Diagnostic Imaging

Question 1

Why is diagnostic imaging lower on an evaluation algorithm?

Answer 1

• it could bias the evaluation process
• should support the evaluation, not form it
• it is considered as a special test

Question 2

How many views should you get when ordering diagnostic imaging?

Answer 2

At least two

Question 3

What views should you get for the lumbar spine?

Answer 3

anterior-posterior and lateral (not oblique)

Question 4

Should you get AP or PA views when imaging for scoliosis? Why?

Answer 4

PA… there is a 3-7x reduction in lifetime ionizing radiation

Question 5

definition: film comes out as black/grey due to the lack of absorption of ionizing radiation in LESS dense materials

Answer 5

radiolucent

Question 6

definition: film comes out as white due to the absorption of ionizing radiation in MORE dense material

Answer 6

radiopaque

Question 7

definition: when the bone becomes more dense due to calcium deposition to the area causing the bone to become thicker/stronger

Answer 7

osteoblastic activity

Question 8

definition: when there is a depletion of calcium making the bone weaker/thinner

Answer 8

osteoclastic activity

Question 9

What type of radiograph activity is radiopaque (whiter) indicating an increased radiodensity? Osteoblastic or osteoclastic?

Answer 9

osteoblastic

Question 10

What type of radiograph activity is radiolucent (darker) indicating a decreased radiodensity? Osteoblastic or osteoclastic?

Answer 10

osteoclastic

Question 11

What has the highest radiodensity?

Answer 11

heavy metals

Question 12

What has the lowest radiodensity?

Answer 12

air

Question 13

What does the acronym ABCs stand for?

Answer 13

Alignment
Bone density
Cartilage spaces
Soft tissues

Question 14

What is important about spaces between the bones?

Answer 14

it can give information on how healthy the surrounding soft tissue is

–> decreased space can be indicative of OA

Question 15

(true/false) When looking at radiographs, you should look at the most obvious things first.

Answer 15

False

Question 16

What can you see on a radiograph that can be an indication of a fracture?

Answer 16

lightening bolts in the periosteum and cortex

Question 17

What could a twisting line on a bone be instead of a fracture?

Answer 17

it could be a nutrient artery going into the bone

Question 18

What are looked for when inspecting the alignment of the spinal column?

Answer 18

Spinal lines

Question 19

What are the spinal lines?

Answer 19

anterior spinal line
posterior spinal line
spinolaminal line
spinous process line

Question 20

When looking at a tag in a radiograph, if the ball-bearings are in the middle, what position was the photo taken in?

Answer 20

NWB

Question 21

A Hangman’s fracture is a fracture in the ____ vertebrae.

Answer 21

C2

Question 22

A clay shoveler’s fracture is a fracture in the ____ vertebrae.

Answer 22

C6/C7

Question 23

Describe a Grade I fracture.

Answer 23

Fracture is only through the physis

Question 24

Describe a Grade II fracture.

Answer 24

fracture is through the physis and metaphysis

Question 25

Describe a Grade III fracture.

Answer 25

fracture is through the physis and epiphysis

Question 26

Describe a Grade IV fracture.

Answer 26

fracture is through the physis, metaphysis, and epiphysis

Question 27

Describe a Grade V fracture.

Answer 27

crush/pressure injury to the physis

Question 28

What are characteristics of a vertebrae that has arthritis?

Answer 28

Bumps/bone spurs/beaking Rough surface Vertebral bodies begin to look like an hourglass Can start in mid-20s

Question 29

definition: imaging that uses radio frequency impulses in a magnetic field with a small amount of radiation

Answer 29

MRI

Question 30

MRI works by alignment of nuclei with an odd # of protrons/neutrons (parallel/perpendicular) to the magnetic field

Answer 30

parallel

Question 31

What are T1 weighted images?

Answer 31

fattier contents become white

Question 32

What are T2 weighted images?

Answer 32

Water contents become white

Question 33

What type of weighted MRI best demonstrates anatomic structure?

Answer 33

T1

Question 34

What type of weighted MRI is most helpful in contrasting normal and abnormal tissue?

Answer 34

T2

Question 35

Water, CSF, acute hemorrhage, and soft tissue tumors appear (dark/bright) on a T1 MRI and (dark/bright) on a T2 MRI.

Answer 35

dark, bright

Question 36

What type of radiography is the most sensitive method for detection of early osteonecrosis?

Answer 36

MRI

Question 37

What type of radiography is the most sensitive method for detection PCL?

Answer 37

MRI

Question 38

What type of radiography is the most sensitive method for detection of occult fractures?

Answer 38

MRI

Question 39

What percent of subjects > 40 y/o have an abnormality found in their c-spine on an MRI?

Answer 39

28%

Question 40

What percent of subjects < 40 y/o show evidence of lumbar disc herniation with MRI imagining?

Answer 40

20-30%

Question 41

What percent of subjects > 60 y/o show evidence of degeneration and bulging of one or more lumbar disc on an MRI?

Answer 41

93%

Question 42

What percent of patients cannot tolerate MRI machines due to claustrophobia?

Answer 42

10%

Question 43

What diagnostic imaging is great for identifying spinal lesions?

Answer 43

CT

Question 44

What diagnostic imaging demonstrates bony abnormalities better than any other study?

Answer 44

CT

Question 45

What diagnostic imaging is valuable for evaluating the following: - C1/C2 subluxation - subtalar joint and coalitions

Answer 45

CT

Question 46

definition: Uses marker (Technetium-99m phosphate) to reflect increased blood flow & metabolism/metabolic uptake

Answer 46

bone scans (nuclear medicine tests)

Question 47

What diagnostic is very useful in diagnosis of subtle fractures, avascular necrosis, decreased bloodflow, osteomyelitis, THA/TKA loosening?

Answer 47

bone scan (nuclear medicine tests)

Question 48

What ultrasound transducer is a mid-range transducer?

Answer 48

linear

Question 49

What ultrasound transducer is used for deeper structures (hip joint, fetus, etc)?

Answer 49

curved linear

Question 50

What ultrasound transducer is used when looking at very superficial structures?

Answer 50

compact linear (hockey stick)

Question 51

What is the single most over-requested diagnostic imaging procedure?

Answer 51

lumbar radiography

Question 52

What is not recommended for acute LBP (<1 month)?

Answer 52

lab tests radiographs advanced imaging

Question 53

What are exceptions to order special tests for acute LBP (<1 month)?

Answer 53

age > 50 history of primary cancer unexplained weight loss progressive neurological deficit severe radicular pain suspicion for Fx or infection patient request

Question 54

What is the indication for an oblique projection view of the lumbar spine?

Answer 54

suspicion of a fracture in the pars interarticularis

Question 55

What is it called when a lumbar vertebrae has no anterior migration but the pars interarticularis is fractured?

Answer 55

spondylolysis

Question 56

What is the weakest portion of a vertebrae?

Answer 56

pars interarticularis

Question 57

(true/false) MRI is probably not medically necessary in adult patient with low back pain without neurological deficits AND without signs of serious disease or "red flags" unless surgery is being considered.

Answer 57

true