STEEPLECHASE RADIOGRAPHY Flashcards
Overexposure
- Black
- High mAs, high kV
Underexposure
- Too white
- Low mAs, low kV
Radiolucent
- Black - radiation passes through
- Gas = black, low atomic no. + specific gravity, does not absorb as many photons
- Fat = lighter grey
- Fluid = shades of grey
Radiopaque
- White - inc absorption of radiation, less radiation passes through to detector
- Bone - high atomic no. + specific gravity, absorbs more photons
- Metal
Radiographic report
- Description - signalment + Hx, area imaged, projections
- Quality - exposure, positioning, technical faults
- Dx - description of image, identify variation from normal, summary of findings
- DDx - prioritise list - most sig, incidental findings
- Recommendations - imaging, Sx, Dx, ongoing managmenet
Radiographic interpretation - what to comment on
- P - positioning
- C - centring
- C - collimation
- E - exposure
- L - labelling
- A - artefacts
- Pink camels collect extra large apples
Positioning
- Area of interest
- Projections - e.g. lateral, R/L
- Lying on back = VD
- Sternal = DV
- Distal limb - radius/ulna = CC, craniocaudal
- Hindlimb = dorsal/plantar/palmar
- Standard views
- Standard pos
- Standard exposure settings
- Orthogonal view - 90 degree, prevent twisting/minimise geometric distortion
- Magnification
- Centring
- SI loops v mobile + easily displaced
Centring
- Anatomical area of interest using bony landmarks
- Allows close collimation to avoid scattering
- Cross on light diaphragm when collimator light on
Collimation
- Reduce radiaiton dose, scatter + improves contrast + image quality
Comment on exposure
Underexposed
Labelling
- L/R marker
- Patient name + date
Lateral views
- Rostral part of animal to viewer’s left
Ventrodorsal/dorsoventral
- Rostral part of animal pointing up + left of animal to viewer’s right
Lateromedial/mediolateral extremities
- Proximal limb up
- Cranial/dorsal limb to viewer’s left
Craniocaudal/caudodorsal extremities
- Lateral aspect of limb to viewers left
Artefacts
- Incorrect/no labelling
- Poor positioning
- Poor collimation
- Movement blur
- Fogging
- Double exposure
- Radiopaque artefacts on patient - mud, wet coat, syringe under patient
Inc size
- Hypertrophy
- Hyperplasia
- Neoplasia
- Torsion
- Cystic change
- Compare size to another structure/fixed landmark e.g. liver enlargement if extended costal arch, comparing kidney to lumbar vertebrae
Dec size
- Atrophy
- Hypoplasia
- Congenital anomaly
Localised/diffuse shape
- Neoplasia
- Necrosis
- Ulceration
- Physiological enlargement e.g. blood in spleen, uterus preg, aerophagia in stomach
- Pathological enlargement - neoplasia
Inc no.
- Accessory ossification centre
- Congenital anomaly
Dec no.
- Congenital anomaly
Inc opacity
- Calculi
- Mineralisation
- Fluid/ST in gas-filled structure
- FB
- Metallic opacity
Dec opacity
- Abnormal gas
- Osteopoenia (dec bone density)
Dec margination
- Periosteal reaction
- Protruding mass
- Free abdominal fluid -> loss in serosal detail
- Young + emaciated animals have poor serosal detail
Positioning
- This is a right lateral thorax of a skeletally mature dog
- The animal is not positioned straight. The forelimbs are not parallel causing rotation of the spine and thorax which can also be seen by the ribs not being superimposed. The forelimbs should also be extended forwards to avoid superimposition of the soft tissue of the legs over the cranial thorax.
Centring
- The image is centred too far caudally resulting in the mid point of the thorax not being in the centre of the image.
Collimation
- The collimation should include the thoracic inlet and caudal rib, and both dorsal and ventral skin edges. In this image the collimation is too wide ventrally and cranially. Some of the last rib is missing. This will be due, in part, to the incorrect centring.
Exposure
- The exposure of the image is sufficient such that the image is of diagnostic quality.
Labelling
- The right marker is just present but not fully in the image so its position could be improved. No patient details are apparent but they may be stored on the file if this is a digital image.
Artefacts
- There is artefact from dirt on the coat ventrally. Geometric distortion is present due to the limbs not being kept parallel but this does not affect the interpretation of the image as such.
