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Test 1 Flashcards

1
Q

• Examples of ionizing radiation for imaging:

A

X-rays
• Computed Tomography (CT)
• Bone Mineral Density scans (DEXA

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2
Q

“Reflective” imaging:Examples

A

Ultrasonography (sound waves)

• MRI (radio frequency waves)

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3
Q

Emitted energy imaging examples?

A

radionuclide scans (bone scans, tagged RBC scan)

Thallium scans (functional cardiac imaging)

Positron emission tomography (PET) scan

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4
Q

The longer the wavelength the?

A

lower the energy

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5
Q

X-rays are generally in the wavelength range of

A

10-9

to 10-11 meters (.1-10 angstroms)

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6
Q

The shorter the wavelength, the

A

higher the

energy

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7
Q

Air, appears ? on the final x-ray image.

A

black

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8
Q

Bone therefore appears ? on the final x-ray image.

A

white

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9
Q

Fat is more dense than air, but far less dense than bone, so fat tissue appears
? on the final x-ray

A

dark gray

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10
Q

Water, which is the major component of soft tissue is much more dense than air or
fat, but less dense than bone, so water will appear ?

A

whitish gray

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11
Q

Substances that absorb x-rays are called

A

radiopaque

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12
Q

Radiopaque substances will appear ? on the x-ray images.

A

white

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13
Q

Substances that allow more x-rays to pass through are called ?

A

radiolucent

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14
Q

• Radiolucent substances will appear ? on the final x-ray images.

A

darker

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15
Q

something further away on xray appears

A

larger (magnified)

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16
Q

the body part of interest needs to be

A

closest to the film or detector

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17
Q

objects closer to the film or detector will be

A

sharper and better defined

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18
Q

objects farther away from film or detector will be s

A

blurred, or have less precise edge

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19
Q

One structure may obscure another by eliminating contrast at the edges, a
phenomenon called

A

“silhouette sign”

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20
Q

• Exposure depends on two things:

A

energy of the x-ray and exposure time

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21
Q

higher kVp means higher energy of the x-rays,

A

• Milliamps,(mA): corresponds to the quantity of x-rays produced

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22
Q

how to control scatter?

A

KVP, grids, air gap

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23
Q

X-rays are excellent tools for

A

Fractures and dislocations

infections

neoplasmsw

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24
Q

• Some organs are known to be more sensitive to radiation effects than others:

A 
Thyroid
• Breast tissue
• Gonads and reproductive organs
eyes, skin, bone marrow, and
vascular structures
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25
Q

Lesions involving new bone formation

• Increased density (radiopaque)

A

Blastic lesions

Reactive bone from any process
• Reparative phase after a bony injury

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26
Q

fracture naming conventions

A

site (distal, proximal, midshaft

Extent
• Complete, incomplete, comminuted

Type
• spiral, transverse, buckle or torus
•
Alignment and displacement of fracture fragments

  • Direction of fracture lines
  • Special features
  • Associated abnormalities
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27
Q

how does cortical bone heal?

A

• Large hematoma, external callous, fluid matrix, periosteal sleeve

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28
Q

how does cancellous bone heal?

A

• Internal callous, better vascularity usually, faster healing

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29
Q

promotes healing?

A

good immobilization

  • growth hormone
  • thyroid hormone
  • calcitonin
  • insulin
  • vitamins A&D
  • hyaluronidase
  • electric currents
  • oxygen
  • physical exercise
  • young age
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30
Q

retard healing

A
  • motion
  • corticosteroids
  • anticoagulants
  • anemia
  • radiation
  • poor blood supply
  • infection
  • osteoporosis
  • osteonecrosis
  • comminution
  • old age
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31
Q

Expected Fracture Healing Times

metacarpal

A

4-6 wk

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32
Q

Expected Fracture Healing Times

metatarsal

A

4-8 wk

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33
Q

Expected Fracture Healing Times

distal radius (extraarticular)

A

6-8 wk

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34
Q

Expected Fracture Healing Times

distal radius (intrarticular)

A

6-10 wk

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35
Q

Expected Fracture Healing Times

humeral shaft

A

12 wk

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36
Q

Expected Fracture Healing Times

femoral shaft

A

12 wk

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37
Q

Expected Fracture Healing Times

radius and ulnar shaft

A

16 wk

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38
Q

Expected Fracture Healing Times

tibial shaft

A

16-24 wk

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39
Q

Expected Fracture Healing Times

femoral neck

A

24 wk

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40
Q

Expected Fracture Healing Times

femoral neck

A

24 wk

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41
Q

Epiphysis remains intact

• Prognosis is good with treatment

A

• Salter-Harris Types I and II

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42
Q

Epiphysis is injured
• Prognosis is poorer, therefore repair must be more precise to prevent growth
abnormality

A

• Salter-Harris Types III and IV

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43
Q

Crush injury
• Usually occurs along with one of the types I-IV.
• Prognosis poor even with repair.

