Actual teaching at the bedside during attending rounds, with emphasis on history taking and physical diagnosis, has declined from an incidence of 75% in the 1960s to an incidence of less than 16% today. Profound advances in technology, in imaging, and in laboratory testing and our fascination for these aspects of patient care, account for part of this decline, but faculty must also assume responsibility for the present lack of bedside teaching. If we are to reverse this trend, we will need to realize the barriers to bedside teaching, both real and imagined, and overcome them. And if we are to become effective bedside teachers, as were our mentors, we will need to sharpen our own physical diagnostic skills. We will need to learn how to be gentle with students and housestaff, how to better communicate with patients, and how to teach ethics and professionalism with the patient at hand.
Radiotherapy for prophylaxis of heterotopic ossification (HO) is commonly used in high risk patients following orthopedic surgery. While treatment is effective and can prevent morbidity associated with HO, with any dose of radiation there is a concern of a radiation induced malignancy. Here we a report a case of radiation induced osteosarcoma which developed 11 years after a single fraction of 700 cGy. We performed dosimetric analysis by superimposing the patient’s original treatment field on a CT scan performed after the diagnosis. The radiotherapy dose for this patient is lower than classically reported for radiation induced sarcomas. We identified greatest bony destruction that was thought to be the epicenter of the tumor, and this was specially contoured on the diagnostic CT scan. This volume appears to be located at the edge of the radiotherapy field. Fifty percent of the treated volume received 240 cGy, the mean dose was 333 cGy. There was a variation across the treatment volume, between 21.8 cGy and 717 cGy. While a rare complication, we stress the importance of informing regarding the risk of a radiation induced malignancy following HO prophylaxis.
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