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Scans/Alignment Flashcards

1
Q

Indications for scans

A
  • History of significant trauma
  • Pain waking the patient at night
  • Identification of a foreign body
  • Changes to a longstanding pain pattern
  • Unrelenting pain
  • If positive radiographic findings would change patient management.
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2
Q

CT Types

A

Bone window- bone is more clear. Articular sites, Bone Degeneration, trauma, bone congenital abnormalities

Soft tissue- Bone appears white.Usually for viewing Herniation, soft tissue masses, haematoma

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3
Q

MRI types

A

T1- fat is the brightest

T2- water is the brightest

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4
Q

ALL ABCS

A

• A = All: Ensure all your films asked for are there
Patients identifying details are present (e.g. The X-rays are of the patient you requested)
All Bones are present which should normally be present
• A = Alignment Alignment of bones with one another in relation to articulation with other bones
• B = Bone Quality Trabecular patterns
Density of bones (e.g. high density = whiter film as opposed to low density films)
Medullary cavities
Cortical continuity, thickness and integrity
Periosteal involvement
• C = Cartilage Note joint space and symmetry
• S = Soft tissues Note any increase in density (for example due to soft tissue injury) or absence or
presence of.

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5
Q

Standard Skull Films (3)

A

● AP (or Townes ½ AP)
● Axial
● Lateral

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6
Q

Standard Facial Films (4)

A

○ Water’s (occipital-mental) PA sinus
○ Occipital-frontal
○ Lateral
○ Caldwell

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7
Q

Cervical Views (5)

A 
○ APOM
○ AP Lower Cervical
○ Lateral
○ Right and Left Oblique Posterior
Davis Series ○ Flexion and extension lateral (along with all other films)
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8
Q

Cervical Alignment Lateral (3)

A

● ALL (Anterior Longitudinal Line)
● PLL (Georges line – posterior longitudinal ligament)
● Spino-Laminar line

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9
Q

Spinal Canal Width

A 
Normal Sagittal Diameter of SLL to PLL (spinal cord Space)
(<12mm stenosis)
C1: 16-30
C2: 14-27
C3: 13-23
C4: 12-22
C5: 12-22
C6: 12-22
C7: 12-22
Should see facets superimposed
DJD
Fracture dislocation
Neoplastic conditions
Arthritides
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10
Q

Cervical Angle

A

Measured: Midpoints of anterior and posterior tubercles of the atlas and a line through inferior endplate of C7.
Perpendiculars are constructed if required.
Angle: 35-45 degrees normal lordosis

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11
Q

Physiological Line of Stress (Ruth Jackson)

A

Measured: Posterior aspect of Dens and Posterior Aspect of C7 (forms a cross)

Neutral: Should pass through C4/5 IVD
Flexion: Should Pass through C5/6
Extension: Should Pass through C4/5 posterior
Significance: Biomechanical compensation

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12
Q

Vertical Line of Stress

A

Measured from the apical point of the dens and the anterior superior aspect of C7 (a line straight down)

Neutral: Should pass through C4/5 IVD
Flexion: Should Pass

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13
Q

Atlanta-dental interspace (ADI)

A

Measured: Anterior aspect of dens and posterior aspect of anterior tubercle.
Distance: 1-3mm adults
1-5mm children
Indications: PARRS, Down Syndrome

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14
Q

Retro-Pharyngeal Line

A

Measured: Anterior Inferior border of C2 and posterior pharyngeal airspace.
Distance: <5mm

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15
Q

Retro-Tracheal Line

A 
Measured: Anterior Inferior border of C6 and posterior tracheal airspace.
Distance: <20mm
Indications: Haematoma,
Trauma
Suppuration
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16
Q

Thoracic Views (3)

A

AP
Lateral
Specific Rib views

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17
Q

Thoracic Alignment AP (4)

A

▪ Side bending (scoliosis)
▪ Rotation pedicular method or SP
▪ Interpedicular distance
▪ Tracheal bifurcation

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18
Q

Thoracic Alignment Lateral (5)

A

▪ ALL, PLL, SLL
▪ Angle of the Thoracic Kyphosis
▪ Tracheal bifurcation

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19
Q

Pedicle Rotation

A

Spinous method: • Spinous process are prone to malformations and
displacement and so not optimally used.
Pedicle method. • Most accepted method.
• Movement of pedicle on convex side of curve is graded between 0 and 4.
• CT the only optimal way to gage exact rotation.

