Exhibit D - Radiology.pdf

ATAMMC PWS

Exhibit D - RADIOLOGY

Exhibit D-1 Radiology Services Exhibit D-2 - Radiology Film/Image Hanging Protocol

Exhibit D-1 - RADIOLOGY SERVICES

UPPER EXTREMITIES

EXAMINATION HISTORY REQUIRED VIEWS

HAND PA, LAT, OBLIQUE

HAND - Arthritis Study Rheumatology PA, LAT, BALL CATCHERS ( Bi-Lateral Study)

FINGER(s) Initial/ Trauma PA HAND, LAT, OBLIQUE

THUMB PA HAND, LAT and AP Thumb

BONE AGE SURVEY Child study PA HAND (Left Hand - Include WRIST)

WRIST PA, LAT, OBLIQUE

(Trauma – Include ULNAR FLEXION)

FOREARM AP, LAT

ELBOW AP, LAT (INT and EXT OBLIQUEs when requested)

HUMERUS INTERNAL, EXTERNAL

SHOULDER General Survey/Trauma & Pediatric (including all 2 view orders)

INTERNAL ROTATION (AP), SCAPULAR “Y “View, AXILLARY

2 view order INTERNAL,EXTERNAL (use only for known proximal humeral fractures from Ortho)

Impingement/Rotator Cuff/ GH Arthritis Series

TRUE AP, AXILLARY VIEW, SUPRASPINATUS OUTLET VIEW

(5-10° CAUDAL), AC JOINT (Zanca) 10°Cephalic

Instability Series (Subluxation/ dislocation)

TRUE AP, AXILLARY VIEW, STRIKER NOTCH (10° Cephalic), WESTPOINT

4 Views TRUE AP, AC JOINT (Zanca), AXILLARY, SCAPULAR Y

CLAVICLE AP, AXIAL AP (15-25° Cephalic)

AC JOINTS Injury/ Separation Series With and Without Weights (Bilateral on same film), Unweighted AXILLARY of affected side

Arthritis Series Zanca View (10° Cephalic)

SCAPULA AP, LATERAL SCAPULA (“Y” View)

LOWER EXTREMITIES

EXAMINATION HISTORY REQUIRED VIEWS

CALCANEOUS, HEEL TANGENTIAL (40° Caudad), LATERAL (Harris View) Standing/ flexed forward - CR> 45° Caudally into

Achilles Tendon [SKIERS VIEW]

FOOT DP(AP), OBLIQUE, LATERAL

TOE (s) PA FOOT, OBLIQUE, LATERAL (of injured digit)

ANKLE AP, OBLIQUE, LATERAL (Mortise OBL > 20°-30°)

TIBIA/ FIBULA AP, LAT

KNEE 2 View AP, LAT (Obliques only when requested) 3 View AP, LAT (Confer with Physician or patient as to ROI or origin of pain) Patella related – SUNRISE Tibia or condyle related - TUNNEL)

4 View AP, LATERAL, TUNNEL (Rosenberg view), SUNRISE (or Obliques when requested, instead of tunnel/sunrise)

4 View Weight-Bearing , (8 view for bilateral)

AP, LATERAL,TUNNEL (Rosenberg View CR> 10°Caudad), SUNRISE (Only non-wgt-bearing view)

FEMUR AP, LAT (Proximal and Distal)

HIP AP PELVIS, LAT (of the affected Hip) Faux Profile AP

THORAX

EXAMINATION HISTORY REQUIRED VIEWS

CHEST PA, LATERAL (Obliques only when requested and present with Nipple Markers) PNEUMOTHORAX PA (Inspiration, Expiration), LATERAL

BI-Lateral Decubitus images in children and infants

RIBS UNILATERAL PA CHEST, AP RIBS, ANTERIOR and POSTERIOR OBLIQUES of the affected side. Lower RIBS completed crosswise.

BILATERAL PA CHEST, AP RIBS, ANTERIOR and POSTERIOR OBLIQUES of both sides. Lower RIBS completed crosswise.

