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1.Lesion location 2.Lesion size 3.Status of the Physis – Physeal Patency 4.Characteristics of Parent Bone a)Sclerosis 5.Characteristics of Progeny Bone.

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Presentation on theme: "1.Lesion location 2.Lesion size 3.Status of the Physis – Physeal Patency 4.Characteristics of Parent Bone a)Sclerosis 5.Characteristics of Progeny Bone."— Presentation transcript:

1 1.Lesion location 2.Lesion size 3.Status of the Physis – Physeal Patency 4.Characteristics of Parent Bone a)Sclerosis 5.Characteristics of Progeny Bone – Static Non-Comparison Measurements a)Visualization b)Fragmentation c)Displacement d)Radio-density of the Center of the Progeny Bone e)Radio-density of the Rim of the Progeny Bone f)Boundary (primary variable to assess healing) g)Shape 6.Characteristics of Progeny Bone – Dynamic Comparison Measurements a)Radio-density b)Boundary X-RAY CRITERIA

2 1.Standing AP – bilateral knees 2.Lateral – bilateral knees 3.Merchant – bilateral knees 4.Notch/Tunnel – bilateral knees 5.Left hand (for skeletal age) X-ray Technique Protocol for these studies – Radiologist input? X-RAY PROTOCOL

3 ClosingOpenClosed 1 – Open 2 – Closing 3 – Closed CRITERION 3 – STATUS OF THE PHYSIS / PHYSEAL PATENCY 1 – Open 2 – Closing 3 – Closed 1 – Open 2 – Closing 3 – Closed Assessment should consider only the femoral physis. Closing’ Definition: - Must be able to see both some areas of the physis that appear to be ‘closed’ and some areas that are clearly still ‘open’.

4 CRITERION 1 – LOCATION OF THE LESION 1 – Medial femoral condyle 2 – Lateral femoral condyle 3 – Patella 4 – Trochlea APLateral 1 – Anterior Condyle 2 – Posterior Condyle 3 – Patella 4 – Trochlea A Post T Pat LATERAL VIEW: Project line off posterior femoral shaft. If posterior to line = Posterior. If between posterior femoral line and Blumenstadts line then =Anterior. If anterior to Blumenstadts then=Trochlear. Pick center of lesion surface predominant compartment

5 LateralAPNotch 1 – Width of OCD lesion 2 – Width of knee 3 – Max. depth of lesion 1 – Length of OCD lesion 2 – Length of condyle 3 – Max. depth of lesion 1 – Width of OCD lesion 2 – Width of knee 3 – Max. depth of lesion CRITERION 2 – SIZE OF THE LESION Need image AP 1 – Width/Length OCD = normal parent bone to normal parent bone margin 2 – Width = inter-epicondylar distance Length = maximal AP dimension measure parallel to joint 3 – Max Depth = in unossified, complete the arc of the parent bone contour and measure the longest perpendicular line to the rim of parent bone and depth of the crater

6 LateralAPNotch 1 – Width of OCD lesion 2 – Width of knee 3 – Max. depth of lesion 1 – Length of OCD lesion 2 – Length of condyle 3 – Max. depth of lesion 1 – Width of OCD lesion 2 – Width of knee 3 – Max. depth of lesion CRITERION 2 – SIZE OF THE LESION Need image Lateral 1 – Length of OCD lesion – normal parent bone to normal parent bone margin. 2 – Length of condyle (anterior-to-posterior). Measure the involved condyle. Measure parallel to physis 3 – Maximum depth of lesion (if unossified, complete the arc of the parent bone contour, and measure the longest perpendicular line to the rim of parent bone in the depth of the crater)

7 LateralAPNotch 1 – Width of OCD lesion 2 – Width of knee 3 – Max. depth of lesion 1 – Length of OCD lesion 2 – Length of condyle 3 – Max. depth of lesion 1 – Width of OCD lesion 2 – Width of knee 3 – Max. depth of lesion CRITERION 2 – SIZE OF THE LESION Need image Notch 1 – Width of OCD lesion – normal parent bone to normal parent bone margin 2 – Width of knee (inter-epicondylar distance) – Select the maximum distance parallel to joint surface 3 – Maximum depth of lesion (if unossified, complete the arc of the parent bone contour, and measure the longest perpendicular line to the rim of parent bone in the depth of the crater)

