Imaging Flashcards
According to the Canadian C-Spine Rule (Ottowa), What are High risk factors that mandate radiography?
- Age over 65
- Dangerous injury mechanism
- Extremity paresthesias
(Dangerous injury mechanism includes:
-Fall from elevation of >3ft
- Axial load to head (ex. diving)
- Car accident with the car going >65mph, car rollover, or person ejected form car
- Injury involving recreational vehicles
- Bicycle collision)
According to the Canadian C-Spine Rule (Ottowa), What are low risk factors that allows safe assessment of ROM, what can this tell you?
- Simple rear-end vehicle collision
- Normal sitting position in ED
- Able to walk at any time since injury
- Not immediate onset of neck pain
- No midline cervical spine tenderness
If not, refer for radiography
According to the Canadian C-Spine Rule (Ottowa), What happens if the patient cannot actively rotate their neck 45° left and right?
Refer to radiography
When should a person with a Thoraco-Lumbar spine trauma be referred for imaging?
If presented with:
- High-energy mechanism of injury
- Back pain or pain on palpation with movement
- Neurological signs of Thoraco-lumbar (TLS) injury
- Concomitant C-spine injury
- Altered mental status
- Evidence of intoxication
What happens if the thoraco-lumbar patient had a high-energy mechanism of injury and a normal physical examination?
Then that person has a low risk of TLS (Thoraco-lumbar spine) injury but monitor.
What happens if the thoraco-lumbar patient had a high-energy mechanism of injury, an abnormal physical examination, and had neurological deficit persistent with pain with motion?
Refer patient to have CT + MRI
What happens if the thoraco-lumbar patient had a high-energy mechanism of injury, an abnormal physical examination, but did not have neurological deficit persistent with pain with motion?
CT or radiographs
If this shows to be abnormal look for indications for MRI
(Indications include:
- Unstable fracture; document instability
- Neurological deficit
- Suspicion of ligamentous injury
If a person has back pain only, when should they get imaging?
If the person has red flags, they should get a radiograph
- if the cause of pain is uncertain they should get an MRI (If the MRI is contraindicated or not available then do CT.
If a person has back pain with neurological signs and symptoms, when should they get imaging? (Sciatic, Cauda Equina, Spinal canal stenosis)
- If its sciatic or radiculopathy, initial try to manage, if no improvement do imaging (MRI)
- If possible cord/cauda Equina, urgent imaging (MRI), if not available or contraindicated CT or myelography
- Possible Spinal Canal Stenosis, imaging may be indicated (MRI)
If a person has chronic shoulder pain with neurologic pain (Brachial plexus, cervical disk), should they be referred for imaging, if so what imaging?
Yes they should be referred to MRI
If a person has chronic shoulder pain with Osteoarthritis or Osseous lesion, should they be referred for imaging, if so what imaging?
They should get a shoulder radiograph, if no cause of pain found or further evaluation is needed, then they should get MRI
If a person has chronic shoulder pain with instability or possible Labral tear, should they be referred for imaging, if so what imaging?
Yes they should get an MRI + MR Arthrograph
If a person has chronic shoulder pain with Adhesive Capsulitis (frozen shoulder), should they be referred for imaging, if so what imaging?
Yes, they should get an MRI to confirm and check Rotator cuff as well
If a person has chronic shoulder pain with suspected impingement, or rotator cuff pathology, should they be referred for imaging, if so what imaging?
Firstly are they a surgical candidate,
- Confirm with ultrasound
If a patient presents negative in the radiograph but you suspect them of having a scaphoid fracture or a major ligament injury, should they be referred to imaging?
Yes, if the MRI and CT are available.
If both MRI and CT are not available, the patient can be immobilized and repeat the radiograph; if patient has ongoing symptoms ->MRI