Displacement of position
- Torsion
- Ectopia
- Hernia
Shoulder
- Mediolateral + caudocranial
Lateral thoracic
- 1y beam centred over mid thorax
- 1y beam collimated to include: manubrium/thoracic inlet, last rib, dorsal + ventral skin edges
Dorsoventral thoracic
- 1y beam centred over mid thorax
- 1y beam collimated to include manubrium/thoracic inlet, last rib, lateral skin edges
Craniocaudal elbow
- 1y beam centred midway between humeral condyles
- 1y beam collimated to include: 1/3 way along radius/ulna distally, 1/3 way along humerus proximally + lateral skin edges
Mediolateral elbow
- 1y beam centred over humeral condyle
- 1y beam collimated to include: 1/3 of way along radius/ulna distally, 1/3 way along humerus proximally + tight to the lateral skin edges as possible w/o compromising the imagine
Lateral abdominal
- 1y beam centred over mid abdomen/last rib
- Centre midway between spine + ventral aspect of body
- 1y beam collimated to include: entire diaphragm, pelvic outlet, dorsal + ventral skin edges
Ventrodorsal abdominal
- 1y beam centred midline caudal to last rib
- 1y beam collimated to include: entire diaphragm, pelvic outlet + lateral skin edges
Mediolateral stifle
- 1y beam centred distal to femoral condyles
- 1y beam collimated to include: distal 1/3 of femur + proximal 1/3 of tibia
Ventrodorsal hip
- 1y beam centred on pubic symphysis/midline between hips
- 1y beam collimated to include: lateral skin edges, cranially to iliac crests, caudally to mid femur
Elbows
- Mediolateral (neutral, flexed, extended)
- Craniocaudal
Carpus
- Mediolateral (flexed + extended)
- Dorsopalmer
Distal limb
- Dorsopalmer
- Mediolateral splayed digits
- Oblique
Hips
- Ventrodorsal + lateral pelvis
Stifles
- Mediolateral
- Caudocranial
Hocks
- Mediolateral (flexed + extended)
- Plantarodorsal
Distal limb
- Plantarodorsal
- Mediolateral splayed digits
- Oblique
Rules of thumb - limb imaging
- Two orthogonal projections at right angles
- Include joint above + below Fx
- Use contralateral limb for comparison
- Include 1/3 long bone proximal + distal to joint
Limb imaging exposure criteria
- Should be able to assess bone + ST
- See trabecular detail in bones
- Cortical bone = dense white
- ST = grey tones
- Underexposure = bone homogenous white
Limb - approach to evaluation - Soft tissue
- Localisation
- Change in tissue mass
- Opacity - around bone
Limb - approach to evaluation - bone
- Lesion description
- Location within bone
- Epiphysis, metaphysis, diaphysis
- Periosteum, cortical bone, endosteum, trabecular bone, medullary cavity
- Opacity
- Margins
- Joint involvement
- ST involvement
Limb - approach to evaluation - joints
- Alignment of bones
- Character + distribution of bony lesion
Soft tissue evaluation - change in tissue mass
- Diffuse inc - SC fluid, oedema, lymphoedema, cellulitis, neoplasia, emphysema (inc air)
- Localised inc - abscess, cyst, haematoma, neoplasia, assess adjoining bony structures for neoplasia
- Atrophy - disuse, neurogenic, myositis, weight loss
Soft tissue evaluation - changes in opacity, inc in opacity (more white)
- Artefacts - dirt, foreign material
- Calcification - calcinosis cutis (Cushing’s/hypoadrenocorticism), calcinosis circumscripta, tendon mineralisation, metastatic (calcium phosphate) mineralisation
- Ossification - extraskeletal osteosarcoma, myositis ossificans
- Radiopaque FB
Soft tissue evaluation - changes in opacity, dec in opacity (more black)
- Fat - lipoma
- Gas - puncture, sinus, open Fx
- Facial planes - radiolucent lines gas lines between
- Inc ST opacity
- Calcinosis circumscripta
Describing lesions - bone
- Monostotic - lesion present in one bone, e.g. osteosarcoma
- Polyostotic - lesion present in many bones, e.g. multiple myeloma
- Focal lesion present in specific bone region e.g. metaphysis/diaphysis
- Generalised - involving all bones, often a metabolic condition
- Symmetrical - present on both sides of a bone e.g. metaphyseal osteopathy
- Asymmetrical - present on one side only e.g. from premature closure of a growth plate due to trauma
- Physis - only present in immature animals where growth plate has not closed, relevant for salter harris fracture classifications
Bone lesion location
- Areas of each bone - periosteum, cortex, medullary cavity, physes
- Proximal or distal? etc - planes
New bone formation
- Response to injury/insult or neoplasia
Internal
- Inside medullary cavity - trabecula, endosteum
- Reactive - inc thickness of normal trabeculae, organised homogenous appearance: panosteitis
- Neoplastic - non-homogenous - osteosarcoma, chondrosarcoma
Periosteal
- External to bone
- As result of injury/insult
Panosteitis - painful inflam of outer surface or shaft of long bone
Periosteal reactions
(In order of aggression)
- Smooth/solid
- Laminated
- Sunburst
- Codman’s triangle
- Amorphous
Periosteal reaction - smooth
- Slow lifting of periosteum over period of time
- New bone laid down below
- Solid + uninterrupted change
Periosteal reaction - laminated
- Slower process
- More aggressive than smooth
- Periosteum lifted in interrupted fashion resulting concentric laminated layers - onion skin
- Layers of periosteum + cortex
Periosteal reaction - sunburst
- Highly aggressive process
- Lesion is growing rapidly that periosteum doesn’t have time to lay down layer of new bone
- Sharpey’s fibres stretched out perpendicular to bone then ossify
- Osteosarcomas
Periosteal reaction - Codman’s triangle
- Rapid process
- Cortical destruction present
- Edges of periosteum raised + ossify forming triangle w/ surface of bone - flap/angle against bone
Periosteal reaction - amorphous
- Not technically periosteal reaction
- Neoplastic new bone seen beyond destroyed periosteum
- ‘Cotton wool’ like
- Highly suggestive of osteosarcoma (almost always neoplastic)
- Solid periosteal reaction
Lamellated/laminated periosteal reaction
Sunburst periosteal reaction
Codman’s periosteal reaction
Types of bone loss
- Lysis, loss = radiolucent
Order of aggression - - Focal
- Geographic - least aggressive + slower growing lesions - single large radiolucent lesion w/ sclerotic rim + cortex destruction
- Moth-eaten - multiple separate foci or lysis, more ill-defined + transitional zone between affected + non-affected bone
- Permeative - most aggressive + rapidly growing lesions, numerous areas of lysis w/ poorly defined borders + wide + indistinct transition zone
Inc bone opacity
- Real - new bone production
- Artefactural - superimposition - of Fx = poor positioning