Skel A- Advanced Imaging For Chiropractor (CT/Bone Scan Flashcards
What are the types of advanced imaging for spinal evaluations?
Plain film
CT
CT w/ Myelography
MRI
Radionuclide bone imaging
Why do we use advanced imaging?
- More accurate
- Detects subtle injuries and pathologies
- Radiographically in depth analysis needed
- Failure of response of condition on plain film
Nuclear Medicine:
Describe radionuclide bone imaging
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.
Nuclear Medicine:
Radionuclide bone imaging has(Poor sensitive/great specificity or Great sensitivity/poor specificity)
Great sensitivity/ poor specificity
*recall that it will show different disorders similarly but picks up subtle changes *
Nuclear medicine:
Radionuclide bone imaging is (non-ionizing/ionizing)
Ionizing
Nuclear Medicine:
The most frequently used NM study that analysis bone, joint and soft tissue?
Radionuclide bone scan
Nuclear medicine:
A radiopharmacologic agent that distributes into organs and tissues and is carrier of radioactive substances into blood stream
Methyline diphosphate
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.
Technetium 99
Nuclear medicine:
What is the term synonymous for NM scan?
Scintigraphy
Nuclear medicine:
In terms of uptake of radioactive isotopes in bone scans, what are hot and cold spots?
Hot spots- areas of increased uptake; increased blood flow in area
Cold spots- areas of decreased uptake; low blood flow in area.
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 ?
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)
Nuclear medicine:
What are the isotopes used today in NM/scintigraphy scans?
(TGI)
Technetium-99 -Methyline diphosphate
Gallium(Ga)-67
Indium(In)-111
Nuclear medicine:
Describe the half life of technetium-99- Methyline diphosphate
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
Nuclear MEdicine:
What are the units to measure NM dose?
Millisieverts
Nuclear medicine:
What is the first phase of the bone scan procedure?
Flow phase/ Radionuclide angiogram-rapid imaging every 2-3 seconds for 30 seconds
Vascular
Nuclear medicine:
What is the second phase of the bone scan procedure?
Blood pool phase- when tracer is in soft tissue, takes about 5 minutes
Nuclear medicine:
What is the third phase of the bone scan procedure?
Delayed of bone phase- Tracer leaves soft tissue and vessels going into bone, takes 2-4 hours (as long as 24hrs)
Nuclear medicine:
A positive NM scan is largely based on what?
Blood flow
Rate of bone activity (osteoblastic)
Nuclear medicine:
Flow of isotopes in body during bone scan
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
Nuclear medicine:
Which two organs will show exceptional activity of the isotope radioactive emissions?
Kidney & Bladder
excretion function
Nuclear medicine
Indications for use of bone scan
BOAB FAMS
(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)
Nuclear medicine:
Contraindications of NM
Pregnancy
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.
Great sensitivity, Poor specificity
Full body
Less expensive
Is as sensitive as MRI (MRI can be more sensitive)
Nuclear Medicine:
How does multiple myeloma show on bone scan
Cold spots
Computerized tomography:
Describe CT
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
Computerized tomography:
Linear tomography
Tube and cassette move in straight line
Computerized tomography:
Plane in which CT image is captured
Axial/transverse plane
Computerized tomography:
CT was invented by whom
Godfrey Hounsfield 1970s
Assisted by Allan Cormack
Computerized tomography:
The first CT brain scan was done in what year
1972
Computerized tomography:
T/F: CT has always been digital
True
Gold standard for lung films?
CT
Computerized tomography:
What is the reconstruction of CT imaging?
Taking the axial slices and putting them into a whole-reduces detail
Computerized tomography:
How thick are the CT slices?
1 mm
Computerized tomography:
T/F: Compared to CT, MRI is true multiplanar
True
Computerized tomography:
Advantages of CT
Can distinguish thousands of densities
Can perform limited Histology- tells you exact what tissue is
Removes overlapping of anatomy
Computerized tomography:
How many densities does plain film have in comparison to CT?
CT=Thousands
Plain film=4( water, fat, air, bone)
Computerized tomography:
Units of CT densities
Hounsfield unit
Computerized tomography:
Densities of water, air, fat and bone on CT
Water= 0
Fat = (-50) – (100)
Air =-1000
Bone= 1000
Computerized tomography:
Images are displayed with a predetermined range of HUs
CT windowing
Computerized tomography:
Gold standard for bone detail and chest film?
CT
*it can pick up air, whereas MRI can’t due to low or no H+ ions
Computerized tomography:
CT is (ionizing/non-ionizing) imaging.
Ionizing
Gold standard for disc herniation.
MRI
Computerized tomography:
Indications for CT use
Cervical and lumbar disc herniation
Stenosis (if MRI contraindicated)
Discitis (MRI Preferred)
Metastasis(if MRI contraindicated)
Compression fx
Trauma
Paranasal sinus pathology
Arthritides
Lung
Computerized tomography:
Contraindications for CT
Pregnancy
Limit use on children
Computerized tomography:
OPLL
Ossification of PLL —> crush spinal cord and/or cause stenosis
