S1_L1: Introduction to Musculoskeletal Imaging Flashcards
Gold standard for imaging and the initial line for screening (first order diagnostic study or first imaging procedure to be done following the clinical examination).
x-ray
A branch of medicine concerned with radiant energy and radioactive substances, including x-rays, radioactive isotopes, ionizing radiation, and the application of the information to prevention, diagnosis, and treatment of disease.
Radiology
Note: Radiology is both diagnostic imaging and medical imaging. Radiology may be used to virtually evaluate all systems of the body.
The gold standard against which all imaging modalities are measured after. It is simple and accessible, and the cheapest option for patients.
Film radiography
It is a type of modified photograph that is sensitive to light and radiation.
X-ray film
Provides real time imaging of physiological function and allows for active diagnosis during the examination.
A. Film radiography
B. Fluoroscopy
C. Computed Radiography
D. Digital Radiography
B. Fluoroscopy
- Images taken may be recorded like x-rays or may be recorded like video.
- Film replacement technology
A. Film radiography
B. Fluoroscopy
C. Computed Radiography
D. Digital Radiography
- B
- C
Direct digital radiography uses an x-ray ____ material to convert x-rays into an electrical charge.
sensitive semiconductor
Indirect digital radiography uses an x-ray ____ material to convert x-ray photons into light photons.
absorbing scintillating
TRUE OR FALSE: The denser the object, the more absorbant the x-ray.
True
Note: When this happens, the bone becomes most white (it is the most dense structure).
Radiodensity is determined by either of these 2 properties
- Composition (effective atomic number and volume density)
- Thickness
A thicker object has more radiodensity than a thinner one. The greater the object’s effective atomic number and volume density, the less its radiodensity.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
A. Only the 1st statement is true
Note: Radiodensity is directly proportional to EAN and VD.
Found in all soft tissues of the body including blood, muscle, cartilage, tendons, ligaments, nerves, and fluid-filled organs
Water
Note: Radiographs have limited value in assessing soft tissue structures without the additions of a contrast medium.
TRUE OR FALSE: Fat is more radiodense than water.
False
TRUE OR FALSE: Fat is more radiodense than air.
True
Subspecialty of diagnostic radiology in which radiologists diagnose and treat diseases non-operatively with the help of imaging modalities
Interventional radiology
____ are of human origin, but invisible to the human eye and
produced in wavelengths varying from 10^-8 to 10^-11 cm.
X-rays
Traditionally only used by the MDs and now used by health professionals to know the functional anatomy of the patient.
Diagnostic imaging
Main goal of diagnostic imaging is ____ to enhance the quality of patient care.
professional collaboration
TRUE OR FALSE: An object with great radiodensity will attenuate almost all the x-rays from the beam so the expression of the radiographic image will be gray black.
False, the radiographic image will be white.
It is also known as body section radiography, the radiographic evaluation of one predetermined plane of the body.
Conventional tomography
TRUE OR FALSE: Ultrasonography is non-invasive and non-ionizing.
True, it uses sound waves, not radiation.
Selective destruction of nerve tissue for chronic pain disorders such as nerve pain or osseous metastases.
A. Epidural steroid injections
B. Spinal nerve blocks
C. Radiofrequency ablation
D. Diskography
E. Percutaneous Vertebroplasty, Kyphoplasty, Cementoplasty
F. Percutaneous Biopsy of the Spine
C. Radiofrequency ablation
- Used for detecting sources of radicular pain
- Applicable for patients with spinal stenosis, disk herniation, or intractable neck or back pain
A. Epidural steroid injections
B. Spinal nerve blocks
C. Radiofrequency ablation
D. Diskography
E. Percutaneous Vertebroplasty, Kyphoplasty, Cementoplasty
F. Percutaneous Biopsy of the Spine
- B
- A
Performed by injecting a contrast medium into the disk to check for disk-related sources of pain.
A. Epidural steroid injections
B. Spinal nerve blocks
C. Radiofrequency ablation
D. Diskography
E. Percutaneous Vertebroplasty, Kyphoplasty, Cementoplasty
F. Percutaneous Biopsy of the Spine
D. Diskography
A procedure done to relieve intractable pain caused by fractures, malignancies, and structural damage to the spinal cord. Bone cement (Methyl methacrylate) is injected into the vertebral body using image-guided injection.
