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ClinMed Final > Imaging Introduction > Flashcards

Imaging Introduction Flashcards

1
Q

Why do we study imaging as PTs?

A
  • Adds to our examination and evaluation (helps us rule out and rule in)
  • Assists with intervention
  • Contributes to prognosis (Ex: how advanced the arthritis, osteoarthritis, etc. is to help determine pain level explanation)
  • Better communication of involved parties
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2
Q

What kind of interventions can imaging help PTs with?

A
  • Motion barriers (ex: bone spurs)
  • Weight bearing or functional levels (ex: looking for that bony callus from clinical union)
  • Location (ex: bone stimulator - where the fracture is so you know where the bone stimulator goes)
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3
Q

What is “routine radiographing”?

A
  • Typically the first imaging preformed (x-ray)
  • Ex: bone break you do an X-ray
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4
Q

What is the major advantage of routine radiographs?

A

It is the most efficient for INITIAL assessment of bone or joint abnormality

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5
Q

What is the major disadvantage of routine radiographs?

A

It is limited for complex and subtle bony abnormalities

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6
Q

What are routine radiographs also called?

A

Commonly referred to as plain films, films or x-rays

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7
Q

How many images are needed and at what degrees when taking an x-ray or a routine radiograph?

A

At least two images at 90 degrees are needed to view all 3 dimensions

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8
Q

One view is _____ view.

A

NO

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9
Q

The standardized positions and views of x-rays help with:

A
  • Greatest visualization
  • Minimize radiation exposure
  • Projection of x-ray beams
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10
Q

What are the options for the projection of x-ray beams?

A
  • Anterior to posterior (AP)
  • Posterior to anterior (PA)
  • Lateral
  • Oblique
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11
Q

Which projection is greater for projection, AP or PA?

A

Anterior to posterior (AP) > Posterior to anterior (PA)

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12
Q

When x-ray beams enter the body what happens at the tissue level?

A

X-ray beams are absorbed by the tissues at differing amounts

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13
Q

What color do x-ray beams produce when they enter the body?

A

Produce shades of gray

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14
Q

Where does the x-ray beam go when it emerges from the body?

A

Onto an interpretation device or image receptor

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15
Q

What color is air on an x-ray?

A

Black

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16
Q

What color are fat and bone marrow on an x-ray?

A

Black/ gray

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17
Q

What color are water; muscle and soft tissue on an x-ray?

A

Gray

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18
Q

What color is bone on an x-ray?

A

White

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19
Q

What color are contrast dyes on an x-ray?

A

Bright white

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20
Q

What color are metals on an x-ray?

A

Solid white

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21
Q

How are you supposed to view an x-ray that was taken in an AP and PA projection?

A

As if the patient was facing you and in anatomical position

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22
Q

What body parts are the exception to the viewing rule when looking at AP and PA x-rays?

A
  • Hands and feet are viewed with the toes and the fingers pointing up
  • These will be the same as your personal hand or foot
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23
Q

How are you supposed to view an x-ray that was taken in a lateral projection?

A

In the path of the beam

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24
Q

How many markers should you identify when viewing a radiograph and what are some examples?

A
  • Identify 2 markers
  • Projected health information (ex: name)
  • Side of the body with R or L (do NOT orient the slide marker to obtain the correct letter position)
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25
Q

What are the ABCS of a radiograph?

A
  • Alignment
  • Bone Density
  • Cartilage Space
  • Soft Tissue
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26
Q

Alignment is seen in what aspect of a radiograph?

A
  • General architecture and anatomy (ex: size, number of bones, etc)
  • General Contour (spurs, breaks, markings)
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27
Q

Bone density is described as the contrast between _____ and _____ _____.

A

Bone and Other Tissue

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28
Q

What are the two kinds of bone contrast?

A
  • Cortical
  • Cancellous
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29
Q

Describe cortical bone contrast:

A
  • Outer layer of bone and predominately in appendicular skeleton
  • Denser and whiter
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30
Q

Describe cancellous bone contrast:

A
  • Interspersed within marrow and predominantly in axial skeleton
  • Less dense and grayer
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31
Q

Bone density helps us see what kind of changes to the bone?

A

Texture/ local density like sclerotic changes

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32
Q

What are sclerotic changes?

A

Increased bone density that may be abnormal or normal

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33
Q

With cartilage spaces in x-rays, what are you typically looking for?

A
  • Narrowing
  • Subchondral bone sclerosis (body is trying to repair damaged bone) and erosion)
  • Epiphyseal plates - position, size, and smooth margin
34
Q

What are you looking for on an x-ray when it comes to soft tissue?

A
  • Muscle wasting and edema
  • Fat pad displacement
  • Capsular effusion
35
Q

What is periosteum and what part of the ABCS is it apart of?

A
  • Bone covering that shows up as a soft tissue shadow
  • The “S” - soft tissue
36
Q

If the periosteum is solid what does this mean?

A

Indication of a slow growth of healing or infection

37
Q

If the periosteum is laminated or layered what does this mean?

A

Indication of repetitive stress

38
Q

If the periosteum is spiculated (needle like) or pointed what does this mean?

A

Indiction of breakthrough due to a tumor

39
Q

What is the Codman’s Triangle?

A

A raised periosteum with any of the following conditions: Solid, Laminated, Layered, Spiculated, or Pointed

40
Q

What are other common MSK imaging techniques besides radiographs?

A
  • Computed Tomography (CT)
  • Magnetic Resonance Imaging (MRI)
  • Ultrasound (US) Imaging
41
Q

What is a CT?

A

Images generated by computerized and targeted x-rays passing through slices of tissue (.1 to 10 mm thick)

42
Q

What are the major advantages of a CT?

