Lead Article – April 2021

Lead Article – April 2021

Are X-rays Really Necessary?

Yes. It is hardly likely that I would pose this question for it to be responded in the negative!

It is important for legal colleagues to understand that the diagnostic and therapeutic programme adopted by medical practitioners is almost universal.

The process involves the gleaning of a full history, the performance of a thorough clinical examination and then a review of appropriate ancillary investigations.

Whilst most diagnoses can be made (more than 85%) based upon the history and examination alone, it is the ancillary investigations that increase the diagnostic accuracy to the high 90%’s.

Of all of the ancillary investigations available to us as Orthopaedic Surgeons, plane radiographs are probably the most important. They allow us to visualise in two dimensions the probable pathological processes involved. Education allows that translation between the x-ray created image and processes learnt about as students in pathology and in the mortuary.

Without those radiographs, the differential diagnosis list can remain very long. Conversely, if appropriate investigations are available, the differential diagnosis list can be reduced to one or two probabilities only.

In the medicolegal spectrum, these plane radiographs are often of vital importance. Negligence cases in particular rely heavily upon images taken before, during and after an alleged negligent event. Opinions can be formulated on the likelihood of progression without the alleged negligent intervention, the true effects of the intervention and the natural history of the aftermath.

High angle view of medical documents and x-rays

Unfortunately, briefs received by Orthopaedic Surgeons seeking an opinion on negligence (or causation at least) are often devoid of these plane radiographs. The ability of the Orthopaedic Surgeon to assist the soliciting agent is seriously hampered.

If I can make a single plea, it would be that you ensure proper ancillary investigations are included with your original requisition.