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Diagnostic Imaging > Radiologic T/S Eval > Flashcards

Radiologic T/S Eval Flashcards

1
Q

List general indications for radiography of the T-spine and ribs

A
  1. Trauma
  2. pain radiating around the chest wall
  3. ROM limitations
  4. Pre-op/post-op
  5. Malignancies
  6. Osteoporosis/compression fracture
  7. Arthropathy
  8. Health conditions associated with spinal abnormality
  9. Evaluation of scoliosis and kyphosis
  10. Suspected congenital abnormality
  11. Monitoring known abnormality
  12. suspected instability
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2
Q

list views available with a radiologic evaluation of the T-spine

A
  1. AP
  2. Lateral
  3. Other possibilities:
    1. Swimmer’s lateral view of the upper thoracic region
    2. Oblique views → z-joints
    3. Thoracolumbar/coned views
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3
Q

list radiologic views for the sternum

A
  1. RAO for sternum (posterior oblique projection)
  2. RAO and LAO for SC joints
  3. Lateral views
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4
Q

list radiologic views for the ribs

A
  1. Rib sections → AP, PA, oblique
    1. anterior, posterior, axillary
    2. R/L
    3. Upper (1-9)/ Lower (8-12)
  2. Chest x-rays
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5
Q

what can be seen in a lateral view of the T-spine?

A
  1. should be able to compare anterior, posterior bodies, spinolaminar lines, and articular pillars → should be smooth lines
  2. disc heights
  3. pedicles superimposed pairs
  4. open lateral foramina
  5. partial viewing of some z-joints
  6. bodies box-like
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6
Q

what is best seen with a posterior oblique (RAO position) radiograph of the T-spine?

A
  1. anterior and posterior ribs
  2. lungs
  3. manubrium and sternal body
  4. sternal angle
  5. sternal body/xiphoid process junction
  6. sternocostal joints
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7
Q

list general indications for CT of the T-spine

A
  1. Acute trauma (Adults)
  2. degenerative conditions
  3. post-op assessment
  4. infection
  5. image-guided intervention procedures
  6. neoplasm
  7. inflammatory lesions
  8. congenital/developmental conditions
  9. Cord Syrinxes/masses (with MRI contraindicated)
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8
Q

list general indications for MRI of the T-spine

A
  1. Acute trauma with suspected cord encroachment
  2. DDD
  3. neoplasms
    1. dx and intervention f/u
  4. intrinsic spinal cord pathology
  5. congenital/developmental conditions
  6. cord masses
  7. pre and post-op assessments
    1. soft tissues
    2. vertebroplasty/kyphoplasty
  8. meningeal abnormalities
  9. infection (disc space infections, epidural abscess, etc.)
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9
Q

List the ACR appropriateness criteria for imaging in the thoracic region

A
  1. suspected spine trauma
  2. suspected spine trauma - child
  3. rib fractures
  4. imaging in the diagnosis of TOS
  5. Back pain - child
  6. Scoliosis - child
  7. Management of vertebral compression fractures
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10
Q

if a patient has a new symptomatic compression fracture that was identified on radiographs or CT with no known malignancy, what follow up procedure(s) is most appropriate?

A
  1. Most appropriate
    1. medical management
    2. MRI spine area of interest
    3. CT spine area of interest
  2. May be appropriate:
    1. percutaneous vertebral augmentation
    2. surgical consultation
    3. bone scan whole body
    4. SPECT or SPECT/CT spine area of interest
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11
Q

what procedure(s) are most appropriate for a patient with an osteoporotic compression fracture (with or without edema on MRI, spinal deformity, worsening symptoms, or pulmonary dysfunction)?

A

medical management and percutaneous vertebral augmentation

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12
Q

what follow up procedure(s) is most appropriate for a patient with a painful osteoporotic compression fracture with edema on MRI and surgery or vertebral augmentation is contraindicated?

A

medial management

(surgical consultation may also be appropriate)

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13
Q

what procedure(s) are appropriate for a pt with a known malignancy and new back? Radiographs or CT having been already performed and identified a compression fracture.

A
  1. Usually appropriate:
    1. MRI spine area of interest
    2. Image guided biopsy
  2. May be appropriate
    1. FDG-PET/CT skull base to mid-thigh
    2. MRI
    3. Bone scan whole body
    4. SPECT or SPECT/CT spine area of interest
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14
Q

what procedure(s) are appropriate in a pt with an asymptomatic pathologic spiral fracture with or without edema on MRI?

A
  1. Usually appropriate:
    1. radiation oncology consultation
    2. medical management
  2. May be appropriate:
    1. percutaneous vertebral augmentation
    2. percutaneous thermal ablation
    3. surgical consultation
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15
Q

what procedure(s) are appropriate for a pt with a pathologic spiral fracture with severe and worsening pain?

A
  1. Usually appropriate:
    1. radiation oncology consultation
    2. percutaneous thermal ablation
    3. percutaneous vertebral augmentation
    4. surgical consultation
  2. May be appropriate:
    1. medical management
    2. systemic radionuclide therapy
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16
Q

what procedure(s) are appropriate for a pt with pathologic spiral fracture with spinal deformity or pulmonary dysfunction?

