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summer 2024 > imaging midterm > Flashcards

imaging midterm Flashcards

1
Q

sensitivity

A

SnNout
negative, out
good for ruling out if test is negative

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2
Q

specificity

A

SpPin
positive, in
good for ruling in if test is positive

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3
Q

potential errors in imaging

A

pt mistaken for another
wrong extremity
less obvious injuries missed
areas of referred pain imaged not area of symptoms
misinterpreted by radiologist
poor quality images

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4
Q

ordering images

A

understand most current standards
evidence base screening
mech of injury and location
brief anatomically correct descriptions
can request priority for routine, serious, life threatening

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5
Q

relevance of pathology

A

comprehensive history and physical examination
radiologist suggests clinical correlation

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6
Q

interpretation

A

interpreting rests primarily with radiologist
skilled review

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7
Q

reflective imaging

A

ultrasound and MRI
energy inserted into system, captured, and converted into and image when returned

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8
Q

ultrasound

A

form mechanical compression of molecules

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9
Q

MRI

A

combination of electromagnetic and radio energy to produce signals from body that can be collected and analyzed to produce an image

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10
Q

ionizing radiation

A

x-rays, CT
require ionizing radiation exposure with attendant risks

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11
Q

CT

A

IR penetrates matter and creates image through computer
hounsfield units- over 2000 levels between black and white

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12
Q

water point in hounsfields

A

negative 1000

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13
Q

air point in hounsfields

A

postive 1000

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14
Q

what is CT good for?

A

bony pathologies

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15
Q

what is MRI good for?

A

soft tissue pathologies

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16
Q

emission imaging

A

bone scan
add radiopharmaceutical agent in blood
shows areas with increased metabolic activity

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17
Q

are bony scans binary

A

yes, give either yes or no answer.
they demonstrate only increased metabolic activity, not the cause

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18
Q

are bone scans diagnostic?

A

no, they are also non-specific

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19
Q

what are bone scans used for

A

injuries to skeleton
degenerative changes
extent of certain metastatic lesions

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20
Q

are bone scans good for fractures?

A

bone scans are time sensitive and positive in case of fractures, such as overuse or stress syndromes

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21
Q

are bone scans expensive?

A

bone scans are more expensive than standard films, but significantly less expensive than CT or MRI

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22
Q

standard x-ray films

A

follows series of analytical steps
requires knowledge of anatomy and spatial relationships
creates bony displacement or reactions such as lesions in surrounding skeletal structures
cost-effective and highly specific for skeletal pathology
ionizing radiation

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23
Q

air density

A

most radiolucent and absorbs least number of particles
darkest portion

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24
Q

fat density

A

considered radiolucent
not as dark as air, but darker than others

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25
Q

fluid density

A

more absorbent than air or fat
intermediate radiolucency

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26
Q

bone densities

A

most dense
calcium is metal like density
radio-opaque
appear white

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27
Q

is cortical or cancellous bone more dense

A

cortical

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28
Q

when are shields used?

A

to protect body parts exposed to radiation that are not of interest in examination

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29
Q

what do you use to select views that limit radiation exposure

A

diagnostic imaging literature

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30
Q

what view do use use for scoliosis and why?

A

PA
reduce exposure to breasts and thyroid

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31
Q

what are plain radiographs not sensitive to?

A

early changes in tumors, infections and some fractures
subtle pathologies - chance of false negative high

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32
Q

where are plain films more specific than bone scans or MRI?

