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Bone & Joint Lecture > Imaging Modalities > Flashcards

Imaging Modalities Flashcards

1
Q

Different tissues absorb more or less x-ray radiation based on ___

A

chemical composition

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2
Q

What are the five radiographic densities in order of most radiolucent to most radiopaque?

A
  1. Air
  2. Fat
  3. Water
  4. Bone
  5. Metal
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3
Q

How much bone density change is required to be detected on x-ray?

A

30-50%

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4
Q

What are some things x-rays are good at showing?

A
  • Bony anomalies
  • Trauma/fractures
  • Arthritic conditions (degenerative changes, inflammatory RA)
  • Biomechanical evaluation (lordosis/kyphosis etc.)
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5
Q

What are some things x-rays are poor at showing?

A
  • Most soft tissue (internal derangements)
  • Bone density changes
  • Marrow diseases
  • Bone malignancies
  • Bone/joint infections
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6
Q

Why aren’t x-rays good at demonstrating marrow diseases, bone malignancies, or bone/joint infections?

A

These are all soft tissue changes, even if they affect bone

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7
Q

About ___% of chiropractors own x-ray machines

A

60%

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8
Q

Can chiropractors take/order x-rays?
Can they order a biopsy?

A

Can take/order x-rays in all states and provinces
Cannot order biopsy

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9
Q

Name six imaging modalities besides x-ray

A
  1. MRI
  2. CT
  3. Nuclear medicine (bone scan)
  4. Fluoroscopy
  5. Ultrasound
  6. PET scan (will never interpret)
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10
Q

What does MRI stand for?

A

(Nuclear) Magnetic Resonance Imaging

does not use ionizing radiation

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11
Q

For internal derangements, such as in ligaments, menisci, or tendons, which imaging modality is particularly useful?

A

MRI

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12
Q

What is the imaging modality of choice for chronic brain problems?

A

MRI

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13
Q

What is the imaging modality of choice for acute (<48 hours since acquired) head/brain trauma such as a stroke?

A

CT

faster than an MRI

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14
Q

MRI cannot be used for ___ structures

A

moving

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15
Q

What are some circumstances in which contrast in MRI is required?

A

Tumor, infection, post-surgical back pain

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16
Q

What are some obstacles that prevent a patient from getting an MRI?

A
  • Tremors (must be still)
  • Presence of surgical hardware
  • Obesity
  • Claustrophobia
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17
Q

What is the biggest benefit of an MRI?

A

Great tissue contrast

differences are seen between muscles, tendons, cartilage, etc.

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18
Q

How many images are produced by a lumbar x-ray?
How many are produced by a lumbar MRI?

A

X-ray: 2-7
MRI: 60-200

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19
Q

Does a chiropractic license authorize the doctor to order an MRI?

A

Yes

insurance approval is another story

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20
Q
A
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21
Q

In which planes can an MRI visualize anatomy?

A

Coronal, axial, sagittal

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22
Q

MRI come with different weightings, aka ___

A

pulse sequences

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23
Q

What are the four basic MRI sequences/weightings?

A
  • T1
  • T2
  • Proton density
  • Fat suppression techniques (STIR)
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24
Q

Which MRI sequences/weightings make up the majority of images?

A

T1 / T2

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25
Q

MRI

T1 is a ___-based imaging sequence

A

fat

bright fat, lucent fluid

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26
Q

MRI

T2 is a ___-based imaging sequence

A

water (fluid)

bright fluid, lucent fat

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27
Q

Which MRI sequence is higher resolution: T1 or T2?

A

T1

28
Q

T1 sequence MRI is excellent for imaging ___ and is mainly used for this purpose

A

bone marrow

29
Q

T2 sequence MRI is excellent for imaging ___, such as ___

A

fluid, such as:

  • CSF (and discs)
  • Synovial fluid
  • Soft tissue swelling
  • Bone marrow edema
30
Q

Which MRI sequence is better for edema: T1 or T2?

A

T2

images fluid

31
Q

Which MRI sequence is best for visualizing edema?

A

Fat suppression techniques (STIR)

more fluid sensitive than T2

32
Q

Which MRI sequence is best for visualizing bone marrow?

