diagnostic imaging module 1 and 2

which term is used for

"prevention, diagnosis and treatment of pathology"

-radiology

-MSK

-radiography

radiology

which term is used for

"Subspecialty of radiology that is focused on diagnostic evaluation of the musculoskeletal system"

-radiology

-MSK

-radiography

MSK

which term is used for

The primary tool and the first ordered diagnostic study

-radiology

-MSK

-radiography

radiography

what do PTs use radiographic images for

assess bony alignment

identify bony blocks

visualize fx location to plan interventions

id exact position of fixation devices

assess bone healing to make decisions about movement or weight bearing

when are clinical decision making rules (CDR) used?

used for clinicians when imaging is necessary for trauma

is this the right order

radiograph -> PT -> medication -> MRI

no

radiograph>medication>PT>MRI

what is the pittsburgh decision for knee trauma

what is the Canadian c/s rules

What are the Ottawa ankle rules?

what are the ottawa knee rules

Why are radiographic films usually the first imaging technique ordered?

A. It is the quickest

B. It is the cheapest

C. It is easy to read the films

D. They are the most accurate

B. It is the cheapest

what are the three necessary things for radiograph

•X-‐ray beam

•The patient

•Image receptor

what is an X-ray

Form of ionizing electromagnetic radiation

•Ionizing-The ability of an atom or molecule to gain or lose and electron

Electromagnetic - Interaction of electronically charged particles

Radiation - Energy that is transferred through space or matter

what is required in step one of X-ray production

-electrons

-something to move e quickly

-something to stop them

what is step 2 of X-ray travel

X-‐ray leaves the tube and is "beamed" through a collimator

what does this mean

"The beam passes through the patient and is attenuated"

Attenuation is the reduction in the number of photons in the beam due do energy loss

(depends on radiodensity)

less density = less attenuation (directly proportional)

what is remnant radiation

Radiation coming out of patient, aka 'exit radiation'

what effects the radiodensity of the tissue

1. What is the tissue made of

•atomic number (number of electrons in the tissue)

•volume density

2. How thick is the tissue

would a thicker object have a higher or lower radiodensity

higher

what color would a high radiodense object appear

what about low?

high: white

low: black

what would air look like on an x ray?

black

what would metal look like on an x ray

white

what does it mean if something is radiodense?

very little x-‐ray reaches the film, more white. Usually seen in heavy metals not human tissue.

what does it mean if something is radiolucent

most of the x-‐ray reaches the film, mostly black, air in the lungs

what is contract media and what can it be used for ?

Contrast studies of viscera

Barium Sulfate

What are the 4 image quality factors?

radiographic density, radiographic contrast, recorded detail, distortion

what are the 3 factors you can adjust to affect the radiographic density

if you want the image to appear as dark as possible what are the parameters for radiographic density

what about as white as possible?

current, exposure time, and distance from the beam

darkest: high current &exposure time and close to the beam

white: low current & exposure time and far from the beam

would this image be white or dark

low current with low exposure and close to the beam

white but not as white if the beam was far away

if the an area of an x-ray is black

is it over or under exposed

overexposed

if the an area of an x-ray is white

is it over or under exposed

underexposed

true or false

radiographic density is the amount of black on the film

true

in regards to radiographic contrast:

what kind of contrast would you use to view lungs?

low contrast

in regards to radiographic contrast:

what kind of contrast would you use to view bone

high contrast

what two factors effect the recorded detail of the x ray image

(sharpness of the image)

-movement

-distance from the beam

what is the most common view for lumbar spine

Lumbar spine AP view most common

(because the spine is closest to the image receptor)

radiographic distortion: if an object is closer to the X-ray tube

what is the result

more distortion and magnification

(flashlight example)

(the image can look bigger if its closer to the beam and the farther away it is to the image receptor, the image will be closer to the actual size)

if an object is father from the X-ray tube and very close to the image receptor what is the result

the image will be LESS distorted and magnified

and the image will appear sharper because it is close to the image receptor

is a conventional radiograph the same as an X ray

no

what are the two ways position is described

1. General body position

2. To describe the body part closest to the image receptor

Ex; left anterior oblique position

how is projection described

Path of the x-‐ray as it moves from tube through the patient

•Ex: Posterior Anterior oblique projection

what is the angle of projection

The angle that the x-‐ray enters the body will influence the radiodensity of the object.