A

characterizing specific calcification patterns and periosteal reactions

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33
Q

number of exposures required for plain

A

minimum of two taken at 90 degrees to one another
cervical and lumbar require 5 each

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34
Q

body position relative to source of beam

A

closer to the plate, the better the resolution will be
further from the light source, the more precise resulting shadow

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35
Q

overuse of imaging

A

significant economic problem in US

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36
Q

clinical prediction rules

A

indicate need, help reduce unnecessary imaging

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37
Q

basic radiographic principles

A

do no harm
request by DPT written clearly in standard terminology
never use x-ray as substitute for taking history and physical
correlate history, physical, labs, x-rays to make PT diagnosis
avoid repetitious exposure and use shields
if fracture indicated, x-ray should be performed
include joint above and below suspected pathology
lack of x-ray evidence of fracture does not rule out fracture
special studies indicated when signs/symptoms do not correlate with x-ray findings
soft tissue films can rule out foreign bodies
look at both sides
frequency of follow up x-rays depends on various factors
suspected fractures not seen on initial x-ray should be x-rayed again in 10-14 days
include all differential diagnoses to be ruled out or accepted
history of neck trauma should have cross-table lateral of c spine to rule out fracture or dislocation before any treatment
post-reduction films to judge adequacy and maintenance
read on view box with hot light
arthrograms have risk of infection or allergic reaction
always view fractures with suspicion of pathological etiology
only accept quality x-rays

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38
Q

orientation of films

A

check pt name
check dates
orient on view box by date and sequence
check for right and left markers
develop a system

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39
Q

how does bone react to its environment

A

just like any other tissue, but in slow motion

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40
Q

wolff’s law

A

stressed bone reacts over time by strengthening areas of increased stress and demineralizing or eliminating areas of lowered stress

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41
Q

ABCS

A

alignment
bone density and dimension
cartilage
soft tissue

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42
Q

alignment (ABCS)

A

study size, number, shape, and alignment of bones

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43
Q

bone (ABCS)

A

health of skeletal system interconnected to overall health of organism
density and dimension

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44
Q

bone density (ABCS)

A

specific to region and that portion of bone being imaged
cancellous bones should have consistent trabecular patterns throughout
is periosteum swelling or lifting from bone

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45
Q

bone dimensions (ABCS)

A

specific to anatomic region and bone being evaluated
compare both sides

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46
Q

cartilage (ABCS)

A

width and symmetry of joint space
cartilage spacer between bony articular surfaces

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47
Q

soft tissue (ABCS)

A

look for swelling, capsular distension, periosteal elevation
soft tissue affects structure of musculoskeletal system

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48
Q

tomography

A

slices down to 1mm
relatively higher IR but confined to smaller are and has superior resolution to plain radiographs

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49
Q

two types of tomography

A

conventional tomography
computed tomography (CT)

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50
Q

film and body part stationary while exposed to radiation

A

plain radiographs

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51
Q

CT

A

tube moves
sequential images in parallel planes
adjust thickness of slices
increased details compared to plain

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52
Q

during CT

A

pt on table moved inside scanning gantry
tube rotated 360 degrees around pt
relative density values in shades of gray
limited differentiation between types of soft tissue
excellent definition of bone

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53
Q

limitations of CT

A

less complex and expensive than MRI
higher radiation doses and cost to conventional
MRI more useful for disc herniations

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54
Q

indications of CT

A

combo of CT and MRI to evaluate combo of bone and soft tissue
CT provides additional details of spinal osteophytes and spinal fractures

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55
Q

MRI

A

ability to image both bone and soft tissue
uses magnetic fields to produce images

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56
Q

MRI physics

A

magnetic properties of body’s tissues
exposed to strong radio-frequency pulses that produce measurable changes in body’s atoms
depend on intrinsic spin of atoms with odd number of neutrons or protons
atomic nuclei align to direction of magnetic field
RF cause nuclei to absorb energy and produce resonance for type of tissue
upon removal of RF energy absorbed is released as electrical signal

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57
Q

signal intensity

A

strength of radio wave that tissue emits following removal of RF

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58
Q

bright images

A

high signal intensity

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59
Q

dark images

A

low signal images

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60
Q

image quality

A

movement can decrease image quality
slices too thin or too close produce interference

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61
Q

longitudinal or T1 relaxation

A

return of protons to equilibrium following application and removal of RF pulse
fat have bright signal
bone bright
proteinaceous material medium to bright
other soft tissues have normal low
T1 weighted clearly delineate soft tissue

