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Differential Diagnosis/Imaging > Intro to General Principles of MSK Imaging Part 2 > Flashcards

Intro to General Principles of MSK Imaging Part 2 Flashcards

1
Q

How to view a radiograph

A
  • view a plain film as if you are facing the patient
  • a minimum of 2 markers is usually imprinted on every radiograph
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2
Q

Identification markers

A
  • provides pt identification
  • establishes anatomic side (R or L)
  • weight bearing or (ERECT) indicates pt was standing for exam
  • decubitus (DECUB) indicates that the pt was recumbent
  • inspiration (INSP) & expiration (EXP) are used in comparison films of the chest indicating the state of respiration
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3
Q

Describe the saying “one view is no view”

A
  • the minimal radiographic examination includes 2 views of the imaged body part at right angle to each other
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4
Q

Define angles of projection

A
  • the path of the x-ray beam as it travels from the X-ray tube through the pt to the image receptor
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5
Q

How many dimensions does a single X-ray provide

A
  • a single X-ray provides only 2 dimensions (LxW)
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6
Q

How do you determine depth with an x-ray

A
  • to determine depth a 2nd x-ray is required at a right angle (90º) to the 1st
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7
Q

What are the most common views for X-rays

A
  • AP (anterior to posterior)
  • lateral: x-ray beam has traveled through the body at right angles to the AP or PA projection/view
  • oblique: involves rotation of a body part so that the beam travels through the body part at an angle between the AP & lateral views
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8
Q

Radiographic positions that best visualize intervertebral foramina versus zygapophyseal

A
  • Intervetebral: oblique 45º (cervical spine), lateral (thoracic spine), lateral (lumbar spine)
  • Zygapophyseal: lateral (cervical spine), oblique 70º (thoracic spine), oblique 45º (lumbar spine)
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9
Q

What is the only body part that is evaluated with a PA view instead of an AP view

A
  • hand
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10
Q

Define position

A
  • the pat’s physical position
  • general body position (supine, seated, standing)
  • wbing versus non-wbing
  • the body part closest to the image receptor offers the best detail
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11
Q

Primary radiographic body positions

A
  • upright
  • seated
  • recumbent
  • supine
  • prone
  • trandelenburg
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12
Q

Factors related to image quality

A
  • Photographic: density = blackness, contrast = variation amongst densities
  • Geometric: detail = sharpness/motion, distortion = object is not perpendicular to X-ray beam
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13
Q

What is included in the routine radiographic exam

A
  • offers the most visualization of structures with the least number of radiographs
  • lowest amount of radiation to create a quality image study
  • ACR appropriateness criteria
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14
Q

Possible radiographic results from routine exam

A
  • Positive for hypothetical clinical diagnosis
  • Negative for hypothetical clinical diagnosis
  • Negative for hypothetical clinical diagnosis but raises suspicion for an alternate diagnosis
  • Inconclusive: additional imaging needed
  • Wrong: False Neg./False Pos.
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15
Q

What view is a chest radiograph always taken at

A
  • PA view
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16
Q

What are the different views for cervical spine plane films

A
  • AP view
  • Lateral view
  • Open mouth view (odontoid/dens view)
  • Anterior Oblique view (right or left)
  • Swimmers view (addresses the issue with poor visualization of C7; AKA modified lateral projection of cervical spine)
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17
Q

What are the different views for shoulder & humerus plain films

A
  • AP view with IR and ER
  • Axillary view
  • Y view (shot at an angle that separates the scapula and humerus from the chest)
  • shoulder trauma protocols suggest at least 3 views
18
Q

What are the different views for elbow plain film

A
  • AP view
  • Lateral view (elbow flexed at 90º)
  • Signs of pathology: fat pad (think fx if see), sail sign (think fx if see), growth plates (well defined boarders)
19
Q

What are the different views for hand and wrist plain films

A
  • PA view
  • Lateral
  • Oblique (lose overlap of carpal bones)
  • Scaphoid view: scaphoid fx suspicion
  • Carpal tunnel view: hamate fx suspicion
20
Q

Current American College of Physicians lumbar plain film series recommendations

A
  • Imaging is only indicated for severe progressive neurological deficits or when medical flags are suspected
  • Routine imaging does not result in clinical benefit & may lead to harm
21
Q

What is the low back pain (LBP) CPG (clinical practice guideline) for radiographs

A
  • Mobility deficits: no imaging with back pain lasting ≤1 mo, no red flags
  • Referred LE pain: adults >65 yrs in whom imaging changes are ubiquitous, severity of disc/facet disease was not associated with pain severity
  • Related generalized pain: non-indicated imaging should be strongly discouraged
22
Q

