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Imaging > Lecture 1 > Flashcards

Lecture 1 Flashcards

1
Q

Roles of Imaging in PT Management: (7)

A
  1. Improve understanding of anatomy
  2. Improve understanding of pathology, trauma, healing
  3. Inform interventions
  4. Help you educate your patients
  5. Support or refute PT Dx.
  6. Improve ICD10 coding
  7. Support PT as practitioners of choice for MS conditions
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2
Q

Large osteophyte at talar head

A

Talar beak

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3
Q

Fibrous or bony attachment in area of foot- causes pain

A

Talocalcaneal coalition

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4
Q

Rare human an atomic variant that usually affects lateral meniscus of knee
MRI used

A

Discoid meniscus

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5
Q

When is imaging needed? (4)

What are examples included within these categories?

A
  1. Trauma: MVA, fall, blunt trauma
  2. Cancer/malignancy/tumor: hx, age >55, weight loss, non-mechanical pain
  3. Infection: fever of unknown origin
  4. Miscellaneous: non-responsive to conservative care
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6
Q

American College of Radiology: Appropriateness Criteria

The _______ the rating number, the more appropriate the study is for that patient

A

HIGHER

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7
Q

ACR Appropriateness Criteria:

Perform variants _____-_____, then if they refer for x-ray, continue ACR rating

A

Variants 1-3

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8
Q

If MRI is not appropriate, then ____ may be more appropriate

A

CT

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9
Q

________ are tools used by clinicians to determine likelihood that patient is presenting with given disorder, based on number of variables that have been shown to have predictive ______ in revealing patients most likely to have specific disorders

A

Clinical prediction rules

Validity

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10
Q

Canadian C-Spine Rule:

What are the 3 questions?

A
  1. Any high risk factor that mandates radiography?
  2. Any low risk factor that allows safe assessment of ROM?
  3. Able to rotate neck actively?
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11
Q

Canadian C-Spine Rule:

What is considered “high risk factor that mandates radiography”

A

Age >65

Dangerous mechanism/paresthesia in extremeties

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12
Q

Canadian C-Spine Rule:

What qualifies as low risk factor that allows safe assessment of ROM

A
  • Simple rear end MVA
  • sitting position in ER
  • ambulatory at any time
  • delayed (not immediate) onset of neck pain
  • absence or midline cervical spine tenderness
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13
Q

Canadian C-Spine Rule:

What is meant by active neck rotation?

A

45 degrees L/R

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14
Q

Ottawa Knee Rules (5 things)

A
  1. Age >55
  2. Isolated patella tenderness
  3. Tenderness at head of fibula
  4. Inability to flex knee to 90 deg
  5. Unable to bear weight immediately after and walk 4 steps in ER
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15
Q

Pittsburgh Knee Rule: 3 things

A
  • Blunt trauma or fall is MOI and either of following is true:
    1. Age <12 or >50
    2. Inability to walk 4 steps in ED
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16
Q

Ottawa Ankle Rules (4)

A
  1. Bone tenderness at posterior edge of distal 6cm of tip of medial or lateral malleolus
  2. Unable both to bear weight immediately after injury and walk 4 steps in ER
  3. Bone tenderness at base of 5th metatarsal
  4. Bone tenderness over navicular
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17
Q

Pittsburgh Ankle Rules (2)

A
  1. Age <12 or >50

2. Unable both to bear weight and walk 4 steps in ER

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18
Q

AROM after Acute Elbow Injury:
Limited ROM in all directions of flexion, extension, sup/pro predictive of ________.
Sensitivity _____%, Specificity ______%
Individuals with limitation in ____ or ____ directions had no signs of fx in x-ray

A

Elbow fx
90, 92
One or two

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19
Q

4 types of imaging modalities

A
  1. Radiographs/X-rays
  2. Computed tomography
  3. Ultrasound
  4. Magnetic resonance imaging
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20
Q

What is the most widely performed imaging exam?

A

X-ray

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21
Q

X-rays are emitted and detected in ______, which can generate either film or digital image.

A

Cassette

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22
Q

Films are kept on file or in digital archive called _____.