8 Same DensityLess DenseMore Dense Need image 1 – More Dense 2 – Less Dense 3 – Same Density CRITERION 4 – CHARACTERISTIC OF PARENT BONE - SCLEROSIS In comparison to the unaffected parent bone, the radio-density of the rim of the parent bone is? 1 – More Dense 2 – Less Dense 3 – Same Density 1 – More Dense 2 – Less Dense 3 – Same Density

9 CRITERION 5a – CHARACTERISTIC OF PROGENY BONE - VISUALIZATION VisualizedNot-visualized Need image 1 – No 2 – Yes 1 – No 2 – Yes Is the progeny bone visualized ON ALL VIEWS? Evaluate all views to determine presence of ossification. If ossification not visualized on any view and appears as a “black hole”, check NO (Not-visualized)

10 CRITERION 5b – CHARACTERISTIC OF PROGENY BONE - FRAGMENTATION 1 – No 2 – Yes Fragmented Need image Non-fragmented Need image 1 – No 2 – Yes Is the progeny bone fragmented? Need to see 2 or more pieces of progeny bone

11 CRITERION 5c – CHARACTERISTIC OF PROGENY BONE - DISPLACEMENT Completely displacedPartially displacedNon-displaced Need image Is the progeny bone displaced? - If any view demonstrates partial displacement, then it should be defined as such, unless any view demonstrates complete displacement, then it should be defined as complete. - Look at all views before rating. 1 – Non-displaced 2 – Partially 3 – Totally 1 – Non-Displaced 2 – Partially 3 – Totally 1 – Non-displaced 2 – Partially 3 – Totally

12 Same DensityLess DensityMore Dense Need image 1 – More 2 – Less 3 – Same 1 – More 2 – Less 3 – Same 1 – More 2 – Less 3 – Same CRITERION 5d – CHARACTERISTIC OF PROGENY – DENSITY OF CENTER In comparison to the unaffected parent bone of the involved condyle, the radio-density of the Center of the progeny bone is……

13 Same DensityLess DensityMore Dense Need image 1 – More Dense 2 – Less Dense 3 – Same Density 1 – More Dense 2 – Less Density 3 – Same Density 1 – More Dense 2 – Less Dense 3 – Same Density CRITERION 5e – CHARACTERISTIC OF PROGENY – DENSITY OF RIM In comparison to the unaffected parent bone, the radio- density of the Rim of the progeny bone is? Progeny Rim is usually just beyond the Parent sclerotic rim.

14 CRITERION 5f – CHARACTERISTIC OF PROGENY BONE - BOUNDARY 1 – Distinct 2 – Indistinct Distinct Need image Indistinct Need image The boundary between the parent bone and progeny bone is? If “Distinct” on any view, pick “Distinct” 1 – Distinct 2 – Indistinct

15 1 – Convex 2 – Linear 3 – Concave CRITERION 5g – CHARACTERISTIC OF PROGENY BONE - SHAPE Concave Need image 1 – Convex 2 – Linear 3 – Concave 1 – Convex 2 – Linear 3 – Concave Convex Linear The predominant shape/contour of the articular side of OCD lesion is?

16 END

17 CRITERION 6a – DYNAMIC COMPARISON CRITERION – RADIO-DENSITY Need image Comparison ImageCurrent image 1 – More dense 2 – Less dense 3 – Same density Need image In comparison to previous radiographs, radio-density of progeny bone is?

18 CRITERION 6b – DYNAMIC COMPARISON CRITERION – BOUNDARY Need image Comparison ImageCurrent image 1 – More distinct 2 – Less distinct 3 – Equally distinct Need image In comparison to previous radiographs, the boundary is?


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