A
  • Less overlap of structures due to slicing
  • Able to locate subtle bone changes
43
Q

What are the major disadvantages of a CT?

A
  • Greater radiation exposure but getting faster and safer
  • Limited with soft tissue abnormalities
44
Q

What can help add more detail to a CT?

A

Contrast agents

45
Q

What is the standard modality for head and abdominal trauma in the ER due to shorter scanning times and quicker availability?

A

CTs

46
Q

Are CTs or MRIs quicker?

A

CTs… they are also quicker than US

47
Q

CTs start with what kind of image?

A

A Scout image

48
Q

Scout images help you to locate what?

A

Locate specific slide position and image

49
Q

A CT produces what plane slice images? (Sagittal, transverse, frontal)

A

Transverse

50
Q

During a CT that patient is placed in supine so the image that is produced has the _____ surface at the top and the _____ surface at the bottom of each image slice.

A

Anterior at the top, posterior at the bottom

51
Q

When looking at a CT you are looking upward at the anatomical structures from below so your _____ is the patients _____.

A

Your right is the patients left and vice versa

52
Q

If you have a sagittal plane sliced CT image how would you view it?

A

Sagittal plane slices are viewed from left to right

53
Q

T/F: Tissue density on a CT appears like the tissue density shades on an x-ray.

A

True

54
Q

What is an MRI?

A

Strong magnetic field with radio-frequency waves

55
Q

What similarities does an MRI have with a CT?

A
  • Generates thin slices
  • May also be used with contrast agents for even more detail
56
Q

What are the major advantages from an MRI?

A
  • Less overlap like a CT due to slicing
  • Excellent in finding soft tissue abnormalities, cancellous bone/ bone marrow conditions (neoplasms and staging metastasis, osteochondral lesions, stress fractures)
  • No radiation like with a CT (high) and X-ray (low)
  • High resolution
57
Q

What are the major disadvantages from an MRI?

A
  • Contraindications with magnetic implants except for stable joint implants
  • Precaution with claustrophobia
58
Q

How do you view an MRI?

A
  • The same way you would a CT
  • Orient yourself to the scout image to find the slice you need
  • View as with the CT
59
Q

When diagnosing someone using an MRI it is often based off of differences seen in what?

A

T1 and T2 images

60
Q

How can you tell the difference between a T1 and T2 image?

A
  • Look for known areas of normal fluid first (ex: bladder, synovial joints, cerebrospinal fluid)
  • If fluid is bright, it is likely a T2 image
  • If fluid is dark, it is likely a T1 image
61
Q

What will a T1 weighted image look like and what is it best used for? (bone, fat, etc.)

A
  • Bright signals from fat and bone marrow
  • Dark signals from cortical bone and fluid
  • Best for demonstrating anatomical definition of structure
62
Q

What will a T2 weighted image look like and what is it best used for? (bone, fat, etc.)

A
  • Bright signal occurs from fluid and water
  • Best for demonstrating swelling and neoplasms particularly in cancellous bone
63
Q

Nerve and muscle have an intermediate signal and are often _____ with both T1 and T2 weighted images. (color)

A

Gray

64
Q

Slide 48 and 49 have tables for T1 vs T2 images and coloring that will come with it and conditions

A

Look at the tables! These might be important!

65
Q

What is an ultrasound or sonography?

A

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

66
Q

What are the major advantages for an ultrasound or sonography?

A
  • Offers real time information for superficial soft tissue
  • Higher resolution for superficial tendon, ligament, and muscle then MRI
67
Q

What are the major disadvantages for an ultrasound or sonography?

A
  • Inability to scan deeper joint structures
  • Image quality highly dependent on operator
68
Q

If there is a brighter signal on a sonograph what does this mean?

A

Indicates swelling, tendinosis (fibrosis/ degeneration), aka hyperechoic appearance

69
Q

If there is an irregular border or lack of structure on a sonograph what does this mean?

A

Indicates a tear(s)

70
Q

If there is a wider structure on a sonograph what does this mean?

A

Indicates swelling and thickening

71
Q

Slide 55 has a chart on abnormal and normal sonograms, look at this!

A
72
Q

Slide 56 has a chart on US vs CT vs MRI… may be helpful

A
73
Q

If there is no trauma, will the results of any imaging influence interventions or psychosocial factors?

A

Most likely no

74
Q

What is imaging benefitted by?

A

A thorough history and exam

75
Q

What are the clinical decision rules for imaging?

A
  • Following trauma based on supportive clinical findings
  • Diagnostic and prognostic decisions
  • Evidenced based with research
76
Q

What is the appropriateness criteria for imaging?

A
  • Foremost decision- making guideline
  • Guides choice of best imaging tool
  • Developed by expert radiologists
  • May use with or without trauma
77
Q

What are factors for decision making for MSK conditions in regards to imaging?

A
  • Age: individual risk factors including PMH
  • Trauma presence/ absence
  • Mechanism of injury
  • Prior surgery/ injury/ imaging results
  • Clinical findings, particularly pain provocation and function (ex: weight bearing ability)
78
Q

Imaging without clinical findings is considered to be …

A

Normal/ asymptomatic

79
Q

Imaging is (+) when it has …

A

matching clinical findings

80
Q

Imaging can be negative with clinical findings of a condition, what is an example?

A
  • Suspicious condition (ex: acts like a fracture but x-ray (-) so consider a more advanced and specific image, like a CT)
  • No structural changes and more of a biomechanical or overuse etiology
81
Q

Imaging can be positive without matching clinical findings, what is an example?

A
  • Unrelated contributions to symptoms
  • Potential negative effect on psychosocial status (fear of activity, failure to work, limit rehab potential)
82
Q

Is imaging best at ruling out or ruling in?

A

Ruling out

ClinMed Final (4 decks)

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