ABCs and Bone Formation
By: Jeff Binder
 Performed
first (usually by the tech)
 ABCs
• Anatomy: Is entire region of anatomy on the film
• Bone: Search for signs of patient motion. Big
white lines and small white lines.
• Cartilage: Check joint spaces are not obscured
by positioning errors
• Soft Tissues: Evaluate technique of the soft
tissues
 Performed
by a Doctor
 ABCs
• Anatomy: sub inventory of all anatomical parts
(pedicles, Tp’s, sp’s, etc)
• Bone: Cortical and trabecular bone. Look for an
increase or absence of either
• Cartilage: Signs of arthritis, injury, or anomaly
• Soft tissue: Regional inspection of soft tissue for
pathology
 Imaging
is for documentation NOT
education
 Every xray must be interpreted to reach
a diagnosis or conclusion
 ALWAYS do an exam prior to taking
xrays
A
written interpretation of the study
 Part of the patients permanent record
 Signed and dated by the individual doing
the interpretation
 All radiographic studies must be
interpreted to reach a diagnosis or
conclusion


Verbal rendition of visual image
Medico legal communication
• Insurance company, work comp, attorneys


Provide a standard for comparison
Part of a patient’s permanent record
• A report may replace lost films


Professional communication
Expedite treatment by highlighting indications and
contraindications for treatment
1.
2.
3.
4.
5.
6.
7.
Stationary
Patient Information
Radiology Information
Technique (optional)
Body (also called Findings)
Impression (also called Conclusion)
Recommendations (when applicable)
Name and address of the clinic or
individual who is creating the report
Joe Bob’s MRI clinic
15 s. main street
Chesterfield, MO 63017
 Patient’s
full name
 Address
 Date
of birth (sometimes patient age is
listed also)
 Sex
 Medical record number (or patient
number)
 All
views performed for interpretation
must be listed here
• Ex: cervical 3 view would state “AP, Lateral and
AP open mouth”
 Location
and dates films were taken
 Patient’s clinical history and reason for
taking the films can be listed here as well
This is optional. If the interpreting Doctor
is supplied with the technique for each
film he/she can list them in this area.
Some doctors list these on special views in
case they need to be repeated at a later
date.
This is where the doctor will list everything
he finds through the ABCs method.
This is the description of findings. There is
no diagnosis here. Basic facts about the
film and findings are listed.
EX: “A geographic lucency is seen in the proximal right
tibia measuring 2.1 centimeters in diameter.”
A
short, concise list of important radiologic
finding and diagnoses based on previous
narrative descriptions (body).
 List them from most importance to least
 Avoid long lists
 Medical diagnoses and terminology should be
used
 Very critical as a percentage of Doctors will not
read the full report.
EX: “Condroblastoma in right proximal
tibia”
 Optional
 Basically
anything the Radiologist wants
the Doctor to pay attention to
 Contraindications
• “Low force technique recommended due to
fracture”
 Additional
performed
exams that may need
• “Recommend MRI to further evaluate
surrounding soft tissues.”
 Intramembranous:
Adding bricks to a
house
 Enchondral: Framework of a house
 Throughout
life
 Adding layers of bone
 Initiated by proliferation of mesenchymal
cells
 Flat bones developed by this (skull,
pelvis)
 No preformed cartilage
 Used for BONE REPAIR
 Increases WIDTH of bone
 Formed
by primary ossification centers
 Use non-ossified matrix as framework
 Osteoblasts and osteoclasts form and
become embedded
 Cell death is followed by ossification
 Increases LENGTH of bone
 Epiphysis:
articular surface, produces
and supports articular cartilage
 Apophysis: attachment site for ligaments
and tendons (trochanters, tuberosities,
tubercles)
 Metaphysis: Most metabolically active,
focus for disease and trauma, indolent
blood flow (very slow, stagnant blood)
 Diaphysis: Shaft of long bones, act as
lever, 50/50 cortical and medullary bone
 Physis:
Growth plate, epiphyseal plate,
bone growth center
 Growth arrest line: line formed by
growth plate showing end of bone
growth. White on xray
 ZPC (zone of provisional calcification):
Most mature layer of the growth plate.
Least Mature layer of the metaphysis
 Periosteum: Part of intramembranous
formation, mediates repair, sensitive to
Gh,
• Sharpe’s fibers anchor periosteum to bone in
adults. Periosteal lifting in adults is SERIOUS
 Calcium Regulators
• Parathormone, 1,25-dihydroxy vit D, Calcitonin
 Maturation hormones
• Glucocorticoids, insulin, t3/t4, androgen,
estrogen, Gh
 Growth factors
• Somatomedin, epidermal gf, platelet-derived gf
 Local Factors
• Prostaglandin E2, interleukins
 Ions
• Calcium and Phosphorus (2:1 ratio, inverse)
 Increase
blood Ca+
 Bone
• Softens bone to allow osteoclasts to work more
efficiently
• NO RECEPTORS ON OSTEOCLASTS
 Kidney
• Increase Ca+ reabsorption at the DCT
 Gut
• Activation of Vit D3 to increase absorption in the
small intestine
 Decreases
blood Ca+
 Stimulates osteoblasts
• ACTS ON RECEPTORS
 Considerable
effect on growth plates
 Hyper or hypo = stunted growth
• Opposite mechanisms
 Estrogens
more responsible for growth
plate closure