A

type V

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44
Q

for salter harris injuries the test of choice for diagnosis is?

A

plain x-ray

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45
Q

The biggest advantage of CT over plain radiography is

A

markedly enhanced detail of

the final image, especially for soft tissue structures (compared to plain films)

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46
Q

• Although ? (see next section) is still the best modality for soft tissues

A

MRI

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47
Q

“Slice thickness” (thickness of the plane that is in focus) can be variable. For most
CT images it is usually between

A

1-20 mm

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48
Q

can detect occult pneumothorax or effusion?

A

CT

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49
Q

CT has to use contrast to see ?

A

vascular

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50
Q 
Slit length determines the width of the
section to be imaged in relation to the long
axis of the whole part being imaged. In
other words, this determines how wide a
slice through the body is obtained on a
given CT scan.
• Think of it as if the body is being sliced
into pies.
• Slit length determines how thick each
entire pie is.
A

Shorter slit length results in narrower
pies, meaning there is higher
discrimination (you can see the pie
filling better)

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51
Q

Slit width determines the size of the slice of
tissue plane imaged with each beam of x-rays.
• In other words, how wide or narrow are the
slices in each pie.
•

A

Again, smaller width usually means more
detail, because the pie slices are narrower, but
also means more slices per pie (images per
slice) and therefore more radiation exposure

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52
Q

(x-ray absorption or transmission) of each pixel is averaged
by the computer from the multiple images that contain the spot that
corresponds to that pixel.

A

attenuation

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53
Q

average attenuation is called the ???, and is

applied to each of the pixels that make up the final image

A

“attenuation coefficient”

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54
Q

• This is a “grayness” scale that extends from -1000 to +1000

A

• Hounsfield scale:

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55
Q

• ? density is assigned a value of -0-, and defines the midpoint of the scale

A

Water

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56
Q

• ? is the least radiodense substance, and is assigned a value of -1000

A

Air

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57
Q

• Very dense ? is the most dense, and is assigned a value of +1000

A

bone

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58
Q

A bone window, for example, may set water (0 Hounsfield units) as completely
black, and shades of gray for everything above it.

A

Likewise a lung window may set water (0 Hounsfield units) as completely
white, allowing better grayness discrimination for less dense structures as seen
in the lungs

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59
Q

• With contrast, CT is excellent for visualizing details of vascular structures • CT angiography is the test of choice for ?

A

pulmonary embolus detection

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60
Q

Excellent modality for detecting fresh blood in tissue spaces (fresh blood has
an extremely high Hounsfield coefficient, but this decreases as clot formation
progresses )
• Non contrast CT is the test of choice for detecting

A

intracranial bleeding

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61
Q

non contrast CT Also excellent for

A

soft tissue hematomas

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62
Q

non contrast CT Also excellent for

A

soft tissue hematomas

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63
Q

• CT is excellent for observing fine detail in areas with high contrast:

A

Soft tissue masses in lungs
• Pneumothorax in lungs
• Calcification in muscle or brain, etc..

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64
Q

(“wobbles”) about the axis of its magnetic vector, the way that a
spinning top precesses as it spins

A

precesses

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65
Q

• It must be the EXACT frequency (energy level).

A

Larmor frequency

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66
Q

• This released energy is referred to as their ??, and this can be measured.

A

echo

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67
Q

This return to original state is referred to as

A

T1

68
Q

which represents the return to

longitudinal equilibrium with the external magnetic field (parallel/antiparallel)

A

T1

69
Q 
When these transverse (xy plane) vectors reach a certain percentage of their
original state (67% to be exact), this is designated as.
A

T2

70
Q

• T2 is far more dependent on the local environment than T1

A

• T2 is always shorter than T1

71
Q

represents decay from high energy state to low energy state, and is a function
of loss of energy

A

T1

72
Q

is often referred to as the thermal relaxation time or spin

lattice relaxation time.

A

T1

73
Q

though is not a return to a resting energy state, but a loss of phase coherence
between adjacent protons

A

T2

74
Q

is sometimes called the spin-spin relaxation

time.

A

T2

75
Q

time to repetition

• The time between subsequent RF pulses which are given in sequence

A

TR=

76
Q

time to echo

• Time from application of a radiofrequency pulse to peak echo signal

A

TE

77
Q

• ?? will be longer in tissue that contains more water.

A

T1

78
Q

?? weighting uses shorter TR and TE, causing tissue with more water to
appear darker, and tissue with less water to appear brighter

A

T1

79
Q

bone marrow is much whiter on

A

T2

80
Q

CSF T1?

