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clinical seminars > musculoskeletal imaging > Flashcards

musculoskeletal imaging Flashcards

1
Q

osteoblasts

A

cells that build bone tissue

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2
Q

osteoclasts

A

cells that break down bone tissue

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3
Q

osteocytes

A

the cells that maintain bone tissue by controlling mineral and calcium homeostasis

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4
Q

compact bone

A

hard, smooth outer cortical layer protects the tissue within

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5
Q

spongy or cancellous bone

A

porous, honeycombed material inside the medullary cavity of most bones
provides strength yet is lightweight

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6
Q

otic capsule

A

aka. osseous labyrinth
dense bone of the petrous temporal bone that surrounds the membranous labyrinth of the inner ear
contains the most dense compact bone tissue in the human body

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7
Q

bone matrix

A

non-living extracellular matrix

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8
Q

bone matrix is made up of

A
  • water
  • hydroxyapetite
  • collagen fibres
  • other minerals, such as calcium carbonate
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9
Q

what gives bone matrix hardness

A

hydroxyapetite

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10
Q

what gives bone matrix flexibility

A

collagen fibres

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11
Q

bone marrow is

A

haemotopoeitic organ

produces blood cells

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12
Q

types of cells produced by bone marrow

A
  • erythrocytes
  • leucocytes (WBC)
  • thrombocytes - platelets
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13
Q

structure of long bones

A
  • articular cartilage
  • proximal epiphysis
  • metaphysis
  • diaphysis
  • metaphysis
  • distal epiphysis
  • articular cartilage
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14
Q

4 different types of bones

A
  • long bone - long, thin eg. arm and leg bones
  • short bone - squat, cubed eg. wrist and ankle bones
  • flat bone - flattened, borad surface eg. scapula, ribes, sternum
  • irregular bone - does not conform to one of these types eg. vertebrea
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15
Q

nutrient canal of a long bone

A

nutrient foramen
nutrient canal
contains the nutrient arteries and veins

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16
Q

nutrient canals are found in

A
  • diaphysis of long bones
  • mandible
  • dental alveoli
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17
Q

periosteum

A

a dense membrane that covers the outer surface of all bones , except the articular surfaces of long bones

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18
Q

endosteum

A

lines the inner surface of the bony wall and covers the bone marrow cavity

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19
Q

exception to periosteum and endosteum

A
  • double layered structure of dura mater
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20
Q

how many bones in the human body

A

206

213 if you view the sacrum as one or 5 bones

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21
Q

bones in the skull

A

22 bones total
8 cranial bones
15 facial skeleton bones

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22
Q

vertebral column bone

A 
33 total (26 in adults) 
7 cervical 
12 thoracic
5 lumbar 
5 sacral (fused in adults)
4 coccygeal (fused in adults)
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23
Q

thoracic vertebrae bones

A

2 x 12 ribes

3 bones in ther sternum (manubrium, body, xiphoid)

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24
Q

features of the skull - caudal side

A
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25
Q

sinuses

A
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26
Q

curve of cervical spine

A

lordotic

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27
Q

curve of thoracic spine

A

hyphotic

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28
Q

curve of lumbar spine

A

lordotic

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29
Q

curve of sacral and coccygeal spine

A

kyphotic

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30
Q

pectoral girdle bones

A 
2 bones (clavicle and scapula)
3 joints (sternoclavicular, acromioclavicular, and glenohumoural)
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31
Q

the upper extremity bones

A

1 bone of the arm - humerous

2 bones of the forerm - ulna and radius

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32
Q

hand bones

A

27 bones total
8 carpal bones
5 metacarpal bones
14 phalangeal bones (4x3 fingers, 1x2 pollux)

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33
Q

pelvic girdle bones

A

os coxae (3 fused bones; ilium, ischium, and pubis)

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34
Q

the lower extremity bones

A

thigh bones - 2- femur, patella

lower leg bones - 2 - tibia, fibula

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35
Q

bones of the feet

A 
2 x 26 total
7 tarsal bones 
- calcaneus and talus 
- 5 midfoot tarsals 
5 metatarsal bones 
14 phalangeal bones (4x3 toes, 1x2 hallux)
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36
Q

fibrous joint

A

adjacent bones are united by fibrous connective tissue, e.g. sutures in the skull
a syndesmosis is a fibrous joint in which the adjacent bones are linked by a strong membrane or ligaments e.g. distal tibiofibular syndesmosis

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37
Q

syndesmosis

A

a fibrous joint in which the adjacent bones are linked by a strong membrane or ligaments e.g. distal tibiofibular syndesmosis

