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Skeletal Radiology A > Skel A- Advanced Imaging For Chiropractor (CT/Bone Scan > Flashcards

Skel A- Advanced Imaging For Chiropractor (CT/Bone Scan Flashcards

1
Q

What are the types of advanced imaging for spinal evaluations?

A

Plain film

CT

CT w/ Myelography

MRI

Radionuclide bone imaging

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2
Q

Why do we use advanced imaging?

A
  1. More accurate
  2. Detects subtle injuries and pathologies
  3. Radiographically in depth analysis needed
  4. Failure of response of condition on plain film
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3
Q

Nuclear Medicine:

Describe radionuclide bone imaging

A

Radionuclide bone imaging is a type of nuclear medicine that utilizes radioactive substances, injected intravenously to detect metabolic and physiologically changes in the body that proceed gross structural alterations.

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4
Q

Nuclear Medicine:

Radionuclide bone imaging has(Poor sensitive/great specificity or Great sensitivity/poor specificity)

A

Great sensitivity/ poor specificity

*recall that it will show different disorders similarly but picks up subtle changes *

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5
Q

Nuclear medicine:

Radionuclide bone imaging is (non-ionizing/ionizing)

A

Ionizing

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6
Q

Nuclear Medicine:

The most frequently used NM study that analysis bone, joint and soft tissue?

A

Radionuclide bone scan

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7
Q

Nuclear medicine:

A radiopharmacologic agent that distributes into organs and tissues and is carrier of radioactive substances into blood stream

A

Methyline diphosphate

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8
Q

Nuclear medicine:

Radioactive isotope used to emit gamma radiation that is sufficient enough to escape tissue and be detected by a gamma ray detector/camera during bone scans.

A

Technetium 99

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9
Q

Nuclear medicine:

What is the term synonymous for NM scan?

A

Scintigraphy

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10
Q

Nuclear medicine:

In terms of uptake of radioactive isotopes in bone scans, what are hot and cold spots?

A

Hot spots- areas of increased uptake; increased blood flow in area

Cold spots- areas of decreased uptake; low blood flow in area.

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11
Q

Nuclear medicine:

Skeletal scintigraphy was introduced in the early 60’s to capture bone changes plain film couldn’t.

What are the isotopes that were use and why are they not used anymore ?

A

Flourine-18

Scrontium-85 & 87

They emitted too much radiation or had too short of a half life (time it takes 50% of substance to be deactivated or flushed out of body)

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12
Q

Nuclear medicine:

What are the isotopes used today in NM/scintigraphy scans?

A

(TGI)

Technetium-99 -Methyline diphosphate

Gallium(Ga)-67

Indium(In)-111

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13
Q

Nuclear medicine:

Describe the half life of technetium-99- Methyline diphosphate

A

Tc-99 Methyline diphosphate has a half life of 6 hours. Within 6 hours 50-60% of the isotope is excreted through urination and this continues by 50% each 6hr

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14
Q

Nuclear MEdicine:

What are the units to measure NM dose?

A

Millisieverts

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15
Q

Nuclear medicine:

What is the first phase of the bone scan procedure?

A

Flow phase/ Radionuclide angiogram-rapid imaging every 2-3 seconds for 30 seconds

Vascular

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16
Q

Nuclear medicine:

What is the second phase of the bone scan procedure?

A

Blood pool phase- when tracer is in soft tissue, takes about 5 minutes

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17
Q

Nuclear medicine:

What is the third phase of the bone scan procedure?

A

Delayed of bone phase- Tracer leaves soft tissue and vessels going into bone, takes 2-4 hours (as long as 24hrs)

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18
Q

Nuclear medicine:

A positive NM scan is largely based on what?