A

BLACK

81
Q

CSF T2

A

WHITE

82
Q

• Fat T1

A

white

83
Q

Fat T2

A

black/dark gray

84
Q

CNS gray matter T1

A

dark gray

85
Q

CNS gray matter T2

A

light gray

86
Q

Cns white matter T1

A

light gray

87
Q

Cns white matter t2

A

dark gray

88
Q

Cns white matter t2

A

dark gray

89
Q

soft tissue edema t1

A

dark

90
Q

soft tissue edema t2

A

light

91
Q

acute stroke t1

A

dark

92
Q

actue stroke t2

A

light

93
Q

T1 shows usefulness for?

A

acute hematoma
fat yellow marrow
lipoma

94
Q

T2 shows useful for

A

chronic hematoma
fluid/edema
soft tissue tumors

95
Q

bone marrow is seen well on

A

MRI

96
Q

• This is an imaging technique that can assess function as well as anatomy

A

PET scan

97
Q

• Usually, Fluorine-18 labeled Fluorodeoxyglucose

A

PET SCAN

98
Q

is used, usually in conjunction with a CT scan, to detect
metabolically active disorders, such as:
• Cancer or metastases,
• Or to assess metabolic activity of tissue
• CNS in Alzheimer’s
• Cardiac blood flow in certain types of ischemic heart disease

A

pet scan

99
Q

-Sound waves are transmitted through the structure, and not
reflected back to the sound transducer.
• Area will appear black on the image
• Most air or fluid filled structures such as cartilage or joint effusions

A

anechoic

100
Q

structures with low level echos.
• These appear gray on the final image, and include muscle, synovium,
nerve structures

A

hypoechoic

101
Q

denser structures that are more reflective of sound waves
• Appear bright or white on the USG image
• Bone, tendon, foreign bodies, areas of calcification

A

hyperechoic

102
Q

acoustic “void” that appears behind a very reflective object

A

shadowing

103
Q

Occurs where highly curved surfaces distort or block sound transmission
• Gallbladder, long bone diaphyses, intermuscular interfaces

A

refractile/critical angle

104
Q

Useful for cyst identification

A

ultrasound

105
Q

useful for real time vascular imaging

• Carotid, cardiac, peripheral arteries as well as veins

A

ultrasound

106
Q

• Real time localization of fluid and abscesses
in ED- cardiac tamponade, pleural effusions, ascites
• in clinic- joint effusions, abscesses

A

ultrasound

107
Q

Distends joint capsule
• Helps mobilize capsolabral sleeve
• Highlights cartilage defects

A

Arthrography-

108
Q

• Screening recommended for those with risk factors for osteoporosis

A

Bone Mineral density imaging

109
Q

Less than 2.5 standard deviations below
mean= high fractures risk, with treatment
recommended

A

• DEXA: Dual Energy X-ray Absorptiometry

110
Q

• Useful for detecting metastatic cancer and for staging primary tumors
and for fracture age

A

bone scan

111
Q

Complex regional pain syndrome (RSD)

• Metabolic bone abnormalities such as Paget disease

A

bone scan

112
Q

• C1 does not have a vertebral body.

A

Stabilization of C1 depends on:
• Transverse ligament
• Facet articulations with C2.

113
Q

• There is no intervertebral disk between C1 and C2

A

• The transverse ligament of C1 is anchored to the odontoid

114
Q

American College of Radiology (ACR) Guideline to the Performance of Spine
Radiography: Indications for imaging:

A
  • Pain or neurologic symptoms
  • Spinal trauma
  • Surgical planning
  • Previous surgery, follow-up or suspected complications
  • Neoplastic (benign and malignant) lesions
  • Congenital anomalies
  • Previously detected abnormality
  • Alignment abnormalities
  • Infection
  • Arthropathy
  • Degenerative disorders
  • Spine instability or limitation of motion
  • Osteoporosis
115
Q

Complete cervical series should include:

• Routine:

A
  • AP
  • Lateral
  • Open mouth odontoid views
116
Q
  • Complete cervical series should include:

* Trauma patients:

A
  • AP
  • Open mouth odontoid
  • Cross-table lateral before moving the patient
  • If the spine cannot be adequately examined, obtain CT or MRI
117
Q

c-spine • When assessment of the neural foramina is necessary.

A

• Bilateral oblique views

118
Q

c-spine• Assessment of the facets, particularly following trauma

A

• Pillar views

119
Q

c-spine• When assessment of cervical instability is necessary

A

• Neutral, flexion, and extension lateral views

120
Q

Oblique views are done whenever there is any suspicion for

A

neuroforaminal

stenosis

121
Q

With lateral views, it is absolutely necessary to see

• If not the view is inadequate:

A

all 7 cervical vertebrae, and the

superior end plate of T1

122
Q

•??? is usually the image of choice to visualize C7-T1.

