Musculoskeletal Section Macros Ankle – AP, lateral, and oblique (ankle mortise) are standard 3 view ankle. Lateral often combined with lateral foot when foot and ankle are performed at the same time. Arthrogram Biopsy Cervical – AP, lateral, and odontoid are standard trauma series. Note that these are billed/listed as 2 views. Swimmers view is often added for cervical-thoracic junction; we don’t get paid for this either. Additional variations include adding bilateral oblique views to show the facets and foramina and adding flexion and extension views. Calcaneus – Lateral and Harris views. Harris view is performed at 45° angle PA projection and demonstrates posterior and middle subtalar joints. Clavicle – AP and cranially angulated views are standard 2. CT Cervical – Easy to modify for T or L spine or even an extremity. Change the title and technique. Elbow – AP and lateral are standard 2. Oblique lateral view can be used to show radial head better. Extremity – Generic radiograph template Femur – AP and lateral. Frequently need multiple exposures/images in the AP or lateral projection to get the entire length of bone, but it is still only 2 views. Finger – Three views frequently performed with PA, lateral, and oblique. May #1-5 or use conventional nomenclature (thumb, index, middle, ring, little) Foot – AP (dorsal-plantar), lateral, and oblique are standard Foot Arthritis – AP and lateral Forearm – AP and lateral Hand – PA, lateral, and oblique are standard Hand Arthritis – PA and ballcatcher (aka Allstate or Norgaard) Hip – AP and lateral. AP frequently is of the whole pelvis for comparison. Lateral is a lateral view of the femoral neck. It is usually crosstable in post-op or trauma setting, frogleg for other pain. Sometimes bilateral hips are done. Humerus – AP and lateral. Frequently need multiple exposures/images in the AP or lateral projection to get the entire length of bone, but it is still only 2 views. Knee – AP and lateral are standard trauma, AP lateral and sunrise (patellofemoral) are the usual 3 view series, AP lateral sunrise and notch are the standard 4 views and frequently include the contralateral sunrise and notch knee when performed by Dr. Geier. Sometimes bilateral knees are done. Leg – Tibia and Fibula. AP and lateral. Frequently need multiple exposures/images in the AP or lateral projection to get the entire length of bone, but it is still only 2 views. Lumbar – AP, lateral, and coned lateral view are the standard 3 view series. Variations include bilateral obliques and flexion extension views. Me – To add your resident signature. i.e. “voice dicated by Resident Smith.” Operative – The operative macro is for cases in which the department is providing C-arm intraoperative images, but we are not interpreting. These are almost always orthopedic surgery cases and usually for fracture fixation. Leave (don’t dictate) barium enemas, cystograms, and biliary/GI fluoro cases alone when they are on the list. Leave IR vertebroplasty cases on the list. Approve (don’t dictate) vascular surgery, heart cath, and pacemaker placement cases to get them off the list. Approve PM&R (Dr. Smith) cases such as epidural steroid and SI joint injections to get them off the list. Pelvis – Note single view below which is the most common exam. Inlet and outlet (2) views for pelvic ring fracture. AP and bilateral oblique views (3) for acetabular fracture. Sacrum and SI joint are different exams. Trauma Pelvis – Single AP view Ribs – PA and oblique, whether PA includes the chest or not. Frequently has multiple images for the oblique projection. Sacrum – Standard is 2 views, a Ferguson view and lateral. The Ferguson view is a coned view of the sacrum which is cranially angled to look en face at the sacrum. Shoulder – AP with internal and external rotation, +/- axillary or scapular Y view. Grashey view profiles the glenoid. Outlet view shows the coracoacromial arch where the rotator cuff is impinged and is frequently done for Dr. Woolf. Sometimes bilateral shoulders are done. Shunt – 2 views skull, 1 view chest, 2 view abdomen. SI Joint – may be done as 1 Ferguson view (see sacrum above) or 3 views with a Ferguson and bilateral obliques. Skull – usually AP and lateral, may include Waters view to show the maxillary