What are the different views for pelvis plain film

A
  • Usually only need AP view: male pelvic is triangular and female pelvic is rounded
  • Pelvis is a ring: fx in more than one place
  • Suspected slipped capital femoral epiphysis (SCFE): Frog view (Peds)
23
Q

What are the different views for knee plain films

A
  • AP view
  • Lateral view
  • Sunrise/Merchant view (patella focused)
  • Tunnel view: PA with bent knee looking between the femur and tibia
24
Q

What are the different views for foot and ankle plain films

A
  • Ankle: AP view, Lateral view, Mortise view (best for identifying a fx)
  • Foot: AP view, Lateral view, Oblique view (best for seeing metatarsals)
25
Q

Describe alignment for radiographic interpretation

A
  • General skeletal architecture: size, shape, number, and alignment
  • Pathology appreciated: fracture, dislocation, and cortical alterations
26
Q

Describe bone density for radiographic interpretation

A
  • General & focal bone density: check contrasts & osteoporosis (X-ray not gold standard)
  • Textual abnormalities: abnormal trabecular architecture indicates metabolic bone disease
  • Local bone density changes: sclerosis at areas of increased stress, fracture healing
  • Pathology visualized: metabolic bone disease, infection, tumor, arthritic changes
27
Q

Describe cartilage spaces for radiographic interpretation

A
  • Joint space width and symmetry: well preserved joint spaces imply normal cartilage or disk thickness
  • Contour and density of subchondral bone: smooth surface
  • Epiphyseal plates: normal size relative to epiphyseal & skeletal age
  • Pathology: degenerative and rheumatoid arthritis
28
Q

Describe soft tissues for radiographic interpretation

A
  • look at soft tissues for gross swelling, capsular dissension, periostea elevation
  • Muscles: soft tissues normally exhibit a water-density shade of gray
  • Fat pads/fat lines: normally radiolucent and parallel to bone/muscle
  • Joint capsules: normally indistinct
  • Periosteum: normally indistinct
29
Q

Describe intra-articular fracture and inter-articular fractures

A
  • Intra-articular fracture: fracture line crosses into the joint
  • Inter-articular fracture: fracture line crosses outside of the joint
30
Q

ABCs: search pattern for radiographic image interpretation

A
  • Alignment
  • Bone density
  • Cartilage spaces
  • Soft tissues
31
Q

Carpals bones in their rows

A
32
Q

When are they likely to ask for a weight bearing film images

A
  • when looking at cartilage space especially for hip/knee OA diagnoses
33
Q

Define heterotrophic ossification (HO)

A
  • diverse pathologic process
  • the formation of extra skeletal bone in muscle & soft tissues
  • can be conceptualized as a tissue repair process gone awry and is a common complication of trauma and surgery
34
Q

Describe errors in observation and interpretation

A
  • Observation: incomplete of faulty search pattern
  • Interpretation: failure to link abnormal radiographic signs to relevant clinical data
35
Q

What is included in the radiologic report

A
  • Heading
  • Clinical information
  • Findings
  • Conclusions/Impressions
  • Recommendations (optimal)
  • Signature of radiologist
36
Q

What does the heading include

A
  • Facility information: identification & address of facility, date of examination
  • Patient information: name, age or date of birth, gender, case number
  • Radiographic information: what anatomy part was examined, the number of views obtained
37
Q

What does the clinical information include

A
  • includes a brief summary of relevant data in the history, physical examination, & laboratory studies
  • Location, duration, onset, & symptoms
  • History of injury
  • Positive orthopedic or neurological tests
  • Prior imaging
  • Abnormal laboratory studies
  • Abnormal physical examination findings
38
Q

What does the findings include

A
  • Body of the report
  • Presented in a narrative form with complete sentences, professional terminology, & absence of eponyms or jargon
  • Describes the radiographic abnormalities or normal appearance; does not state diagnosis except for fx or dislocation
39
Q

What does the conclusions include

A
  • Could be labeled: impression, diagnosis, judgement, interpretation, or reading
  • Is a point by point summation of the data presented in findings
  • Conditions are labeled & diagnoses are reported
  • Diagnoses are reported in order of severity, beginning with the most serious condition
40
Q

What does the recommendations include

A
  • Optimal section that appears only if follow up procedures are indicated
  • Recommendations are specific for the condition diagnosed or suspected
  • Recommendations may include additional conventional radiographs, optimal projections or positions, other imaging modalities, laboratory evaluation, or referrals to other healthcare providers
41
Q

What does every radiograph report must have

A
  • All reports must be signed
42
Q

Malignant versus benign bone tumor

A
  • Malignant: wider than it is long, irregular borders, invades the joint space, grows outwards from the bone
  • Benign: longer than it is wide, grows along the bone, well defined borders, does not invade the joint space

Differential Diagnosis/Imaging (20 decks)

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