PowerPoint 1

Question 1

What should we know about imaging

Answer 1

Indications
Limitations
Risks
Benefits

Question 2

What type of imaging should we request

Answer 2

Imaging modality to best illustrate the suspected pathology
Least risk
Reasonable price
If unable to directly order imaging, we can recommend

Question 3

When should we order imaging

Answer 3

History, review of systems, and objective testing point to a need
Ex ( femoral neck stress fractures, suspected cervical spine fracture)
Failure to progress with treatment
Only order when positive findings will alter intervention

Question 4

VINDICATE

Answer 4

Vascular
Infection
Neoplasm
Drugs
Inflammatory/idiopathic
Congenital
Autoimmune
Trauma
Endocrine/metabolic

Question 5

Considerations for imaging

Answer 5

Acute injuries & x-ray
False positives
False negatives
High level of suspicion

Question 6

Potential errors in imaging

Answer 6

Poor quality (movement artifact, technical error)
Imaging wrong are (referred pain)
Inappropriate modality

Question 7

Requesting diagnostic imaging

Answer 7

Order/recommendation

F/B brief statement (mechanism of injury, anatomical area of pathology)

Question 8

Who interprets the imaging

Answer 8

It’s role in diagnosis is legally for the radiologist
However, we participate in the interpretation
Basis = relationship with MD

Question 9

What is our role in interpretation of imaging

Answer 9

Indications for imaging
Integrate info from written radiologist report into to plan
Appropriate selection of imaging modality (be familiar with best imaging modality based in suspected pathology)
Area of imaging
Usefulness of viewing imaging for info related to rehab, but not in report
Interaction regarding the interpretation

Question 10

Conventional radiographs

Answer 10

The standard x-ray
Useful for cortical & trabecular bone
Certain bony reactions associated with infection and neoplasms
Fractures

Question 11

Radiographs

Answer 11

Low cost
Limitations (scaphoid fracture)
Ionizing radiation (absorbed or dispersed, bone (high density) absorbs more radiation)
Protect reproductive organs

Question 12

X-ray production four major densities

Answer 12

Air
Fat
Fluid
Bone
Plus 1 - metal

Question 13

Air on x-ray

Answer 13

Most radiolucent
Absorbs least number of particles
Black/darkest portion

Question 14

Fat on x-ray

Answer 14

• Fat absorbs more of the beam than air or gas but less than the other densities
• Air and fat are considered radiolucent (black on x-ray, greater film exposure because more x-ray energy is transmitted through these medial in the body to the film or cassette)

Question 15

Fluid on x-ray

Answer 15

• fluiid is of intermediate radiolucency
• More absorbent than air or gas and fat-
  Represents the varying densities if soft tissue organs and muscle

Question 16

Bone in x-rays

Answer 16

• The most dense, naturally occurring substance in the body
• Cortical bone is much denser than cancellous bone
• Radio-opaque

Question 17

Metal on x-ray

Answer 17

completely radio-opaque

Question 18

what views should be requested

Answer 18

• depends on suspected injury

- typically minimum of 2 views at righ angles to each other

Question 19

conventional radiographs: ionizing radiation, what needs protection

Answer 19

thyroid
breast
gonads
reproductive organs

Question 20

conventional radiographs ionizing radiation: who needs protection

Answer 20

patient

practitioner

Question 21

conventional radiographs ionizing radiation: limit exposre via

Answer 21

shields
vests
gloves
collars

Question 22

conventional radiographs limitations

Answer 22

difficulty in detecting early changes

dificulty in viewing soft tissue

Question 23

conventional radiographs limitations: difficulty in detecting early changes with

Answer 23

neoplasms
infection
fractures
early osteoperosis

Question 24

interpreting radiographs systematically ABCS

Answer 24

alignment
bones
cartilage
soft tissue

Question 25

interpreting radiographs systematically: A, Alignment

Answer 25

• continuity of the bones and joint surfaces
• study size, number, shape, and aligment of bones
• e.g fx, dislocation, cortical alterations

Question 26

interpreting radiographs systematically: B, bones

Answer 26

• uniform color
• areas with decreased density appear darker
• study bone density (general and focal) and trabecular bone alterations
• eg. metabolic bone disease, infection, tumors, arthritic changes

Question 27

interpreting radiographs systematically: C, cartilage

Answer 27

• joint spaces should be smooth
• study cartilage space (width, symmetry) density of subcondral bone
• eg. degenerative and rheumatic disorders

Question 28

interpreting radiographs systematically: S, soft tissue

Answer 28

• soft tissue cannot be seen

- swelling within or between soft tissue and bones can be seen

Question 29

interpreting radiographs systematically: study soft tissue for

Answer 29

• swelling
• capsular distention
• periosteal elevation
• eg. truama, tumors, look for specific signs
• sail sign

Question 30

stress radiograph

Answer 30

stress is applied to the joint to measure joint laxity

Question 31

computed tomography (CT) scan

Answer 31

• x-ray source and detectors rotate around the body
• computer determines the density of the tissue
• creates a two-dimensional image (slice)
• allows detailed axial views of entire body
• slice tickness (1-20 mm)
• radiation is not cumulative
• excellent discrimination of tissue density
• images may be reconstructed

Question 32

computed tomography (CT) scan: combined with contrast

Answer 32

myelogram
arteriogram
arthrogram