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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
What should we see on a lateral view of the lumbar spine on a radiograph?
3 ~ parallel lines
26
What are the 3 parallel line on a lateral lumbar spine radiograph?
- anterior vertebral borders - posterior vertebral borders - spinolaminar line
27
What is the spinolaminar line?
- Spinous process and laminae junction - Represents posterior extent of central spinal canal
28
What should the 3 line in a lateral view of the lumbar spine do with movement?
Should remain constant whether low back is in neutral, flexed, or extended aka stress views when investigating mechanical instability
29
What do vertebral bodies look like on a lateral view of the L/S?
boxed with smooth edges
30
What should we note about the intervertebral disc spaces on a lateral view of the L/S?
preserved
31
What intervertebral or lateral foramen is the smallest on a lateral view of the L/S?
L5,S1
32
What can we NOT observe on a lateal view of the L/S on a radiograph?
L5,S1 due to iliac crest
33
What is a lateral L5,S1 view?
Close up of lumbosacral junction
34
What should we see on a lateral L5, S1 view?
- Normal vertebral alignment by 3 ~ parallel lines - Well preserved disc spaces
35
What is Barge's Angle on a lateral L5,S1 view?
Angle between sacral base and vertical line 53° average
36
What can happen if Barge's Angle is smaller?
Anterior pelvic tilt~ hyperlordotic position, more influenced by gravity
37
What is ferguson's angle?
Angle between sacral base and horizontal line 41° average
38
What happens if Ferguson's angle is smaller?
posterior pelvic tilt
39
What happens with a smaller Barge's and larger Ferguson's?
- More lordosis - Greater facet compression, anterior shearing forces, and lateral foramen narrowing
40
What happens with a larger BArge's and a smaller Ferguson's?
- Less lordosis - Greater vertebral body and discal compression
41
What are the two types of oblique views of the L/S?
left and right posterior oblique views
42
What makes up the "scottie dog" in an oblique view of the L/S?
Articular processes, facets, pars interarticularis, and pedicles are well visualized in what appears to be a Scottie dog
43
What is an oblique view of the L/S BEST at picking up on?
BEST for picking up spondylolysis and spondylolisthesis on radiograph
44
What are major advantages of a CT?
* LESS OVERLAP of structures due to slicing * Able to locate subtle bone changes
45
What are major disadvantages of a CT?
* Greater radiation exposure due to slicing but getting faster and safer * Limited with soft tissue abnormalities
46
What can give even more detail to a CT scan?
Contrast agents
47
How can we start to understand the positioning of a CT image?
Start with Scout image Locate specific slice position
48
What are transverse plane slices with a CT scan?
* 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
How are sagittal plane slices of a CT image viewed?
left to right
50
What is the tissue density witha CT like?
x-ray
51
What are major advantages of a MRI?
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
What are major disadvantages with MRI?
disadvantages * Contraindications with magnetic implants except for stable joint implants * Precaution with claustrophobia
53
How do we understand a MRI?
Orient to scout image View as with CT
54
WHat should we look for first with a MRI?
known areas of normal fluid first, i.e., bladder, synovial joints, cerebrospinal fluid
55
If fluid is bright, it is likely a T___ image
T2
56
If fluid is dark, it is likely a T__ image
T1
57
What is a T1 weighted image?
- Dark signals from cortical bone and fluid - Bright signals from fat and bone marrow
58
What is a T1 weighted image BEST for?
BEST for demonstrating anatomical definition of structure
59
What is a T2 weighted image?
Bright signal occurs from fluid and water
60
What is a T2 weighed image BEST for?
BEST for demonstrating swelling and neoplasms particularly in cancellous bone
61
What should we know about nerve and muscle with T1 and T2 images?
Nerve and muscle have an intermediate signal and often gray with both T1 and T2- weighted images
62
What are some routine radiographs for the hip?
AP Lateral Frog Leg
63
What does a hip AP view show?
Visualizes hip joint and proximal Femur
64
What are some important observations of a hip AP image?
- 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
What is shenton's hip line?
smooth curve around obturator foramen
66
What is the iliofemoral line?
smooth curve along outer ilium that extends into the neck
67
What should we be observing on a normal hip AP view radiograph?
- 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
What does the hip lateral frog leg view show?
Visualizes head, neck, and proximal femur
69
What are some important observations on the hip lateral frog leg view?
- 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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