A. Epidural steroid injections
B. Spinal nerve blocks
C. Radiofrequency ablation
D. Diskography
E. Percutaneous Vertebroplasty, Kyphoplasty, Cementoplasty
F. Percutaneous Biopsy of the Spine
E. Percutaneous Vertebroplasty, Kyphoplasty, Cementoplasty
Additional: Cementoplasty is used primarily as a palliative treatment in cancer patients.
Used to detect possible pathologic fractures, malignant lesions, osteomyelitis or disciitis.
A. Epidural steroid injections
B. Spinal nerve blocks
C. Radiofrequency ablation
D. Diskography
E. Percutaneous Vertebroplasty, Kyphoplasty, Cementoplasty
F. Percutaneous Biopsy of the Spine
F. Percutaneous Biopsy of the Spine
Enumerate the ABCs of radiologic analysis
Alignment
Bone density
Cartilage space
Soft tissues
It is the ability of higher forms of radiation to disrupt the composition of matter and, as a result, may disrupt life processes. It is also the process by which a neutral atom gains or loses an electron, thus acquiring a net charge.
Ionization
Additional: Ionization may come from natural or artificial radiation. Medical and dental x-ray exposures constitute the greatest artificial source of radiation exposure.
- Changes in epiphyseal plate
- Textural abnormalities
- Changes in fat pads and fat lines and muscles
- Changes in bone contour
A. Alignment
B. Bone density
C. Cartilage space
D. Soft tissues
- C
- B
- D
- A
- Changes in joint capsule and periosteum
- Changes in subchondral space
- Changes in the gross size, appearance, and number of bones
- Less radiopaque bones
A. Alignment
B. Bone density
C. Cartilage space
D. Soft tissues
- D
- C
- A
- B
- Nuclear medicine
- First image intensifier for television viewing system for conventional radiograph
- Military use of X-Rays during WWI
A. 1910s & 1920s
B. 1930s & 1940s
C. 1950s & 1960s
D. 1970s & 1980s
E. 1990s to 21st Century
- B
- C
- A
- Sonar Technology
- Radiation protection
- Computer assisted diagnostics & three-dimensional image/ computer assisted/ robotics guided surgery
A. 1910s & 1920s
B. 1930s & 1940s
C. 1950s & 1960s
D. 1970s & 1980s
E. 1990s to 21st Century
- A
- C
- E
- Digital Radiography (Digital subtraction angiography, invasive radiology)
- Positron Emission Tomography (PET/CT, PET/MR)
- Little consideration for adverse effects of radiation
A. 1910s & 1920s
B. 1930s & 1940s
C. 1950s & 1960s
D. 1970s & 1980s
E. 1990s to 21st Century
- D
- E
- B
- Shift from analog to digital through the use of charge-coupled devices
- Computed Tomography, Magnetic Resonance Imaging, & Functional MRI
- Precursor of diagnostic US (would eventually evolve to US)
A. 1910s & 1920s
B. 1930s & 1940s
C. 1950s & 1960s
D. 1970s & 1980s
E. 1990s to 21st Century
- E
- D (CT: 1970s, MRI: 1984, Functional MRI: 1990s)
- A
It is the precursor of diagnostic US (would eventually evolve
to US) and was used to help find enemy submarines.
Sonar technology
TRUE OR FALSE: All x-rays created are artificial.
True
One of the founding scientists who discovered radiation and kept a sample of radioactive element in her pocket which contributed to her eventual death.
Marie Curie
TRUE OR FALSE: The average range of age of death of radiologists was 50-60 y/o d/t high radiation absorption and leukemia. They usually die of cancer-related problems
because of excessive radiation exposure.
True
Moving MRI used in neurologic examination of brain to view
electrical impulses and composition of the brain in thought processes
Functional MRI
Energy that is transmitted through space or matter
Radiation
Energy that may be mechanical, heat, nuclear, gamma rays/alpha particle or electromagnetic.
Radiation
Note: MRI falls under electromagnetic radiation and US falls under mechanical radiation.
Fundamental tool of the musculoskeletal radiologists that screens for a significant portion of pathologies, with little risk to the patient and extreme time and cost effectiveness.