A

Blood flow

Rate of bone activity (osteoblastic)

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19
Q

Nuclear medicine:

Flow of isotopes in body during bone scan

A

MDP & Tc-99m, 2-3 sec of imaging for 30 second, Flow phase —> 5 minutes later, isotope in soft tissue, Blood pool phase —> 2-4 hours later, clearance of isotope into bone/skeleton, Delayed/Bone phase —> 24hrs later,in bladder then excreted

20
Q

Nuclear medicine:

Which two organs will show exceptional activity of the isotope radioactive emissions?

A

Kidney & Bladder

excretion function

21
Q

Nuclear medicine

Indications for use of bone scan

BOAB FAMS

A

(BOAB FAMS)
Bone metastasis

Osteomyelitis

Arthritis

Benign bone lesion

Fractures not readily seen with plain film

Avascular necrosis (Cold Spots)

Myositis Ossificans (Hot Spots)

Spondylodiscitis (Hot Spots)

22
Q

Nuclear medicine:

Contraindications of NM

A

Pregnancy

23
Q

Nuclear medicine:

NM scans have great (sensitivity/specificity) and poor (sensitivity/Specificity).

Nm is (full body/regional), is (less/more) expensive than MRI, and is (as / less/ more) sensitive as MRI.

A

Great sensitivity, Poor specificity

Full body

Less expensive

Is as sensitive as MRI (MRI can be more sensitive)

24
Q

Nuclear Medicine:

How does multiple myeloma show on bone scan

A

Cold spots

25
Q

Computerized tomography:

Describe CT

A

CT is a further progression from plain film that utilizes a thin slicing mechanism of anatomy through the coordinated motion of the source (tube) and the receptor (cassette) which results in great detail

26
Q

Computerized tomography:

Linear tomography

A

Tube and cassette move in straight line

27
Q

Computerized tomography:

Plane in which CT image is captured

A

Axial/transverse plane

28
Q

Computerized tomography:

CT was invented by whom

A

Godfrey Hounsfield 1970s

Assisted by Allan Cormack

29
Q

Computerized tomography:

The first CT brain scan was done in what year

A

1972

30
Q

Computerized tomography:

T/F: CT has always been digital

A

True

31
Q

Gold standard for lung films?

A

CT

32
Q

Computerized tomography:

What is the reconstruction of CT imaging?

A

Taking the axial slices and putting them into a whole-reduces detail

33
Q

Computerized tomography:

How thick are the CT slices?

A

1 mm

34
Q

Computerized tomography:

T/F: Compared to CT, MRI is true multiplanar

A

True

35
Q

Computerized tomography:

Advantages of CT

A

Can distinguish thousands of densities

Can perform limited Histology- tells you exact what tissue is

Removes overlapping of anatomy

36
Q

Computerized tomography:

How many densities does plain film have in comparison to CT?

A

CT=Thousands

Plain film=4( water, fat, air, bone)

37
Q

Computerized tomography:

Units of CT densities

A

Hounsfield unit

38
Q

Computerized tomography:

Densities of water, air, fat and bone on CT

A

Water= 0
Fat = (-50) – (100)
Air =-1000
Bone= 1000

39
Q

Computerized tomography:

Images are displayed with a predetermined range of HUs

A

CT windowing

40
Q

Computerized tomography:

Gold standard for bone detail and chest film?

A

CT

*it can pick up air, whereas MRI can’t due to low or no H+ ions

41
Q

Computerized tomography:

CT is (ionizing/non-ionizing) imaging.

A

Ionizing

42
Q

Gold standard for disc herniation.

A

MRI

43
Q

Computerized tomography:

Indications for CT use

A

Cervical and lumbar disc herniation

Stenosis (if MRI contraindicated)

Discitis (MRI Preferred)

Metastasis(if MRI contraindicated)

Compression fx

Trauma

Paranasal sinus pathology

Arthritides

Lung

44
Q

Computerized tomography:

Contraindications for CT

A

Pregnancy

Limit use on children

45
Q

Computerized tomography:

OPLL

A

Ossification of PLL —> crush spinal cord and/or cause stenosis

Skeletal Radiology A (5 decks)

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