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PTRS 746 Exam 1 > Medical Imaging Part 1 > Flashcards

Medical Imaging Part 1 Flashcards

1
Q

Q: What is the error rate in radiological interpretation (by radiologists and radiology residents)?

A

May be as high as 20-40%

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2
Q

Defn: Errors of observation

A

The image doesn’t look like what you think it is Ex. Fracture doesn’t show up

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3
Q

Defn: Errors of interpretation

A

The injury is there but the radiologist misses it. Ex. Fracture is there but is not seen

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4
Q

T/F: With interpretation, insignificant findings may prove significant, while significant findings may prove insignificant.

A

True

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5
Q

Q: What can a PT offer when interpretation is difficult for even the specialist? (3)

A
  1. Managing care 2. Directing imaging 3. Relating imaging studies to clinical evaluation
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6
Q

T/F: PT’s should be independently interpreting imaging results.

A

False

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7
Q

T/F: Diagnostics are the tools and are the answer.

A

False: they are a tool, NOT the answer.

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8
Q

T/F: Diagnostic findings, including imaging, must be used in the context of clinical presentation.

A

True

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9
Q

T/F: Diagnostic imaging and PT improves the PT/physician communication.

A

True

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10
Q

T/F: Diagnostic imaging and PT adds nothing to the comprehensive PT eval.

A

False: enhances

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11
Q

T/F: diagnostic imaging and PT guides and informs the PT’s treatment plan.

A

True

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12
Q

Q: By what percent was diagnostic imaging reduced when military PT’s were given the ability to order images.

A

50%

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13
Q

Defn: True positive

A

Test detects something that is really there

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14
Q

Defn: False positive

A

Test detects something that is not really there

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15
Q

Defn: True negative

A

Test detects nothing and nothing is there

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16
Q

Defn: False negative

A

Test detects nothing, but there is something there

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17
Q

Term: Refers to a test’s ability to identify a true positive.

A

Sensitivity

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18
Q

Defn: Sensitivity

A

A test’s ability to identify a true positive

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19
Q

Q: Sensitivity - A negative test means…

A

You definitely don’t have the condition

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20
Q

Q: What acronym is helpful for sensitivity?

A

SNOUT Sensitivity, Negative, Ruled Out

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21
Q

Term: Refers to a test’s ability to identify a true negative

A

Specificity

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22
Q

Defn: Specificity

A

A test’s ability to identify a true negative

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23
Q

Q: Specificity - A positive test means…

A

You definitely have a condition

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24
Q

Q: What acronym is helpful for specificity?

A

SPIN Specificity, Positive, Ruled In

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25
Q

Q: Given that HIV blood tests are very sensitive, what can you assume about the presence of the virus from a negative test?

A

That the test will rarely come up negative is the virus is present - SNOUT

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26
Q

Q: Given that home pregnancy tests are very specific, what can you assume about the presence of a pregnancy from a positive test?

A

That a positive test is almost always due to pregnancy - SPIN

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27
Q

Q: What are the 4 advantages of conventional radiographs (x-rays)?

A
  1. Time and cost efficient
  2. Non-invasive
  3. Low risk
  4. Good for screening
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28
Q

Q: What is the first order diagnostic modality?

A

Conventional radiographs or x-rays

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29
Q

Q: What is the main disadvantage of conventional radiographs?

A

They may be normal when a pathology actually exists

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30
Q

Diagram: X-ray Basics

A
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31
Q

Term: Reduced strength or density of the x-ray beam as it passes through a medium

A

Attenuation

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32
Q

Term: Ability of the x-ray beam to pass through substance to reach the film plate

A

Permeability

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33
Q

Q: What color is the exposed film in radiographic images?

A

Dark

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34
Q

Term: X-ray absorption capacity, based on substances composition, density, and thickness

A

Radiodenisty

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35
Q

T/F: The radiodensity of an object is directly related to the radiodensity (amount of blackening) on the radiograph.

A

False: inversely

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36
Q

Q: High object radiodensity results in _____________ radiography density on the film, thus the object appears ________.

A

Decreases, whiter

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37
Q

T/F: A radiograph is simply a representation of the radiographic densities of anatomical structures

A

True

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38
Q

Term: easily penetrated by x-rays - i.e. low attenuation

A

Radiolucent substance

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39
Q

Term: Not easily penetrated by x-rays - i.e. high attenuation

A

Radioopaque substance

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40
Q

Q: List the substance that represents the color on radiograph (shown below) from darkest to lightest.

A
  1. Air
  2. Fat
  3. Water
  4. Bone
  5. Contrast Media
  6. Heavy Metals
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41
Q

Diagram: Radiograph coloring review

A
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42
Q

Table: Fill in the table below

A
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43
Q

Q: What is the least radiodense stubstance in the body?

A

Air

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44
Q

Q: What contrast media is typically used?

