Radiologic Eval and Dx

Question 1

List the ABCs of Radiologic Analysis

Answer 1

1. Alignment
2. Bone Density
3. Cartilage spaces
4. Soft tissues

Question 2

What things should be considered with “Alignment”?

Answer 2

1. General Skeletal Architecture
2. General Contour of Bone
3. Alignment of bone to adjacent bone

Question 3

describe normal and abnormalities to consider with general skeletal architecture

Answer 3

1. Normal → size, and number
2. Abnormalities
   
   1. superumerary bones
   2. congenital abnormalities
   3. absence of bone
   4. developmental deformity

Question 4

describe normal and abnormalities to consider with general contours of bones

Answer 4

1. normal → smooth and continuous
2. abnormalities
   
   1. cortical frx
   2. avulsion frx
   3. impaction frx
   4. spurring
   5. prior surgery

Question 5

describe normal and abnormal alignmenst of bone to adjacent bone

Answer 5

1. normal → articulation, spatial relationships
2. abnormal
   
   1. fracture
   2. dislocation
   3. subluxation

Question 6

what to consider relating to bone density and what is normal for each factor?

• general bone density*
• textured abnormalities*
• local density changes*

Answer 6

1. general bone density → sufficient contrast
2. textural abnormalities
   
   1. normal → expected trabecular architecture
3. local density changes
   
   1. normal → sclerosis in areas of stress

Question 7

describe what would be considered abnormal relating to bone densities

Answer 7

1. general bone density
   
   1. loss of bone density
   2. thinning/absence cortical margin
2. textural abnormalities
   
   1. fluffy, thin, delicate, coarsened, smudged
3. local density changes
   
   1. osteophytes, excessive sclerosis, reactive sclerosis

Question 8

what should be considered relating to cartilage spaces? Describe normal vs abnormal findings for each

Answer 8

1. joint space width
   
   1. normal → well-preserved
   2. abnormal → decreased space
2. subchondral bone
   
   1. normal → smooth surface
   2. abnormal → increased sclerosis or erosion
3. epiphyseal plate
   
   1. normal vs abnormal → look at position, size, borders of physes

Question 9

ABCs of Radiographic Analysis: Soft Tissues and normal findings

Answer 9

1. Muscles
   
   1. normal size
2. Fat pads and fat lines
   
   1. radiolucent crescent parallel to bone
   2. radiolucent lines parallel to length of muscle
3. Joint capsules
   
   1. indistinct
4. Periosteum
   
   1. indistinct or solid reaction w/fracture healing
5. Miscellaneous Soft Tissue Findings
   
   1. water-density shades of gray

Question 10

ABCs of Radiographic Analysis: Soft Tissues and abnormal findings

Answer 10

1. Muscles
   
   1. wasting, swelling
2. Fat pads and fat lines
   
   1. blurring and displacement
3. Joint capsules
   
   1. distension
4. periosteum
   
   1. observe reactions
5. Miscellaneous soft tissue findings
   
   1. foreign bodies, gas bubbles, radiolucent, calcifications radiopaque

Question 11

list errors related to the ABCs of Radiographic Analysis

Answer 11

1. Errors of observation → related to search patterns (incomplete/faulty)
2. Errors of interpretation → related to poor ability to link clinical presentation to radiologic findings

Question 12

how can errors be reduced?

Answer 12

improved interdisciplinary communication, especially with radiologist

Question 13

list and describe the categories of skeletal pathology

Answer 13

1. Monostotic/Monoarticular → affects only 1 bone/joint
2. Polystotic/Polyarticular → affects multiple bones/joints
3. Diffuse → affects nearly all bones or joints

Question 14

List the characteristic findings of osteoporosis

Answer 14

1. 30% reduction in bone mass for detection on radiograph
2. cortical thinning
3. low bone mass
4. trabecular changes
5. fractures

Question 15

what is DXA?

Answer 15

Dual Energy X-ray Absorptiometry

1. best precision with lowest radiation dose
2. T/L Spine and non-dominant hip analyzed by computer
3. T-score: BMD and young matched healthy female compared
4. Z-score: BMD and age matched healthy female compared

Question 16

list radiologic characteristics of osteomyelitis

Answer 16

1. soft tissue swelling 24-48 hours after onset
2. radiolucent lytic lesions in 7-10 days
3. sequestra and involurca in 6-8 weeks
4. draining sinus tracts

Question 17

list the radiologic characteristics of joint infections/septic arthritis

Answer 17

1. soft tissue swelling
2. joint effusion
3. periarticular rarefaction
4. joint space narrowing
5. subchrondral bone erosion

Question 18

list characteristic findings of soft tissue/cellulitis

Answer 18

1. soft tissue swelling
2. radiolucent streaks or bubbles representing gas gangrene