What to Look for When You Need Orthopedic Imaging

Huffington Post—May 7, 2009

by Helene Pavlov, MD, FACR
Radiologist-in-Chief
Hospital for Special Surgery

Orthopedic medical imaging, including Magnetic Resonance (MR), Computed Tomography (CT), Ultrasound (US), Nuclear Medicine (NM), interventional musculoskeletal and spinal procedures, in addition to traditional X-ray examinations, can be daunting for older patients and those with decreased mobility.

Older individuals or those with mobility limitations should seek an imaging provider who understands their special needs and concerns and can help ensure that the experience, from registration to discharge, flows easily.

The imaging center should be familiar with the needs of older patients and patients with mobility limitations and have established protocols for image acquisition that address the special needs of these patients and ensures that they are comfortable. In addition, the team of radiologists and technologists should be familiar with specific diagnosis that may be responsible for their aches, pains, and limited range of motion.

It is recommended that elderly patients and their caregivers consider the following:

  • Verify that the department's radiologists, the physicians supervising the image acquisition and interpreting the images, have specific subspecialized training for the imaging examination being requested.
  • Ideally, the imaging department or center should be dedicated to patients with similar conditions (e.g., orthopedics, oncology, etc.) so the requested examination is "routine" and performed often. At these dedicated centers, the personnel are usually experienced in
    positioning patients with decreased range of motion in order to acquire the best image.
  • Ensure that the provider has patient liaisons that can help to facilitate the process, help with putting on an examination gown, and provide knowledgeable answers to questions or concerns.
  • Inquire about the availability of footstools, handrails/grips and other devices to steady patients while standing for weight bearing images.
  • Inquire about wheelchair availability.
  • Inquire about parking access and accommodations.
  • Ask if higher chairs are available in waiting areas, which are more comfortable for patients with hip and back conditions.
  • Ask if there are handicap accessible bathrooms and/or toilets with elevated seats for those with hip and back limitations.
  • Inquire if imaging is digitally acquired and can be distributed to the referring physician using a PACS system. This process eliminates the need to hand carry x-rays to the doctor's office. If copies of digital images are required, the images are burned onto a CD, which is much easier to transport.
  • If not routinely provided, ask for padding on the x-ray and CT tables.
  • Diagnostic accuracy can be enhanced if the technologist obtains information as to prior surgery or any internal fixation devices that may be present. Individuals with surgical screws, nails, pins and/or total joints may require special imaging protocols. This information may negate the need for repeat examinations. If the technologist does not inquire, volunteer the information.
  • Inquire about the image retake rate. A facility focused on specific conditions typically has fewer image retakes, which means less time in radiology and less ionizing radiation.

Paying attention to the above tips will help older individuals and patients with limited mobility make a more educated choice in their imaging provider.

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