Advertisement

Find answers, ask questions, and connect with our community around the world.

  • Leg length discrepancy studies

    Posted by Unknown Member on August 26, 2008 at 9:15 pm

    Hoping someone can help. What needs to be reported on leg length discrepancy studies?

    Thanks.

    Unknown Member replied 2 years, 1 month ago 9 Members · 34 Replies
  • 34 Replies
  • 12677

    Member
    August 27, 2008 at 6:52 am

    put the ruler under one leg. don’t move the patient. get three images with the fluoro unit, the central ray over ankle, hip, knee.,the ruler over the joints.
    this eliminates beam divergence.  subtract the numbers to get the length of the femur and the length of the tibia.
    repeat for the other leg and report the difference in the length.

    • romacs8ae

      Member
      August 27, 2008 at 10:12 am

      forget about the old xray technique.  We stopped doing that in the early 80’s with the advent of CT scanning
       
      Use your CT scanner and do a scanogram from the pelvis down to the ankles.  THen just measure the length of the femur, and the tibia, and get a total length for each leg separately.
       
      Your tech can do all that for you.
       

      • Unknown Member

        Deleted User
        September 18, 2008 at 12:29 pm

        What consideration are you giving for dose in utilizing CT instead of a three shot xray coned down to the area of interest??Like none.

        • Donpacini77_632

          Member
          September 18, 2008 at 1:04 pm

          ORIGINAL: Msammons

          What consideration are you giving for dose in utilizing CT instead of a three shot xray coned down to the area of interest??Like none.

          What consideration are you giving for the [b]modern[/b] practice of orthopedic radiology in utilizing a “three shot xray coned down to the area of interest” instead of CT??  Like none. 

          1.  The DLP from a typical MDCT scout scanogram is not significantly greater than 3 xrays.
          2.  CT is a robust, reliable technique less prone to variability.

          Look, I am sure there are many remote rural clinics in the US that do not have a CT scanner and I applaud the training and expertise of the technologists in those clinics who produce quality work.  However, this does not mean it is the accepted standard of care in the rest of the country nor should it serve as an excuse to inhibit progress.

          • mario.mtz30_447

            Member
            September 18, 2022 at 10:23 am

            Anyone see studies for these cosmetic leg lengthening procedures yet?  
             
            Please share tips, links for what to put in report (in addition to no fx or hardware failure)
            Might be of interest for an academic MSK rad to write up the topic.

             [link=https://www.gq.com/story/leg-lengthening]https://www.gq.com/story/leg-lengthening[/link]
             
            This article concludes there is a high complication rate (all indications taken together, not just cosmetic indications).
             
            [link=https://www.tandfonline.com/doi/full/10.1080/17453674.2020.1835321]https://www.tandfonline.com/doi/full/10.1080/17453674.2020.1835321[/link]
             
             
             
             

            • Unknown Member

              Deleted User
              September 18, 2022 at 10:32 am

              Removed due to GDPR request

  • Donpacini77_632

    Member
    August 27, 2008 at 12:27 pm

    CT scout scanogram.

    • romacs8ae

      Member
      August 27, 2008 at 3:22 pm

      isn’t that what I just said?

      • vanevela49

        Member
        August 27, 2008 at 5:19 pm

        Just do a “CT scout scanogram”

        • winterberry

          Member
          August 27, 2008 at 8:02 pm

          Do a scout on GE CT
          Do a Scanogram on Siemens

      • Donpacini77_632

        Member
        August 28, 2008 at 4:39 am

        ORIGINAL: MRI_CT_ULTRASOUND_MAMMO_NUCS

        isn’t that what I just said?

         
        Yes…well said.  Just trying to support you in case there are further posts touting
         “good old plain films cheaper and work just as well..”

      • Unknown Member

        Deleted User
        August 28, 2008 at 7:38 am

        So scouts only, no other axial images? 

        • Unknown Member

          Deleted User
          August 28, 2008 at 9:09 am

          our rads like both~a scout, scanogram, pilot, whatever you want to call it; then one slice at the femoral heads, one at the tibial plateau, and one at the talus.  Use the axial positioning light at the iliac crests to make sure they are straight, and tape the feet together.  We then measure on the scout image from the femoral head to the notch, and from the tibial plateau to the mortise.

