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Clin Med II - FINAL > Imaging - Lumbar Spine and Hip > Flashcards

Imaging - Lumbar Spine and Hip Flashcards

1
Q

What should we know about the rate of false positives in the lumbar spine?

A

SUBSTANTIAL

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2
Q

What should we know about the correlation of anatomical abnormalities and symptoms?

A

Anatomical abnormalities demonstrate a POOR correlation with symptoms

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3
Q

Who should get imagine with LBP?

A
  • > 50 yrs. of age with a hx of cancer
  • Saddle paresthesias
  • Bowel and bladder dysfunction
  • Specific neurological deficits (spinal n., brain, spinal cord)
  • Progressive/disabling symptoms
  • No improvement after 6 weeks of conservative Rx
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4
Q

What does imaging NOT do?

A

improve outcomes

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5
Q

What do guidelines recommend against?

A

routine imaging

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6
Q

What does black show in a radiograph?

A

air

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7
Q

Wha does grey show in a radiograph?

A

soft tissue

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8
Q

What does white show in a radiograph?

A

bone

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9
Q

What does bright white show in a radiograph?

A

dyes

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10
Q

What does solid white show in a radiograph?

A

metal

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11
Q

How should we view AP and PA projections of images?

A
  • Place on viewer as if patient were facing you and in anatomical position
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12
Q

What is the exception of how to view a AP or PA radiograph?

A

Exception: hands and feet viewed with toes or fingers pointing up

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13
Q

What does a lateral radiograph indicate?

A

in the path of the beam

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14
Q

What should we do to be sure we are reading a radiograph correctly?

A

Identify at least 2 markers
* Protected Health Information i.e., name, etc.
* Side of body with an R or L- do not orient the slide marker to obtain the correct letter position

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15
Q

What should we NOT do with the R/L markers?

A

do not orient the slide marker to obtain the correct letter position

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16
Q

What are the ABCs of a radiograph?

A
  • Alignment
  • Bone density
  • Cartilage space
  • Soft Tissues
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17
Q

What are we looking for with alignment on a radiograph?

A

possible misalignment indicating fx/dislocation and possible cord compromise

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18
Q

What are we looking for with bone density on a radiograph?

A

outer cortical bone brighter white than inner cancellous bone

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19
Q

What are we looking for with cartilage space on a radiograph?

A

narrowing, sclerosis, growth plates

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20
Q

What are we looking for with soft tissues on a radiograph?

A
  • Muscle wasting, capsular distention from swelling
  • Periosteal disruption or raising
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21
Q

What are routine radiograph views of the lumbar spine?

A

AP
Lateral
Right and Left Obliques
Lateral L5, S1

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22
Q

What can we see on an AP view of the lumbar spine?

A

Vertically aligned vertebral bodies
Preserved intervertebral spaces
Midline Spinous Processes:
>Tear drop shaped
>Larger in upper segments
>Smaller spacing in lower segments

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23
Q

What do articular processes present as on an AP lumbar spine radiograph?

A
  • Casts a butterfly-shaped shadow on vertebral bodies
  • Joints not specifically visible but alignment is noted
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24
Q

What do pedicles present as on an AP lumbar spine radiograph?

A
  • Oval densities
  • Equidistance from SPs
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25
Q

What should we see on a lateral view of the lumbar spine on a radiograph?

A

3 ~ parallel lines

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26
Q

What are the 3 parallel line on a lateral lumbar spine radiograph?

A
  • anterior vertebral borders
  • posterior vertebral borders
  • spinolaminar line
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27
Q

What is the spinolaminar line?

A
  • Spinous process and laminae junction
  • Represents posterior extent of central spinal canal
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28
Q

What should the 3 line in a lateral view of the lumbar spine do with movement?

A

Should remain constant whether low back is in neutral, flexed, or extended aka stress views when investigating mechanical instability

29
Q

What do vertebral bodies look like on a lateral view of the L/S?

A

boxed with smooth edges

30
Q

What should we note about the intervertebral disc spaces on a lateral view of the L/S?

A

preserved

31
Q

What intervertebral or lateral foramen is the smallest on a lateral view of the L/S?

A

L5,S1

32
Q

What can we NOT observe on a lateal view of the L/S on a radiograph?

A

L5,S1 due to iliac crest

33
Q

What is a lateral L5,S1 view?

A

Close up of lumbosacral junction

34
Q

What should we see on a lateral L5, S1 view?

A
  • Normal vertebral alignment by 3 ~ parallel lines
  • Well preserved disc spaces
35
Q

What is Barge’s Angle on a lateral L5,S1 view?