sinuses, Caldwell view to show the orbits, or submental views to show the zygomatic arches Survey – For myeloma/mets. 2 skull, 2 each of C, T, and L spine. Chest and pelvis AP. Proximal humeri and femurs AP. Thoracic Spine – AP and lateral Thoracolumbar - AP and lateral Toe – AP and lateral, +/- oblique. We are currently only billing for 2 views, even when 3 are done. Wrist – PA and lateral. Scaphoid view is ulnar deviated wrist that elongates the appearance of the scaphoid. Bone Ankle EXAMINATION: ANKLE RADIOGRAPH %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX]. TECHNIQUE: [XXXXX] views of the ankle labeled [XXXXX] were performed. FINDINGS: [There is no evidence of fracture or dislocation]. [Visualized soft tissues are unremarkable]. [The joint spaces are maintained]. [Alignment of the ankle mortise is normal]. IMPRESSION: [Negative [xxxxxxxxx] ankle radiographs]. VOICE DICTATED BY: %fullName% Bone Arthrogram EXAMINATION: FLUOROSCOPIC GUIDED ARTHROGRAM %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% TECHNIQUE/FINDINGS: The nature of the procedure as well as the risks, benefits, and alternatives were explained to the patient. Written informed consent was obtained and placed in the patient's chart. The patient was placed [XXXXX] on the fluoroscopic table and a suitable area for access to the [XXXXX] [XXXXX] was identified and marked. The access site was then prepped and draped in the usual sterile fashion. 1% lidocaine mixed with bicarbonate was used as a local anesthetic. An [20] gauge spinal needle was then used to access the joint and fluoroscopic confirmation of the position of the needle within the joint was obtained. A mixture of 10cc of Omnipaque, 10 cc of normal saline, and 0.1 ml of gadolinium was injected. The patient tolerated the procedure well and there were no immediate complications. IMPRESSION: 1. Successful [XXXXX] arthrogram without immediate complication. 2. Dr. [XXXXX] was present for the entire procedure and no overlapping procedures were performed. VOICE DICTATED BY: %fullName% Bone Biopsy EXAMINATION: CT GUIDED BIOPSY %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX] TECHNIQUE: After the nature of the procedure as well as the benefits, risks, and alternatives were explained to patient, written informed consent was obtained. Patient was placed on the CT table in the [XXXXX] position and multiple helical slices were obtained through the [XXXXX] without IV contrast. After the projected tract of the biopsy needle was determined, the [patient] was prepped and draped in the usual sterile fashion. Conscious sedation and pain control were obtained with intravenous Versed and Fentanyl. 1% lidocaine solution buffered with sodium bicarbonate was used for local anesthesia. Next, under CT guidance, a [14 gauge Bonopty bone introducer was advanced through the cortex. The 16-gauge Bonopty bone biopsy needle was used to obtain core samples.] [13 gauge Cook bone introducer was advanced through the cortex. The 15-gauge Cook bone biopsy needle was used to obtain core samples.] [An 18-gauge Temno needle was used to obtain core sample.] [A 22-gauge Franseen needle was used to for aspiration of the lesion.] [Pathology deemed samples adequate.] After the procedure, the skin surface was cleansed using a hydrogen peroxide solution, and a sterile bandage was applied. The patient tolerated the procedure well. FINDINGS: Intraprocedural images demonstrate biopsy needle placed within the region of interest. IMPRESSION: 1. CT guided [bone] biopsy as described above. 2. Dr. [XXXXX] was present during the entire procedure and no overlapping procedures were performed. VOICE DICTATED BY: %fullName% Bone Cervical EXAMINATION: CERVICAL SPINE %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [ XXXXX]. TECHNIQUE: [XXXXX] views of the cervical spine were performed. FINDINGS: [There is no evidence of fracture]. [Alignment of the craniocervical junction and vertebral bodies is normal]. [Facets are aligned]. [Disc spaces are maintained]. [There is no evidence of prevertebral soft tissue swelling.] IMPRESSION: [Negative cervical spine radiographs.] VOICE DICTATED BY: %fullName% Bone Calcaneus EXAMINATION: CALCANEUS RADIOGRAPH %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXXX]. TECHNIQUE: [XXXXXX ] views of the calcaneus labeled [XXXXXX ] were performed]. FINDINGS: [There is no evidence of fracture]. [Alignment is normal]. [Appearance of the soft tissues is normal]. IMPRESSION: [Negative [XXXXX] calcaneus radiographs] VOICE DICTATED BY: %fullName% Bone Clavicle EXAMINATION: CLAVICLE RADIOGRAPH %examDate% ACCESSION NUMBER: [%accessionID%] INDICATION: [%clinicalHistory%] COMPARISON: [XXXXX] TECHNIQUE: [XXXXX ] views of the clavicle labeled [XXXXX ] were performed. FINDINGS: There is [no evidence of clavicle fracture]. [Alignment of the clavicle is normal]. IMPRESSION: [Negative [XXXXX] clavicle radiographs.] VOICE DICTATED BY: %fullName% Bone CT cervical EXAMINATION: CT CERVICAL SPINE %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX] TECHNIQUE: Helical axial imaging was performend through the cervical spine without intravenous contrast. Coronal and sagittal reconstructions were performed. FINDINGS: [ Visualized skull base and craniocervical junction demonstrate no evidence of fracture or dislocation.] [There is no evidence of cervical spine fracture]. [Alignment is normal]. [No soft tissue abnormality is seen]. [Disc spaces are preserved]. [Visualized portions of the lung apices demonstrate no evidence of pneumothorax.] IMPRESSION: [Negative for acute osseous injury of the cervical spine.] VOICE DICTATED BY: %fullName% Bone Elbow EXAMINATION: ELBOW RADIOGRAPH %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX]. TECHNIQUE: [XXXXX] views of the elbow labeled [XXXXX] were performed. FINDINGS: [There is no evidence of fracture]. [Alignment is normal]. [No visible joint effusion]. [No significant degenerative findings are seen]. IMPRESSION: [Negative elbow radiographs]. VOICE DICTATED BY: %fullName% Bone Extremity EXAMINATION: [XXXXX] RADIOGRAPH %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX] TECHNIQUE: [XXXXX] views of the [XXXXX] labeled [XXXXX] were performed. FINDINGS: There is [no evidence of fracture or dislocation]. [Visualized soft tissues are unremarkable]. IMPRESSION: [Negative [XXXXX] radiographs]. VOICE DICTATED BY: %fullName% Bone Femur EXAMINATION: FEMUR RADIOGRAPH %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX] TECHNIQUE: [XXXXX] views of the femur labeled [XXXXX] were performed. FINDINGS: There is [no evidence of fracture or dislocation]. [Visualized soft tissues are unremarkable]. IMPRESSION: [Negative [XXXXX] femur radiographs]. VOICE DICTATED BY: %fullName% Bone Finger EXAMINATION: FINGER RADIOGRAPH %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [xxxxx] TECHNIQUE: [XXXXX] views of the finger labeled [XXXXX] were performed. FINDINGS: There is [no evidence of fracture or dislocation]. [Visualized soft tissues are unremarkable]. [There is no evidence of foreign body]. [There is no evidence of finger arthritis]. IMPRESSION: [Negative radiographs of the finger]. VOICE DICTATED BY: %fullName% Bone Foot EXAMINATION: FOOT RADIOGRAPH %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX]. TECHNIQUE: [XXXXX] views of the foot labeled [XXXXX] were obtained. FINDINGS: [There is no evidence of fracture]. [Alignment is normal]. [Appearance of the soft tissues is normal]. IMPRESSION: [Negative [XXXXX] foot radiographs]. VOICE DICTATED BY: %fullName% Bone Foot Arthritis EXAMINATION: FOOT RADIOGRAPH %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX] TECHNIQUE: [AP and lateral] views of the bilateral feet were obtained FINDINGS: Right: [There is no evidence of fracture]. [Alignment is normal]. [Bone density appears normal]. [No focal soft tissue abnormality is seen]. [There are no visible erosions]. [No significant productive changes]. Left: [There is no evidence of fracture]. [Alignment is normal]. [Bone density appears normal]. [No focal soft tissue abnormality is seen]. [There are no visible erosions]. [No significant productive changes]. IMPRESSION: [No evidence of erosive arthritis of the feet]. VOICE DICTATED BY: %fullName% Bone Forearm EXAMINATION: FOREARM RADIOGRAPHS %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX] TECHNIQUE: [XXXXX] views of the forearm labeled [XXXXX] were performed. FINDINGS: There is [no evidence of fracture]. [Alignment is normal]. [Visualized soft tissues are unremarkable]. IMPRESSION: [Negative [XXXXX] forearm] VOICE DICTATED BY: %fullName% Bone Hand EXAMINATION: HAND RADIOGRAPHS %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX]. TECHNIQUE: {XXXXX] views of the hand labeled [XXXXX]were performed. FINDINGS: [There is no evidence of fracture or dislocation]. [Visualized soft tissues are unremarkable]. [The joint spaces are maintained]. IMPRESSION: [Negative [XXXXX] hand]. VOICE DICTATED BY: %fullName% Bone Hand Arthritis EXAMINATION: HAND RADIOGRAPHS %examDate% ACCESSION NUMBER #: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX] TECHNIQUE: [PA and lateral] views of both hands were performed. FINDINGS: Right: [There is no evidence of fracture]. [Alignment is normal]. [Bone density appears normal]. [No focal soft tissue abnormality is seen]. [There are no visible erosions]. [No significant productive changes]. Left: [There is no evidence of fracture]. [Alignment is normal]. [Bone density appears normal]. [No focal soft tissue abnormality is seen]. [There are no visible erosions]. [No significant productive changes]. IMPRESSION: [No evidence of erosive arthritis of the hands]. VOICE DICTATED BY: %fullName% Bone Hip EXAMINATION: HIP RADIOGRAPHS %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX] TECHNIQUE: [XXXXX] views of the hip labeled [XXXXX] were performed. FINDINGS: There is [no evidence of fracture]. [Alignment is normal]. [No significant degenerative findings are seen]. IMPRESSION: [Negative hip radiographs]. VOICE DICTATED BY: %fullName% Bone Humerus EXAMINATION: HUMERUS RADIOGRAPHS %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX]. TECHNIQUE: [XXXXX] views of the humerus labeled [XXXXX] were performed. FINDINGS: There is [no evidence of fracture]. [Alignment is normal]. [Visualized soft tissues are unremarkable]. IMPRESSION: [Negative [XXXXX] humerus] VOICE DICTATED BY: %fullName% Bone Knee EXAMINATION: KNEE RADIOGRAPHS %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX]. TECHNIQUE: [XXXXX] views of the knee labeled [XXXXX] were obtained. FINDINGS: [There is no evidence of fracture]. [Alignment is normal]. [No visible joint effusion]. IMPRESSION: [Negative knee radiographs]. VOICE DICTATED BY: %fullName% Bone Leg EXAMINATION: LEG RADIOGRAPHS %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX] TECHNIQUE: [XXXXX] views of the leg (tibia and fibula) labeled [XXXXX] were performed. FINDINGS: There is [no evidence of fracture]. [Alignment is normal]. [Visualized soft tissues are unremarkable]. IMPRESSION: [Negative radiographs of the leg (tibia and fibula)]. VOICE DICTATED BY: %fullName% Bone Lumbar EXAMINATION: LUMBAR SPINE RADIOGRAPHS %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX]. TECHNIQUE: [XXXXX] of the lumbar spine were obtained. FINDINGS: [There are five non-rib bearing lumbar vertebral bodies]. [There is no evidence of fracture]. [Alignment is normal]. [Disc spaces are preserved]. IMPRESSION: [Negative for lumbar spine fracture]. [ ]. VOICE DICTATED BY: %fullName% Bone Me VOICE DICTATED BY: %fullName% Bone operative EXAMINATION: INTRA-OPERATIVE IMAGES %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% FINDINGS/IMPRESSION: [ Intra-operative imaging provided by the department of radiology. No professional interpretation or fee]. VOICE DICTATED BY: %fullName% Bone Pelvis EXAMINATION: PELVIS RADIOGRAPHS %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [NONE]. TECHNIQUE: [XXXXX] view(s) of the pelvis. FINDINGS: There is [no evidence of fracture]. [Alignment is normal]. IMPRESSION: [Negative pelvis radiographs.] VOICE DICTATED BY: %fullName% Bone trauma Pelvis EXAMINATION: PELVIS RADIOGRAPHS %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [NONE]. TECHNIQUE: [XXXXX] view of the pelvis. FINDINGS: There is [no evidence of fracture of the pelvic ring, acetabulum or visualized proximal femurs]. [Femoral-acetabular alignment is normal]. IMPRESSION: [Negative for pelvic fracture.] VOICE DICTATED BY: %fullName% Bone Ribs EXAMINATION: Rib Radiographs %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX]. TECHNIQUE: [XXXXX] views of the ribs labeled [XXXXX] were performed. FINDINGS: There is [no visible rib fracture]. [No focal pleural thickening or fluid]. [Visualized portions of the lungs are normal]. IMPRESSION: [No evidence of rib