Conventional radiography (X-Rays)
3 requirements for production of a radiograph
- X-ray beam source
- Patient
- Image receptor (either digital or analog/film receiver)
It is composed of Roegentographs/radiographs (WWI), plain films, and X-ray film containing images or parts of a patient’s anatomy.
Conventional radiography (X-Rays)
Formerly known as musculoskeletal radiology and orthopedic radiology
Musculoskeletal imaging
A form of ionizing electromagnetic radiation discovered by Wilhelm Conrad Roentgen in 1895.
X-rays
X-rays used for the treatment of superficial malignancies (e.g., eye and skin cancers).
Soft x-rays
X-rays used in diagnostic radiography
Hard x-rays
Computed radiography is the process of producing a digital radiography by exposing a ____ to x-rays.
phosphor screen (digital receiver in replacement of film)
Note: Image is viewed on a screen but may still be printed out for hard copies or for storage.
Contrast media used in patients with dysphasia to know where in the GI tract the swallowing process stops
Barium sulfate used in the Barium Swallow Test
Substance used to brighten up areas with hollowness.
Contrast media
- Referred to as positive contrast media (very radiopaque, bright white)
Substance used in tooth fillings, prosthetic devices (e.g., total joint replacements), pins and wires in fractures, or lead shields used for gonad protection that produces a uniformly solid white image.
Heavy metals
Note: An abnormal appearance of metal density would be seen in unretrieved metal fragments or metal discharges in the body.
Defined as not easily penetrated by x-rays, or impenetrable to x-rays. Examples are heavy metals or contrast media such as barium sulfate.
Radiopaque
Note: Human tissues do not normally possess enough radiodensity to be described as radiopaque. However, there are instances when the body can produce radiopaque structures (e.g., gallstones).
Defined as easily penetrable by x-rays and attenuates small amounts of x-rays. Examples are air in air-filled organs such as the lungs, or decreased radiodensity due to abnormal findings such as osteoporosis, osteolytic tumors, etc.
Radiolucent
Note: Radiolucent areas of decreased radiodensity become gray or a darker shade because most x-rays reach the image receptor.
Radiographic term describing the path of the x-ray beam as it travels from the x-ray tube through the patient, and into the image processor.
Projection
A study in musculoskeletal imaging that merges x-ray technology with computer technology. It is usually used for cancer patients.
Computed tomography
In Computed Tomography, the x-ray beam and detector system is housed in a ____ and it moves through an arc around the patient, the computer then reconstructs the image based on geometric plots where measurements were taken.
circular scanner
A study in musculoskeletal imaging that does not involve ionizing radiation but uses the interaction of tissue with radiofrequency waves in a magnetic field.
Magnetic resonance imaging
A study in musculoskeletal imaging that generates anatomic images using reflected sound waves.
Ultrasonography
A distinct advantage of ___ is the dynamic visualization of movements such as active muscle contraction, passive stretching, or traction.
musculoskeletal ultrasound
Note: Ultrasound can also be used as biofeedback.
A specialty that uses radiopharmaceuticals for diagnosis, therapy, and research. Diseases are diagnosed based on the physiologic or functional changes of the tissue or organ.
Nuclear imaging
A disadvantage of computed tomography where the computer applies average values to a volume of tissue and thus, displaying it in one shade even though it contains more than one type of tissue.
Average volume effect
A study in musculoskeletal imaging where a contrast medium is injected or ingested into the body before taking the radiograph. The contrast media may be radiolucent (air), radiopaque (barium sulfate or iodide), or both.
Contrast enhances radiographs
Note: It is invasive and carries risks to the patient.
TRUE OR FALSE: Radiographs of the hands and feet are usually viewed with the toes and fingers pointing upward.
True
Most radiodense tissue of the body
Bone
TRUE OR FALSE: The information the clinician seeks is often of a different nature from the information the physician seeks and of a different nature described in the radiologist’s report.
True
Contrast enhances radiograph that produces images of specific joints and its soft tissue structures and demonstrates abnormalities in the synovium, ligaments, articular cartilage, and joint capsule.
Arthrography
Contrast enhances radiograph that produces images of spinal cord, nerve root, and dura mater
Myelography
Note: It’s puncture site is at L2-L3, L3-L4 or C1-C2. It is commonly performed with a CT scan and is termed CT myelogram.