A

Barium sulfate (in swallow studies)

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45
Q

T/F: In x-rays, one view is no view.

A

True, in terms of interpretation. X-rays are 2D images, need more than one image to reconstruct into 3D

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46
Q

Term: visibility of the image

A

Photographic qualities

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47
Q

Term: amount of blackening on the radiograph dependent on distance, time, and current

A

Density

48
Q

Term: differences between adjacent tissue densities

A

Contrast

49
Q

Term: Clarity of the image

A

Geometric qualities

50
Q

Term: also known as sharpness or resolution

A

Detail

51
Q

Term: Maximized by positioning patient so structure of interest is closest to film plate

A

Detail

52
Q

Term: Usually occurs due to distance between beam source, patient, and image receptor, and from alignment and positioning issues

A

Distortion

53
Q

Q: What gives an x-ray image with the most detail and least distortion?

A

Have the part of interest as close to the film or plate as possible

54
Q

Term: Image appears shorter and wider than the actual object or structure

A

Foreshortening

55
Q

Term: Objects or structures further from the film appear larger than closer points

A

Magnification

56
Q

Q: How are radiographs named?

A

For the beam directions relative to the patient/patient position

57
Q

Q: What are the 3 common radiograph names?

A

anterioposterior (AP), posterioanterior (PA), Lateral/oblique

58
Q

Q: How are lateral view named?

A

For the side closer to the film plate

59
Q

Q: What is one thing to be careful of when viewing radiographs?

A

The identification letters may appear backward or upside down

60
Q

Q: What are the ABCs of Radiology?

A

Alignment, Bone Density, Cartilage, Soft tissue

61
Q

Content: The 4 parts of alignment

A
  1. Gross bone size
  2. Number of bones
  3. Shape and contour of cortical outline
  4. Joint position and alignment
62
Q

Diagram: In the image below label each line

A

Red = anterior vertebral line

Blue = posterior vertebral line

Green = spino-laminar line

Orange = posterior spinous line

63
Q

Content: 4 parts of bone density

A
  1. Cortical margins dense, lower density in cavity
  2. Weight bearing should be higher density
  3. Osteoporosis is suggested by low contrast - “washed out”
  4. Sclerosis or arthritis will appear as a brighter white
64
Q

Diagram: Identify the problem

A

Biconcave “fish” vertebrae, indicative of osteopenia

65
Q

Diagram: Identify the problem

A

Metastic bone lesion (from primary lung cancer)

66
Q

Content: 4 parts of cartilage

A
  1. Joint space width
  2. Subchondral bone
  3. Joint margins (smoothness)
  4. Epiphyses and growth plates
67
Q

Diagram: Identify the problem

A

Osteoarthritis of the left hip, with joint collapse

68
Q

Content: 3 parts of soft tissue

A
  1. Gross size of musculature
  2. Outline of joint capsules
  3. Periosteum
69
Q

Diagram: Identify the problem

A

Fat pad or “sail” sign: note faint density change at arrows as edema pushes fat pad out of fossa

70
Q

Diagram: Identify the problem

A

Left intertrochanteric and subtrochanteric hip fractures

71
Q

Diagram: Identify the problem

A

“Teardrop” fracture of 2nd cervical vertebrae

72
Q

Diagram: Identify the problem

A

Osteonecrosis of femoral head, femoral head begins to flatten

73
Q

Diagram: Identify the problem

A

Compression fracture of 4th lumbar vertebrae

74
Q

Defn: Contrast enhancement

A

Injection or ingestion of radiocontrast medium prior to radiographic study

75
Q

Diagram: Identify the contrast enhancement

A

Barium swallow

76
Q

Content: Computed tomography basics (4)

A
  1. Uses x-ray attenuation to produce cross-sectional images
  2. X-ray tube and film move about a fulcrum
  3. Provides detailed anatomical imaging of bone
  4. Travserve images are read from the bottom looking up
77
Q

Diagram: CT Basics

A
78
Q

Q: What are the 2 advantages of CT?

A
  1. Sensitive and specific for fracture
  2. Useful for rapid assessment of brain or neurologic injury
79
Q

Q: What are the 3 disadvantages of CT?

A
  1. Radiation exposure
  2. Discriminates density, but limited in precise histologic differences
  3. Small volume of tissue image as a uniform shade of gray
80
Q

Diagram: Identify the image below

A

CT image of left actabular fracture

81
Q

Diagram: Identify the image below

A

3D image of tibial plateau and proximal fibular fractures

82
Q

Q: How does an MRI generate an electromagnetic field?

A

Uses pulses of radiofrequnecy and a strong external magnet

83
Q

Term: Atomic nuclei allign in an electromagnetic field

A

Resonance

84
Q

Q: During an MRI, nuclei realign to their _________ state when the field is _________, release _________ energy.