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62
Q

transverse or T2 relaxation

A

describes associated loss of coherence or phase between individual protons immediately following application of RF pulse
fluids are bright - 2 like H2O
overall less details in soft tissue

63
Q

proton density weighted

A

combine properties of T1 and T2 weighted images and produce good anatomic detail with little tissue contrast

64
Q

fat spin echo (FSE)

A

T2 weighted produce bright fat
fat suppression produces dull fat for contrast to bright fluid
second RF rapidly applied
FSE T2 reveal marrow pathology

65
Q

inversion recovery (STIR)

A

reduces signal from fat and increases signal from fluid and edema

66
Q

MRI contraindications

A

any ferromagnetic metal implants
claustrophobia
relative high cost

67
Q

MRI indications

A

high quality images of large joint components
3 orthogonal planes, one suppresses fat
FSE or gradient echo should be included
intra-articular contrast increases sensitivity to diagnose rotator cuff tears, labral lesions or articular cartilage injuries
useful to diagnose muscle and tendon tears
superior to ultrasound for monitoring stages of healing

68
Q

scintigraphy (bone scans)

A

reveal uptake of radiopharmaceutical substance into areas of reactive bone
injected hours prior to bone scan
reveal areas of radionuclide uptake

69
Q

hot spots

A

metabolically active areas such as healing have higher uptake
appear dark

70
Q

bone scan indications

A

scan for presence and distribution of lesions
help screen for metastasis
sensitive but not specific
sensitive for changes in fractures, infection, tumors

71
Q

what is the one exceptions to sensitivity of bone scan

A

multiple myeloma

72
Q

what is multiple myeloma

A

diffuse osteopenia and multiple lucent areas of bone that result in painful fractures
lucent areas represent cold lesions that may not be metabolically active enough to cause increased uptake of radiopharmaceutical on bone scan
increased erythrocyte sedimentation rate on plain

73
Q

DPT applications

A

bone scans to detect stress fractures
displaced femoral neck fractures and subsequent AVN of femoral head from unrecognized FHSF

74
Q

stress fracture

A

MRI with T2 and STIR sequences warranted

75
Q

radionuclide bone scan reveals

A

old and well healed fractures
degenerative joint disease
open growth plates
sacroiliac joints

76
Q

ultrasound

A

fast and inexpensive
no IR
highly sensitive to identification of fine soft tissue changes

77
Q

applications of US

A

real time muscle contractions
tendon gliding
muscle size

78
Q

US physics

A

sound waves
differences in signal return provide ability to distinguish structures
better images of superficial structures, more useful on thin pts
bone and metal reflect sound and cannot be imaged

79
Q

clinical applications of US

A

excellent for rotator cuff, glenoid labrum hard to see
evaluation of hemarthrosis of knee, cannot see menisci, articular cartilage, ACL/PCL
early changes in RA
acute muscle and tendon injures

80
Q

DPT applications of US

A

direct operator interaction with pt
power doppler very detailed, can demonstrate hyperemia in RC and biceps tendon

81
Q

standard views for glenohumeral joint

A

ap external rotation
ap internal rotation
CR perpendicular to 1 inch inferior to coracoid process

82
Q

shoulder distance from glenoid fossa to humeral head

A

5mm

83
Q

internal rotation

A

allows to see lesser tuberosity on medial humeral head

84
Q

west point view

A

used for glenoid rim and relationship of humerus to glenoid
pt prone and arm at 90-90 position, beam angled 25 degrees cephalad and 25 degree lateral to medial
used for bankart lesions with history of instability
acromion superior to glenoid
coracoid inferior to glenoid
CR through axilla toward AC joint

85
Q

AC joint

A

tearing of ligaments cause it to shift upward

86
Q

AP view of AC

A

pt seated beam in ap direction but 15 degrees cephalad
CR perpendicular to midline of body at level of AC

87
Q

Weighted AC

A

weights hung from wrists to depress AC joint without causing muscle stabilization
include both affected and unaffected side

