Do You See What I See?

Sherri Priestly, MRT(R)

Have you ever had a frustrating interaction with an orthopedic surgeon? Unfortunately, it has been my experience as an x-ray tech that this happens on a regular basis. Recently, I have been reflecting about this and asking why. Why is there frustration and tension between x-ray techs and orthopedic surgeons? Aren’t we all on the same team? Don’t we have the same goals?

One goal that we share is our concern for patient outcomes, what we often do not share is the lens with which we view our radiographs. As x-ray techs our primary goal is to please the radiologist by demonstrating the anatomy in a certain way based on long established criteria. Our images are viewed by radiologists in absence of the patient in order to diagnose specific pathologies. The two key differences when you ask yourself what an orthopedic surgeon needs from your images are first of all that they view the images with a patient sitting or standing right in front of them. They are looking to correlate the images you have taken with the appearance and concerns of a live person. Second, the orthopedic surgeon then uses the images to make a treatment plan. This is important because some subtle differences in images can radically change this plan.

For example, look at this oblique ankle:

Most x-ray techs would judge this to be a good oblique ankle projection because the fibulotalar joint is open. But what does an orthopedic surgeon need from this image?

I interviewed several orthopedic surgeons and discovered that when they are looking at an oblique ankle they need to visualize all three joint relationships around the mortise and evaluate if there is any widening on the lateral aspect when compared to the medial. If there is joint space widening the patient requires surgery, if there is not the patient can be treated with a cast only. What a difference this decision makes to the patient! And how frustrating and painful for the patient if the wrong decision is made. Suddenly, it made sense to me why I had experienced orthopedic surgeons asking for repeat mortise views when I thought my original images were acceptable. We had different criteria for what made the image acceptable, and this led to frustration on both sides.

I discovered these sorts of differences over and over as I investigated different projections. It’s too bad that we do not have a chance to sit down with orthopedic surgeons more often to understand their needs and their perspective on our images, our patients would thank us for this.

Here’s my take away thought for you all: the next time you feel frustrated about the demands placed on you by an orthopedic surgeon, take some time to investigate why they might be making this request. The internet contains a bounty of information when you take the time to look, and one could argue that it falls under our professional responsibilities to do so. After all our ACMDTT Standards of Practice centers around the philosophy of patient centered care. We are professionals who strive to meet the needs of our patients and their families by maintaining competence and utilizing evidence based and reflective practice. We need to be people who never stop learning if it means better outcomes for our patients.

Sherri has been an x-ray and CT technologist for the last 20 years. She recently made a move into an educational role at NAIT because she is a bit of nerd and loves to share interesting facts with other people. 

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