A study in musculoskeletal imaging accomplished by accessory equipment that allows the x-ray tube and film to move about a fulcrum during a film exposure.
Conventional tomography
A study in musculoskeletal imaging that can be used for fracture evaluation and evaluation of a tumor within a bone.
Conventional tomography
A study in musculoskeletal imaging that can be used for:
1. Bone and tissue tumors
2. Subtle or complex fractures
3. Intra-articular abnormalities
4. Detection of small bone fragments
5. Quantitative bone mineral analysis
Conventional tomography
Type of nuclear imaging that is a bone scintigraphy. It may show a cancerous tumor.
Radionuclide Bone Scan
Note: Abnormal conditions show increased activity, hyperfunction, or increased mineral turnover in the bone.
TRUE OR FALSE: Bone density loss is more common than bone density gain.
True
These individuals are more predisposed to osteoporosis & rheumatoid arthritis.
Elderly female
Contrast enhances radiograph that produces images of the blood vessels and their lumen
Angiography
Case: radiograph is (+) for a stress fracture & no further imaging needed. Ankle is immobilized and pt is instructed to return for
follow-up radiographs in 4 weeks.
A. Positive for suspected diagnosis
B. Negative for suspected diagnosis
C. Negative for one diagnosis but raising the index of
suspicion for another
D. Inconclusive, requires additional imaging
E. Wrong
A. Positive for suspected diagnosis
Case: Radiograph is (-) for fx, pathology, or degenerative changes. No further imaging needed; pt is referred to PT for conservative management, and possibly a strain only or old sprain.
A. Positive for suspected diagnosis
B. Negative for suspected diagnosis
C. Negative for one diagnosis but raising the index of
suspicion for another
D. Inconclusive, requires additional imaging
E. Wrong
B. Negative for suspected diagnosis
Case: Radiograph is (-) for fx pathology or degenerative changes, but a radiolucent lesion characteristic of infection or osteonecrosis is identified (hollow space within ankle joint). Pt is referred to MRI and blood work for better visualization.
A. Positive for suspected diagnosis
B. Negative for suspected diagnosis
C. Negative for one diagnosis but raising the index of suspicion for another
D. Inconclusive, requires additional imaging
E. Wrong
C. Negative for one diagnosis but raising the index of suspicion for another
Case: Radiographs appear normal except for an inconclusive finding (is this an avulsion fx, normal accessory ossicle, etc.) Pt is recommended to undergo CT-scan.
A. Positive for suspected diagnosis
B. Negative for suspected diagnosis
C. Negative for one diagnosis but raising the index of
suspicion for another
D. Inconclusive, requires additional imaging
E. Wrong
D. Inconclusive, requires additional imaging
Excellent in the diagnosis of lesions to muscles, tendons, ligaments, and as well as detections of cysts and soft tissue tumors and the assessment of blood flow
Ultrasonography / Musculoskeletal Ultrasound
The musculoskeletal system is ideally suited for MRI, but specifically for the ___.
soft tissues
Noninvasive test used for the assessment of blood flow and tracking of healing process
Doppler ultrasound
Note: In the Philippines, it is used with either steroid or ultrasound-guided botox injections for muscles or joints.
TRUE OR FALSE: The signal intensities from all the components of the musculoskeletal system differ well enough to create high quality images using the MRI.
True
Produces multiple slices of an area and its major uses include soft tissue trauma, internal joint derangement, and tumors
Magnetic resonance imaging
TRUE OR FALSE: In radiography, the body’s anatomic position serves as the reference. General body positions used can be upright, seated, supine, prone, erect, recumbent, or Trendelenburg.
True
Note: Reference to specific radiographic positions are erect or weight bearing status
TRUE OR FALSE: Air is radiolucent
True
Substance seen normally in the trachea, lungs, stomach
air/gas
Note: Air is seen as the black surrounding background of the radiograph. It may be used in contrast studies as a negative contrast medium.
In the thorax, an abnormal appearance of ___ is seen in pneumothorax, esophageal hiatal hernias, and pulmonary abcesses.
air/gas
Arrange the 4 radiodensities of the body from least to most radiodense.
