Special studies

Question 1

What are the four phases of bone scans?

Answer 1

Phase 1: Immediate/flow phase also known as an angiogram. 2-3 seconds.

Phase 2: Blood pool phase. 2-3 minutes

Phase 3: Delayed phase 2-3 hours.

Phase 4: Fourth phase 24 hours.

Question 2

What do each of the phases of a bone scan test for?

Answer 2

Phase 1: Blood flow
Phase 2: Soft tissue infection
Phase 3: Bone activity
Phase 4: Bone uptake when Peripheral vascular disease is present.

Question 3

What are the structures that commonly light up in a bone scan?

Answer 3

Bladder
Ribs/Sternum
Epiphysis of a growing child
Fractures
Tips of the scapula

Question 4

What is the half life of Tech 99?

Answer 4

6 hours

This means you cannot do the 24 hour phase with this bad boi

Question 5

Say a bone scan lights up during phase 1 and phase 2 but not in phase 3.
What’s the interpretation?

Answer 5

This is indicative of likely cellulitis

Question 6

Name a way to test between charcot disease and osteomyelitis via imaging.

Answer 6

Ceretec scan or Indum 111 scan.

Indium-111 and Ceretec scan tags WBC’s

Question 7

What does indium-111 tag?

Answer 7

WBC

Ceretec scan does the same

Question 8

What does Indium-111 test for?

Answer 8

Highly sensitive and specific for acute soft tissue and osseous infections.

Question 9

What does gallium-67 test for?

Answer 9

Acute inflammation and infection

Question 10

How long does it take for gallium-67 test to work?

Answer 10

2-3 days, it localizes a little better than Indium-111

However, it is very expensive.

Question 11

Why would you use a Tech-99 scan with a Galium-67 scan?

Answer 11

It helps to differentiate between Acute osteomyelitis, chronic osteomyelitis, and septic arthritis.

Can further be used to differentiate between fractures, acute cellulitis, and charcot.

Question 12

What causes increased signal intensity in a T1 image?

Answer 12

T1 is the Fat image.

Fat lights up with increased signal intensity here.

Question 13

What causes an increased signal intensity in a T2 image?

Answer 13

T2 is the pathological image.

Fluid, infection, inflammation, and tumors light up here.

Question 14

What does the FIIT mnemonic describe with T2 imaging?

Answer 14

Describes the four things that generally have an increased signal intensity on T2 imaging.
Fluid
Infection
Inflammation
Tumor

Question 15

For MRI what are the indications for STIR imaging?

Answer 15

Useful for the evaluation of edema in high lipid regions, such as bone marow.

Also for evaluating cartilage.

Question 16

What is Fat saturation imaging used for?

Answer 16

Evaluating fat…

Question 17

What is gradient echo imaging also known as?

Answer 17

Steady state magnetization

Question 18

What is Gradient echo used for?

Answer 18

Joint imaging

Question 19

What are the two uses for gadolinum?

Answer 19

NOTE THIS IS DIFFERENT THAN GALLIUM

Intravenous use: Distributes to places with increased vascularity such as neoplasms, inflammations, and the walls of abscesses.

Intraarticular use: Tests the cartilage integrity.

Question 20

How will a stress fracture appear in T1 imaging?

Answer 20

Linear zone of decreased signal intensity surrounded by a less defined area of signal intensity.

Question 21

How will a stress fracture appear in T2 imaging?

Answer 21

Linear zone of decreased signal intensity surrounded by an increased signal intensity due to edema.

Question 22

How will a stress fracture appear in STIR imaging?

Answer 22

Increased signal intensity because fatty bone marrow is suppressed.

Question 23

How will osteomyelitis appear in T1 imaging?

Answer 23

Break in cortex with decreased signal in the bone marrow.

Question 24

How will osteomyelitis appear in T2 imaging?

Answer 24

Break in cortex, increased signal intensity in the bone marrow!!

Question 25

How will avascular necrosis appear on T1 and T2 imaging?

Answer 25

Decreased signal intensity in both!!
Tissue is dead here.
“FIIT” (Fluid, Infection, Inflammation, tumor)

Question 26

How will avascular necrosis appear on STIR and Long T2 imaging?

Answer 26

Double rim signal!!
Inner margin will show an increased signal intensity (Granulation tissue).

Outer margin will show a decreased signal intensity (Showing mineralized tissue)

Question 27

What does MRA stand for?

Answer 27

Magnetic Resonance Angiography

Used for PVD, DVT, Neoplasm, and anatomic studies

Question 28

What is an MRA used for in Lower Extremity?

Answer 28

PVD, DVT, Neoplasm, and anatomic studies

Most commonly ordered by a vascular surgeon for further description of occlusions/stenosis.

Question 29

What are the three planes of CT imaging?

Answer 29

Coronal
Axial
Sagittal

Question 30

Which plane of CT imaging is computer generated?

Answer 30

The Sagittal plane!

Question 31

The coronal plane in CT is the same as the…. plane in radiographs.

Answer 31

Frontal plane!

Memorization tip: 1st vowel in coronal and frontal is “O”

Question 32

What does the axial plane of a CT scan represent?

Answer 32

This plane represents the transverse plane in radiographs.

Question 33

What must be discontinued before an angiogram is taken?

Answer 33

“Glucophage medications”

Think Metphormin

Question 34

What are some tests for sickle cell anemia

Answer 34

Microscope analysis

Electrophoresis

Question 35

How many phases are in a Ceretec scan?

Answer 35

One phase

Question 36

What does HMPAO stand for?

Answer 36

Hexymethylpropyleneamineoxide

Also the same thing as a Ceretec scan.

Question 37

What does MDP stand for?

Answer 37

Methyldiphosphate

Used in Tech99 scans/same thing as a Tech99 scan