(three images of cheese)

when viewing x-ray film what will hands and feet look like?

the toes and fingers will face upward

when viewing a lateral view x-ray, what is the perspective

perspective of the x-ray beam

(in this picture its a left view, if it was a right the person would be facing the opposite direction)

what does a right anterior to posterior view of the ankle look like

this is a right ankle facing you in anatomical position

what are the ABCS of radiologic evaluation

Alignment

Bony Density

Cartilage spaces

Soft tissues

using the ABCs of radiologic evals what does the A consist of

correct number of bones

the size of bones

bone abnormalities

developmental deformities (growth plate not closed)

contour of bones

cortical bone outline

bone spurs

what may you see at muscle attachments

or where two bones rub

example Achilles tendon

bone spurs

in regards to bone density is sclerotic bone abnormal when looking at X-ray, whats an example

no, it can be both normal or abnormal depending on the area

normal is bone healing

abnormal is OA

what does a trabeculae abnormality look like

what is sclerosis as it relates to bone

increase in bone density

what does normal sclerosis at the hip look like and why

the whiter parts of the acetabulum

(because of WB)

what does knee OA look like

what does Excessive Sclerosis look like

when looking at the cartilage spaces what are you looking for

joint space width

subchondral bone

-erosions

epiphyseal plates

-disruption

-sclerotic bone

-the size of the plate is related to age

what does gout look like

increased radiolucency

will got be more radiodense or radiolucent

Subchondral bone erosions

what does normal epiphyseal plates look like

are there any abnormalities in this image

at what angle is the ap cs taken?

15-20 deg

what does a normal AP cs look like

when looking at the c/s what is the better view to see the disc height

lateral

what view of the c/s can you see the pedicles?

AP

what are you looking for during AP view of CS

after a trumatic event to the C/S what image will you expect them to take

AP open mouth view

what does a normal AP x-ray of C1-2 look like

what does the spinolaminar line, anterior and posterior vertebral line look like

purple anterior

posterior: blue

spinolaminar line: green

between blue and green is the spinal cord

what does a left oblique cs image look like

(it says right but its really left)

when looking at the thoracic spine

what view should you choose to see

vertebral bodies

AP

when looking at the thoracic spine

what view should you choose to see

transverse process

AP

when looking at the thoracic spine

what view should you choose to see

spinous process

AP

when looking at the thoracic spine

what view should you choose to see

pedicles

AP

when looking at the thoracic spine

what view should you choose to see

vertebral bodies

lateral

when looking at the thoracic spine

what view should you choose to see

intervertebral disc height

lateral

when looking at the thoracic spine

what view should you choose to see

intervertebral foramina

lateral

what are the three lines for the thoracic spine

for a chest xray what kind of view will they take

PA

because you want the heart furthest away from the xray beam and closer to the IR

during a chest xray what kind of contrast should you use to view soft tissue

low

true or false you can use a chest xray to view lungs, vascular system and metastatic disease

true

what does a normal lumbar AP look like

what does lumbar spina bifida look like

what does a lateral view of the lumbar spine

when looking at an oblique image for the lumbar spine, which side are you looking at whether its right or left?

the side closest to the image receptor or the side that is labeled

(posterior)

what is the most common reason for taking a oblique image of the lumbar spine

to see if there is a fracture of the pars interarticularis

what is a pedicle

the segment between the transverse process and the vertebral body

what kind of image will show a scotty dog?

lumbar oblique view

what part of the scotty dog is the neck?

pars interarticularis

label the scotty dog

what are the two views of the SIJ

(what are you looking for in each view)

AP (looking at the joint surface)

R/L oblique ( joint space)

when looking at a R oblique of the SIJ what side are you looking at

the left

what kind of angle is the CR shot for an AP SIJ xray

inferior to superior 30-35 degrees

what is an example of an oblique image of the SIJ

for the SIJ would you use a AP or an oblique view for joint space

oblique

what are the three indications for hip radiograph

hip pain

avascular necrosis

stress fractures

for the pelvis what position is the hips for an AP view

IR 15-20 degrees

what are the three important portions of the acetabulum (ap view)

what position will the hip be if you want to see the medial portion of the femur (AP view)

frog leg

what is the difference between patella alta and baja

what is the sulcus angle at the knee

the greater the angle = greater chance of dislocation

on an xray AP of the ankle what will you see with ankle instability

shortened fibula or fibular displacement