Choices: bone, fat, air/gas, water
- Air/gas
- Fat
- Water
- Bone
TRUE OR FALSE: The denser the body structure, the more it attenuates the x-ray, resulting in a brighter image.
True
X-ray images are made by:
1. ___ passes through the patient
2. Remnant radiation is caught by an ___
3. Image is processed to reveal image
- X-ray beam
- image receptor
In film radiography, the various intensities of light and radiation cause chemical reactions in the ____ coated emulsion on the film.
silver
Note: The film has a silver bromide covering that reacts to radiation which produces an image.
Analogy:
Radiograph is to photograph, as
Fluoroscopy is to ____
Movie/video
Imaging that produces a dynamic or continuous radiograph. It shows the difference of anatomy through an image of continuous movement.
Fluoroscopy
TRUE OR FALSE: An inverse relation exists between the radiodensity of an object and the radiographic density on the radiograph.
True
- Greater radiodensity, lesser radiographic density, whiter image.
- Lesser radiodensity, greater radiographic density, blacker image
Substance normally present in the subcutaneous layers, along muscle sheaths, and surrounding the viceras.
Fat
Abnormal appearance of fat is a visualization of a fat pad that is displaced from its bony fossa as a result of _____.
joint effusion
TRUE OR FALSE: An example of the abnormal appearance of water is the distention of a joint capsule when there is joint effusion, hemorrhage, or infection.
True
The teeth are whitest of all because these have the highest amount of ____.
calcium
Note: If the bone is not as white, it may signify that the patient has decreased in density/calcium content in the bone.
TRUE OR FALSE: A wide range of white shades is normal for the bone because they vary in thickness.
True
The measure of the number of electrons in a substance
Effective atomic number
The foundation of x-rays and the combination of physical qualities of an object (or person) that determines how much radiation it absorbs from an x-ray beam.
Radiodensity
An abnormal appearance of ___ density is seen in conditions such as myositis ossificans and heterotopic ossification.
bone
TRUE OR FALSE: Heterotopic ossification may be due to aggresive PROM. It can be seen in the hip and elbow joints.
True
A general rule in radiology is to have a minimum of 2 radiographs made at ____ angles with each other for:
* Providing information about the dimensions of the structure
* Locating lesions and foreign bodies
* To determine fracture positions.
right / 90º
Note: A simple radiograph only provides 2 dimensions: length and width. Depth is compensated by viewing a second radiograph projected at a 90º angle to the first image.
Variations/Abnormalities to look for in ABCs
- Joint subluxation, joint dislocation
- Reactive sclerosis, osteophytes, excessive sclerosis
A. Alignment
B. Bone density
C. Cartilage spaces
D. Soft tissues
- A
- B
Variations/Abnormalities to look for in ABCs
- Erosions as seen in inflammatory arthritis
- Gas bubbles (radiolucent)
A. Alignment
B. Bone density
C. Cartilage spaces
D. Soft tissues
- C
- D
Variations/Abnormalities to look for in ABCs
- Calcifications (radiopaque)
- Elevation or blurring of fat planes indicates swelling of nearby tissues
A. Alignment
B. Bone density
C. Cartilage spaces
D. Soft tissues
- D
- D
Variations/Abnormalities to look for in ABCs
- Markings of past surgical sites
- Supernumerary bones
A. Alignment
B. Bone density
C. Cartilage spaces
D. Soft tissues
- A
- A
Variations/Abnormalities to look for in ABCs
- Altered trabeculae appearance
- Thinning or absence of cortical margins
- Codman’s triangle, solid, onionskin, spiculated or sunburst periosteal reactions
A. Alignment
B. Bone density
C. Cartilage spaces
D. Soft tissues
- B
- B
- D
The ___ is at one end of the x-ray tube located at a disc made of Tungsten, a material that attracts the electrons.
Anode
High energy beam that can be absorbed only by dense body tissues such as bones.
X-ray beam
Filament that releases energy with the introduction of an electrical current. Its energy is released in the form of electrons.
Cathode
Term for when the patient absorbs or takes in the x-ray and it passes through the body
Attenuation
TRUE OR FALSE: Whatever substance does not attenuate the x-ray is the remnant radiation or aerial image.
True