          • 12677

            Member
            August 29, 2008 at 4:41 pm

            you ct guys don’t have many tools in your toolbox.  When the rural clinic (without CT) calls you and asks how to do it
            you will be perceived as a newbee moron by the older techs and the family practice docs.

            • 12677

              Member
              August 29, 2008 at 4:43 pm

              fluoro is also not necessary, just overhead films with central ray over the joints.

              • Unknown Member

                Deleted User
                August 29, 2008 at 4:46 pm

                not all of are newbees…………I remember using the big ruler.  I also remember pelvimetry and mastoids………..Yikes, I’m old!

                • spring0326v_807

                  Member
                  August 31, 2008 at 5:58 pm

                  We are a pediatric site and have been performing CT Scanograms for several years.  There are several advantages…including fewer repeats, consistent exposures, no need for wedge filters, no distortion of measurements, and easily PACS adaptable.
                   
                  We also use a radiographic ruler on our images.  It placed on the table underneath the patient.  It takes into account magnification by table height.  Note that alterations in magnification will not occur in the scan direction or z-axis (that is constant), it is in the x-axis that such magnification can occur. 
                   
                  Ensure that the dose or KVP for the Scanogram is adequate to penetrate the hips…on large patients we would use 120 kvp at 10 mA.
                   
                  The radiologists use the PACS software for the measurements.
                   
                  Hope that this helps.

                  Radiant1

                  • 12677

                    Member
                    August 31, 2008 at 9:43 pm

                    I get the feeling that the ct scanogram proponents do not understand physics and geometry and the concept of central ray.  tell me again what you will instruct the rural clinic without ct, just plain film capability to do with the patient.   my guess is “drive 45 miles to my ct scanner”. 

                    • spring0326v_807

                      Member
                      September 2, 2008 at 11:16 am

                      Well no, I wouldn’t suggest that since I am not even in your country :), :D.  Is it possible  anyhow, to have a 45 mile distance to a CT Scanner in the USA? –just kidding…you have way more scanners still than we have here.  I do think that follow ups are best performed consistently, by the site who may opt to surgically treat the condition.
                       
                      For assessment of LLD, one could do what we use to call a scanogram radiographically.  This would work for lesser LLD’s.
                       
                      The technologist places lead on the lower 2/3’rds of a 14 x 17 film.  They also lay a ruler down on the middle of the table.
                      They then have the patient lay down on the table on top of the ruler.  The patient should be holding their feet against a book end or something to stabilize their feet–tape also helps with this.  On the top 1/3 of the film, a single exposure of the hips is performed.  The lead moved to cover the top exposure and the lower third.  The knees are then x-rayed…the lead is moved again and then the same for ankles….adusting for technique accordingly…(The use of Lead prevents scatter spreading over the other exposures).  You get a film that looks much like a scanogram…but is subjected to less distortion due to the optimization of the central x-ray beam over each joint.  The only down side of this procedure is that you do not see the entire length of the long bones.
                       
                      Hope that this helps.

                      Radiant1

                       

                    • 12677

                      Member
                      September 2, 2008 at 8:09 pm

                      I have not seen that three exposure done, but it seems to be a reliable ,reproducible non ct method

                    • spring0326v_807

                      Member
                      September 3, 2008 at 5:34 am

                      Hello there,
                      I forgot to add, although it may be obvious….that one would use the bucky tray of the x-ray table for all three exposures.  It did work well for us, provided that the LLD was not large.  It did get replaced when CT Scanograms came into play.

                      Good luck

                      Radiant1

  • Unknown Member

    Deleted User
    September 4, 2008 at 8:05 am

    This is funny this same issue came up yesterday at our hospital.
    I was coming here to get some information on this very issue. Some tech’s here have always done these with the patient laying on the ruler with one leg then under the other leg. Then some of our tech’s tape the ruler down to the table and tape the feet together and then both legs at the same time. I feel this way is a better then having the patient move around and switching legs. Doing both legs together you only take 3 exposures not 6 like when doing them separate. Which way is more accurate?
    I have also mentioned using the CT scanner and doing scanograms. Which is fine but can anyone give the amount of dose and how much more or less it is compared to using general radiology.Also the price difference?
    Any information would be helpful.
    Thanks!

