Roentgen Signs Flashcards by Jake Aleck

5 Radiographic Densities

– Air
– Fat
– Water
– Bone
– Metal

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______ determines if further imaging

is indicated

Plain film radiography

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Need at least ______ decarse in bone density to see lesion in Conventional Radiography

30-50%

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Need a lesion at least _____ in size to detect

Conventional Radiography

1-5cm

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Time until a lesion is seen by plain film radiography

Radiographic Latent Period

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Osteomyelitis in peripheral bone radiographic latent period

10-14 days

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Spinal osteomyelitis radiographic latent period

21 days

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Aggressive tumors radiographic latent period

4-6 weeks

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– Trauma – Unexplained weight loss – Night pain – Motor deficit – Malignancy

red flag

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– Inflammatory arthritis – Fever of unknown origin – Abnormal blood results – Deformity

red flag

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– Failure to respond to therapy – Medicolegal concerns

red flag

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– >50 yo – Drug or alcohol abuse – Corticosteroid use – Old or lost previous x rays – Research

yellow flag

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– Systemic disease – Recent immigration – Rule out contraindications – Therapeutic response

yellow flag

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– Patient education – Routine screening – Habit – Discharge status assessment – Routine biomechanical analysis – Pre-employment status

non indicators

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– Physical limitations of patient – Inadequate equipment – Non-trained personnel – Financial gain – Recent high-level radiation exposure – Pregnancy

non indicators

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evidence-based guidelines to assist referring
physicians and other providers in making the
most appropriate imaging or treatment decision for a specific clinical condition.

The ACR Appropriateness Criteria

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Injection of water soluble iodinated contrast into IVD’s nucleus
pulposus via fluoroscopic control in order to determine pain
generator

Discography

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Radionuclide Imaging

Bone Scan

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used to identify pars fractures (gymnastic athletes)

SPECT Scan

“Single-Photon Emission Computed Tomography”

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detects:
Metastatic disease
Tumors Infection Arthritis Fracture (occult, stress, recent fx) Avascular Necrosis (AVN)

bone scan

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– Detects as little as 3-5% bone destruction/production
– 10x more sensitive than plain film radiography
– Great for early detection of many disease processes

bone scan

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No uptake in Multiple Myeloma unless pathological

fracture

bone scan

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vascular dz
msk disorders
abdominal and pelvic imaging

diagnostic ultrasound

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high level of radiation dose

excellent bone detail

Computed Tomography (CT)

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Mathematical Data from Axial Images is Reformatted rendering Sagittal Lumbar Spine Image

Computed Tomography (CT)

excellent for soft tissue resolution very sensitive for detecting bone marrow dz great for spinal dz, especially disc dz

Model of bone structure formed by condensed mesenchymal cells after which bone is formed • Skull • Clavicles • Mandible

Intramembranous Ossification

Controls width of long bones via activity of periosteum

Appositional Bone Growth

– Osteoblasts transform cartilage template into bone • Tubular bones • Vertebrae – Chondroblasts and chondrocytes form and produce a cartilage cast of the definitive bone

Enchondral Ossification

surrounds bone except at ends of bone

Periosteum

Located at ends of long bones

Epiphysis

Consists of layers of progressively maturing cartilage & developing bone

Physis

Harris Growth Arrest (Park) Lines

growth arrest during systemic disease

Thin radiopaque line at junction of | physis and metaphysis

Zone of Provisional Calcification (ZOPC)

* Most metabolically active region of a bone | * Most common site for tumors and infection

Metaphysis

(bones appear wider than usual)

Undertubulation

(bones appear slender)

Overtubulation

• Longest part of bone • Thickened cortex and decreased medullary space • Provides mechanical strength and contains bone marrow

Diaphysis = Shaft

• Densest and strongest part of bone • Densely packed compact lamellar bone and osteons and is interconnected by Haversion canal systems

Cortex

predominates in all bones in children

Red marrow

Adults have red marrow only in

axial skeleton, | epiphyses, and metaphyses

• Does not cover epiphysis; does not enter synovial joint. Forms synovial lining of synovial joint. • Thin membrane covering diaphysis and metaphysis