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38
Q

cartilaginous joint

A

bones are joined by a hyaline hyaline cartilage (synchrondosis) or fibrocartilage (symphysis)

39
Q

symphysis

A

symphysis pubis, intervertebral discs, sacrococcygeal symphysis

40
Q

synchrondrosis

A

epiphyseal plate of growing long bones, spheno-occipital, ischiopubic, manubriosternal synchondrosis

41
Q

synovial joint

A

the articulating surfaces of the bones are not directly connected, but instead come into contact with each other within a joint cavity that is filled with a lubricating fluid

42
Q

general structure of a synovial joint

A
43
Q

uni-axial joints

A

synovial joint allowing motion around a single axis

pivot (C1/2 articulation, radius/ulna rotation) or hinge (elbow)

44
Q

bi-axial joints

A

condyloid (radiocarpal and metacarpophalangeal joint)

saddle (thumb joint)

45
Q

tri-axial joints

A

ball and socket (hip and shoulder)

plane (intervertebral disc)

46
Q

pivot joint

A

allows rotation around a single axis
C1/2 articulation
radius/ulna rotation

47
Q

hinge joint

A 
allows flexion and extension 
elbow (between humerous and ulna) 
interphalangeal joints of the hand and foot 
knee joint 
ankle joint
48
Q

condyloid joint

A

a condyle is a round, elliptical or ovoid prominence at the end of a bone that serves as an articular surface which is received into an elliptical cavity

49
Q

condylar articulations are found

A 
knee (medial and lateral condyles of the femur and tibia) 
elbow joint (humerous condyle) 
temporomandibular joints (mandibular condyles) 
atlanto-occipital joint (occipital condyles)
50
Q

saddle joint

A

a type of synovial joint in which the opposing surfaces are reciprocally concave and convex
offers a wide range of motion, though axial rotation is not possible

51
Q

examples of saddle joints

A

carpometacarpal joint of the thumb
sternoclavicular joint of the thorax
incudomallear joint of the middle ear (anvil-hammer)
calcaneocuboid joint of the heel

52
Q

tri-axial plane joint

A

the intervertebral disc

a cartilagenous joint that unites the bodies of two adjacent vertebrae

53
Q

3 types of muscle tissue

A

skeletal
smooth
cardiac

54
Q

skeletal muscle

A

voluntary and striated

muscle that attach to bones and control conscious movement

55
Q

smooth muscle

A

involuntary and nn-striated

in the hollow organs of the body, such as the GI tract and in the walls of the blood vessel

56
Q

cardiac muscle

A

involuntary and striated

only found in the heart

57
Q

nuclea medicine

A

functional imagin technique
a radionuclide is labelled to a molecule, which is responsible for its biodistribution (radiopharmacuticals)
often referred to as tracers as the molecule itself is administered in subtherapeutics quantities, and has no direct biological effect
it is instead used to study or visualise a physiological process

58
Q

radiopharmacuticals are administeress

A

usually IV

may be inhaled, ingested or injected into specific sites

59
Q

gamma rayss

A

ionizing electromagnetic radiation that originates in an unstable nucleus
gamma rays are photons of energy originating in a nucleus
x rays are photons of energy originating outside of the nucleus
gamma rays have a wide range of energy
the energy for each radioisotope is discrete and defined by the decay scheme

60
Q

iodine 123

A

gamma emitter - 13 hour half life, used for imaging

61
Q

iodine 125

A

gamma emitter

60 day half life, not used for imaging as half life is too long

62
Q

iodine 131

A

gamma and beta emitter
used for imaging and therapy
8 day half life

63
Q

radiation protection

A

the patient is the radiation source - they become radioactive
physical properties of the nucleotide - how radioactive it is
time/distance - radiation exposure is inversely proportional to the square of the distance
shielding - gamma rays shielded by lead, beta particles are shielded by perspex
biological factors - excretion (urine, saliva)

63
Q

radiation protection

A

the patient is the radiation source - they become radioactive
physical properties of the nucleotide - how radioactive it is
time/distance - radiation exposure is inversely proportional to the square of the distance
shielding - gamma rays shielded by lead, beta particles are shielded by perspex
biological factors - excretion (urine, saliva)

64
Q

2 types of gamma cameras

A

dynamic imaging

static imaging

65
Q

dynamic imaging

A

short acquisition times per frame, allow a cine view of activity over time. this is performed after injection, and reflects blood flow and changing biodistribution

66
Q

static imaging

A

acquired at a single timepoint when biodistribution is usually stable

67
Q

2 types of static imaging

A

planar imaging - 2D imaging - the patient is moved through the camera detectors
SPECT - (single photon computerised tomography): 3D imaging. the detectors rotate around the patient to create a 3D image