    • 12677

      Member
      September 4, 2008 at 9:28 am

      one ruler between the legs I think is not accurate enough, drawing horizontal line is difficult, the ruler is too far from the joints.
      you need the central ray through the joint, which is impossible for one exposure and two joints.

      • Unknown Member

        Deleted User
        September 4, 2008 at 12:39 pm

        My question for a rural site is: If you are so small that you don’t have a scanner then who is going to do anything about what you find? Any orthopod that was comtemplating surgery wouldn’t be doing it in a facility so small that they had no CT.

        • 12677

          Member
          September 5, 2008 at 8:03 pm

          [size=1]My question for a rural site is: If you are so small that you don’t have a scanner then who is going to do anything about what you find? Any orthopod that was comtemplating surgery wouldn’t be doing it in a facility so small that they had no CT.[/size]
           
          [size=3]the rural site does screening.  this forum site has a never ending parade of ivory tower expensive workup gurus. [/size]
          [size=3]I guess the rural site cannot do cxr because they have no pulmonologist or ct scanner. [/size]

          • Unknown Member

            Deleted User
            September 8, 2008 at 6:11 pm

            I work at rural site, not ivory tower. That said I still believe that this is best done at site where problem is going to be taken care of. This is not a routine screening exam, but only done for specific indications.

            • berberyanhaykanush20

              Member
              September 8, 2008 at 7:07 pm

              What if the rural site does not have fluoroscopy?
              Is the plain film method with a long film or stitched together OK?

              • 12677

                Member
                September 8, 2008 at 9:29 pm

                without fluoro, just get overhead films taken with central ray through each joint,  just 6 separate exposures. and you have accuracy and reproducibility of less than 5mm. 
                there is no stitching and no long film , just 6 separate cone down small films .
                the ruler is through the joint in each image. 
                 
                My rural site has no endocrinologist, therefore I can’t do bone age because there is noone there to take care of the problem(according to raddocmed)
                 
                If leg length is not a routine exam then neither is a chest xray, or scoliosis exam
                 
                 

                • Unknown Member

                  Deleted User
                  September 9, 2008 at 8:56 am

                  In five years here and 20 years in rads I have only rarely been asked for leg length films. Any exam done only once a year isn’t routine in my book. If you are doing these routinely, I would argue that you are doing to many. Most orthopods I know don’t even believe that they are of any use.
                   
                  As for bone age, I would say that if you have no pediatricians in your town then cases should go to where you have at least that. I believe FP has it’s place, but it isn’t to replace all the specialists. I have seen to many times that they tried to care for patients out of their league and screwed things up. If you think that 3 years of FP is the same as 3 of peds,3 of IM, 4 of OB/Gyn combined then I think you are sadly mistaken.

                • Donpacini77_632

                  Member
                  September 10, 2008 at 6:36 am

                  ORIGINAL: roentgensohn
                  If leg length is not a routine exam then neither is a chest xray, or scoliosis exam

                  Hmmm.  If a leg length exam is as common as a CXR in your town, then I suggest you call the CDC to launch an investigation into the root cause of this situation.

                  • 12677

                    Member
                    September 11, 2008 at 11:26 am

                    I suggest a review the meaning of the word “routine” and the word “common”.  Common means usual or frequent in my state of Michigan and province of Alberta.  Routine means the technologists know how to do the exam without much thought (without any addition training or supervision).  I get one pediatric brain u/s per year at my place and it is routine because my techs know how to do them. 

                    • Donpacini77_632

                      Member
                      September 12, 2008 at 6:59 am

                      Entry Word:
                      common
                      Function:
                      adjective
                      Text: 1 often observed or encountered <horse ranches are a [i]common[/i] sight in that part of the state> [b]Synonyms[/b]commonplace, everyday, familiar, frequent, garden, household, ordinary, routine, ubiquitous, usual[/align] [/align] [/align]source: Merriam-Webster Dictionary[/align]

  • Unknown Member

    Deleted User
    September 5, 2008 at 7:07 am

    We do have a CT scanner so my quesiton is what is the dose difference from doing them in general radiology vs. CT?
    What is the cost difference between the to?

    • Unknown Member

      Deleted User
      September 5, 2008 at 4:23 pm

      The dose difference isn’t huge. This isn’t a full scan of the legs. The cost is what you make it. You can charge for both the same. As far as I know there the CPT code doesn’t specify how you get the images. What you can’t do is charge for CT legs.