A

A swimmers lateral view

123
Q

??? should be obtained in trauma patients if a swimmers view is not
available or attainable

A

CT

124
Q

SCIWORA-

A

Spinal Cord Injury Without Radiographic Abnormality

• Special case occurring in trauma patients, especially children

125
Q

AP cervical spine films are obtained with patient sitting

or standing The X-ray beam directed toward

A

C-4 (about Adam’s

apple level)

126
Q

AP C-SPINE is used to assess the anteroposterior portion

of

A

C3-C7.

127
Q

AP Difficult to assess cartilage on this view,

??? is better

A

lateral

128
Q

hyperextend the neck

• May occasionally be done when an unobstructed view of the odontoid is absolutely required

A

Fuchs View

129
Q

usually the most informative cspine

view

A

lateral

130
Q

Straightening of the normal lordotic

curve may indicate ???, associated with occult injury

A

cervical muscle

spasm

131
Q

Reversal of the lordotic curve, or

kyphosis may indicate???

A

an unstable injury

132
Q

The atlanto-dens interval, ADI, (distance
between the anterior ring of C1 and the
odontoid process) must be no more than ???

A

3

mm

133
Q

• A wider ADI indicates ???

A

C1-C2 instability

134
Q

Look for soft tissue swelling in the retropharyngeal
tissue anterior to C2.
• Normally, the soft tissue in this area is ????
in width.

A

< 7 mm

135
Q

Similarly, look at the soft tissue in the retrotracheal
space at C6-7
• Normal soft tissue thickness at this level is ???

A

<22

mm

136
Q

They are taken with the patient rotated 45

degrees to the plane of the film/detector

A

Oblique views

137
Q

• T- spine is a common location for

A

metastatic cancer

138
Q

standard exams for thoracic spine?

A

AP

lateral

139
Q

t-spine lateral view Technique similar to lateral CXR:

• Patient erect, arms elevated• X-ray focused at ?

A

T-6 level

140
Q

•lumbar standard examination includes :

A

• AP and lateral (or PA and lateral)

141
Q

In general clinical practice for most adults, five standard views are usually obtained: l-spine

A 
AP
• Lateral
• Right and left obliques
• Cone down sacral view
• Oblique views
142
Q

• lumbar AP X-ray beam directed at the ?

A

mid-abdomen

143
Q

lumbar later view • X-ray beam directed toward

A

L3

144
Q

Particularly useful for evaluation of the zygoapophyseal joints
• Best views to assess spondylolysis and spondylolisthesis.

A

oblique

145
Q

oblique view l-spine Side-lying with knees & hips flexed and rotated 45 degrees
• Beam directed toward L3

A

*only thing that moves is the patient

146
Q

oblique view l-spine Side-lying with knees & hips flexed and rotated 45 degrees
• Beam directed toward L3

A

*only thing that moves is the patient

147
Q

Scotty dog eyes:

A

• Pedicles:

148
Q

Scotty dog ears:

A

superior

149
Q

• Scotty dog legs:

A

inferior

150
Q

• Scotty dog tail:

A

superior process,

opposite side

151
Q

• Scotty dog nose

A

Transverse process

152
Q

scotty dog neck

A

par interarticularis

153
Q

scotty dog wearing collar =?

A

spondylolysis

154
Q

scotty dog decapitated?

A

spondylolisthesis

155
Q

Sensitivity about 70%/specificity about 90% for fracture, OA and osteonecrosis
of the HIP

A

CT is much more sensitive for fracture and osteonecrosis (approaching 100%)

156
Q

test of choice to confirm osteonecrosis (specificity ~100%, but sensitivity
only about 38%) of the HIP

A

MRI

157
Q

American College of Radiography (ACR) recommends the following views for hip?

A 
AP
LATERAL (frog leg or true lateral)
158
Q

American College of Radiography (ACR) recommends the following views for the pelvis?

A

AP

159
Q

American College of Radiography (ACR) recommends the following views for the femur?

A

ap

lateral

160
Q

• Shows femoral head and neck and greater and lesser trochanters

A

FROG LEG

161
Q

Inferior lip of the anterior surface of

acetabulum

A

radiographic u

162
Q

ilioischial line,
acetabular articular surface, and
radiographic U sign

A

teardrop

163
Q

Imaginary line formed along the inferior border of the superior pubic rami
(superior border of the obturator foramen) and along the inferomedial
border of the femoral neck

A

shenton’s line

164
Q

Same patient position as AP
• X-ray tube angled about 30
degrees cranially
for the hip?

A

ferguson view (pelvic inlet)

165
Q

Technique is similar to Ferguson view, but x-ray tube is angled about 60
degrees

A

pelvic outlet

166
Q

• AP view taken with patient in a 45 degree oblique position of the hip?

Affected hip anterior gives better view of anterior column and posterior
acetabular rim

Affected hip posterior shows better visualization of posterior column and
anterior acetabular rim

A

judet vidw

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