STERNUM RAO, LAT

STERNO-CLAVICULAR JOINTS PA, BI-LATERAL OBLIQUES

Serendipity Views AP (CR > 40° Cephalic at the level of the manubrium)

EXAMINATION HISTORY REQUIRED VIEWS

ABDOMEN Kidney, Ureters, Bladder (KUB) AP (Include Bladder)

Acute Abdomen Series (AAS) PA CHEST, UPRIGHT ABDOMEN (Include Diaphram), SUPINE ABDOMEN (Include Symphysis Pubis on supine)

PERFORATION r/o Free Air Patient laterally recumbent on left side for approximately 10-15 minutes at which time image a LEFT LATERAL DECUBITUS CHEST Image, SUPINE

KUB, UPRIGHT CHEST,

PELVIC GIRDLE

EXAMINATION HISTORY REQUIRED VIEWS

PELVIS 1 View AP

3 View (JUDET VIEWS) AP, Shallow Obliques (RPO/ LPO >15°-20°) 3 View (INLET/ OUTLET) AP, AP (CR > 25°-30° Cephalic), AP (CR >30°-35° Caudad)

SACRUM AP (CR > 15° Cephalic), LATERAL

COCCYX AP (CR > 10 Caudad) , LATERAL

SACROILIAC JOINTS AP (CR >30° Cephalic), Shallow Obliques (RPO/ LPO >15°-20°)

SPINE

EXAMINATION HISTORY REQUIRED VIEWS

CERVICAL SPINE 2 VIEW AP, LATERAL (No odontoid view)

2 VIEW FLEXION/EXTENSION ONLY (NO NEUTRAL LATERAL)

3 VIEW (trauma) AP, LATERAL, Open Mouth Odontoid 5 VIEW AP, LATERAL, Open Mouth Odontoid, OBLIQUES 5 VIEW w/Flex/Ext AP, LATERAL, Open Mouth Odontoid w/ Flexion/

Extension (NO OBLIQUES)

NECK Soft Tissue AP, LATERAL

THORACIC SPINE AP, LATERAL (Breathing Technique), SWIMMERS LATERAL (If ROI is T1-T3)

LUMBAR SPINE 2 VIEW AP, LATERAL (No L-5/S-1 SPOT)

3 VIEW AP, LATERAL, L-5/ S-1 SPOT

5 VIEW AP, LATERAL, L-5/ S-1 SPOT, OBLIQUES

5 VIEW w/Flex/Ext AP, LATERAL, L-5/ S-1 SPOT, w/ Flexion/ Extension

(NO OBLIQUES)

SPECIALTY STUDIES

EXAMINATION HISTORY REQUIRED VIEWS

METASTATIC BONE SURVEY CHEST (PA), C-SPINE, T-SPINE & L-SPINE (AP/ LAT),

LONG BONES (AP) FOREARMS,HUMERUS,TIB/FIB

and FEMUR, KNEES (AP), PELVIS (AP), SKULL (AP, LAT)

LONG BONE SURVEY FOREARMS,HUMERUS,TIB/FIB and FEMUR(AP Only)

METABOLIC SURVEY METASTAIC SURVEY - CHEST (PA), C-SPINE, T-SPINE

& L-SPINE (AP/ LAT), LONG BONES (AP), KNEES

(AP), PELVIS (AP), SKULL (AP, LAT), and PA HANDS

SHUNT SURVEY AP, LATERAL SKULL; AP, LATERAL C-SPINE

PA CHEST, KUB (FLAT)

SKELETAL SURVEY (Pediatric ) NON ACCIDENTAL

TRAUMA

SKULL (AP, LAT), CHEST (AP, LAT, Bi-LAT Obliques), L-SPINE (LAT), C-SPINE (LAT), HUMERUS (Both APs), FOREARM (Both APs), HANDS (Bi-LAT), FEMUR (Both APs), TIB/FIB (Both APs), FEET (Both APs)

SKELETAL SURVEY (Pediatric ) SKULL (AP-include face, LAT), CHEST (AP-include Ribs), BiLATERAL OBLIQUE RIBs), ABDOMEN include Pelvis), , C-T-L-SPINE (LAT), TIB/FIB (Both APs include Knee and Ankle), BILATERAL FEET (Imaged together), HUMERUS (Both APs include Shoulder and Elbow), FOREARM (Both APs include Elow and Wrist), BiLATERAL HANDS (Imaged together), FEMUR (Both APs Include Hip and Knee)

Scoliosis Survey

Scanogram

XR spine entire 2 or 3 views; AP & Lateral

XR Bone Length Studies Scanograms; AP hip to ankle w/ruler

EXAMINATION HISTORY REQUIRED VIEWS

SKULL CALDWELL. TOWNES, BI-LATERALS (Children under

6 yrs LATERAL of affected side only)

FACIAL BONES CALDWELL. WATERS, BI-LATERALS

NASAL BONES WATERS, BI-LATERALS (Soft-tissue)

ORBITS CALDWELL. WATERS, BI-LAT 3 POINT LANDING

ORBITS (MRI) WATERS, LATERAL

SINUS SERIES CALDWELL (Coned), WATERS LATERAL, SMV

ZYGOMATIC ARCHES WATERS, CALDWELL, JUG HANDLES

TEMPORAL MANDIBULAR JOINTS (TMJs) AP AXIAL MANDIBLE, AXIAL-LATERAL OBLIQUES (Open and Closed)