20
Q

Interpedicular Distance

A

• Should not be below 14mm

21
Q

Tracheal Bifurcation

A 
Can vary due to mechanical considerations of the body (hyperkyphotic will lower
approximate level)
Alterations can be due to: Infection
Tumours
Mechanical influences
22
Q

Georges Line (ALL,PLL,SLL)

A

Measured: Line tracing the anterior longitudinal line, Posterior
longitudinal line and spino lamina line.
Normal Measurement:
Line should be smooth, regular and uninterrupted.
Significance:
Variety of interruptions due to many pathologies.
Spondylolisthesis.

23
Q

Angle of the Thoracic Spine

A

If superior and inferior vertebrae not clear T4 and T9 can be taken for apices.
Measured: Draw parallel lines to the superior endplate of T1 (T4) and straight line through inferior endplate of T12
(T9). Drop perpendicular lines to measure appropriate angle.

Varied angles approx. 20-50degrees common.

Varying ages see different angles.
Differences in angle can reveal a variety of problems: Age, Osteoporosis, Scheurmann’s, Congenital
abnormalities.

24
Q

Scoliosis

A

The four basic parameter investigated in scoliosis are, 1) curvature
2) rotation
3) flexibility
4) skeletal maturation
Two common measuring systems Cobb-Lippmann and Risser-Ferguson systems.
Cobb method most accepted standard for quantifying scoliotic deviation.

Cobb Lippman Method: • A line is drawn along superior border of cephalad (top) vertebrae
• A line is drawn along inferior of caudad (bottom) vertebrae
• If endplates not visible then bottoms and tops of pedicles used.
• Perpendicular lines are then drawn from each horizontal line, and the
angle of their intersection measured.
• Seven groups: 1: 0-20􀁱, 2: 21-30􀁱,3: 31-50􀁱,4: 51-75􀁱,5: 76-
100􀁱, 6: 101-125􀁱,7: 126 and above,
• Cobb method gives larger