88
Q

Scapula views

A

AP
lateral or trans-scapluar

89
Q

AP scapula

A

CR perpendicular to midscapular area 2 inches inferior to coracoid process

90
Q

lateral scapula

A

CR perpendicular to mid-lateral border of scapula

91
Q

anterior oblique (Y) scapula

A

pt 60 degrees anterior oblique position and CR through GH perpendicular to image receptor
scapula looks like a Y

92
Q

bankart lesion

A

anterioinferior aspect of glenoid labrum
complication of anterior shoulder dislocation
often with hill-sachs lesion

93
Q

hill-sachs lesion

A

posterolateral humeral head compression fracture
anterior shoulder dislocations

94
Q

shoulder osteoarthritis

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

95
Q

standard views of shoulder

A

AP with hand supinated
lateral with hand positioned laterally
oblique with hand pronated

96
Q

AP elbow

A

CR perpendicular to elbow joint
elbow straight

97
Q

carrying angle of forearm

A

longitudinal axes of distal humerus and proximal ulna

98
Q

lateral right elbow

A

CR perpendicular to elbow
elbow at 90 degree angle

99
Q

normal position of capitulum

A

longitudinal axis of proximal radius passes through center of capitulum
anterior border of humerus normally intersects middle 1/3 of capitulum

100
Q

oblique view of elbow

A

CR perpendicular to arm and enters at elbow joint
can see the coronoid process very well

101
Q

standard wrist views

A

PA
lateral
semipronated oblique

102
Q

semipronated oblique

A

evaluation of scaphoid and distal radius

103
Q

special views for wrist

A

radial and ulnar deviation
scaphoid visualization in ulnar deviation

104
Q

PA wrist

A

CR passes through mid carpal joint

105
Q

three arcuate lines

A

arc 1 - under proximal row
arc 2 - above proximal row
arc 3 - under distal row

106
Q

ulnar variance

A

want ulna and radius level
negative when ulna shorter
positive when ulna longer

107
Q

radial angle

A

formed by line perpendicular to long axis and line drawn across radial articular surface
should be 15-25 degrees

108
Q

oblique wrist

A

CR through midcarpal joint
hand flat

109
Q

lateral wrist

A

CR passes through midcarpal joint
through lateral side of wrist

110
Q

hand views

A

PA
oblique
lateral

111
Q

PA hand

A

CR perpendicular to hand at 3rd MC joint
hand flat

112
Q

radiographic spatial relationships with PA hand

A

slant through 3-5 MC
2nd MC through center of radius
4th IP above 5th IP

113
Q

boxer’s fracture

A

pinky
sometimes 4th finger

114
Q

oblique hand

A

CR through 3rd MC joint
45 degree foam block used

115
Q

why is a foam block used for oblique hand

A

elevation of fingers opens MCP and IP

116
Q

lateral hand

A

CR through 2nd MCP joint
through lateral hand

117
Q

terrible triad

A

dislocation of elbow
fracture of radial head
fracture of coronoid process

118
Q

radial head fracture classifications

A

1: non displaced
2: non comminuted, displaced
3: comminuted

119
Q

coronoid fracture classifications

A

1: avulsion of tip of bone
2: detached fragment of less than 50%
3: detached fragment of more than 50%

120
Q

kienbock disease

A

osteonecrosis of lunate
dominant wrist of young adult men due to repeated loading
middle age women equally between dom and non dom
with negative ulnar variance

121
Q

scaphoid AVN

A

~75% arterial supply to scaphoid from branches of radial artery
vascular supply to proximal pole is mainly retrograde

122
Q

how many vertebrae total and in each section

A

total: 33
cervical:7
thoracic: 12
lumbar: 5
sacral: 5 fused
coccygeal: 4 fused

123
Q

C1 or Atlas

A

no vertebral body
wrapped around dens of C2
held in place by transverse ligament - prevents anterior displacement of C1 and C2
articular facets more horizontal in AP to facilitate rotation, wedge shaped in ML plane
lacks intervertebral disk - decreased shock absorption and stabilization

