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Differential Diagnosis/Imaging > Musculoskeletal Imaging Modalities > Flashcards

Musculoskeletal Imaging Modalities Flashcards

1
Q

Describe the historical development of medical imaging tools & techniques

A
  • Roentgen created the X-Ray in 1895
  • named an X-Ray due to unknown type of radiation
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2
Q

Describe radiology

A
  • branch of medicine dealing with radiant energy, radioactive substances (X-Ray), radioactive isotopes or ionizing radiation
  • used for prevention, diagnosis, & treatment of disease
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2
Q

Describe radiation

A
  • mechanical, electrical, thermal, nuclear, & electromagnetic energy all emit radiation
  • Ionize atoms = ionization (results in disruption of the composition of matter & disrupts life process)
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3
Q

Radiology modalities

A
  • Musculoskeletal: X-Ray (ionizing), CT (ionizing), MRI (non-ionizing), Bone scan (ionizing), Ultrasound (non-ionizing)
  • Neurological/Advanced imaging: diffusion weighted imaging/DWI (non-ionizing), cortical morphometry (non-ionizing), susceptibility weighted imaging/SWI (non-ionizing), myelin water imaging.MWI (non-ionizing)
  • MRI & CT are done for both musculoskeletal and neurological
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4
Q

Describe X-Rays/Radiographs

A
  • 1st order diagnostic study
  • excellent at viewing basic boney anatomy
  • Drawbacks: ionizing radiation, harmful to biological tissue, lacks ability to demonstrate soft tissue structures, & unable to appreciate complex boney anatomy structures
  • cheap, easy to take, not cumbersome for the patient
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5
Q

How do X-Rays work

A
  • Electricity applied to cathode
  • Electrons emitted and strike anode target
  • Target reflects electrons to emit an X Ray beam
  • Beam passes through anatomy
  • Image receptor takes latent image and produces visual image
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6
Q

Production of images (X-Rays)

A
  • Flesh = lower atomic weight (transparent)
  • Bones = higher atomic weight (attenuate)
  • absorption of radiation depends on substance’s density & atomic weight
  • Attenuation: the degree to which x-rays are absorbed/deflected by the body part
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7
Q

Describe radiodensity

A
  • The physical qualities of an item/object that determines how much radiation it can absorb from a x-ray beam
  • Composition (# of electrons in the object)
  • Density (thickness)
  • Radiolucent = easily penetrated by X ray beams
  • Radiopaque = not easily penetrated by X ray beams
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8
Q

Order of most radiolucent to most radiopaque for X-Rays

A
  • Air = black (radiolucent)
  • Fat = dark gray
  • Water = medium gray
  • Bone = off white/light gray
  • Metal = white (radiopaque)
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9
Q

Describe contrast enhanced imaging

A
  • Angiography: injection of contrast into the blood supply of an organ
  • Arteriography: injection into a specific artery to determine blood flow
  • Arthrography: joint
  • Myelography: injection of material around the subarachnoid space to show abnormalities of the spinal cord
  • Contrast medium is injected or ingested into the body to improve visualization by increasing radiographic contrast in areas with minimal inherent contrast (static or dynamic images)
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10
Q

Describe fluoroscopy

A
  • X-Ray exam in real time
  • commonly used in fracture fixation, orthography, pyelography, discography, biopsy, gastrointestinal evaluation
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11
Q

Describe conventional tomogram

A
  • X-Ray technique
  • allows for precise localization of lesions as small as 1mm
  • used for fractures around irregularly shaped bones & healing of fractures
  • high radiation, image easily impacted by motion
  • replaced by CT & MTI
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12
Q

Describe CT (computed tomography) scan

A
  • X-Ray technology with advanced computer processing (all digital)
  • creates images based on cross-sectional slices
  • excellent demo of cortical bone anatomy, but poorer soft tissue demo
  • fast, esy to perform, readily available
  • multi planar & 3-D images
  • costly & high radiation dosage
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13
Q

Indications for a CT scan

A
  • trauma
  • subarachnoid hemorrhage
  • acute cervical spine injury
  • acute appendicitis
  • ureteric calculus
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14
Q

Contraindications for a CT scan

A
  • pregnancy
  • young age
  • claustrophobia
  • allergy to contrast medium
  • weight/girth
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15
Q

