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Diagnostic Imaging > Introduction to Imaging > Flashcards

Introduction to Imaging Flashcards

1
Q

Why do PTs need to understand imaging

A
  1. Potential PCP
  2. Military model
  3. International
  4. Improved communication among health care providers
  5. Enhancing understanding of pathology for clinical decisions & goals
  6. Patient education
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2
Q

How do PTs use imaging knowledge?

A
  1. Organize & interpret relevant information

2. Use for diagnostic process - obtain history, perform systems review, and select and administer tests & measures

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3
Q

Reasons for overuse of imaging

A
  1. Accuracy & ease of use
  2. Malpractice fear
  3. Patient pressure
  4. Health care chaos
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4
Q

Plain films are fastest way to assess & first imaging modality requested for

A
  1. Fractures
  2. Bony alignment
  3. Arthritis
  4. Bone infections
  5. Cancer
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5
Q

Plain Film Appearances

A

Increased object radiodensity appears white and decreased object radiodensity appears dark

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6
Q

Plain Film ABCS

A
  1. Alignment
  2. Bone Density
  3. Cartilage
  4. Soft tissue
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7
Q

Bone Scan (Scintigraphy)

A
  • Inject radiopharmaceutical and medication concentrates in increased area of function
  • Bright spot = increased activity
  • Good for detecting Bone cancer/mets, fracture, bone infections, metabolic disease (Paget’s)
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8
Q

CT - viewing of image

A
  • Axial - your right is patient’s left
  • Coronal - your right is patient’s left
  • Sagittal - viewed left to right
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9
Q

Useful in diagnosing

A
  1. Cancer
  2. Cardiovascular disease
  3. Infectious disease
  4. Internal trauma
  5. Musculoskeletal disease
  6. Bone density
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10
Q

Advantages of CT Scan

A
  1. Good alternative for people who cannot due MRI due to metallic implants
  2. More readily available
  3. Less expensive
  4. Less problematic
  5. Quicker test time
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11
Q

Limitations of CT Scan

A
  1. MRI is more suitable to assess fine details of soft tissue - intervertebral discs, shoulder and knee, tissues with similar make up
  2. Images only in axial plane
  3. High radiation exposure
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12
Q

Myelogram

A
  • Injection of contrast dye into subarachnoid space and radiograph taken after injection
  • Used to assess spinal cord, nerve roots, meninges, and cysts
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13
Q

MRI use

A
  • Diagnose broad range of diseases - cancer, heart disease, vascular disease, and musculoskeletal disorders
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14
Q

MRI T1

A
  • Good anatomical detail

- Fluids dark and fat bright

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15
Q

MRI T2

A
  • Good for detecting inflammation

- Water bright, fat dark

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16
Q

Structures that are black in all sequences on MRI

A
  1. Tendons
  2. Muscles
  3. Labrum
  4. Ligaments
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17
Q

Proton Density Imaging

A
  • T1 & T2 properties

- Helpful with tendon, meniscus, ligament & cartilage

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18
Q

STIR

A
  • Similar to T2 images
  • Poor resolution
  • Emphasizes structures that are fluid rich
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19
Q

Viewing of MRI

A
  • Coronal - your right is pt’s left
  • Axial - your right is pt’s left
  • Sagittal - left to right on both sides of body
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20
Q

MRI Advantages

A
  1. Better able to assess soft tissue fine details
  2. MRI less likely to produce allergic reaction
  3. No exposure to radiation
  4. Better view o changes in bone marrow
  5. Different sequences increase change of disease process being picked up
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21
Q

MRI Limitations

A
  1. Pacemaker - will stop its function
  2. Any ferromagnetic implants
  3. Metal implants safe but distort image
  4. CT better for unstable patients
  5. Does not distinguish between tumor tissue and edema
22
Q

Transient effects of strong magnetic field

A
  1. Dizziness
  2. Vertigo
  3. Nausea
  4. Concentration issues
23
Q

2 categories of ultrasound imaging

A

Rehabilitative ultrasound imaging (RUSI) & diagnostic imaging

24
Q

RUSI

A
  • Used to evaluate morphology & behavior of muscles; assist in application of therapeutic interventions aimed at improving clinical outcomes through restoration of neuromuscular function; carry out basic, applied, & clinical rehab research
25
Q

Things you can measure with ultrasound imaging

A
  1. Muscle length
  2. Muscle depth
  3. Muscle diameter
  4. Muscle cross-sectional area
  5. Muscle volume
  6. Muscle contraction/timing of contraction
  7. Tissue deformation with contraction
  8. Qualitative assessment of muscle/tissue density
  9. Muscle discontinuity/tears
26
Q

Why ultrasound imaging?

