Intro

Question 1

Military PTs have been utilizing imaging privileges since _______

Answer 1

1972

Question 2

List clinical environments other than the military in which PTs have imaging privileges

Answer 2

1. Public Health Service
2. Indian Health Service
3. Veterans Administration Health System
4. The Bureau of Prisons
5. Civilian Systems
   
   1. Kaiser-Permanente Northern California
   2. University of Wisconsin Hospital and Clinics

Question 3

how many states include some type of direct referral for imaging? List them

Answer 3

9

1. Washington DC
2. Maryland
3. Colorado
4. New Jersey
5. Utah
6. North Dakota
7. Wisconsin
8. Pennsylvania
9. Rhode Island

Question 4

Countries such as Australia, UK, Netherlands, Norway and South Africa have imaging privileges and report the following benefits:

Answer 4

1. improved patient satisfaction
2. reduction of wait time for care
3. fewer surgical referrals
4. decreases in cost of care
5. diminished exposure (reduced with imaging without sacrificing quality of care)

Question 5

T/F: PTs have been shown to have equivalent abilities as orthopedic surgeons in diagnostic accuracy of MSK conditions, and categorize pts for course of care or referral, including indications for imaging

Answer 5

TRUE

Question 6

T/F: PTs have been found to be more accurate diagnostically than non-orthopedic providers in evaluating pts with MSK conditions

Answer 6

TRUE

Question 7

list the data utilized in the ACR appropriateness criteria:

Answer 7

1. age
2. presence or absence of trauma
3. MOI
4. presence or absence of prior surgery
5. presence or absence or risk factors
6. physical appearance
7. findings of pain provocation or physical function tests
8. other imaging results
9. inability or ability to weight bear
10. tenderness to palpation

Question 8

describe the Canadian C-Spine Rules

Answer 8

Question 9

list the 5 criteria in the NEXUS Low Risk Rule

Answer 9

1. No midline cervical tenderness
2. No focal neurologic deficit
3. Normal alertness
4. No intoxication
5. No painful, distracting injury

Question 10

List the components of the Ottawa Knee Rules

(there are 5 criteria)

Answer 10

a knee x-ray series is only required for knee injury pts with any of these findings:

1. age 55 or older
2. isolated tenderness of patella (no bone tenderness of knee other than patella)
3. tenderness to head of fibula
4. inability to flex 90
5. inability to bear weight both immediately and in the ER for 4 steps (unable to transfer weight twice onto each lower limb regardless of limping)

any of these criteria

Question 11

according to the Ottawa Ankle rules, an ankle x-ray s only required if there is pain in malleolar zone and any of these findings:

Answer 11

1. bone tenderness at posterior edge or tip of the lateral OR medial malleolus (zone A or B)
2. inability to bear weight both immediately and in the ER for 4 steps

Question 12

according to the Ottawa Ankle rules, a foot x-ray is only required if there is any pain in midfoot zone and any of these findings:

Answer 12

1. bone tenderness at navicular or base of 5th met (zone C or D)
2. inability to bear weight both immediately and in ED for 4 steps

Question 13

Pediatric Emergency Care Applied Research Network (PECARN) rules

Answer 13

High risk for cervical spine injury (do imaging) if one or more of the following are present:

• Altered mental status
• Focal neurologic findings
• Neck pain
• Torticollis
• Substantial torso injury
• Conditions predisposing to cervical spine injury
• Diving
• High-risk motor vehicle crash