What does a CT scan do best

A
  • evaluate for loose bodies in joint
  • Not as claustrophobic for patients
  • Cheaper than MRI, but still expensive
  • Very accurate
  • Usually 1st imaging choice in trauma patients
  • Best for subtle fractures, complex fractures, degenerative changes, evaluation of spinal stenosis
  • 3D images
  • White colors = hyper dense
  • Black colors = hypodense
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16
Q

What is an MRI/MR (magnetic resonance imaging)

A
  • non-ionizing
  • based on measurements of energy emitted from hydrogen nuclei, energy emitted varies due to tissues, this allows MRI/MR to distinguish between different tissues
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17
Q

T1 weighted image versus T2 weighted image (MRI/MR)

A
  • T1: best for anatomical localization (measures energies rapidly & early), high water content areas appear darker, picks up adipose tissue & bone bone marrow well
  • T2: best for contrasting normal & abnormal tissue (measures energies slow & late), high water content areas appear bright (fluid, edema, CSF, cysts, abscess, tumors, acute hemorrhage), excellent at detecting inflammation (think H2O)
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18
Q

Contraindications for an MRI/MR

A
  • pacemakers (malfunction)
  • aneurysmal clips
  • metal/foreign bodies in the eye
  • hardware
  • large area tattoos
  • cochlear implants
19
Q

Advantages of MRI/MR

A
  • high quality images of the musculoskeletal system
  • soft tissue trauma
  • stage tumors
  • internal joint derangement
  • variations in bone marrow
20
Q

Disadvantages of MRI/MR

A
  • claustrophobia
  • poor imaging of cortical bone
  • time consuming
  • expensive
21
Q

Describe the different image planes

A
  • Cross sectional imaging = 2D view of 3D image
  • Axial = transverse, sliced horizontally
  • Sagittal = from nose to back of head cut
  • Coronal = frontal, slice down the middle separating front from back
22
Q

Describe radionuclide bone scan (Scintigraphy)

A
  • nuclear medicine is a specialty that uses radiopharmaceutical for diagnosis, therapy, & research (moderate radiation dosage)
  • injection of radioactive tracers and a gamma or scintillation camera picks up the rays emitted to make an image
  • info gained by viewing where & how much the radiopharmaceutical have concentrated in the body
  • abnormal conditions = increased uptake of radiopharmaceutical
  • normal bone appears transparent/gray except for growth plates & SI joint
  • “hot spots” are black or white areas indicative of increased metabolic activity
  • highly sensitive test but poor specific test
23
Q

Advantages and disadvantages of a bone scan

A
  • Pros: cheap, most valuable in confirming the presence of disease & demonstrating the distribution of disease in the skeleton
  • Cons: not specific, requires injection
24
Q

Describe sonography/ultrasound

A
  • production of anatomic images using sound waves
  • reflected sound waves are detected & serve as a basis for the image
  • produces a cross sectional image
  • used to view: Soft tissue pathology (tendon, muscle), Assessment of hematoma, abscess, foreign body, Articular cartilage defect, Fracture healing, Nerve entrapment
25
Q

Advantages of ultrasound/sonography

A
  • demonstrates the soft tissue well
  • low cost
  • portable/convenient
  • non-ionizing
  • dynamic
  • no radiation
26
Q

Disadvantages of ultrasound/sonography

A
  • skill of operator
  • superficial
  • limited view
  • obesity obstructs view
27
Q

Describe a DEXA scan

A
  • DEXA = dual energy X-ray absorptiometry (low dose X-ray, 2 energies)
  • preferred way to measure bone mineral density & body composition
  • calculates a T and Z score
  • T score = BMD compared to a healthy young adult of the same gender
  • Z score = BMD compared to a peer age group of the same gender
  • Normal T score = within 1 standard deviation from young adult
  • T score 1-2.5 SD below the mean = osteopenia (low bone density)
  • T score >2.5 SD below the mean = osteoporosis
28
Q

Indications for a DEXA scan

A
  • osteopenia on X-ray
  • height loss >2.5”
  • metabolic disorder
  • chronic disease
  • hormone replacement
  • non-traumatic vertebral fracture in postmenopausal female
29
Q

