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Prompt 1 questions (Case 6)
Hi,
In this case I have some questions:
1) When we suspect patient might have airway issues do we necessarily have to include “polysomnogram” as one of the answers to additional records? Because my thought process was to add here as an answer “sleep questionnaire” and from there we would probably refer to an ENT if that is the case and then they would be the ones to order a sleep study.
2) Why CBCT was one of the answers here? Am I missing something? Because I thought that was already presented as part of his records.
3) Whenever we see hypotonic muscles should we always include electromyographic evaluation as part of additional records answers? I have never seen this type of exam in any ortho patient, but maybe is just me LOL , just wondering when to add that as answer for the exam.
4) Could you explain the rationale of serial cephs? Wouldn`t that be overexposing the patient to radiation? Since we are already requesting PA ceph and already have the CBCT to check on vertebra maturation. When answering those type of questions should we have minimal radiation in mind or should we add as many things as we can?
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3 Replies
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Maria,
Replying in line with your questions here.
1) When we suspect patient might have airway issues do we necessarily have to include “polysomnogram” as one of the answers to additional records? Because my thought process was to add here as an answer “sleep questionnaire” and from there we would probably refer to an ENT if that is the case and then they would be the ones to order a sleep study. – If you say “Sleep Questionnaire” then I would keep qualifying the answer with what action that leads to so “Sleep Questionnaire to evaluate referral to ENT for Polysomnogram”
2) Why CBCT was one of the answers here? Am I missing something? Because I thought that was already presented as part of his records. Yes, those are a pano and ceph reconstructed from a CBCT but the 3D volumes are not presented. Just trying to spur the thought that you’d want to evaluate the 3D volumes in addition to constructing a pano and ceph from the scan.
3) Whenever we see hypotonic muscles should we always include electromyographic evaluation as part of additional records answers? I have never seen this type of exam in any ortho patient, but maybe is just me LOL , just wondering when to add that as answer for the exam. It is in a sample response for the board which is why it’s included. Definitely a tool in the toolbox but I’ve only ever had one patient that I referred for that evaluation…
4) Could you explain the rationale of serial cephs? Wouldn`t that be overexposing the patient to radiation? Since we are already requesting PA ceph and already have the CBCT to check on vertebra maturation. When answering those type of questions should we have minimal radiation in mind or should we add as many things as we can?
Serial Cephs ensure growth cessation. CVM gives us general ideas on growth but the mandible has a mind of it’s own. I have many surgical patients of men in their mid to late 20’s who have runaway mandibular growth that we do serial cephs before initiating treatment.
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Thank you so much for your thoughts, very helpful, as usual 🙏
Just wonder, in cases like that would we be penalized for adding as many exams as possible that involves radiation to check on growth status? Because I agree here serial cephs along with the CBCT, PA ceph and Tec-99 would be helpful but I just wanted to be sure that would be considered right for the ABO standards. Thank you again!
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Maria,
Good thoughts on ALARA. You could communicate that clearly if that is your concern.
E.G.
“Construct PA Ceph from exisiting CBCT”
“Review 3D volume of CBCT captured”
Lateral cephs for growth checks are lower radiation. Also for a Tech-99 Scan you are not just randomly ordering it for every patient. This patient has a condition which if you do not order this you can end up mis-treating the patient. Important to have a great relationship with your services that can order this directly.
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