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PTRS 746 Musculoskeletal > Imaging > Flashcards

Imaging Flashcards

1
Q

Errors of Observation/Interpretation

A

Errors in detecting and diagnosing pathologies in imaging that are there but are missed, or saying something is there that is not.

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2
Q

True Positive

A

Detects something that really IS there

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3
Q

False Positive

A

Detects something that really it NOT there

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4
Q

True Negative

A

Detects nothing when nothing is there

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5
Q

False Negative

A

Detects nothing when something is there

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6
Q

Specificity

A

Ability for test to detect true negatives. Example - if X-ray detects a fracture, there really is a fracture there. (SPIN)

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7
Q

Sensitivity

A

Ability for test to detect true positives. Example - MRI does not detect soft tissue injury so there is no soft tissue injury. (SNOUT)

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8
Q

X-ray Advantages

A
  • Time/cost effective
  • Non-invasive
  • Low exposure risk
  • Good for initial screening
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9
Q

X-ray Disadvantages

A
  • May miss diagnosis of pathology that really is there.
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10
Q

X-ray Attenuation

A

Reduction of X-ray beam’s density/strength as is it passes through a medium.

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11
Q

X-ray Permeability

A

Ability of the X-ray beam to pass through a medium and reach the film plate.

Example - Air is more permeable than bone.

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12
Q

X-ray Radiodensity

A
  • Ability for X-rays to be absorbed by a structure.
  • Based on structure’s density, composition and thickness
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13
Q

Radiodensity relationship

A
  • Radiodensity of an object is inversely related to the amount of blackening on X-ray film
  • Example - bone is more radiodense (shows up white on film) than air (shows up black on film)
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14
Q

Photographic Qualities

A

Refers to the visibility of an image

-Density, contrast

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15
Q

Geometric Qualities

A

Refers to the clarity of an image

  • Detail, distortion, foreshortening, magnification
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16
Q

Density

A

Amount of blackening on the film.

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17
Q

Contrast

A

Differences in color (density) of nearby structures.

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18
Q

Detail

A

Sharpness or resolution of image. Structures closest to the film plate have more detail.

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19
Q

Distortion

A
  • Structures farther from the film plate or beam source have clarity issues.
  • Occurs due to distance between the beam source, patient and image receptor (film)
  • May also be caused by alignment and patient positioning issues
20
Q

Foreshortening

A

Image appears shorter and wider than it actually is.

21
Q

Magnification

A

Structures farther from the film appear larger than structures closer to the film.

22
Q

X-Ray Views

A
  • Anterior/Posterior (AP)
  • Lateral/Oblique
  • Special
23
Q

Radiology ABCs

A

A - Alignment

B - Bone Density

C - Cartilage

S - Soft tissue

24
Q

A - Alignment

A
  • Gross size of bones
  • # of bones
  • Shape of cortical bone outline
  • Joint position/alignment
25
B - Bone Density
- Cortical bone = dense; Medullary/Cancellous bone = less dense - Weight bearing surfaces are more dense - "Washed out" bone indicates osteoporosis - Sclerosis (hardening/thickening of bone) indicates arthritis or RA
26
C - Cartilage
- Joint space - Subchondral bone integrity - Joint margins (smooth or rough) - Epiphyses and growth plates (esp. children)
27
S - Soft tissue
- Size of musculature/soft tissue - Outline of joint capsules - Periosteum integrity
28
CT Advantages (2)
- Sensitive and specific for fractures - Useful for quick brain/neurological injury assessment
29
CT Disadvantages (3)
- Radiation exposure - Issues with diagnosing histological problems - Small amounts off tissue show up uniformly gray
30
MRI
Magnets cause protons of all cells to align according to electromagnetic field (resonance) that then return to their resting state after EMF is removed.
31
MRI Advantages (4)
- Good sensitivity - Great for soft tissue images - No radiation exposure - Little distortion of images
32
MRI Disadvantages
- Expensive - Low specificity - Can't be done on patients with ferrous (iron based) materials in their body (implants, exposure to metal)
33
T1 Images
- How long it takes excited protons to return to resting state - Fat, bone, and hemorrhage are BRIGHT - Fluid/fluid filled structures are DARK
34
T2 Images
- How long excited protons remain "in phase" or aligned with EMF - Fat and bone are DARK - Fluid/fluid filled structures are BRIGHT
35
Contrast MRI
- Contrast media injected intravenously or into joint - Where contrast travels to depends on blood flow - Increased T1 image signals - Compares images before and after contrast administration
36
fMRI
- MRI done to determine which area of the brain is being utilized when the patient is asked to perform or think about specific tasks - Contrast media is deoxyhemoglobin - Dependent on blood flow (increased blood flow to brain area means that area is primarily being used to perform the task)
37
DEXA
- Type of X-ray used to determine bone density and body composition. - Considered the Gold Standard for bone density
38
Nuclear Medicine
- Imaging done with radiographic tracers to diagnose patients - Includes PET, SPECT, and radionuclide scintigraphy
39
Radionuclide Scintigraphy
- Uses label methylene injections - Scan taken 2-3 hours after injection - Looks at areas of bone activity/mineral turnover - Gold standard for stress fracture diagnosis
40
Radionuclide Scintigraphy Advantages (3)
- Very sensitive for early bone and joint diseases (stress fractures, metastatic bone disease) - Fast - Reasonable cost
41
Radionuclide Scintigraphy Disadvantages
- Poor specificity - Easily tricked by areas of high osteoblast activity and blood flow
42
Ultrasound
- Sound waves used to produce image - Most commonly used in OBGYN settings - Can be used by PTs but should be used for confirmation of diagnosis only - Requires a lot of training, technique mastery, and practice to get accurate results
43
Pittsburgh Knee Trauma Decision Rule
X-ray ordered if: 1. Patient has history of fall or blunt trauma AND... 2. Age \< 12 or \>50 AND/OR... 3. Inability to walk 4 steps in ER
44
Ottawa Knee Rule
X-ray ordered if: 1. Age \>55 2. Tenderness at fibular head 3. Isolated tenderness to patella 4. Inability to flex knee to 90 5. 5. \*\*Inability to walk 4 steps after injury or in ER
45
Ottawa Ankle Clinical Decision Rule
- Patient must have pain in the malleolar area AND - Point tenderness of posterior aspect/tip of medial malleolus OR - Point tenderness of posterior aspect/tip of lateral malleolus OR - Inability to walk 4 WBing steps after injury and in ER
46
Ottawa Foot Clinical Decision Rule
- Patient must have pain in the midfoot area AND - tenderness at the base of 5th metatarsal OR - tenderness at the navicular bone OR - Inability to WB for 4 steps after injury and in ER

PTRS 746 Musculoskeletal (9 decks)

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