Describe interventional techniques

A
  • Vascular procedures: angioplasty, vascular stenting, thrombolysis/thrombectomy, chemotherapy
  • Non-vascular procedures: biopsies, abscess drainage
30
Q

Interventional techniques for musculoskeletal system

A
  • Epidural steroid injections
  • Spinal nerve blocks with fluoroscopy
  • Radiofrequency ablation
  • Percutaneous diskectomy
  • Vertebroplasty/kyphoplasty
31
Q

What are epidural steroid injections used for

A
  • used to relieve pain in patients with spinal stenosis, disk herniation, or intractable neck or back pain of uncertain cause by decreasing nerve root inflammation & swelling at the nerve-disk interface
32
Q

What are nerve blocks used for

A
  • used for therapeutic or diagnostic purposes
  • diagnostically are helpful in identifying the source of radicular pain
  • once identified, blocking the transmission of pain via administration of an anesthetic to it, therapeutic steroids are then administered
33
Q

Describe radiofrequency ablation (RFA)

A
  • RFA is the selective destruction of nerve tissue to treat chronic pain disorders
  • the procedure involves thermal ablation from radio waves applied to the nerve via placement of a needle electrode under imaging guidance
34
Q

Describe vertbroplasty

A
  • Vertbroplasty: an image guided injection of bone cement into the vertebral body to relieve intractable pain in patients with osteoporotic compression fractures
35
Q

Improper use of imaging

A
  • unnecessary imaging can cause harm
  • scan to abdomen/pelvis, chest, & head
  • 1/3 projected cancers for people aged 35-54
36
Q

Radiation dosage for bone

A
  • Spine X-ray: 6 mo comparable to natural background radiation
  • Extremity (hoot, foot, etc.) X-ray: 3 hrs comparable to natural background radiation
37
Q

Radiation dosage for CNS

A
  • CT of the Head: 8 mo comparable to natural background radiation
  • CT for the Head repeated w/o contrast: 16 mo
  • CT of the Spine: 2 yrs
38
Q

CT radiation dosages

A
  • Head: equal to 30 chest X-rays
  • Neck: 55
  • Suspected Stroke: 199
  • Chest: 117
  • Coronary Angiogram: 309
  • Abdomen: 220
  • Multiphase Abdomen/Pelvis: 442
39
Q

3 components that define PT scope of practice

A
  • Professional
  • Personal
  • Legal
40
Q

Describe a PT’s professional scope

A
  • practice that is grounded in the profession’s unique body of knowledge supported by educational preparation based on a body of evidence and linked to existing or emerging practice frameworks
41
Q

Describe a PT’s personal and legal scope

A
  • Personal: activities for which a person is educated and trained to completely perform; continuing education
  • Legal: state practice at and statutes; professional board sets rules
42
Q

States that don’t include use of roentgen rays (radiology) and radioactive materials (radium) for diagnosis and therapeutic purposes

A

-VA
- AK
- CA
- CT
- FL
- KS
- KY
- LA
- NH
- OH
- OK
- TX
- WA
- WV

43
Q

Clinical hypotheses where suspected positive imaging findings would require urgent medical care

A
  • Suspected acute fracture
  • Critical region stress fractures
  • Dislocations
  • Complete muscle tears
  • Progressive neurological deficit
  • Stroke
  • Infection
  • Vascular condition (DVT, pulmonary embolism, abdominal aortic aneurysm - AAA)
  • Prior history of cancer with constitutional signs
44
Q

Information to provide in a physical therapy referral for imaging

A
  • Pt name and contact info
  • Referring PT name & contact info
  • Brief clinical summary detailing need for imaging (MOI, anatomical location, & results of essential clinical tests, brief results from prior imaging studies)
  • Hypothesized clinical diagnosis
  • Study being requested
  • Statement on urgency or results if needed sooner than routine reporting timeline
45
Q

When is PT referral for imaging not warranted

A
  • Pos. imaging results would indicate need for urgent medical care & follow up medical care is not readily accessible
  • Referral for imaging to external facility would delay timely course of care
  • Condition or body region of interest is outside the PT scope of practice
46
Q

When is PT referral for imaging warranted

A
  • PT is located within a health system which can expedite medical care for findings requiring urgent medical care w/o delay in care
  • Client condition is non-emergent & imaging results will not require urgent medical care

Differential Diagnosis/Imaging (20 decks)

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