Thorax, Chest, CP imaging

T-spine imaging is used to identify/exclude what disease processes

• osteoporosis

• tuberculosis osteomyelitis

• Scheuermann’s disease

• Neoplasm

• metabolic disorders

T-spine imaging is used to identify/exclude what anatomic abnormalities

• scoliosis

• rib fx

• spine fx

• ligamentous injury

• dislocations

describe scheuermann’s disease

back ache/kyphosis of the lumbar spine that leads to osteochondrosis of secondary ossification centers

• in adolecents

routine XR of t-spine

AP

lateral

What is 1

rib

What is 2

vertebral body

What is 3

costovertebral joint

What is 4

spinous process

What is 5

transverse process

What is 6

costotransverse joint

What is 7

intervertebral disc

What is 8

pedicle

What view is this

AP

What is 9

facet joint

What is 10

inferior articular process

What is 11

superior articular process

What is 12

intervertebral foramen

What view is this

sagittal

What view is this

sagittal MRI

What view is this

axial

What view is this

coronal

what does the anterior column consist of

anterior longitudinal ligament and ant 2/3 of vertebral body and annulus fibrosis

what does the middle column consist of

posterior 1/3 of the body and annulus, posterior longitudinal lig

what does the posterior column consist of

posterior lig complex and the vertebral arch structures

indications of CT for t-spine

• acute trauma (adults)

• degenerative conditions

• postop eval

• infectious processes

• image guidance

• neoplastic conditions

• inflammatory lesions

• spine abnormalities

• spinal cord assessment (if MRI contraindicated)

steps of CT interpretation for t-spine

Alignment

Bone density

Canal space

Disk integrity

Soft tissues

indications of MRI for t-spine

• spinal cord malformations

• inflammatory/autoimmune diseases

• infectious conditions

• vascular disorders

• degenerative conditions

• trauma

• neoplastic abnormalities

• misc. fluid leaks, procedural check ups, or a combo of above

MRI contraindications

• pacemakers

• ferromagnetic intracranial aneurysm, clips, foriegn bodies, electronic devices

• certain neurostimulators

• certain cochlear implants

• extensive tattoos

• nonremovable body piercings

steps of MRI interpretation for t-spine

Alignment

Bone density

Canal space/CNS

Disk integrity

Soft tissues

range for right thoracic scoliosis

T4/6-T11/L1

range for right thoracolumbar scoliosis

T4/6-L2/4

range for Left lumbar scoliosis

T11/12 - L5

describe a double major scoliosis curve

thoracic one way and a lumbar the opposite with equal prominence

What curve is this

right thoracic

What curve is this

right thoracolumbar

purpose of scoliosis SB test

to determine if the curve is structural (rigid) or flexible

describe a structural cure results

R curve stays when SB to R

describe a flexible cure results

L curve disappears when SB to L

describe the pedicle method for measuring curve size

identifying how far the convex side pedicle has rotated toward midline

score of 0 on the pedicle method

no rotation

score of +1 on the pedicle method

pedicle toward midline

score of +2 on the pedicle method

pedicle 2/3 to midline

score of +3 on the pedicle method

pedicle in midline

score of +4 on the pedicle method

pedicle beyond midline

describe the Cobb method for measuring curve size

• find the upper and lower most vertebrae involved

  • last/first vertebrae who’s pedicles align

• draw a line along that angle

• create a 90 degree line to original lines

• measure the angle of intersection

What view is used for Cobb method

frontal plane of AP projection

types of compression fxs

• step defect

• wedge deformity

• linear zone of impaction

• displaced endplates

• loss of IVD height

• paraspinal edema

  • abdominal ileus

describe displaced endplates

anterior shearing of the IVD may avulse the bony rim of the endplate or displace it ant

How will displaced endplates appear

greater ant/post diameter of the vertebral body at the involved endplate (lateral view)

describe loss of IVD height

herniation of the disc will cause a decrease in the potential space and possibly a misalignment of adjacent vertebrae

describe paraspinal edema

soft tissue edema or hematoma, often associated with compression fx

describe abdominal ileus

disturbance to the visceral autonomic nerves/ganglia leading to excessive amounts of gas in the small or large bowel

What does abdominal ileus indicate

severe underlying trauma and great likelihood of fx

describe step defect

step off at the anterior portion due to the endplate no longer being connected

What patho is this

step defect

What patho is this

step defect with endplate disruption

What patho is this

wedge deformity

describe wedge deformity

anteriorly, trapezoidal collapse

how much loss of height indicates significant damage

30%

How is fx stability determined

number of columns involves (ant/middle/post)

hyperflexion injury affect on ant column

compression fx

hyperflexion injury affect on middle column

tear PLL

hyperflexion injury affect on post column

tear posterior lig complex

hyperflexion + rotation injury affect on ant column

endplate fx

disc rupture

hyperflexion + rotation injury affect on middle column

tear PLL

hyperflexion + rotation injury affect on post column

tear PLC

dislocation/fx facet

hyperflexion + shear injury affect on ant column

fx of vert body or disc

hyperflexion + shear injury affect on middle column

tear PLL and body fx

hyperflexion + shear injury affect on post column

fx pedicles and PLC tear

seatbelt injury affect on ant column

horizontal body fx

seatbelt injury affect on middle column

horizontal body fx

seatbelt injury affect on post column

fissuring of lamina, pedicles, and t.p.

describe a seatbelt injury

hyperflexion over fixed restraint

What injury is this

hyperflexion

What injury is this

hyperflexion+ rotation

What injury is this

hyperflexion + shear

What injury is this

seatbelt

standard imaging for sternum

posterior oblique

lateral

standard imaging for ribs

PA

AP

anterior oblique

posterior oblique

What ribs can be seen during inspiration

1-10

What ribs can be seen during expiration

8-12

Where is the CR for sternal imaging

through SC joint, body of sternum, or the clavicle

What view is this

sternal posterior oblique

What view is this

sternal posterior oblique

Which ribs are analyzed with a AP image

posterior ribs

Which ribs are analyzed with a PA image

anterior

difference between ant and post ribs

Ant: angulated/shadows

post: horizontal

What view is this

lateral rib

What occurs if their are 3 or more consecutive rib fxs

flail chest

chest imaging options

• x-ray

• nuclear scanning

• MRI

• CT

• US

• angiography

indications for chest imaging

evaluation of s/s

eval for line placement

pneumothorax (PTX) screen

symptoms indicative of chest imaging

• pain

• SOB/cough

• hemoptysis

• fever

• chest pain

sings indicative of chest imaging

trauma

hypoxemia

What is the most common chest imaging

CXR

routine projections of CXR

PA

lateral

What side is a lateral CXR taken to see the heart

L

Why is CXR typically taken first

• determine pulm v cardiac

• identifies patho to begin tx

• narrows differential dx/further testing needed

What CXR view exaggerates the size of the heart? Why?

AP because the heart is further from the image receptor

steps for CXR interpretation

Airway

Bone and soft tissue

Cardiac silhouette

Diaphragm & Pleura

Effusion

Fields, fissures, foreign bodies

Gastric bubble and great vessels
Hila and mediastatum

Inspiration

J - all that jazz

What is the normal ratio for thoracic assessment for cardiomegaly

1 heat: 2 thorax