Module 2 Evaluation Procedures in Diagnostic Imaging

What is Error of Observation?

Incomplete or faulty search patterns

What is Error of Interpretation?

Practitioner’s failure to link radiographic findings to clinical data

Why should we use a “search pattern” when looking at imaging?

To visually examine for abnormalities

What is the common approach to reviewing x-ray images?

ABC’S

What do the ABC’S stand for?

A - Abnormalities
B - Bone Density
C - Cartilage Spaces
S - Soft Tissues

What is A - Alignment?

The overall shape and contour of an anatomical structure

What are 3 main components when viewing Alignment?

General Skeletal Architecture
General Contour of Bones
Alignment of Bones to Adjacent Bones

True or False: Looking at Alignment can help identify fractures, dislocations and subluxations

True

What is B - Bone Density?

The observation of the contrast between bone and soft tissue and the dense cortical and less dense cancellous bone

What are the 3 main components when viewing Bone Density?

General Bone Density
Texture
Local Bone Density changes

What are some texture abnormalities that can be seen by viewing Bone Density?

Fluffy (random osteoblast/clast formation)
Smudged (Osteomalacia)
Coarsening (Chronic disease states)
Lacy, delicate (Thalassemia)

What are some local density changes that can be seen by viewing Bone Density?

Sclerosis (normal is WB joints; signs of repair)
Excess Sclerosis (site of healing fracture or bone callus or arthritis)
Reactive Sclerosis (when body acts to surround and contain disease area like tumor or infection)

What is C - Cartilage Spaces?

Cartilage itself cannot be view, but the spaces that the cartilage occupies can be. Joint space width can reveal information about if it is narrower or larger than expected

What are the 3 components when viewing Cartilage Spaces?

Joint Space Width
Subchondral Bone
Epiphyseal Plate

What would be a “well preserved” or “decreased” joint space mean?

Well preserved = implies normal cartilage
Decreased = implies thinning or injured cartilage/disk

What would be a “increased sclerosis” or “erosion” subchondral bone mean?

Increased sclerosis = DJD, articular cartilage loss
Erosion = inflammatory arthritis, gout, radiolucent cysts

When looking at the Epiphyseal Plates, what do we look for exactly?

Position, Size and Borders

What is S - Soft Tissues?

Soft tissues are difficult for distinction, however, gross changes can be observed. Therefore checking for symmetry, muscle wasting, swelling or inflammation, fat pad lines, foreign bodies, and calcifications

What are the 5 categories for viewing Soft Tissue?

Muscle
Fat Pads & lines
Joint Capsule
Periosteum
Miscellaneous Findings

If fat pads are evident on x-ray, is this normal?

No, usually due to swelling

True or False: Joint capsules become visible when distended due to effusion

True

What would a solid vs laminated periosteum indicate?

Solid = indicates a slow growing process seen in healing fractures or osteomyelitis
Laminated (onionskin) = indicates reparative injury (such as Ewing Sarcoma)

What does it mean when a lesion affects on bone or joint?
Multiple?
Nearly all?

Monoarticular
Polyarticular
Diffuse

Behavior of a Lesion could be Osteoblastic or Osteolytic. What do those mean?

Osteoblastic = new or reactive bone present (increased radiodensity - white)
Osteolytic = bone being destroyed (radiolucency - black)

Margin of a Lesion could be Sharp or Poorly Defined. What do those mean?

Sharp = usually slow growing, benign; the body has had time to adapt and thicken borders
Poorly Defined = no reactive sclerosis present, lesion is growing fast

True or False: Infections do not cross joint spaces or growth plates, however Tumors (lesions) do cross

False; Tumors (lesions) do not cross joint spaces or growth plates, however Infections do cross

What are some broad classifications of skeletal disease?

Congenital
Inflammatory
Metabolic
Neoplastic
Traumatic
Vascular

What is Rheumatoid Arthritis?

inflammatory connective tissue disease affecting synovial joints

What are the main characteristics of RA seen on imaging?

Periarticular swelling
Articular erosions
Joint space narrowing
Periarticular osteoporosis
Telescoping (digits)
Joint deformities
Cervical Spine (C1/2- 3mm subluxation)

What are the main characteristics of OA seen on imaging?

Joint space narrowing
Subchondral sclerosis
Osteophyte formation
Cysts of pseudocysts

True or False: RA is symmetric joint space narrowing

True

True or False: RA presents with osteophytes

False; OA

True or False: Joint effusion is more common in RA than OA

Truem

True or False: Joint subluxations are uncommon in OA

True; more common in RA

True or False: Subchondral cysts are common in OA

True

What is Hallmark patterns of RA?

Symmetric/concentric joint-space loss
Erosions
Periarticular osteopenia
Soft-tissue swelling

What is Hallmark patterns of OA?

Asymmetric joint-space loss
Subchondral sclerosis
Osteophytes

What is Osteoporosis?

A metabolic bone disease characterized by decreased osteoblastic activity with increased osteoclastic resorption of bone. This results in decreased overall bone mass and density, while the amount of bone is decreased and the bone has normal mineralization.

What is Hallmark patterns of Osteoporosis?

Generalized osteopenia
Cortical thinning
Increased fracture risk
Trabecular changes (diminished in # and thickness)

What is the Hallmark sign of Osteoporosis on a radiograph?

Increased radiolucency (Osteopenia specifically)

What could be the earliest radiographic sign of MSK infection, preceding obvious osseous changes?

Soft-tissue swelling

Musculoskeletal infections gain entry into the body in 3 main ways:

Direct implantation
Contagious adjacent tissues
Blood stream

What is the chief imaging modality for the evaluation of bone tumors?

Conventional radiograph

What is the Heading component of the radiographic report?

Includes facility information, patient information, and radiographic information. 

What is the Clinical Information component of the radiographic report?

This section includes a summary of the relevant patient history and indications for the diagnostic imaging based on presentation and laboratory findings.

What is the Findings component of the radiographic report?

This is the body of the report and is presenting a narrative of the radiological abnormalities or normal appearance. Often divided into ABC’S paragraphs

What is the Conclusions/Impressions component of the radiographic report?

This section labels the conditions, and a diagnosis is reported. This section will also report on the seriousness of the condition

What is the Recommendations component of the radiographic report?

This section may be used to suggest other imaging modalities, laboratory assessments, or referral to other healthcare providers

What is the Radiologist Signature component of the radiographic report?

All reports must be signed by the radiologist and provided credentials.