Weeks 1-2 Jeopardy & Sample Images

"ABCS"

_______ is the GOLD standard (structured approach) when it comes to reading plain film radiographs

More clinical info and context passed along to a radiologist

Q: benefits of PT-ordered imaging studies vs. a physician intermediary

Radio-opaque (ex: heavy metal, bone)

Q: this image shows up white on plain film due to high density

1987

Q: in this year Direct Access Language was adopted for the state of Wisconsin

Radiology Technician Practice Act

Q: from 2013-2017, this healthcare provider's practice act prompted a stop to PT's ordering plain films in WI

We had proof that we were ALREADY doing it!!

Bonus question: why did amending the Radiology Technician Practice Act work?

Full-body CT scan (necessary in major, multi-trauma incidents, but worrisome when a series is performed in a short period of time)

Q: this imaging modality can expose a person to some of the highest radiation doses

Polarized atoms

Q: the moving of direction from this type of matter, magnetized, is what makes up the physics for MRI

Deep intra-articular ligaments (ex: ACL or PCL)

NOTE: you CANNOT see these w/ ultrasound (however, when it comes to the MCL and LCL, ultrasounds are AMAZING)

Q: MRI is the BEST tool to visual these types of ligaments

TRUE!! (however, when it comes to the MCL or LCL, ultrasounds are AMAZING because you can perform dynamic tests)

True or false: you cannot see deep intra-articular ligaments with ultrasound

PT-ordered imaging will not get reimbursed by insurance

What is an unfounded concern by PT's that is NOT consistent with evidence when it comes to ordering imaging?

T2 MRI

Q: fluid is BRIGHT on this MRI sequence

T1 MRI

Q: fat is bright under this MRI

Radiolucent (ex: air)

Q: these tissues show up dark on plain film due to low density

1. DPT degree

2. Board certification specialization (OCS)

3. Fellowship/residency

Q: to order a plain film study in the state of WI, a PT must hold the following...

Radiation

Q: MRI is very safe in that is does not emit __________

Fluoroscopy

Q: these video x-rays are commonly used in the operating room

Colorado, DC, Maryland, Utah, NJ, WV, Iowa (2023)

Q: these states permit a PT from not only ordering plain films but also MRI

Iowa

Bonus: which state most recently granted PT's the right to order plain films AND MRI?

American College of Radiology (ACR) Appropriateness Criteria

Q: gold standard in decision making for ordering imaging studies

VOMIT and BARF

Which acronyms describe the over-utilization and inappropriate use/interpretation of imaging?

Brainless Application of Radiological Findings

What does 'BARF' stand for?

Victim of Medical Imaging Technology (note: the image is slightly off what we learned in class)

What does 'VOMIT' stand for?

Board Certified Specialists

Q: Mabry et al, 2022 publication identified this group as having the strongest imaging skill performance across the PT profession

Diagnostic ultrasound

Q: this imaging modality has the lowest student competency rate for faculty evaluation

Chest x-ray

Q: a coast to coast flight is similar in radiation exposure dose to which imaging modality

Air + bone = radiolucency

Bone + bone or bone + organs = radio-opaque

In terms of superimposition, air upon bone creates more ________ while bone on bone or organs on bone creates more ________

View: AP

Structure: left shoulder

State the type of view and structure being depicted.

View: right lateral

Structure: right knee

State the type of view and structure being depicted.

View: PA

Structure: left wrist

State the type of view and structure being depicted.

View: PA

Structure: left hand

State the type of view and structure being depicted.

View: PA

Structure: chest

State the type of view and structure being depicted.

Femur shifted MEDIALLY over tibia; patella shifted SUPRALATERALLY; bone spur on the lateral tibial plateau

Work through your "ABCS". Start with A: alignment.

- General architecture (aberrant size, supernumerary, congenital abnormalities, absence, developmental deformities)

- General contour (irregularities, cortical outline, spurs and osteophytes, fracture)

- Alignment related to adjacent bones

In general, what encompasses "A: alignment"? (hint: 3x)

Sclerosis along bilateral tibial plateaus -- more pronounced laterally (hallmark of OA, along with the bone spur noted in "A: alignment")

Work through your "ABCS". Start with B: bone density.

- General (contrast b/w bone and adj. soft tissue, bone vs. bone)

- Textual abnormalities - trabeculae

- Local density changes - sclerosis

In general, what encompasses "B: bone density"? (hint: 3x)

Loss of joint space along the lateral tibiofemoral component. Diminished joint space along the medial side.

Work through your "ABCS". Start with C: cartilage space.

- "Space" can be an indirect assessment of radiolucent cartilage

- Subchondral bone: sclerosis vs. erosions

- Epiphyseal plates

In general, what encompasses "C: cartilage space"? (hint: 3x)

Calcification superior to the patella, Baker's cyst on the posterior side, LOTS OF SWELLING

Work through your "ABCS". Start with S: soft tissue.

- Muscles, atrophy, swelling

- Fat pads and fat lines

- Joint capsules (effusion)

- Periosteum (solid, laminated, sunburst, Codman's triangle)

- Misc. (foreign bodies, calcifications)

In general, what encompasses "S: soft tissue"? (hint: 5x)

S: soft tissue...olecranon bursitis (typically caused by trauma or patients wearing slings due to the rubbing/friction)

Describe the MOST obvious "ABCS" component.

A: alignment...bilateral plantar heel spurs (associated w/ plantar fasciitis)

Describe the MOST obvious "ABCS" component.

A: alignment...femoral neck fracture (the greater trochanter is superimposing on the head)

Describe the MOST obvious "ABCS" component.