Comparison of reporting radiographers' and medical doctors' performance in reporting radiographs of the appendicular skeleton, referred by the emergency department.

INTRODUCTION: There is an increasing trend towards deploying reporting radiographers in Danish hospitals who, among various professional groups, interpret and report skeletal radiographs from the emergency department (ED). This study aimed to compare the quality of the reports issued by reporting radiographers to three different groups of medical doctors (MDs) who interpret or report skeletal radiographs at the ED. METHODS: Four professional groups (i.e. four reporting radiographers, two radiology trainees, two orthopaedic senior trainees, and two orthopaedic trainees) reported 100 radiographs of the appendicular skeleton. The Consequence of clinical Outcome score (CO-score), accuracy, sensitivity, and specificity of each group were compared. The relative risk of a false-negative, false-positive or wrong result, the risk of a serious error, as well as the odds ratio of a more severe CO-score for each of the three MD groups, were compared to the reporting radiographers. RESULTS: There was a significant difference between the groups in reference to the CO-score (P ≤ 0.001), accuracy (P = .003), specificity (P = .022), and in the proportion of serious errors (P ≤ 0.001). Compared to the reporting radiographers, all three groups of MDs showed a significantly higher CO-score and a significantly increased risk of a wrong result. Moreover, two of the MD groups showed a significantly increased risk of a false-positive result and for severe errors. CONCLUSION: Based on the CO-score, the relative risk of errors, which could potentially cause malpractice in treatment and patient recall, significantly decreased when the reports were completed by reporting radiographers. IMPLICATIONS FOR PRACTICE: To explore the need for a 24-h radiographer reporting service to the EDs, an upscaled study, like the current, with more participants representing the professional groups is highly recommended.

[Body building aided by intramuscular injections of walnut oil]. / Bodybuilding ved hjaelp af intramuskulaer injektion af valnøddeolie.

This case report describes a 26-year-old body builder who had practiced several months of intramuscular self-injection of walnut oil. Apparently this is a normal procedure amongst body-builders. Our patient complained of swelling and tenderness overlying an injection site. Injections of oil may cause foreign body reactions, leading to tumours named according to the injected material; e.g. paraffinoma, oleoma. Systemic distribution has been reported to result in pulmonary complications.

[Bowing fracture of the ulna with concomitant dislocation of the distal radioulnar joint]. / Bøjningsfraktur af ulna og samtidig distal radioulnar luksation.

This work presents the first case of bowing fracture of the ulna associated with dislocation of the distal radioulnar joint. Etiology, radiographs and treatment are described and discussed. Bowing fractures are frequently missed on primary examination, mainly due to their rarity and the fact that the primary examination in the accident and emergency department is undertaken by junior doctors. We find that careful clinical examination combined with good radiographs should reveal the diagnosis. As closed reduction of bowing fractures may be very difficult to carry out, open reduction may frequently be preferable.

[Lipomas and liposarcomas. 10-year incidence in a local area]. / Lipomer og liposarkomer. Ti års forekomst i et lokalområde.

The aim of this study was to show the clinical expression and histologic diagnosis in 105 patients, 46 males and 59 females, treated for lipomas of the extremities. The coincidence between the histological and peroperative diagnosis was also evaluated. The patients were successively treated at the Department of Orthopaedic Surgery, Glostrup county Hospital in the period 1978-88. Ninety-seven patients were found to have a lipoma and eight of the patients had a malignant tumour (liposarcoma). There were no significant differences in the appearance of malignancy with respect to age or sex. Tumours greater than 100 cm2 in size were significantly more often malignant than those less than 100 cm2. There was a considerable discrepancy between the surgeon's peroperative judgement of malignancy and the histological diagnosis. The tumours were located in the humeroscapular region (39), the femoral region (30), the crural region (10), and in the forearm region (7). We conclude that diagnostic clearing and treatment ought to be centralized in regional centres, where liposarcomas might also be diagnosed. However, the liposarcomas should afterwards be treated in oncological centres. Furthermore, we conclude that histological examination of lipomas in imperative.

[Hepatitis B transmitted by ear-piercing]. / Hepatitis B infektion overført ved ørestikning.

A case of hepatitis B occurred in connection with piercing the earlobes for ear-rings. The most probable source of infection was repeated use of the instruments following disinfection in hydrogen peroxide. Disposable instruments are therefore recommended for this procedure.