A

PACS (Picture archiving and communications system)

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23
Q

X-rays are a form of _____ ______ radiation (discovered in 1895)

A

Ionizing electromagnetic

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24
Q

X-rays are produced in tube and beamed out of collimator, which controls ______ and _____ of X-ray field

A

Size and shape

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25
Q

X-rays pass through patient and undergo _________

A

Attenuation

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26
Q

Reduction in number of X-ray photons in beam as result of photons interaction with matter and losing energy through either scattering, absorption, or beam divergence is known as _____

A

Attenuation

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27
Q

3 ways X-ray photons lose energy

A
  1. Scattering
  2. Absorption
  3. Beam divergence
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28
Q

Combination of physical qualities of an object that determines how much radiation it absorbs from X-ray beam is _______

A

Radiodensity

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29
Q

4 shades of gray from radiolucent —–> radiopaque

A
  1. Air: black
  2. Fat: gray-black
  3. Water: gray
  4. Bone: white
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30
Q

What color is radiolucent

A

Black- nothing is blocking it

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31
Q

What color is radiopaque

A

Bright white

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32
Q

What color is fat on X-ray

A

Gray-black

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33
Q

What color is air on X-ray

A

Black

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34
Q

What color is bone on X-ray

A

White

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35
Q

What color is water on xray

A

Gray

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36
Q

X-ray: ___D seen in ___D

A

3D, 2D

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37
Q

Image of xray is summation of _______

A

An atomic shadows

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38
Q

Radiodensity is function of ____ and _____

A

Thickness and composition

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39
Q

T/F: One view is no view

A

TRUE

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40
Q

5 limitations of radiographic imaging

A
  1. Film quality
  2. Sensitivity (not sensitive to subtle pathology)
  3. Specificity
  4. Appropriateness (inability to adequately visualize soft tissue)
  5. Examination errors
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41
Q

Pros of radiographs (5)

A
  1. Widely available
  2. Inexpensive
  3. Doesn’t require advanced technologist knowledge
  4. Can be performed quickly
  5. Portable
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42
Q

Cons of radiographs (3)

A
  1. Ionizing radiation
  2. Relatively intensive
  3. Patient cooperation
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43
Q

4 types of radiographic distortion

A
  1. Enlargement
  2. Superimposition
  3. Elongation
  4. Foreshortening
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44
Q

What is foreshortening

A

Occurs when beam strikes object that is not at R angle to beam

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45
Q

What is superimposition

A

One object on top of another on xray

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46
Q

What is enlargement (xray)

A

Anything in front of the expanding beam looks smaller compared to those in the back

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47
Q

T/F: it is ok to perform X-rays as often as needed

A

FALSE- “Because of the cumulative and harmful effects of ionizing radiation, X-rays should only be done when necessary and never as a routine procedure”

48
Q

CT: T/F

X-ray beam rotates 180 degrees around object

A

False- 360!

49
Q

CT: provides superior contrast and better visualization of _______ than radiography

A

Soft tissue

50
Q

CT: T/F

Not as good for imaging of bone fragments and fractures

A

FALSE! Better imaging of bone fragments and fxs

51
Q

Dynamic and continuous radiographic examination that provides REAL TIME imaging of physiological function is _____

A

Fluoroscopy

52
Q

What is a scintigraphy?

A

Bone scan

53
Q

Bone scan: Injection of polyphosphate and _____ ______ binds to hydroxyapatite found in _____ ______ bone

A

Radioactive isotope

Metabolically active

54
Q

What is a bone scan used for? (3)

A
  1. Bone tumors
  2. Metastasis
  3. Early detection of stress fx
55
Q

What type of imaging is used to see developing baby

A

Diagnostic U/S

56
Q

Diagnostic U/S is an image created by transmitting ________ into body that reflect off tissues. The intensity of the reflected ______ are then interpreted.

A

sound waves

Echoes

57
Q

Ultrasound origins are in ______

A

SONAR

58
Q

What are the 3 components of diagnostic u/s

A
  1. Pulser
  2. Transducer
  3. Scan converter and monitor
59
Q

What are the measurements of the pulser (u/s)

A

2-15 MHz

60
Q

What does the U/S transducer do

A

Converts electricity to sound

61
Q

How is U/S produced?

A

Reverse piezoelectric effect

62
Q

What are the beam characteristics of U/S

A

Converges to focal zone then diverges

63
Q

4 ways U/S sound waves travel

A
  1. Absorption
  2. Reflection
  3. Refraction- waves transmitted across interface an change directions
  4. Scattering
64
Q

How well the surface will reflect the U/S beam is called

A

Echogenicity

65
Q

U/S: Tissues or interfaces that reflect MUCH energy are ______

A

Hyperechoic

66
Q

U/S: Tissues and interfaces that reflect LITTLE energy are called

A

Hypoechoic

67
Q

U/S: Tissues and interfaces that reflect little energy (…thinking should say “no”?)