MASTOIDS AP, TOWNES, BI-LATERAL STENVERS, LAWS and MAYERS (Coned)

SELLA TURCICA CALDWELL (Coned), LATERAL

INTERNAL AUDITORY CANAL (IAC) PA, TOWNES, BI-LATERAL STENVERS (Coned)

MANDILBLE CHAMBERLAIN TOWNES (CT), PA MADIBLE, BOTH

OBLIQUES

*ALL EXAMS ARE NONCONTRAST*

MRA Brain/Head w/o Contrast MRI Knee w/o Contrast Left MRI Ankle w/o Contrast Left MRI Knee w/o Contrast Right MRI Ankle w/o Contrast Right MRI Lower Extremity w/o Contrast

Bilat MRI Brain w/o Contrast MRI Lower Extremity w/o Contrast Left MRI Elbow w/o Contrast Left MRI Lower Extremity w/o Contrast

Right MRI Elbow w/o Contrast Right MRI Sacrum w/o contrast MRI Femur w/o Contrast Bilat MRI Shoulder w/o Contrast Left MRI Femur w/o Contrast Left MRI Shoulder w/o Contrast Right MRI Femur w/o Contrast Right MRI Spine Cervical w/o Contrast MRI Finger(s) w/o Contrast Left MRI Spine Lumbar w/o Contrast MRI Finger(s) w/o Contrast Right MRI Spine Thoracic w/o Contrast MRI Foot w/o Contrast Left MRI Tibia/Fibula w/o Contrast Bilat MRI Foot w/o Contrast Right MRI Tibia/Fibula w/o Contrast Left MRI Forearm w/o Contrast Left MRI Tibia/Fibula w/o Contrast Right MRI Forearm w/o Contrast Right MRI Toe(s) w/o Contrast Left MRI Hand w/o Contrast Left MRI Toe(s) w/o Contrast Right MRI Hand w/o Contrast Right MRI Wrist w/o Contrast Left MRI Hip w/o Contrast Left MRI Wrist w/o Contrast Right MRI Hip w/o Contrast Right MRI IAC w/o Contrast MRI Humerus w/o Contrast Left MRI Humerus w/o Contrast Right

Weekly workload is 72-78 studies.

Exhibit D-2 - RADIOLOGY FILM/ IMAGE HANGING

PROTOCOL

UPPER EXTREMITIES

AP OBL (RT) LAT (LT) LAT (RT) AXILLARY (LT) AXILLARY

Fingers, Hands, Wrists Fingers-UP Fingers-UP Palm Facing -LT Palm Facing -RT Forearm Wrist-UP Wrist Pointing-RT Wrist Pointing-LT Elbow Wrist-UP Wrist-UP Ulna/Radius Pointing-RT Ulna/Radius Pointing-LT Humerus Elbow-DOWN Elbow-DOWN Elbow-DOWN Shoulder Coricord Process-CNTR Humeral Head-UP (Flip Image) Humerus Pointing-LT (Flip Image) Humerus Pointing-RT

LOWER EXTREMITIES

AP/ DP OBL (RT) LAT (LT) LAT

Toes Toes-UP Toes-UP Toes Facing -RT Toes Facing -LT Feet Foot-Toes UP Foot-Toes UP Feet/ Toes Facing -RT Feet/ Toes Facing -LT Calcaneous Axial View/ Toes-UP Toes Facing -RT Toes Facing -LT Ankle Leg-UP Leg-UP Toes Facing -RT Toes Facing -LT Tib/Fib Knee-UP/ Canty-Corner Knee-UP/ Canty-Corner Knee-UP/ Canty-Corner Knee Apex Patella-DOWN Apex Patella-DOWN Patella Facing-LT Patella Facing-RT Femur Femoral Head-UP Femoral Head-UP Femoral Head-UP

Pelvic Girdle r

THORAX

PA/ AP OBL LAT

Chest C7-UP C7-UP Facing-LT C-Spine C1-UP C1-UP Facing-LT T-Spine T1-UP T1-UP Facing-LT L-Spine L1-UP L1-UP Facing-LT Abdomen Illiac Crest-UP Illiac Crest-UP

All adjustments made in respect and for the benefit of the reader and their point of view

AP OBL (RT) LAT (LT) LAT

Pelvis Illiac Crest-UP Illiac Crest-UP Hip IlliacCrest-UP/ Canty-Corner Femur Extending-LT Femur Extending-RT

Exhibit K - RADIOLOGY