68
Q

timing of imaging

A

nuclear medicine images the biodistribution of a radiopharmaceutical in a patient

  • immediately following administration (eg. bone scan - blood flow)
  • after delay period for steady state (bone scan 2-4hr, gallium citrate 48hrs)
69
Q

administered activity of radiopharamcuetical is determined by

A

test requirements

adjusted according to patient weight and/or age

70
Q

ALARA principle

A

as low as reasonably achievable

71
Q

pregnancy and breast feeding

A

some tests will be absolutely contraindicated and others can be performed but are modified for pregnancy and breastfeeding

72
Q

impaired renal function

A

impaired renal function is usually not a contra-indication for nuclear medicine imaging, as the radioisotopes decay with short t1/2

73
Q

drug allergy/ allergic reactions

A

nuclear medicine radiopharmaceuticals are administered in tracer doses and it is extremely rare to have any side-effects or allergic reaction

74
Q

technetium-99m

A

the most common nuclear medicine radioisotope for imaging due to ideal imaging properties and flexible radiochemistry
physical half-life - 6 hours
gamma energy 140KeV (ideal photopeak for imaging)
generator eluted (molybdenum 99)

75
Q

mechanism of uptake of Tc99m

A
  • local blood flow (hyperaemia_
  • bone repair

binds to hydroxyapatite during active bone formation
uptake reflects osteoblastic activity

76
Q

patient preparation for a bone scan

A

non requred

77
Q

restrictions for bone scan

A

no restriction for renal impairment and no interaction with medications
must not be pregnant
breast feeding - radiation excreted in breast milk, delay breastfeeding post scan
keep well hydrated and encourage to drink water on the day of test

78
Q

after injecting radiotracer

A

1) image immediately for FLOW/BLOODPOOL to assess vascularity - for fracture or infection (performed only if clinically indicated)
2) delayed imaging (at 2-4 hours post injection) to assess for sites of increased osteogenesis/osteoblastic activity

79
Q

radiation dose to pateint

A

6mSv (normal background radiation in perth is 2mSv per year)

80
Q

indications

A

whole body or localised imaging can be performed
indications for a bone scan include
- oncology (metastases)
- orthopaedics (fracture, infection, assessment of joint replacements)
- rheumatology (arthritis)
- endocrinology (metabolic bone disease, paget’s disease)

81
Q

skeletal metastases

A

bone scan is commonly used for detection and follow up of skeletal metastatic disease in oncology patients

82
Q

advantages for use of bone scan in skeletal metastases

A

whole body imaging, easily accessible, inexpensive

sensitivity 79-86% and specificity 81-88% for detection of skeletal metastases

83
Q

causes of false positives in skeletal metastases

A

fracture, degenerative change, benign bone lesion

84
Q

commonest sites of bone metastases

A 
axial skeleton (spine, pelvis, ribs, skull) and proximal appendicular skeleton (proximal long bones) 
low sensitivity for lytic regions
85
Q

superscan

A

widespread skeletall metastases
bone activity much higher than soft tissue or renal activity
activity prominent in axial and proximal appendicular skeleton

86
Q

lytic metastasis

A

gap in activity on scan

87
Q

bone scan has poor sensitivity in assessment of

A

myeloma

88
Q

bone scan used for fractures

A

very sensitive for detecton of fractures
only used for evaluation of fractures which is difficult to assess on X-ray eg.
- stress fractures (sports, repetitive injury)
- osteoporotic fractures - vertebral compression fracture rib fracture, pelvic insufficiency fractures
- undisplaced fractures - neck of femur

89
Q

undisplaced fractures

A

radiogrraphic features of undisplaced fracture may take days to weeks to evolve, however bone scan changes occur within 1-2 days of injury

90
Q

periostitis

A

shin splints
usually shows minimal hypereamia on blood pool imaging
delayed imaging shows linear activity in posterior or posteromedial tibia

91
Q

rheumatological bone scan

A

can be useful in the evaluation of sites of bone pain in pateints with arthritis and rhuematological conditions

  • osteoarhtirits
  • rheumatoid arhtiritis
  • seronegative spondyloarthropathy

bone scan can localise site of pain and direct treatment

92
Q

metabolic bone disease

A 
diffuse increased bone activity 
loss of soft tissue and renal outline 
skull activty, perpheral bone involvement and periarticular activity are common 
may be seen incidentally - important to recognise and differentiate from skeletal mets 
dfferential disgnosis 
- primary hyperparathyroidism 
- renal osteodystrophy 
- hyperparathyroidsim

clinical seminars (8 decks)

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