A

Angle between sacral base and vertical line
53° average

36
Q

What can happen if Barge’s Angle is smaller?

A

Anterior pelvic tilt~ hyperlordotic position, more influenced by gravity

37
Q

What is ferguson’s angle?

A

Angle between sacral base and horizontal line
41° average

38
Q

What happens if Ferguson’s angle is smaller?

A

posterior pelvic tilt

39
Q

What happens with a smaller Barge’s and larger Ferguson’s?

A
  • More lordosis
  • Greater facet compression, anterior shearing forces, and lateral foramen narrowing
40
Q

What happens with a larger BArge’s and a smaller Ferguson’s?

A
  • Less lordosis
  • Greater vertebral body and discal compression
41
Q

What are the two types of oblique views of the L/S?

A

left and right posterior oblique views

42
Q

What makes up the “scottie dog” in an oblique view of the L/S?

A

Articular processes, facets, pars interarticularis, and pedicles are well visualized in what appears to be a Scottie dog

43
Q

What is an oblique view of the L/S BEST at picking up on?

A

BEST for picking up spondylolysis and spondylolisthesis on radiograph

44
Q

What are major advantages of a CT?

A
  • LESS OVERLAP of structures due to slicing
  • Able to locate subtle bone changes
45
Q

What are major disadvantages of a CT?

A
  • Greater radiation exposure due to slicing but getting faster and safer
  • Limited with soft tissue abnormalities
46
Q

What can give even more detail to a CT scan?

A

Contrast agents

47
Q

How can we start to understand the positioning of a CT image?

A

Start with Scout image
Locate specific slice position

48
Q

What are transverse plane slices with a CT scan?

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 the patient’s left
49
Q

How are sagittal plane slices of a CT image viewed?

A

left to right

50
Q

What is the tissue density witha CT like?

A

x-ray

51
Q

What are major advantages of a MRI?

A

Excellent
- Soft tissue abnormalities
- Cancellous bone/bone marrow conditions
- Neoplasms and staging metastasis
- Osteochondral lesions
- Stress fxs
NO radiation like with CT (high) and X-ray (low)
High resolution

52
Q

What are major disadvantages with MRI?

A

disadvantages
* Contraindications with magnetic implants except for stable joint implants
* Precaution with claustrophobia

53
Q

How do we understand a MRI?

A

Orient to scout image
View as with CT

54
Q

WHat should we look for first with a MRI?

A

known areas of normal fluid first, i.e., bladder, synovial joints, cerebrospinal fluid

55
Q

If fluid is bright, it is likely a T___ image

A

T2

56
Q

If fluid is dark, it is likely a T__ image

A

T1

57
Q

What is a T1 weighted image?

A
  • Dark signals from cortical bone and fluid
  • Bright signals from fat and bone marrow
58
Q

What is a T1 weighted image BEST for?

A

BEST for demonstrating anatomical definition of structure

59
Q

What is a T2 weighted image?

A

Bright signal occurs from fluid and water

60
Q

What is a T2 weighed image BEST for?

A

BEST for demonstrating swelling and neoplasms particularly in cancellous bone

61
Q

What should we know about nerve and muscle with T1 and T2 images?

A

Nerve and muscle have an intermediate signal and often gray with both T1 and T2- weighted images

62
Q

What are some routine radiographs for the hip?

A

AP
Lateral Frog Leg

63
Q

What does a hip AP view show?

A

Visualizes hip joint and proximal Femur

64
Q

What are some important observations of a hip AP image?

A
  • Iliofemoral line- smooth curve along outer ilium that extends into the neck
  • Shenton’s hip line- smooth curve around obturator foramen
  • Femoral neck angle
    > Angle between femoral shaft and neck
65
Q

What is shenton’s hip line?

A

smooth curve around obturator foramen

66
Q

What is the iliofemoral line?

A

smooth curve along outer ilium that extends into the neck

67
Q

What should we be observing on a normal hip AP view radiograph?

A
  • Well, preserved joint space
  • Smooth margins of acetabulum and femoral head
  • Obvious ball and socket
  • Cortex margins on shaft
  • Cancellous markings on head and neck
68
Q

What does the hip lateral frog leg view show?

A

Visualizes head, neck, and proximal femur

69
Q

What are some important observations on the hip lateral frog leg view?

A
  • Lesser trochanter is more anterior
  • Well, preserved joint space
  • Smooth margins of acetabulum and femoral head
  • Obvious ball and socket

Clin Med II - FINAL (5 decks)

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