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Clin Med > Imaging intro - exam 3 > Flashcards

Imaging intro - exam 3 Flashcards

1
Q

why study imaging as a PT?

A

add to examination and evaluation
assist with intervention
–> motion barriers, WB/functional levels, intensity based on the integrity of injury, location
contribute to prognosis
better communication of involved parties

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2
Q

what does radiology utilize and what is it used for?

A

utilizes radiant energy and radioactive substances
used for prevention, diagnosis, and intervention

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3
Q

what is typically the first imaging performed?

A

x-ray

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4
Q

what is the major advantage of x-rays?

A

most efficient for assessing initial bone or joint abnormality

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5
Q

what is the major disadvantage of x-rays?

A

limited for complex and subtle bony and soft tissue abnormalities

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6
Q

how many images are needed to view all 3 dimensions with an x-ray?

A

at least 2 images at 90 deg
“one view is no view”

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7
Q

what is considered standard for positions and views of x-rays?

A

greatest visualization
minimize radiation exposure
projection of x-ray beams
– AP > PA, lateral, oblique

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8
Q

when an x ray enters the body it is absorbed by __________
x-ray beam emerges from patient and onto _______

A

tissues at differing amounts
interpretation device or image receptor

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9
Q

what type of relationship exists between density and an x-ray?

A

inverse
less dense = black
more dense = white

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10
Q

list what you would see on a x-ray and the color of it from least dense to most dense

A

air - black
fat and bone marrow - black/gray
water like muscle and soft tissue - gray
bone - white
contrast dyes - bright white
metal - solid white

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11
Q

how should you place an anterior-posterior and posterior-anterior projection x ray on the viewer? what is the exception to this?

A

place on viewer as if patient were facing you and in anatomical position
exception: hands and feet viewed with toes or fingers pointing up

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12
Q

how should you place a lateral projection x ray on the viewer?

A

in the path of the beam

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13
Q

what are 2 markers on an x ray to help orient yourself?

A

PHI
side of body w a R or L (orientation of this letter does not depict correct position)

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14
Q

what are the ABCS to understanding an x ray

A

alignment
bone density
cartilage space
soft tissues

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15
Q

what are two generalities on a x ray that help with alignment?

A

general architecture/anatomy - size, number of bones, position
general contour - spurs, breaks, markings

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16
Q

is it necessary to always take hardware out after a fracture/dislocation?

A

no, only take out if problematic

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17
Q

what is the outer layer of bone predominately in appendicular skeleton? density? color?

A

cortical (80%)
most dense and white

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18
Q

what is the layer that is interspersed within marrow and predominantly in axial skeleton? density? color?

A

cancellous (20%)
least dense and gray

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19
Q

what are definitive characteristics you see on an x ray to contrast between bone and other tissue?

A

bone contrast
texture
local density (sclerotic changes)

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20
Q

what could you see on a x ray of the cartilage spaces?

A

narrowing
subchondral bone sclerosis and erosion
epiphyseal plates - position, size, smooth margin

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21
Q

what are some characteristics of soft tissue on an x ray/

A

muscle wasting/edema
fat pad displacement
capsular effusion
periosteum

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22
Q

what is periosteum?

A

bone covering that shows up as a soft tissue shadow

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23
Q

what are the 4 types of periosteum?

A

solid - slow growth of healing or infection
laminated or layered - repetitive stress
spiculated or pointed - breakthrough due to tumor
codman’s triangle - raised periosteum with any of the above conditions

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24
Q

What are x-rays best for imaging?

A

bone

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25
Q

what is a CT scan?

A

images generated by computerized and targeted x rays are passing through slices of tissues

26
Q

what are major advantages of CT scan?

A

less overlap of structures due to slicing
able to locate subtle bone changes

27
Q

what are major disadvantages of CT scan/

A

greater radiation exposure
limited with soft tissue abnormalities

28
Q

where is CT scan the standard modality? particularly for what?

A

in ER due to shorter scanning times and quick availability
particularly for head and abdominal trauma

29
Q

what imaging takes less time than MRI and US?