Periosteum

produced due to pus, blood or tumors produced due irritation or elevation from bone

Periosteal Reactions

Trabeculae and inner cortical margins are covered by ______ that has osteogenic properties

endosteum

– May be separated from bone by a thin layer of soft tissue – Originates in muscle, nerve, arterial, or synovial tissue – May see pressure erosion of bone with sclerotic margin – Do not originate in bone

Extraosseous Lesions - bone dz

``` – Lytic lesions such as fibrous dysplasia, and cartilaginous lesions the endosteal surface of the medullary cavity – Thinning of the cortex along ```

Endosteal Scalloping - bone dz

``` – Poor, hazy, ill defined margins, long zone of transition – Gradation between normal and abnormal bone occurs gradually – Indicates aggressive bone destruction • Infections • Malignancy ```

Imperceptible Margination - bone dz

– Definite and sclerotic margins – Narrow zone of transition – Clear identification between normal and abnormal bone – Usually slow growing lesion

Sharp Margination - bone dz

Loss of bone density and structure

Osteolytic Lesions

– Circumscribed lesion – Uniformly lytic lesion – Usually solitary – >1cm – Sharp margin – Usually slower growing and are usually benign – May be septated or soap bubbly

Geographic Lesion

– Multiple, poorly defined, small radiolucent lesions – 2-5mm in size – Ragged irregular margins of lesions – Confluence of lesions occurs – Aggressive lytic lesions • Multiple myeloma • Metastatic disease • Infection

Moth-Eaten Lesion

``` – Numerous, tiny, pinhole size lesions – < 1.0mm in size – Wide zone of transition – Most rapidly aggressive bone tumors – Easily missed on conventional radiography ```

Permeative Lesion

– Increased density due to overproduction of bone or calcium laden tissue – Blastic Metastasis – Osteosarcoma – Paget’s Disease

Osteoblastic Lesions

– Continuous layer of new bone that attaches | to outer cortex – Usually benign process – Slow disease process – Elliptical, undulating, continuous

Solid Periosteal Reaction

– Slow and aggressive tumors – Infection – Ewing’s Sarcoma – Alternating layers of lucent and opaque densities on external cortical surface – Radiolucent zones contain loose connective tissue and dilated blood vessels that have not ossified

Laminated: Lamellated, Onionskin

``` – Perpendicular, brushed whiskers, hair on end – Sunburst: radiating spicules of bone from a point source – Aggressive tumors – Fine linear spiculations of new bone perpendicularly oriented away from cortex ```

Spiculated Periosteal | Reactions

``` Periosteal new bone at the peripheral lesion – cortex junction as result of subperiosteal extension of lesion • Primary malignant bone tumors • Benign bone tumors • Infections ```

Codman’s Triangle

Increased soft tissue density

Synovial Sarcoma

Soft Tissue Calcification

Synovial Sarcoma

– Increased tendency of rbc’s to precipitate out due to increased concentrations of fibrinogen – Nonspecific index for disease – Especially good for Inflammatory Diseases

ESR: Erythrocyte Sedimentation Rate

– Due to inflammatory changes or tissue necrosis – Released by liver – Nonspecific

CRP: C - Reactive Protein

– Normally within strict limits – Disorders of bone destruction – Disorders of increased parathormone activity

Serum Calcium

– Indicator of bone destruction – Important indicator of bone activity – Inverse relationships to calcium levels

Serum Phosphorus

– Reflects an increase in osteoblastic activity | – Paget’s disease – Metastatic disease – Healing fractures – Lymphoma

Alkaline Phosphatase

``` • Metastatic lesions in bone and soft tissue liberate acid phosphatase – Located in prostate gland – Increased in Prostate metastasis and Gaucher’s disease – Capsule of prostate must be disrupted ```

Acid Phosphatase

– Multiple Myeloma: • IgG spike • IgA spike • Bence Jones proteinuria (40%) of patients with MM – Elevated total serum protein often indicates metastatic disease or multiple myeloma

Total Protein