fracture]. VOICE DICTATED BY: %fullName% Bone Sacrum EXAMINATION: SACRAL RADIOGRAPHS %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX]. TECHNIQUE: [XXXXX] views of the sacrum were performed. FINDINGS: There is [no visible sacral fracture]. [Alignment is normal]. [Sacral-iliac joints appear normal]. IMPRESSION: [Negative for sacral fracture.] VOICE DICTATED BY: %fullName% Bone Shoulder EXAMINATION: SHOULDER RADIOGRAPHS %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [ XXXXX]. TECHNIQUE: [XXXXX] views of the shoulder labeled [XXXXXX] were performed. FINDINGS: There is [no evidence of glenohumeral fracture]. [Alignment is normal]. [Alignment of the acromioclavicular joint is normal]. [Glenohumeral joint space is preserved]. IMPRESSION: [Negative shoulder radiographs]. VOICE DICTATED BY: %fullName% Bone Shunt EXAMINATION: SHUNT SERIES %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX] TECHNIQUE: [Frontal and lateral views of the skull and neck. Frontal view of the chest. Frontal and lateral radiographs of the abdomen]. Findings: [XXXXX] [sided ventriculoperitoneal shunt catheter is intact]. Valve setting is at the [XXXXX] o’clock position. [There is no evidence of acute chest disease]. [No focal osseous abnormality is seen]. IMPRESSION: [Intact [XXXXX] sided ventriculperitoneal shunt catheter]. [Valve setting at the [XXXXX] position]. VOICE DICTATED BY: %fullName% Bone SI joints EXAMINATION: SI JOINTS %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX]. TECHNIQUE: [Frontal and bilateral oblique views of the sacroiliac joints were performed]. FINDINGS: There is [no evidence of fracture or dislocation]. [Sacroiliac joint spaces are preserved with no evidence of ankylosis or sclerosis]. IMPRESSION: [Negative sacroiliac joint radiographs]. VOICE DICTATED BY: %fullName% Bone Skull EXAMINATION: SKULL %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX] TECHNIQUE: [XXXXX] view(s) of the skull. FINDINGS: [There is no evidence of skull fracture]. [There is no evidence of acute sinus disease]. IMPRESSION: [Negative skull exam]. VOICE DICTATED BY: %fullName% Bone Survey EXAMINATION: OSSEOUS SURVEY %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX] TECHNIQUE: [Frontal and lateral views of the skull, frontal and lateral views of the cervical spine, frontal and lateral views of the thoracic spine, frontal and lateral views of the lumbar spine, frontal view of the chest, frontal views of the right and left proximal humerus, frontal view of the pelvis, and frontal view of the right and left proximal femurs was performed. FINDINGS: [There is no evidence of lytic or destructive lesions.] [No vertebral compression fracture is seen]. [] IMPRESSION: [Negative radiographic skeletal survey]. VOICE DICTATED BY: %fullName% Bone Thoracic EXAMINATION: THORACIC SPINE %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX]. TECHNIQUE: [XXXXX] views of the thoracic spine were performed. FINDINGS: There is [no visible fracture]. [Alignment is normal]. [No significant degenerative findings are seen]. IMPRESSION: [Negative thoracic spine radiographs]. VOICE DICTATED BY: %fullName% Bone Thoracolumbar EXAMINATION: THORACOLUMBAR SPINE %dateShort% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX]. TECHNIQUE: [XXXXX] views of the thoracolumbar spine were performed. FINDINGS: There is [no visible fracture]. [Alignment is normal]. [No significant degenerative findings are seen]. IMPRESSION: [Negative thoracolumbar spine radiographs]. VOICE DICTATED BY: %fullName% Bone Toe EXAMINATION: TOE RADIOGRAPH %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX]. TECHNIQUE: [XXXXX] views of the toe labeled [XXXXX] were performed. FINDINGS: There is [no evidence of fracture or dislocation]. [The joint spaces are maintained]. [There is no visible foreign body]. IMPRESSION: [Negative toe radiographs]. VOICE DICTATED BY: %fullName% Bone Wrist EXAMINATION: WRIST RADIOGRAPHS %examDate% ACCESSION NUMBER: %accessionID% INDICATION: %clinicalHistory% COMPARISON: [XXXXX]. TECHNIQUE: [XXXXX] views of the wrist labeled [XXXXXX] were performed. FINDINGS: There is [no visible wrist fracture]. [Alignment is normal]. [There is no evidence of significant arthritis]. IMPRESSION: [Negative wrist radiographs]. VOICE DICTATED BY: %fullName%