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PHTY3260 > L4: Radiological investigation of the cervical and thoracic spines > Flashcards

L4: Radiological investigation of the cervical and thoracic spines Flashcards

1
Q

What are 2 characteristics of private physiotherapists in QLD?

A
  1. MBS for plain films
    1. Spine (including cervical),
    2. Hip
  2. Non referred status
    1. Other regions where limited if any rebate for the patient
    2. MRI
    3. Has to be accepted by the radiologist
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2
Q

What are 2 characteristics of public physiotherapists in QLD?

A
  1. Legislation change for accredited Physiotherapists to refer within the public health system
  2. Facility based decision on need and experience
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3
Q

What are 6 MBS requirements for referrals/requests for cervical imaging?

A
  1. Form
    1. No specific form but ‘in writing and contain sufficient information, in terms that are generally understood by the profession, to clearly identify the item/s of service requested’
  2. Clear and legible request
  3. Identity of patient
  4. Identity of the requestor
  5. Clinical detail
  6. Meets MBS requirement
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4
Q

What are deterministic effects of ionising radiation in cervical imaging?

A
  • Describe a cause and effect relationship between radiation and some side-effects. They are also called non-stochastic effects to contrast their relationship with the chance-like stochastic effects, e.g. of cancer induction.
  • Deterministic effects have a threshold below which, the effect does not occur. The threshold may be very small and may vary from person to person. However, once the threshold has been exceeded, the severity of an effect increases with dose.
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5
Q

What are 7 examples of deterministic effects (doses are given as absorbed dose) for cervical imaging?

A
  1. skin erythema: 2-5 Grays Gy
  2. irreversible skin damage: 20-40Gy
  3. hair loss: 2-5Gy
  4. sterility 2-3Gy
  5. cataracts: 5Gy
  6. lethality (whole body): 3-5Gy
  7. fetal abnormality: 0.1-0.5Gy

(Gy Gray – absorbed dose of radiation)

(Sv Sievert - dose equivalent) – accounts for type of radiation

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6
Q

What are stochastic effects of ionising radiation in cervical imaging?

A
  • Occur by chance and can be compared to determinstic effects which result in a direct effect.
  • Risk is proportional to the dose and the severity is independent of the dose
  • Although the risk increases with dose, the severity of the effects do not; the patient will either develop cancer or they will not.
  • Cancer induction as a result of exposure to radiation occurs in a stochastic manner: there is no threshold point and risk increases in a linearquadratic fashion with dose. This is known as the linear-quadratic no threshold theory.

Likelihood of cancer increases with increased radiation exposure

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7
Q

What are 4 considerations of ionising radiation in cervical imaging?

A

–> increase of 1.2mSv per annum per person

  • Effects of
  • Single dose
  • Cumulative dose

Minimise radiation exposure

  1. Consider minimal radiation
  2. Modality
  3. Size of area required
  4. Age (risk is higher younger ages)
  5. Anatomical area (reproductive organs)
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8
Q

What are 3 common cervical imaging modalities?

A
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9
Q

What are 12 characteristics of x-ray as cervical imaging?

A
  1. Good for 0verview
  2. Quick (screening)
    1. Full series of 6 views Vs CT
  3. Anatomy
    1. Vertebrae
    2. Relative canal size
    3. Soft tissue shadows
  4. Alignment
    1. Straightening of the lordosis due to muscular spasm
    2. Anterior / retro listhesis
  5. Views (Most common, but would need 2 views min. = give 3D interpretation)
    1. Planar - Normally least two views
    2. AP / lateral
    3. Oblique (labelled L = L intervertebral foramen)
    4. Open mouth / odontoid
    5. Swimmers visualise Cx/Tx junction
    6. Stability views (neutral/flexion/extension)
  6. Good availability
  7. Relatively inexpensive
  8. Minimal contraindications
  9. Physiotherapists can refer
    1. Rebate available
    2. 2 views relatively quick (c/f CT for multipleviews)
  10. Radiation (lesser dose than CT)
  11. Poor soft tissue definition
  12. Inability to see neural tissues
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10
Q

What are 8 characteristics of CT as cervical imaging?

A

Improved imaging technology

  1. Each voxel now is a cube where previously a rectangle
  2. Bone and soft tissue windows
    1. Good anatomical information
    2. Good / excellent bony detail
    3. Less soft tissue detail
  3. Radiation doseage
    1. Reduced with improved machines (Low dose)
  4. Thinner slices
  5. Imaging skull base to mid T1 (or lower)
  6. 28% fractures multiple (Can see the sequence (multiple #))
  7. Relatively quick for whole Cx
    1. Verse six plain films
  8. Moderate availability
  9. Physiotherapists can’t refer

Soft tissue

X-ray< CT < MRI

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11
Q

What is a characteristics of CTA as cervical imaging?

A

Vascular

  • Cervical arterial disease / dysfunction
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12
Q

What are 9 characteristics of MRI as cervical imaging?

