Exam 1 Flashcards
Role of PTs play in diagnostic imaging
-recognize need for imaging
- integrate imaging reports into treatment plan
- understand visually to develop treatment and modify treatment plan
- know when imaging is and is not needed for optimal outcome
-communicate effectively with physician, radiologist
Factors of over utilization
-physician self referral
-incomplete evidence
- patients desire
- liability risk
- med student education
Indications for diagnostic imaging
- pt history, systems review, and measures make it evident that further diagnostic is needed
- if imaging results will change the course of treatment or alter the outcome of the problem
- in the absence of appropriate response to PT
Types of imaging modalities
Radiographs (x-ray)
Nuclear imaging
MRI
Ultrasound
Conventional and computed tomography
Can radiographs distinguish the difference between bone, air, calcification, fat, soft tissue and fluids
Yes
Are radiographs good at detecting early stress fractures
No
What is a: injection into specific artery to demonstrate blood flow
Ateriography
What shows upper GI tract
Barium swallow
Who looks at: gall bladder, urograms, pyelograms, cystograms
Cholecystography
What contrast study is this: injected into joint. May be used with other media such as MRI and CT
Arthography
Contrast material injected into subarachnoid space to look at the spinal cord, nerve roots and dura mater is what
Myelography
For radiographs more x-ray beam absorbed means the tissue has greater what
Radiodensity
Form an AP view will the lateral borders or the middle of the bone be more radiopaque
Lateral borders because it is “thicker”
When an object absorbs the X-rays fewer photons produced, film stays light what is this
Radiopaque
X-rays not absorbed, screen produces photons when struck, and exposes the film, turning it dark is what
Radiolucent
When were x-rays discovered
1895
In a radio graph air is what color
Black
In a radiograph fat is what color
Grey-black
What color is water on a radio graph
Grey
What color is bone on a radiograph
White
What color is contrast media or heavy metal on a radiograph
Bright white
What does the ABC’s pattern stand for
Alignment
Bone changes
Cartilage spaces
Soft tissues
When checking bone density in the vertebral column where should you look
Segments above and below
Decreased joint space implies what on a radiograph
Cartilage or disk thinning
Subchondral bone changes indicates what
RA or gout, decrease reparative sclerosis and create cysts
Lipohemarthrosis- Fat-blood interface (FBI)
-Fat floats on surface of blood
- should left you to intra-articular fracture
What are the 7 elements to describe a fracture
- anatomic site and extent
- type
- alignment of segments (from anatomical position)
- direction of fracture
- special features
- presence of abnormalities such as dislocated joint
- special types of fracture
Salter Harris fractures are named from what position
Anatomical position
Salter Harris fractures classifications
1- separated
2 - above
3 - lower
4- through
5 - rammed
Most common sites of traumatic injury in C spine
C1-C2 and C6-C7
Commonly missed fractures
C1-C2, C6-C7, scaphoid and femoral neck
Signs of RA using ABCS
A - B joint involvement, MCP subluxation and ulnar deviation, swan neck or boutonnière deformity in IPs, acetabular profusion of hip
B - localized area of decreased bone density; periarticular osteoporosis
C - Articular cartilage erosion, joint space narrowing, subchondral erosions, subchondral cysts or synovial pseudocysts
S - periarticular swelling of joints
Two types of degenerative joint disease
Primary - idiopathic
Secondary - result of injury
Radiologic signs of OA using ABCS
A - unilateral involvement, heberdens nodes DIP, Bouchard nodes PIP
B - Sclerotic subchondral bone
C - loss of articular cartilage w joint space narrowing
S- joint effusion
Heberdens nodes are where
DIP
Bouchard’s nodes are where
PIP
Types of bony reactions
Sclerosis
Buttressing
Periosteal
What is sclerosis
Bone growth to fortify an area subjected to increased stress
What is buttressing
Formation of bony exostosis or osteophytes to strengthen architecture of joint
What is periosteal
Solid, laminated (onion skin), speculated (sunburst), Colman’s triangle
Types of abnormal periosteal reactions
- solid
- laminated or onion skin
- speculated or sunburst
- Codman’s triangle
What is nuclear imaging
Pt is injected with a radioactive substance that collects in areas of increased metabolic activity
Both PET and SPECT are nuclear medicine imaging techniques that provide metabolic and biochemical function of your ____ and _____ ( CT and MRI unable)
Tissues and organs
Diagnostic imaging is effective at imaging what
Superficial soft tissue strictest such as muscle, tendon, ligament nerve and foreign bodies
Hypoechoic is what
Tissue that reflects little energy produce dark image
Hyperechoic is what
Tissue that reflects much energy. Produce bright images
Is bone hyper or hypoechoic
Hyeperechoic
Are tendons hyper or hypoechoic
Hyper
Are ligaments hyper or hypoechoic
Hyper
Is fat hyper or hypoechoic
Hypo
Advantages of US
- higher resoluation
- low cost and portability
- no known hazards
- a lot more
Disadvantages of US
- limited ability to show joint surfaces and intra-articular structures
- only shows cortical outline of bone
- obese pt not imaged well
- metal not imaged well
Etc
What is this : exposes patients to higher doses of ionizing radiation but is confined to smaller areas
CT
Lateral views of a CT scan are called what
Sagittal views
Benefits of CT
- best for identify subtle or complex Fx
- best for eval of degenerative bony changes
- often 1st imaging choice in trauma
- CT excels in eval of spinal stenosis
Etc
CT negatives
- CT has limited ability to differentiate between types of soft tissues (tendon, ligaments)
- higher doses of radiation
- price
MRI absolute contraindications
Ferry magnetic implants
MRI relative contraindications
- PT intolerance due to claustrophobia
- inability of patient to remain motionless during scan
- expensive
MRI best at diagnosing _____
Disk herniations
Disadvantages of MRI
- Long scanning times
- expensive
- ferromagnetic implants
- claustrophobia
