Radiographs - need to re-format since import from StudyBlue Flashcards
Why is it important for us to know how to interpret radiographs?
“If you’re incapable of interpreting x-rays, you’re incapable of evaluating orthopedic functional impairment.” T.R. Miller, MD
Dr. Davies put this on a slide
Radiograph
an x-ray. Use this term when talking to medical professionals, use x-ray when talking to patients
What is attenuation when referring to a radiograph?
The degree to which x-rays are absorbed/deflected by the body part.
plain film radiograph
- x-ray
- The most common diagnostic radiograph format
- no contrast material
What are the types of Radiology/Imaging?
- plain flim
- Radiographs
- Bone Scan
- Ultrasound
- CT
- MRI/MRAs
Four Types of Radiographic Densities
- Gas (Air)
- Fat
- Water
- Bone
The greater the density of the anatomy, _______ the absorption of x-rays.
And Does the denser part of the anatomy look darker or lighter?
Greater
It looks lighter
List 6 types of material that show on an x-ray on a continuum from radiolucent to radiopaque.
- Gas (Air)
- Fat
- Water
- Bone
- Contrast Media
- Heavy Metal
What is the “fat pad sign?”
a sign of joint swelling causing increased opacity of adipose tissue
What are the factors that Affect Image Quality (5)?
- Thickness of tissue
- Motion
- Scatter
- Magnification
- Distortion
What are two variations on plain films?
- Fluoroscopy
- Tomography
Tomography
Any of several techniques for making detailed x-rays of a predetermined plane section of a solid object while blurring out the images of other planes.
Fluoroscopy
A special radiographic diagnostic method in which a “live view” of the internal anatomy is possible.
what is the most common diagnostic radiograph format?
plain films/radiographs
What to look for when viewing a radiograph? (4 basic categories)
- Correct patient
- Orient to correct side-patient position (looking at patient)
- Adequate film
- Systematic Scanning
What things do you consider when checking for adequate film when looking at a radiograph? (3)
- Are structures visualized?
- Were correct views taken?
- is the density of the structures normal?
What things do you consider when systematically scanning a radiograph? (8)
- General Appearance
- Periosteum and cortex
- joints
- normal, anatomic curves
- fracture lines
- Long bones: general appearance
- Long bones: Fracture extended into the joint space?
- Long Bones: Epiphyseal injuries (Salter-harris fracture classification)
What are the radiograph interpretation ABCS?
- Alignment
- Bone
- Cartilage
- Soft Tissues
ABCS: What 4 things should you assess for A?
A = Alignment
- Assess size of bone
- Assess/count number of bones
- Assess bones for normal contour and shape
- Assess the position of the bone in relation to the joint
ABCS: What 3 things should you assess for B?
B = Bone
- Assess Bone density
- Compare bone density at weight bearing surfaces
- Look at the texture of the one
ABCS: What 3 things should you assess for C?
C = Cartilage 1. Look at the joint space 2. Assess subchrondral bone 3. Look at the growth plates and epiphysis
What are the Hallmarks of OA (Fairbanks Changes)? (4)
- Joint space narrowing 2. Bone spurs 3. Sclerotic borders 4. Subchrondral bone cysts
ABCS: What 3 things should you assess for S?
S = Soft Tissue 1. Look at gross size of surrounding muscle 2. Notice joint capsule outline (might see effusion) 3. Look at periosteum
What are 5 things to remember when interpreting radiographs?
- Stability of affected area 2. Joints/area proximal & distal to the area of concern 3. Area of concern associated with pathology, such as 4. Chest films with neoplasms 5. Calcaneal fx associated with thoracolumbar Fx
Why is it important to get two radiograph views?
one view is no view because each one is in two dimensions, but the body is in three. Two views creates a 3D picture.
What are CPRS? and why are they useful?
Clinical Prediction Rules. They are a set criteria by which to determine when a radiograph is needed. They can help reduce needless recommendations for radiographs. An example he used was the Ottawa Ankle Rules (find out mech of injury; palpate, palpate, palpate)
Where should you check in addition to at the joint with the primary injury/complaint?
Proximal and distal to the area
Clusters of signs and symptoms (fractures) - know at least 6
MOI Localized pain Decreased function of involved part Feel the ends of the bones grating (crepitus) Swelling Deformity Abnormal Movement Ecchymosis Localized Tenderness on palpation Muscle Spasms
Radiographic Signs of Fracture (know at least 6)
Displacement of bone Change in shape of the bone Avulsion fragment Double Density Abnormal Fat pat Linear region of sclerosis Lucent Line Focal discontinuity in the structure of the bone (cortical disruption) Etc
Language of fracture (know 6)
Location within involved bone (epiphysis, metaphysis, intra-articular) Closed or open Complete or incomplete (crack/hairline/greenstick) Morphology of fractures (transverse, oblique, spiral, comminuted) Alignment or angulation Position Articular involvement Classification
Language of Fracture: 4 Locations with in involved bone
- Epiphysis 2. Metaphysis 3. Diaphysis 4. Intra-articular
Language of fracture: Open vs. closed
Used in place of the outdated terms “simple” vs “compound” open: bone breaks through the skin closed: does not break through the skin
Language of fracture: complete vs. incomplete fracture
complete - broken all the way through incomplete - only part of the cortex is fractured (common in children or adults with soft bone) (Crack/Hairline/greenstick are all types of incomplete I think)
Language of Fractures: 4 Morphologies of fracture
- Transverse - butterfly component 2. Oblique 3. Spiral - usually create big problems 4. Comminuted
butterfly fracture
A comminuted fracture resulting in two fragments of bone on either side of a main fragment; the result resembles a butterfly.
Transverse Fracture
s complete & the break occurs at a right angle to the axis of the bone
comminuted fracture
bone break where bone shatters into many small fragments (at least three)
Spiral fracture
produced by twisting stress
*Oblique Fracture
* fracture occurring at an angle
angulation of fracture
angle between the distal and proximal fragments as a function of the degree to which the distal fragment is deviated from its normal position
tension fracture
force pulls bone in longitudinal way in one direction
Fracture classifications are usually based on what two things?
Description or MOI
Fracture Description Classifications (based on relation ship of fracture fragment to each, undisplaced or displaced). (6)
- Translated (shifted sideways) 2. angulated 3. rotated 4. distracted 5. overriding 6. impacted
Radiographic signs of Open fractures (6)
- Soft tissue defects 2. Bone fragments protruding beyond soft tissues 3. gas in soft tissues 4. intro-articular gas 5. presence of foreign body 6. missing bone fragments