A
  1. Gold standard for soft tissues
    1. Muscle / tendon
    2. Ligament
    3. Spinal cord
      1. Myelomalacia / myelopathy
    4. Nerve roots
  2. Different weightings
    1. T1, T2, STIR, fat saturated
    2. T1 anatomical detail = (bony outline)
    3. T2 for nerve / spinal cord = (water)
  3. Limited availability
  4. (Cost)
  5. Bony definition
  6. Physiotherapists can refer
    1. (no rebate)
  7. Rebate for Medical Specialist & specific GP referral eg suspected Cx radiculopathy
  8. Artifact
    1. esp with metal (can include fillings)
    2. Time for acquisition (at risk patient)
      1. Movement sensitive
  9. Improving technology
    • Tesla 0.5T –> 3T
    • 3T = faster
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13
Q

What are 6 contraindications of MRI as cervical imaging?

A
  1. Pacemaker
  2. Metal in eye (preimage Xray)
  3. Metallic stents
  4. Certain aneurysm clips
  5. Neural stimulators
  6. Inner ear implants (cochlear)
  7. Claustrophobic
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14
Q

What is T1 and T2 cervical imaging?

A
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15
Q

Who should we image (cervical imaging)?

A
  1. Cx Rules
    1. Nexus
    2. Canadian C spine
  2. ACR appropriateness guidelines

(Need to only image when necessary –> only makes patient catastrophise)

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16
Q

What is the Canadian C-Spine Rule?

A
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17
Q

What are the ACR guidelines for cervical imaging for non-traumatic neck pain and non-traumatic radiculopathy?

A
18
Q

What are the ACR guidelines for cervical imaging for chronic neck pain and chronic pain with degenerative changes?

A
19
Q

What are 7 characteristics of the cx interpretation? What are 5 observations (sequence)?

A
  1. Name and date
  2. Sagittal view
  3. (coronal view)
  4. Axial view
  5. Using both to match findings
  6. Different weightings
  7. Interpret in a sequential way
    1. General Alignment
    2. Vertebral bodies
    3. Discs
    4. Nerve roots
    5. Canal
20
Q

What are 4 characteristics of soft tissue in cervical imaging?

A
  1. Can look anteriorly, posteriorly & within canal ( haemorrhage, disc)
  2. Ant. soft tissue criteria can vary
    1. 6mm @ C2
    2. 2cm @ C6
    3. Ant to C2 & 3 – 1/3 of vert body
    4. Lower vert – 1 vert body
  3. Posterior soft tissues not clear
  4. Consider contours as much as specific measurement
21
Q

What are 6 anatomical lines in the standard lateral interpretation of cervical imaging?

A

Anatomical lines

  1. Prevertebral soft tissues
  2. Anterior body line
  3. Posterior body line
  4. ‘Facetal line’ – equally stacked
  5. Spino-lamina line
  6. Spinous process line
22
Q

What does normal and degenerative CT scans look like?

A
23
Q

What does normal and degenerative MRI scans look like?

A
24
Q

What are the 3 classifications- stability/instability in the column model of cervical imaging?

A
25
Q

What are 3 trauma sources of cervical imaging? What are 6 mechanisms of injury?

A
  1. MVA
  2. Sports
  3. Other
  4. Hyperflexion
  5. Hyperextension
  6. Hyperextension & rotation
  7. Vertical compression
  8. Lateral flexion
  9. Diverse / Imprecisely understood
26
Q

What is the craniocervical junction instability and dislocation?

A
27
Q

Why is the craniocervical junction important?

A
  1. ? Image with lateral Xray first rather than into CT
  2. How stabilise?
    1. Powers ratio 0.64
28
Q

What are the 3 types of odontoid fracture for cervical imaging?

A

Differential

  • Subdental synchondrosis
  • Os odontoideum
  1. Type I
  2. Type II
  3. Type III
29
Q

What are 4 characteristics of type I odontoid fractures as cervical imaging?

A
  1. rare
  2. fracture of the upper part of the odontoid peg
  3. above the level of the transverse band of the cruciform ligament
  4. usually considered stable
30
Q

What are 5 characteristics of type II odontoid fractures as cervical imaging?

A
  1. most common
  2. fracture at the base of the odontoid
  3. below the level of the transverse band of the cruciform ligament
  4. unstable
  5. high risk of non-union
31
Q

What are 3 characteristics of type III odontoid fractures as cervical imaging?

A
  1. through the odontoid and into the lateral masses of C2
  2. relatively stable if not excessively displaced
  3. best prognosis for healing because of the larger surface area of the fracture
32
Q
A
33
Q

What is increased interspinous distance in cervical imaging?

A
34
Q

What is flexion tear drop fracture in cervical imaging?

A
35
Q

What is extension tear drop in cervical imaging?

A
36
Q

What is perched facet in cervical imaging?

A
37
Q

What is facet dislocation (naked facet/hamburger sign) in cervical imaging?

A
38
Q

What is bilateral locked facet in cervical imaging?

A
39
Q

What is a Jefferson fracture in cervical imaging?

A
40
Q

What is the mechanism of a Jefferson fracture in cervical imaging?

A

Burst fracture of the atlas.

  • For example diving injury
41
Q

What are 4 clinical reasons for when to image (cervical)?

A
  1. Guidelines and rules
  2. Red flags
    1. Trauma (guidelines)
      1. Recent injury
      2. (Past injury that has never been imaged)
    2. Other red flags
  3. Persistent / unresponsive symptoms
    1. New symptoms in chronic condition
  4. Neurological deficit
    1. (esp progressive & cord signs)
42
Q

What are 2 implications for treatment for when to image (cervical)?

A
  1. What might imaging findings mean to your clinical reasoning
  2. Will it change your treatment

PHTY3260 (27 decks)

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