximum distance parallel to joint
surface3 – Maximum depth of lesion (if unossified, complete the arc of the parent bone contour, and
measure the longest perpendicular line to the rim of parent bone in the depth of the crater)
1
32
32
1
1
2
3
Same DensityLess DenseMore Dense
Need imageNeed imageNeed image
1 – More Dense2 – Less Dense3 – Same Density
CRITERION 4 – CHARACTERISTIC OF PARENT BONE - SCLEROSIS
In comparison to the unaffected parent bone, the radio-density of the rim of the parent bone is?
1 – More Dense2 – Less Dense3 – Same Density
1 – More Dense2 – Less Dense3 – Same Density
CRITERION 5a – CHARACTERISTIC OF PROGENY BONE - VISUALIZATION
Visualized Not-visualized
Need image
1 – No2 – Yes
1 – No2 – Yes
Is the progeny bone visualized ON ALL VIEWS?
Evaluate all views to determine presence of ossification.
If ossification not visualized on any view and appears as a “black hole”, check NO (Not-visualized)
CRITERION 5b – CHARACTERISTIC OF PROGENY BONE - FRAGMENTATION
1 – No2 – Yes
Fragmented
Need image
Non-fragmented
Need image
1 – No2 – Yes
Is the progeny bone fragmented? Need to see 2 or more pieces of progeny bone
CRITERION 5c – CHARACTERISTIC OF PROGENY BONE - DISPLACEMENT
Completely displacedPartially displacedNon-displaced
Need imageNeed image
Is the progeny bone displaced?- If any view demonstrates partial displacement, then it should be
defined as such, unless any view demonstrates complete displacement, then it should be defined as complete.
- Look at all views before rating.
1 – Non-displaced2 – Partially3 – Totally
1 – Non-Displaced2 – Partially3 – Totally
1 – Non-displaced2 – Partially3 – Totally
Same DensityLess DensityMore Dense
Need imageNeed imageNeed image
1 – More 2 – Less3 – Same
1 – More 2 – Less3 – Same
1 – More 2 – Less 3 – Same
CRITERION 5d – CHARACTERISTIC OF PROGENY – DENSITY OF CENTER
In comparison to the unaffected parent bone of the involved condyle, the radio-density of the Center of the progeny bone is……
Same DensityLess DensityMore Dense
Need imageNeed imageNeed image
1 – More Dense2 – Less Dense3 – Same Density
1 – More Dense2 – Less Density3 – Same Density
1 – More Dense2 – Less Dense3 – Same Density
CRITERION 5e – CHARACTERISTIC OF PROGENY – DENSITY OF RIM
In comparison to the unaffected parent bone, the radio-density of the Rim of the progeny bone is? Progeny Rim is usually just beyond the Parent sclerotic rim.
CRITERION 5f – CHARACTERISTIC OF PROGENY BONE - BOUNDARY
1 – Distinct2 – Indistinct
Distinct
Need image
Indistinct
Need image
The boundary between the parent bone and progeny bone is?If “Distinct” on any view, pick “Distinct”
1 – Distinct2 – Indistinct
1 – Convex2 – Linear3 – Concave
CRITERION 5g – CHARACTERISTIC OF PROGENY BONE - SHAPE
Concave
Need imageNeed image
1 – Convex2 – Linear3 – Concave
1 – Convex2 – Linear3 – Concave
Convex Linear
The predominant shape/contour of the articular side of OCD lesion is?
END
CRITERION 6a – DYNAMIC COMPARISON CRITERION – RADIO-DENSITY
Need image
Comparison Image Current image
1 – More dense2 – Less dense3 – Same density
Need image Need image
In comparison to previous radiographs, radio-density of progeny bone is?
CRITERION 6b – DYNAMIC COMPARISON CRITERION – BOUNDARY
Need image
Comparison Image Current image
1 – More distinct2 – Less distinct3 – Equally distinct
Need image Need image
In comparison to previous radiographs, the boundary is?