A

CT

30
Q

how do you start to understand a CT image?

A

start with scout image
locate specific slice position and image

31
Q

how do you read transverse plane slices of CT?

A

patient is supine so anterior surface is at the top of each image slice
looking upward at the anatomic structures from below so your right is patient’s left

32
Q

how are sagittal plane slices viewed on CT image?

A

left to right

33
Q

what are MRIs best at looking at?

A

soft tissue

34
Q

how does an MRI work?

A

radiofrequency waves introduced in the presence of strong magnetic fields

35
Q

what are major advantages of MRI?

A

less overlap like CT due to slicing
excellent at soft tissue abnormalities, cancellous bone, staging metastasis
no radiation like with CT and X ray
high resolution

36
Q

what are major disadvantages of MRI?

A

contraindications with magnetic implants except for stable joint implants
precaution with claustrophobia

37
Q

diagnosis from an MRI image is based on differences between T1 and T2. what does that refer to?

A

the time between magnetic pulses and when the image is taken
each type is used to assess different structures or conditions

38
Q

In a T2 image, fluid is ____

A

bright

39
Q

in a T1 image, fluid is _____

A

dark

40
Q

in a T1 image bright signals are from and dark signals are from:

A

bright: fat and bone marrow
dark: cortical bone and fluid

41
Q

what are T1 best for demonstrating?

A

anatomical definition of structure

42
Q

in a T2 image bright signals occur from?

A

fluid and water

43
Q

what are T2 best for demonstrating?

A

swelling and neoplasms particularly in cancellous bone

44
Q

what two structures are often gray in both T1 and T2 images?

A

nerve
muscle

45
Q

how does inflammation present on T1 images? T2?

A

low (dark)
high (white)

46
Q

MRI has high __________ meaning:

A

sensitivity
so good at finding + that when it doesn’t you can really rule conditions out

47
Q

which imaging is the least used?

A

ultrasound

48
Q

how do ultrasound waves construct an image?

A

US waves are absorbed, reflected and diffused differently from varying tissues to construct an image

49
Q

what are major advantages of US?

A

offers real time information for superficial soft tissue
higher resolution for superficial tendon, ligament and muscle than MRI

50
Q

what are major disadvantages of US?

A

inability to scan deeper joint structures
image quality highly dependent on operator

51
Q

what does a brighter signal indicate from an ultrasound?

A

swelling, tendinosis aka hyperechoic appearance

52
Q

what do irregular borders or lack of structure indicate on an ultrasound?

A

tears

53
Q

what does wider structure on an US indicate?

A

swelling, thickening

54
Q

what imaging is excelllent for seeing muscle and tendons?

A

US and MRI

55
Q

what imaging is good/excellent at seeing ligaments?

A

US (good)
MRI (excellent)

56
Q

what imaging is excellent at seeing bone? Good?

A

CT (excellent)
US, MRI (good)

57
Q

what imaging is excellent at seeing cartilage?

A

MRI

58
Q

if there is no trauma, what questions should you consider when deciding whether to recommend imaging or not?

A

will the results of any imaging influence intervention or psychosocial factors?

59
Q

what is the clinical decision rule for determining whether a patient should get imaging or not?

A

follow trauma based on supportive clinical findings
diagnostic and prognostic decisions
evidenced based with research

60
Q

what are factors used for decision making under the appropriateness criteria for imaging recommendation?

A

age
trauma presense/absence
MOI
prior surgery/injury/imaging results
clinical findings, particularly P! provocation and function

61
Q

what are the 4 possible outcomes of what you find on imaging vs your clinical findings?

A
  1. imaging (-) without clinical findings = normal/asymptomatic
  2. imaging (+) with matching clinical findings
  3. imaging (-) with clinical findings
    — suspicious condition, no structural changes w/ symptoms
  4. imaging (+) without matching clinical findings
    — asymptomatic age related changes, unrelated findings contributing to symptoms, potential neg. effects on psychosocial status

Clin Med (7 decks)

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