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Biomedical subjects

G de Lacey

Publications and source records attributed to G de Lacey.

7 recordsLinked to original sources
PubMed1979

Reasons for requesting radiographs in an accident department.

A prospective study of 500 patients was performed to determine the reasons for requesting radiographs in an accident and emergency department. Most examinations were requested either to confirm a clinically suspected abnormality or because of difficulty in excluding a significant bone injury on clinical grounds alone. Several requests were also made to reassure the patient. Medicolegal reasons were relatively few, and those made purely because the doctor feared litigation probably accounted for only 5% of requests. Undue emphasis on the medicolegal aspects of accident and emergency radiography in the United Kingdom is unhelpful in that it directs attention away from the real reasons for x-ray referral. Although a reduction in the number of x-ray examinations is desirable on the grounds of expense and radiation exposure it is likely to be obtained only by improving experience and acumen in the clinical assessment of injuries.

Clinical Competence↗
PubMed1979

Rationalising requests for x-ray examination of acute ankle injuries.

Radiographs of injured ankles represent about 1 in 50 of all radiological examinations. The notes and radiographs of 100 patients with ankle injuries were reviewed, and the films of a further 93 patients who had ankle fractures treated by immobilisation were also scrutinised to assess the presence of absence of soft tissue swelling over the malleoli. Any accompanying radiographs of the foot requested at the same time were also studied. In 65 of the 100 cases of ankle injury there was no soft tissue swelling, and none of the patients had a major fracture, while 92 of the 93 patients with a major fracture had soft tissue swelling at the level of the malleoli. In 32 of the 100 cases of ankle injury foot radiographs had also been requested, but only three foot injuries were found. If the simple maxim of "No swelling adjacent to a malleolus, no radiographs" were applied radiography of twisted ankles could be reduced by as much as two-thirds. Moreover, if this maxim included the rider "and no routine foot films" the total casualty radiographic work load could be reduced by 8%.

Acute Disease↗
PubMed1978

Retained surgical swabs: possible causes for errors in x-ray detection and an atlas to assist recognition.

A swab or pack left in a patient may not be recognised on a radiograph. This will usually be due to poor observation, but errors may result from unfamiliarity with the pattern of the markers. In addition, some markers may be difficult to detect, though this usually applies only to swabs which are very small or to those produced by some continental manufacturers. It should also be realised that, in a very few hospitals, swabs which do not have an opaque marker may occasionally be used in theatre. All the X-ray detectable swabs provided by the major suppliers in the U.K. are demonstrated.

Contrast Media↗
PubMed1977

Pneumoperitoneum: the misleading double wall sign.

Both sides of the gut wall seen on a plain film of the abdomen is regarded as evidence of free air in the peritoneal cavity. However, this appearance may be precisely simulated when two loops of distended intestine lie in contact with each other. In vitro studies and clinical examples emphasise the necessity of exercising caution when making the diagnosis of pneumoperitoneum on this sign alone.

Abdomen, Acute↗