124
Q

C2 or Axis

A

projection through C1
odontoid/dens
no IVD between it and C1

125
Q

dens fractures

A

by trauma, congenital malformation, failure to fuse

1: oblique fx through upper 1/3 of odontoid, stable
2: transverse fx through base where it joins to body
3: fx of odontoid down into body

126
Q

lower C spine

A

C3-C7
size, components, shape, density, dimensions similar
compare above and below to each other

127
Q

standard views of c spine

A

odontoid (open mouth)(APOM)
AP
left oblique
right oblique
lateral

128
Q

odontoid

A

beam directed into the open mouth of pt

129
Q

alignment in APOM

A

demonstrate odontoid and lateral masses of C1
distance between lateral edges of odontoid and medial edges of lateral masses are symmetrical
articular surfaces of C1 and C2 should be parallel

130
Q

jefferson’s fracture

A

lateral overhanging of lateral mass beyond lateral margins of C2

131
Q

offset in C1 and C2

A

over 2mm is abnormal
under 1-2mm can be from head rotation or tilt

132
Q

bone density with APOM

A

odontoid should have no luncencies

133
Q

AP c spine

A

pt supine or sitting
C3-C7

134
Q

AP c spine alignment

A

spinous processes make vertical line
each segment assess for rotation and tilting

135
Q

comparison of vertebra

A

vertebra above and below each other within C3-C7 can be compared to assess and changes in density

136
Q

soft tissue AP c spine

A

dark shadowlike trachea seem in midline
may indicate presence of tumor, pneumothorax, or hemothorax

137
Q

pancoat’s tumor

A

white mass in upper lung area
displaces trachea

138
Q

left and right oblique C spine

A

compare both for side by side consistency
evaluate IV foramina, pedicles, articular facets

139
Q

lateral view C spine

A

usually most informative of standard views
best viewed after other 4
often supports differential established during review of previous routine views

140
Q

alignment in lateral view of c spine

A

absence of lordosis, kyphosis, normal lordosis
follow anterior and posterior longitudinal ligament and junctions of lamina and spinous processes

141
Q

atlantodens interval (ADI)

A

must not exceed 3mm
any distance above must be evaluated for stability
risk factors: trauma, CT/AI disease, congenital disease
if at risk, flex/ex studies done before any manual therapy

142
Q

lateral view with flexion (C spine)

A

pt in full flexion
ADI should not widen

143
Q

hangman’s fracture

A

cervical trauma
anterior body of C2 overhangs C3
lucency through pedicles of C2
occurs with rapid deceleration and with hyperextension
most do not survive

144
Q

anklylosing spondylitis

A

syndesmophytes bridging anterior vertebral bodies
aka bamboo spine
uncinate joints in column two

145
Q

rheumatoid arthritis

A

decreases mineralization of c spine and anterior subluxation

146
Q

soft tissue in lateral view of c spine

A

decreased density indicative of hemorrhage
increased distance between spinous processes may indicate ligament tear

147
Q

what is flattening of the cervical spine an indication of?

A

cervical spasm

148
Q

in compromise of soft tissue…

A

… possible to have dislocation of spine without fractures

149
Q

compression fracture

A

anterior body is not the same height as posterior body

150
Q

variations on normal

A

absence of space between two bodies may represent HNP or failure of embryonic segmentation
block vertebrae, hemivertebrae, transitional vertebrae

151
Q

spina bifida occulta of atlas

A

absence of spinal laminal line in lateral projection
incompletely ossified posterior arch

152
Q

block segments - congenital and acquired

A

acquired - from pathology or surgery
columnar shape
congenital - wasp waist, hourglass shaped
also could have a mixed block - combo of the two

153
Q

variations of block segments

A

lack of complete segmentation considered in differential in absence of obvious explanation of pain in atraumatic cases
aggressive manual therapy not recommended on non-mobile segment levels
found throughout spine

summer 2024 (9 decks)

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