A
  1. Safe
  2. Scans in real time
  3. Cost effective
  4. Portable
  5. Clinically accessible
  6. No ionizing radiation
27
Q

Ultrasound imaging limitations

A
  1. Operator dependent
  2. Cost issue for clinics
  3. Limited evidence
  4. Limited training available
28
Q

Curvilinear transducer - ultrasound

A
  • Lower frequency (3.5-5MHz) –> deeper structures; sacrifice resolution
29
Q

Linear transducer - ultrasound

A
  • Higher frequency (7.5-10 MHz) –> superficial structures
30
Q

Sonographic apperance

A
  1. Hyperechoic –> very bright
  2. Hypoechoic –> darker
  3. Anechoic –> black
31
Q

Visible structures seen on ultrasound

A
  1. Muscle
  2. Bone
  3. Subcutaneous tissue
  4. Tendon/ligament
  5. Cartilage
  6. Nerve
  7. Blood vessels
32
Q

Appearance of muscle tissue

A

hypoechoic

33
Q

Appearance of bone/calcification

A

hyperechoic

34
Q

Appearance of tendon

A

hyperechoic

35
Q

Appearance of ligament

A

hyperechoic

36
Q

Appearance of cartilage

A

Hyaline - hypoechoic; fibro - hyperechoic

37
Q

Appearance of peripheral nerve

A

Individual fascicles - hypoechoic; surrounding connective tissue - hyperechoic

38
Q

Appearance of epidermis and dermis

A

hyperechoic

39
Q

Appearance of hypodermis

A

adipose tissue - hypoechoic; fibrous septa - hyperechoic

40
Q

Fluoroscopy

A

X ray source and fluorescent screen; real time motion; various structures & systems

41
Q

Why are fractures missed?

A
  1. Failure to order radiography
  2. Failure to recognize fractures on radiograph
  3. Subtle fractures that may not be evident on initial radiograph
  4. Presence of multiple injuries
  5. Inadequate patient history
42
Q

What to look for in report of fracture

A
  1. Open vs. closed
  2. Complete vs. incomplete
  3. Alignment of fragments
  4. Direction of fracture
  5. Special features
  6. Associated abnormalities
  7. Special types
43
Q

Fracture Classification Systems

A
  1. Salter-Harris

2. Weber fractures of the ankle

44
Q

Fracture Healing - Primary bone

A

Direct contact between bone fragments with compression. ORIF; osteoclastic then osteoblastic activity; new bone growth at ends of fracture

45
Q

Fracture healing - secondary bone

A
  • No fixation
  • Cast immobilization
  • External fixation
  • Some movement at fracture site
  • Callous formation
  • Three stages: Inflammatory, reparative, remodeling
46
Q

Inflammatory phase of healing

A
  • Hematoma forms –> inflammatory cells –> osteoclastic activity
  • Lasts several weeks
47
Q

Reparative phase of healing

A
  • Chrondroblasts & fibroblasts enter hematoma and form callus matrix
  • Osteoblasts enter callus matrix and form bony callus
  • Delayed and non-union can occur here
48
Q

Remodeling phase of healing

A
  • Bony matrix more organized
  • Reabsorbs less organized callous as organized structure is laid down
  • Callous is reabsorbed and fracture is no longer visible
49
Q

Factors affecting healing

A
  1. Degree of fracture
  2. Age
  3. Nutrition
  4. Systemic factors
  5. Hormones
  6. Vascular injury (AVN)
  7. Intra-articular
  8. NSAIDs
  9. Cipro
  10. XRT
  11. Smoking
50
Q

Abnormal fracture repair

A
  • Delayed union: longer than expected for age, site, severity of injury
  • Mal-union: union in poor functional position
  • Non-union: Shaft of long bones > 6 months, femoral neck > 3 months, sclerosis at both ends, pseudoarthritis final stage; forms = hypertrophic, atrophic, fibrous, pseudoarthritis, septic
51
Q

Stress Fracture Common Areas

A
  1. Sacral
  2. Pubis
  3. Femoral neck
  4. Tibia
  5. Calcaneal
  6. Navicular
  7. Metatarsals
  8. Sesamoid

Diagnostic Imaging (2 decks)

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