A

Resting, removed, resonant

85
Q

Q: What produces a radio frequency signal that can be captured and processed into an MRI image?

A

The release of resonant energy

86
Q

Content: 4 advantages of MRI

A
  1. Good sensitivity
  2. Images soft tissue well
  3. No radiation
  4. Little distortion as images are obtained in one plane
87
Q

Content: 3 disadvatnages of MRI

A
  1. Relatively low specificity
  2. Expensive
  3. Contraindicated if pt. has ferrous metal implant or exposure
88
Q

T/F: Ortopedic hardware is ferromagnetic, however surgical clips and pacemakers are safe during an MRI.

A

False, flip it

89
Q

T/F: MRI images are based on two different processes of proton realignment.

A

True

90
Q

Term: How long it takes protons to relax back to resting state following a RF pulse

A

Longitudinal magnetization (T1)

91
Q

Term: How long resonating protons remain in phase following a RF pulse

A

Transverse magnetization (T2)

92
Q

Table: Fill in the table below

A
93
Q

Q: With ________ MRI, tissue enhancement is ______________ to blood flow to the tissue.

A

Contrast, proportional

94
Q

Q: In what ways can MRI contrast be delivered into the pt.’s system?

A

IV or intra-joint injection

95
Q

Diagram: Identify the type of MRI image.

A

T2 image of a herniated lumbar disk

96
Q

Diagram: Identify the type of MRI image

A

T1 image of right hip chondrosarcoma

97
Q

Diagram: Idenifty the type of MRI image

A

T2 image of tibial plateau and femoral condyle contusion

98
Q

Content: Functional MRI (2)

A
  1. Based on increased BF that accompanies cerebral activity
  2. Uses magnetic properties of deoxyhemoglobin as an endogenous contrast agent
99
Q

Content: DEXA (4)

A
  1. Gold standard for body composition
  2. Measure bone density
  3. Determines density based on difference between absorption of beams
  4. Radiation exposure approx. = to a flight from NYC to LA and back
100
Q

Content: Nuclear Medicine (3)

A
  1. Uses radiopharmaceuticals for diagnosis, therapy, and reserach
  2. Radiopharmaceuticals are radioactive tracers that are absorbed according to the metabolic properties of the tissue
  3. Detection of the location and concentration of radioactive elements is used to produce an image
101
Q

Content: Types of Nuclear Medicine (4)

A
  1. SPECT
  2. PET
  3. SPECT or PET in combo with CT
  4. Radionuclide scintigraphy or bone scan
102
Q

Content: Radionulcide scintigraphy (3)

A
  1. Labeled methylene is injected, scanning occurs 2-3 hours following injection
  2. High uptake = increased bone activity or mineral turnover
  3. Modality of choice for detecting stress fractures and metastatic bone disease
103
Q

Content: 3 advatanges of radionuclide scintigraphy

A
  1. Highly sensitive for early bone and joint disease
  2. Fast
  3. Reasonable cost
104
Q

Content: 2 disadvantages of radionuclide scintigraphy

A
  1. Poor specificity
  2. Easily influenced by osteoblastic activity or BF of any etiology
105
Q

Diagram: Idenifty the type of image

A

Radionuclide scintigraphy - metastatic prostate cancer

106
Q

Content: Ultrasonography (4)

A
  1. Images produced by sound waves
  2. Tissues have unique acoustic qualities
  3. Useful for OBGYN and musculoskeletal tissue
  4. Can be used with activity
107
Q

T/F: Ultrasound is operator independent, and does not require practice to have good technique.

A

False

108
Q

T/F: Ultrasound is included in the PT practice act, but should only be used to confirm diagnosis.

A

True

109
Q

Q: ____________ ____________ are generally the first order modality.

A

Conventional , radiographs

110
Q

Q: ______ is used to visualize complex anatomy

A

CT

111
Q

Q: ________ is used to assess soft tissue.

A

MRI

112
Q

Content: 3 parts of a trauma survey

A
  1. Diagnose and evaluate fracture or disloaction
  2. Match MOI to clinical presentation
  3. Assess treatment and monitory healing
113
Q

Q: What types of images are typically taken for a trauma evaluation? (3)

A
  1. Lateral chest
  2. AP chest
  3. AP pelvis
114
Q

Diagram: Identify the following clinical decision rule;

Sensitivity ______, Specificity ______

A

Pittsburg Decision Rule for Knee Trauma

99%, 60%

115
Q

Diagram: Identify the following clinical decision rule;

Sensitivity ______, Specificity ______

A

Ottowa Knee Rule

97%, 27%

116
Q

Diagram: Identify the following clinical decision rule;

Sensitivity ______, Specificity ______

A

Ottowa Ankle and Foot Rules

100%, 40%

117
Q

Diagram: Identify the following clinical decision rule;

A

Imaging Guidelines for Actue LBP

PTRS 746 Exam 1 (9 decks)

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