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Clinical Medicine 1 > introduction to musculoskeletal imaging > Flashcards

introduction to musculoskeletal imaging Flashcards

1
Q

limits of imaging

A
  • images are still, dont show stationary movement pattern

- patient may be asymptomatic

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2
Q

radiology

A

radriograph=film that contains image of pt

  • plain film has no injection to enhance image
  • “normal” xray
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3
Q

X-rays (plain film or conventional radiograph)

A
  • is a negative not a print
  • making of an x-ray
  • -x-ray beam source
  • -pt
  • -x-ray film
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4
Q

positioning for radiographs

A
  • “routine radiographic projections”
  • AP
  • PA
  • lateral (facet joints)
  • oblique (IV foramen)
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5
Q

reading a radiograph

A
  • need a view box or illuminator

- place radiographs on view box as if patient were facing the person viewing the films

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6
Q

osteoblastic activity terminology for looking at a radiograph

A
  • opacity: whiteness
  • sclerosis: laying done bone
  • hypertrophic bone: nodes
  • increased radiodensity
  • blastic region: reparative, reactive bone
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7
Q

osteoclastic terminology

A
  • radiolucent (beam passes through)
  • lucency
  • osteopeni(decreased bone mineralization)
  • decreased radiodensity(osteoporosis)
  • lytic lesion or lysis
  • -bone destroying
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8
Q

radiodensities

A
  • more dense of tissue less x-rays penetrate the tissue to expose the film
  • more dense an object the greater absorption of x-rays and less exposure of film
  • radiodensity is also influenced by thickness of material
  • distortion
  • interface-edge
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9
Q

radiodensities of various materials

A
  • air/gas: very dark, black
  • soft tissue/fat-relatively dark/gray-black
  • water-appears gray
  • bone-relatively white (radiopaque
  • -bone will vary in presentation depending on thickness, density, calcification
  • metals-bright white
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10
Q

reading a radiograph-what do you look for

A

-alignment, density bone, cartilagenous spaces

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11
Q

bone: evaluate for on xrays

A
  • density
  • fracture
  • tumor
  • infection
  • foreign body
  • anomaly
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12
Q

joint: look for

A
  • foreign body
  • arthritis
  • dislocation
  • fracture
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13
Q

soft tissues: look for

A
  • edema
  • hemorrhage
  • masses
  • calcifications
  • foreign bodies
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14
Q

contrast enhanced radiographs

A
  • contrast medium is injected into the body prior to taking a radiograph
  • contrast may be radiopaque or radiolucent
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15
Q

fluoroscopy

A

-epidural

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16
Q

arthrography

A

-injection of fluid into joint space

17
Q

myelography

A

-contrast medium can have bad side effects, not usually used

18
Q

computed tomography

A
  • use of a computer and cray to image a cross sectional slice of the body
  • CT uses x-ray beams which move through an arc of 360 degrees around a patient
  • each image represents an axial cross-sectional slice of the body
  • each slice measures .3-2.5 cm in thickness
  • shades of gray are assigned specific to each tissues radiation absorption properties
  • CT is valuable in evaluation of bone and soft tissue tumors, fractures, intrarticular abnormalities, and bone mineral analysis
  • also used in diagnosis of pathology in other body systems
19
Q

magnetic resonance imaging

A
  • does not involve ionizing radiation

- utilizes radiofrequencies of tissues within a magnetic field

20
Q

MRI-technique

A
  • patient positioned in a scanner containing..
  • extremely powerful magnetic field coils
  • -magnets, strength measured in tesla units
  • -1 tesla=10.000 times magnetic strength of the earth
  • -radiowave transmitters and radiowave receivers
  • -powerful computer
  • patient within bore of magnet
  • this magnet is superconducting and must be cooled to 4 degrees k
  • magnetic field causes certain alignment (magnetization) of atomic nuclei with the field
  • radiowaves are turned on which causes a shift in the direction of the body’s magnetic field
  • radiowaves are then turned off an the atoms return to their original magnetized state
  • the resonant energy which is released is used to create an image
  • -this energy is called a signal
  • each tissue in the body gives off a slightly different signal based on its location in the bore of the magnet and its chemical composition (bone, fat, blood)
21
Q

MRI-T1 vs T2 weighted images

A
  • T1 weighting: anatomy
  • T2 weighting: pathology
  • MRI can also be completed with contrast material injected IV
22
Q

T1 weighting

A

water appears dark, fats are more white in appearance

23
Q

T2 weighting

A

most pathology has higher water content (edema), water lights up (white) with T2 imaging

24
Q

bone marrow and cortex appearance (CT/xray, T1, T2)

A
  • CT/xray: marrow: gray Cortex: white
  • T1: marrow: bright cortex: gray/black
  • T2: marrow: gray Cortex: dark gray
25
Q

fat

A

Ct/xray:black
T1: white
T2: gray

26
Q

air

A
  • xray:balck
  • T1: dark
  • T2: dark
27
Q

water

A
  • ct/xray: gray
  • T1: dark
  • T2: bright
28
Q

MRI

A
  • can distinguish bone, muscle, articular cartilage, fibrocartilage, ligaments, tendons, vessels, nerves, fat
  • excellent for evaluation of the CNE
  • best study for the diagnosis of soft tissue trauma and tumors
29
Q

MRI contraindications

A
  • ferrous metals or mechanical devices implanted in the patients body-can disrupt magnetic field
  • orthopedic appliances-NOT a contraindication to MRI, but will distort the image
  • open vs closed (claustrophobia) vs “open feeling”
30
Q

nuclear scans (nuclear medicine imaging-NM)

A
  • patient is temporarily made radioactive with an isotope
  • -sensitive to inflammation
  • -SNOUT to rule out
  • isotopes are attached to certain physiologic molecules
  • physiologic function is utilized to obtain image of organ or tissue
  • ex thyroid
  • no blackening on bone scan, can rule out inflammation
  • RA=hot spots all over
  • bone scan can be used over MRI to show stress fracture
  • increased uptake implies more disease
31
Q

ultrasound

A
  • high frequency sound waves create an image of living tissue
  • harmless to pt
  • creates a real time movie
  • viewed as sections
  • used commonly with abdominal imagin, obstetrics, vascular studies (doppler-like police radar)
  • form of biofeedbakc, see real time movement
32
Q

myelogram

A
  • contrast injected into the subarachnoid space mixes with cerebrospinal fluid to produce a column of radiopaque fluid
  • typically utilized prior to surgery
  • no longer used, side effect=violently ill
33
Q

cost and reimbursement

A
  • costs of diagnostic images is expensive, however third party payers have cut back he reimbursement for them
  • -heirarchy of diagnostic tests
  • some third party payers require pre-approval of diagnostic imaging tests

Clinical Medicine 1 (7 decks)

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