25
Lumbar Views (5)
* AP (tilt 15 degree SIJ) * Lateral * Oblique R & L * L5/S1 spot (AP and Lat)
26
Lumbar Curve Angle
Measured: 1: Horizontal line to superior endplate L1. 2: Horizontal line to inferior endplate L5. Normal Measurement: Upright: 35 – 45 Can vary from recumbent to upright positions. Significance: Muscular imbalance Postural considerations. Nucleus pressure
27
Ferguson's Line (lumbar gravitational line)
Measured: Perpendicular line dropped from centre of L3. Normal Measurement: Should strike anterior margin or anterior ¼ of sacral base. Significance: Variety of interruptions due to many pathologies. Spondylolisthesis. Postural Compensation
28
Lumbar Spondylolisthesis
• Meyerding Measured: To classify a spondylolisthesis. Sacral base is divided into 4 equal parts. The relative slip of the vertebrae above is classified. • Ulman’s Measured: Line extended upwards at a 90 degree angle to the superior surface of the sacral base at its anterior margin and it should clear the anterior inferior margin of the L5 body.
29
Lumber interpedicular Distance
Should not be below 20mm
30
Pelvis and Hip Views (4)
- AP widely collimated - Spot AP Hip - Frogleg - Lateral (uncommon due to superimposition)
31
Hip joint width (Teardrop distance)
Significance: Various disorders. (some examples) Superior: most common DJD Axial: DJD, inflammatory arthritides Medial: DJD, RA. Effusion
32
Acetabular Depth
Measured: A line drawn from the superior margin of the pubis at the symphysis joint to upper outer acetabular margin. The greatest distance from this line to the acetabular floor is measured. Significance: < 9mm considered shallow and dysplastic.
33
Symphysis Pubis Width
Measured: Distance between opposing articular surfaces. Significance: Widening due to dysplasia, trauma, HPT, inflammatory (AS, Reiter's). Decrease DJD.
34
Femoral Angle
Measured: Angle formed by the axis of the neck and the long axis of the shaft of femur. Normal Measurement: 120-130 degree's Significance: < 120 Coxa Vara, > 130 Coxa Valga) Varying conditions
35
Illio-femoral Line
Measured: A line along lateral margins of the ilium should continue as an unbroken curve along the superior margins of the femoral neck. Normal: Even appearance bilaterally Significance: Congenital dysplasia, SFCE, Dislocation, #
36
Shenton's Line
Measured: Curvilinear line traced along under-surface of femoral neck and continued across the joint to the inferior margin of the superior pubic ramus. Normal Measurement: Line should be smooth and uninterrupted. (occasionally a portion of the femoral head may slightly cross the line) Significance: Interrupted or discontinuous line is useful in detecting hip dislocations, fem neck #, SFCE.
37
Skinners Line
Measured: Line drawn through and parallel to axis of femoral shaft. 2nd line at right angle to the shaft line is constructed tangential to the tip of the greater trochanter. Normal: Relationships to the fovea is assessed and fovea should lie above or at the level of the level of the trochanteric line. Significance: Conditions causing Coxa Vara #
38
Klein's Line
Measured: Line drawn tangential to the superior margins of the femoral neck. Bilateral examinations should be made. Normal Measurement: If there is a failure of the femoral head to cut the line drawn, then SFCE suspected. Significance: Dysplasia, SFCE Perthes destructive conditions
39
Knee Views (5)
``` AP Lateral Intercondylar Skyline Medial oblique ```
40
Ankle Views (3)
AP Lateral Oblique
41
Foot Views (3)
Dorsal Plantar Lateral Oblique (medial)
42
Shoulder Views (6)
``` AP AP internal rotation AP external rotation Axial Scapular Y Shoulder AC Joints (spot, weighted ```
43
Elbow Views (4)
AP – Lateral Flexion – Medial Oblique – +- supination or pronation AP
44
Wrist and Hand Views (5)
PA Carpal joints, distal radio-ulnar joint, radio-carpal and ulnocarpal joints. Lateral Displays carpals (particularly lunate) alignment, esp. in relationship to distal radius. Lateral Oblique (PA) (zither player, ball catcher) Metacarpal-phalangeal joints Medial Oblique (PA) Radio-carpal and ulnocarpal joints Scaphoid Ulna deviated and flexed.
45
Hand Ossification
``` • Capitate: 1st year • Hamate: 2nd year • Triquetral: 3rd year • Lunate: 4th year • Trapezium: 5th year • Scaphoid: 6th year • Trapezoid: 7th year • Pisiform: 10-12th year Shafts of metacarpals and phalanges ossify in utero ```
46
Foot Ossification
• Tibia Distal epiphysis 2nd year and joins the shaft at about 18 years • Fibula Primary centre appears at 8 weeks fetal life Proximal end 4th year and fuses with the shaft at about 20 years Distal end 2nd year and fuses with the shaft at about 18 years • Foot Bones of the tarsus are ossified at birth calcaneus 6/12, talus 7/12, cuboid 9/12 (cuboid ossification is medico-legal evidence of maturity) Secondary centres calcaneum appear at 10 yrs. and fuse at about 18 yrs. • Navicular 4th year • Cuneiforms Lateral 1st yr., Medial 3rd yr., Intermediate 4th yrs. • Metatarsals 2 - 3 years later than those of the hand at about the 5th year, and fuse at about 18 years (epiphysis of the 1st is at the base and at the head of the other toes) • Secondary centres may also appear in the lateral tubercle of the talus, the tuberosity of the navicular and the styloid process of the 5th metatarsal

Radiology (4 decks)

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