A

Anechoic

68
Q

Sound waves reflect off ______ tissue and interfaces between tissue that are dissimilar in ______ and produce _____ images

A

Hyperechoic
Density
Bright

69
Q

Dx U/S Scanning Planes:

Longitudinal sonogram results in _____ image

A

Sagittal

70
Q

Dx U/S Scanning Planes:

Transverse sonogram results in ______ image

A

Axial

71
Q

Dx U/S Scanning Planes:

Structures can be followed through ______

A

All planes

72
Q

DU/S Advantages: (7)

A
  1. High resolution
  2. Low cost
  3. Safe
  4. Fast
  5. Portable
  6. Easy comparison
  7. Well tolerated
73
Q

D U/S Disadvantages (3)

A
  1. Operator dependent
  2. Bone not penetrated
  3. Poor imaging of obese
74
Q

T/F: U/S is powerful dx tool for examining musculoskel disorders

A

TRUE

75
Q

T/F: Dx MS ultrasound does not fit well with orthopedic PT practice

A

FALSE- it does

76
Q

T/F: U/S substitutes for MRI in evaluating soft tissue injuries such as RTC, Achilles tendon

A

TRUE

77
Q

T/F: U/S provides biofeedback for transverse abdominus contractions

A

TRUE

78
Q

Procedure used to evaluate muscle and related soft tissue morphology and function during exercise and physical tasks

A

Rehabilitative U/S Imaging

79
Q

Measures spatial distribution of protons from H+ atoms in body when excited by radio frequency waves in magnetic field

A

MRI

80
Q

Signal emitted from MRI is ____ _____ ____

A

Nuclear magnetic resonance (NMR)

81
Q

2 kinds of NMR used in MRI

A
  1. Free induction decay T2*

2. Echo (Spin, Gradient, Multi) T1, T2, PD

82
Q

Repetition time (TR) modifies ______-weighing

A

T1

83
Q

The longer the TR, the ____ T1- weighing the image is

A

Less

84
Q

Echo time (TE) modifies the ______-weighing

A

T2

85
Q

The ____ the TE, the less T2- weighed the image is

A

Shorter

86
Q

Short TR, short TE

A

T1-weighted image

87
Q

Long TR, long TE

A

T2-weighed image

88
Q

Long TR, short TE

A

PD-weighed image

89
Q

______ has a high intensity signal with T1

A

FAT

90
Q

____ has high intensity signal with T2

A

WATER (“H20-T2”)

91
Q

What is seen as high intensity with PD weighing

A

Fat and fluid

92
Q

MRI contrast- evaluates ______ and joint injuries, bone and _____ tumors

A

Soft tissue, soft tissue

93
Q

MRI: Changes in water content (H+ atoms)common in acute injuries and _____

A

Chronic inflammatory conditions

94
Q

MRI sequences are used for detecting _______ such as edema, effusions, synovial fluid, tumors, hematoma

A

Water changes

95
Q

Bright signal from _____ is often hindrance to dx in MR imaging

A

Fat

96
Q

MRI: More contrast is possible by manipulation of number of variables and by adding contrast medium such as _____

A

Gadolinium

97
Q

Relative tissue appearance:

Bone marrow T1, PD, T2

A

T1 Bright gray
PD Gray
T2 Gray

98
Q

Relative Tissue Appearance:

Fat T1, PD, T2

A

T1 Bright
PD Bright
T2 Gray

99
Q

Relative Tissue Appearance:

Edema/fluid T1 PD T2

A

T1 Dark
PD Bright
T2 Bright

100
Q

What color are ligaments and tendons on MRI

A

Dark

101
Q

Fluid-sensitive sequences:

T2 =

A

Fat-suppressed T2-weighted

102
Q

Fluid-sensitive sequences:

PD =

A

Proton density-weighted

103
Q

Fluid-sensitive sequences:

What is FSE

A

Fast spin echo

104
Q

Fluid-sensitive sequences:

What is short tau/T1 inversion-recovery

A

STIR

105
Q

MRI Artifact (4)

A
  1. Motion
  2. Flow
  3. Chemical shift
  4. Magic angle
106
Q

What is the “magic angle” of MRI

A

Can alter look of MRI if at 5 degree angle from view

107
Q

Limitations of MRI (3)

A
  1. Expensive
  2. Time consuming
  3. False positives
108
Q

3 contraindications to MRI

A
  1. Ferrous metals
  2. Implanted devices
  3. Fixation devices and total joint components made of ferrous metals
109
Q

What is the Lexicom for Uniform Indexing and Retrieval of Imaging Information acronym?

A

Radlex (terminology standards for MRI radiologists)

110
Q

Why do MRIs make noise?

A

Banging is vibration of metal coils of MRI magnet caused by rapid pulses of electricity. The stronger the magnet and stronger the vibrations, louder the banging.

111
Q

In ______ MRI, ear protection is recommended

A

3T

112
Q

Open vs. closed MRI:

Measured in ______

A

Tesla (T)

113
Q

Open vs. Closed MRI:

1.5 T is _____

A

Open

114
Q

Open vs. Closed MRI:

______ is standard and closed

A

3T

115
Q

Open vs. Closed MRI:

_____ T is used in research

A

7

Imaging (2 decks)

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