A
  1. Usually appropriate:
    1. radiation oncology consultation
    2. surgical consultation
    3. percutaneous vertebral augmentation
  2. May be appropriate:
    1. medial management
    2. percutaneous thermal ablation
17
Q

what procedure(s) are appropriate in a patient with pathologic spiral fracture with neurologic deficits?

A
  1. Usually appropriate:
    1. surgical consultation
    2. radiation oncology consultation
  2. May be appropriate:
    1. medical management
18
Q

what initial imaging is most appropriate for a child with congenital scoliosis?

A
  1. Usually appropriate:
    1. radiography complete spine
    2. MRI complete spine
  2. may be appropriate
    1. CT spine area of interest
19
Q

what initial imaging is most appropriate for a child (0-9 years old) with early onset idiopathic scoliosis?

A

radiography and MRI of complete spine

20
Q

what initial imaging is most appropriate for an adolescent (10-17 years old) with idiopathic scoliosis and no risk factors?

A

radiography complete spine

21
Q

what initial imaging is most appropriate for an adolescent (10-17 years old) with idiopathic scoliosis and risk factors?

A

radiography and MRI complete spine

22
Q

what initial imaging and follow-up imaging after surgery or intervention are most appropriate for a pt with neurogenic TOS?

A
  1. Usually appropriate:
    1. MRI chest
    2. Radiography chest
  2. May be appropriate:
    1. CT chest
    2. CTA chest
    3. US duplex Doppler subclavian artery and vein
23
Q

what initial imaging and follow-up imaging after surgery or intervention are most appropriate for a pt with venous TOS?

A
  1. Usually appropriate:
    1. catheter venography UE
    2. US duplex Doppler subclavian and vein
    3. CT chest
    4. Radiography chest
  2. May be appropriate
    1. CTV chest
    2. MRI chest
    3. MRV chest
    4. MRA chest
    5. CT chest
24
Q

what initial imaging and follow-up imaging after surgery or intervention is most appropriate for a pt with arterial TOS?

A
  1. Usually appropriate:
    1. CTA chest
    2. MRA chest
    3. Radiography chest
    4. US duplex Doppler subclavian artery and vein
    5. Arteriography UE
  2. May be appropriate
    1. CT chest
    2. MRI chest
    3. MRA chest
25
Q

what initial imaging is most appropriate for pt with suspected rib fractures from minor blunt trauma (injury confined to ribs)?

A
  1. Usually appropriate → radiography chest
  2. may be appropriate → radiography rib views
26
Q

what initial imaging is most appropriate for a pt with suspected rib fractures after cardiopulmonary resuscitation?

A
  1. usually appropriate:
    1. radiography chest
  2. may be appropriate
    1. radiography rib view
    2. CT chest
27
Q

what initial imaging would be most appropriate for a pt with suspected pathologic rib fractures?

A
  1. Usually appropriate:
    1. radiography chest
    2. CT chest
    3. bone scan whole body
  2. May be appropriate
    1. FDG-PET/CT skull base to mid-thigh
    2. Radiography rib views
28
Q

what initial imaging is appropriate for a child with back pain and no clinical red flags?

A

no imaging usually appropriate

29
Q

for a child with back pain and 1 or more of the following clinical red flags (constant pain, night pain, radicular pain, pain lasting >4 weeks, abnormal neuro exam) what initial imaging is most appropriate?

A
  1. Usually appropriate :
    1. x-ray spine area of interest
  2. May be appropriate
    1. MRI
30
Q

for a child with back pain and 1 or more of the following clinical red flags (constant pain, night pain, radicular pain, pain lasting >4 weeks, abnormal neuro exam) what imaging is appropriate if radiographs were negative?

A
  1. Usually appropriate
    1. MRI complete spine
  2. may be appropriate
    1. MRI complete spine
    2. CT spine area of interest
    3. Bone scan whole body with SPECT or SPECT/CT complete spine
31
Q

for a child with back pain and 1 or more of the following clinical red flags (constant pain, night pain, radicular pain, pain lasting >4 weeks, abnormal neuro exam) what imaging is appropriate after a positive radiograph?

A
  1. Usually appropriate:
    1. MRI complete spine
  2. May be appropriate
    1. CT spine area of interest
    2. Bone scan whole body with SPECT or SPECT/CT complete spine
32
Q

for a child with chronic back pain associated with over use and is classified as mechanical back pain, what imaging is most appropriate?

A
  1. Usually appropriate
    1. X-ray spine area of interest
    2. MRI spine area of interest
  2. May be appropriate
    1. CT spine area of interest
    2. Bone scan whole body with SPECT or SPECT/CT complete spine
33
Q

for a child with back pain associated with suspected inflammation, infection, or malignancy; what imaging would be most appropriate?

A
  1. Usually appropriate
    1. MRI complete spine
    2. X-ray complete spine
  2. May be appropriate
    1. MRI complete spine
    2. CT spine area of interest
    3. Bone scan whole body with SPECT or SPECT/CT complete spine

Diagnostic Imaging (15 decks)

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