A

T1

33
Q

Which MRI sequence is best for visualizing fibrocartilage, tendons, and ligaments?

A

Proton density

34
Q

If an MRI sequence is using a hybrid of T1 and T2, it is a ___ weighting.

A

proton density

35
Q

MRI

Proton density sequence is a hybrid of T1 and T2.
What is it best at visualizing?

A
  • Fibrocartilage
  • Tendons
  • Ligaments
36
Q

Where in the body is proton density MRI typically used?

A

Extremities

37
Q

Which MRI sequence roughly shows where the problem is, but has poor image quality and will need other sequences to investigate further?

A

Fat suppression techniques (STIR)

38
Q

In fat suppression technique (STIR) weighted MRI, fluid appears ___ and fat appears ___

A

fluid appears bright, fat appears dark (lucent)

39
Q

What does CT stand for?

A

Computed tomography

40
Q

Which uses more radiation: X-ray or CT?

A

CT

substantially higher dose

41
Q

Where are some common areas in the body for CT to be performed?

A
  • Bone
  • Brain
  • Chest
42
Q

Which has better bony resolution/detail: X-ray or CT?

A

CT

43
Q

If a patient is suspected to have had a stroke, what imaging modality would be used?

A

CT

acute head/brain

44
Q

If a patient is suspected to have dural hematoma, what imaging modality would be used?

A

CT

acute head/brain

45
Q

Which imaging modality is the gold standard for imaging the chest and abdomen?

A

CT

46
Q

What is required for CT to provide excellent vascular detail?

A

Contrast

47
Q

Which nuclear medicine method is used the most by chiropractors?

A

Bone scan

48
Q

nuclear medicine

Which cells take up the radiation of a bone scan to represent metabolic activity of bone?

A

Osteoblasts

49
Q

Bone scan has ___ sensitivity and ___ specificity to bone diseases

A

high sensitivity and poor specificity

50
Q

How much bone destruction is required to be seen in a radiograph?
How much is required to be seen in a bone scan?

A

X-ray: 30-50%
Bone scan: 3-5%

51
Q

What areas of the body are visualized by a bone scan?

A

Whole skeleton

52
Q

Bone scan is the imaging follow up of choice for ___ diseases

A

polyostotic

ie. metastasis, Pagets

53
Q

What are some pathological features that may be visualized by a bone scan?

A
  • Metastasis and primary malignancy
  • Stress fractures
  • Osteomyelitis

early detection

54
Q

If metastatic disease is suspected and a bone scan is performed, where in the spine should you look first?

A

Pedicles

55
Q

DEXA scan allows for quantification of ___

A

bone density

56
Q

Which imaging modality is the best tool for evaluating osteoporosis?

A

DEXA scan

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57
Q

Which imaging modality can be described as a “motion picture x-ray”?

A

Fluoroscopy

58
Q

What is the value of fluoroscopy?

A
  • Allows for assessment during full range of motion
  • Picture quality is poor

limited for chiropractors because of past overuse

59
Q

Does ultrasound utilize radiation?

A

No radiation

60
Q

What is the primary use of ultrasound imaging?

A

Soft tissue: babies, solid organs, blood vessels

61
Q

Is ultrasound more useful in the spine or extremities?

A

Predominantly extremities

NOT useful for spinal imaging

62
Q

What is a PET scan?

A

Positron emission tomography, a new type of nuclear medicine scan

63
Q

What is the primary use of a PET scan?

A

Neurology and ocology (ie. brain mapping)

64
Q

What does ABCS stand for in regards to an x-ray search pattern?

A

Alignment/anatomy
Bone
Cartilage (can’t see on x-ray)
Soft tissues (not great on x-ray)

65
Q

ABCS search pattern

What are some changes in bone that may be visible in an x-ray?

A
  • Density
  • Cortical margins
  • Trabecular patterns
66
Q

ABCS search pattern

What are some changes in cartilage that may be visible in an x-ray?

A
  • Joint space
  • Secondary bone effects
67
Q
A

Bone & Joint Lecture (1 decks)

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