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ClinMed II > Test 3: Imaging > Flashcards

Test 3: Imaging Flashcards

1
Q

what are the routine radiographs of the hip

A

lateral frog leg

AP

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2
Q

what can you visualize with a hip AP radiograph

A

hip joint and proximal femur

looking at iliofemoral line, shenton’s hip line, and femoral neck angle

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3
Q

what are the iliofemoral line and shenton’s hip line

A

iliofemoral = smooth curve alone outer ilium that extends into neck

shenton’s = smooth curve around obturator foramen

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4
Q

important obervations when viewing the hip xray (ABCDS)

A

well preserved joint space

smooth margins of acetabulum/femoral head

obvious ball and socket

cortex margins on shaft

cancellous markings on head and neck

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5
Q

what is the purpose of the lateral frog view

A

visualizes head, neck, and proximal femur

lesser trochanter is more anterior

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6
Q

routine radiographs of the knee

A

AP
lateral
PA axial “tunnel” view
tangential

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7
Q

what can you see with a knee AP view

A

distal femur
proximal tibia (and respective joint)
fibular head

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8
Q

important things to obeserve with AP knee

A

patella superimposed and not typically visible unless baja

well defined/equal joint spaces

tibia/femur alignment

distinct cortical margins and cancellous markings

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9
Q

advantage of the knee lateral view

A

visualize profile of PF joint

can determine alta/baja positioning of patella

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10
Q

how similar should the length of the patella and the patellar tendon be?

A

within 20% variance

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11
Q

what can you view with the knee PA axial tunnel view

A

intercondylar fossa and eminence

posterior femur and tibia

tibial plateaus

used to detect loose bodies, osteochondral defexts, or narrowing of joint space

performed in standing for ARJC

tunnel should be round and open

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12
Q

what can you see with the knee tangential view

A

PF joint space and surfaces

can see sulcus angle; obs depth; if shallow may be more prone to dislocation

can see congruence angle; helps determine patellar position within sulcus (>16 deg associated with hyper)

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13
Q

ottawa knee rules

A

over 55
fibular head tenderness
isolated patellar tenderness
inability to flex knee to 90
inability to walk 4 steps after injury

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14
Q

routine ankle radiographs

A

AP
AP oblique
lateral

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15
Q

what can you see with the ankle AP view

A

distal tib/fib and talar dome

lateral malleolus should me more distal than medial

can see upper and medial talus; medial or lateral shift is abnormal

cam see distal tib/fib joint space

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16
Q

what can you see with the ankle AP oblique view

A

mortise is visible with 15-20 deg hip IR

can see entire talocrural joint space

mortise is typically 3-4 mm or < 1/2 cm all the way around

> 6mm measure used for syndesmotic injury

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17
Q

what can you see with ankle lateral view

A

tibiotalar and subtalar

talonavicular and calcaneocuboid joints

bony members

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18
Q

what is the ankle anterior drawer stress view used for

A

xray while performing ligament test

measure from tibia to posterior talus

normal = 5mm or 1/2 cm

abnormal = > 10 mm or 1 cm

5-10 mm of separation requires comparison between sides

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19
Q

what is the ankle EV/IV stress view used for

A

measure angle between the bottom of the tibia and the talar dome

abnormal = mortise widens, >15 deg for IV or >10 deg for EV

also abnormal if >5 deg difference between sides

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20
Q

routine radiographs for foot

A

AP
lateral
oblique

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21
Q

what can you see with foot AP view

A

mid and fore foot

can note individual bones

look at 1st intermetatarsal angle; intersection of lines bisecting 1st and 2nd MT shafts (normal is < 5-10 deg)

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22
Q

what can you see with the lateral view of the foot

A

subtalar, talonavicular, and calcaneocuboid joints and members

different from ankle because less tibiofibular imaged

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23
Q

what can you see with the foot oblique view

A

foot and leg medially rotated

visualizes forefoot primarily but also all tarsals except cuneiform and a portion of the talus

24
Q

important observations with foot oblique view

A

MTs image with sharp clearly defined cortical borders

sesamoids

2nd-4th distal phalanges DIFFICULT TO SEE

joint spaces and midtarsal joints

25
Q

what are the ottawa ankle rules

A

tender at posterior aspect or tip of lateral malleolus OR

at posterior aspect or tip of medial malleolus OR

inability to bear weight immedialtely and at ER

26
Q

what are the ottawa foot rules

A

tender at base of 5th MT
tender at navicular bone
inability to bear weight immediately after or in ER

27
Q

major advantages of US

A

real time info for superficial soft tissue

higher resolution for superficial tendon, ligament, and muscle than MRI

28
Q

major disadvantage of US

A

inability to scan deeper joint structures

image quality is dependent on operator

29
Q

things to understand about a sonograph

A

brighter signal from reflextion of smoother and denser structures = swelling, tendinosis; akak hyperechoic appearance

irregular borders or lack of structure = tear

wider structure = swelling/thickening

30
Q

how to choose imaging options

A

radiograph = initial

CT and MRI recommended for complex fxs and osteochondral lesions

MRI recommended for stress fxs and tendon abnormalities

MRi arthrography (+contrast) for ligament and cartilage issues

US appropriate for superficial soft tissue abnormalities

31
Q

who should get imaging with LBP

A

over 55 and hx on cancer
saddle paraesthesias
bowel/bladder dysfunction
specific neuro deficits
progressive/disabling symptoms
no improvement in 6 wks

32
Q

what structures are what colors with radiographs

A

black = air
gray = soft tissue
white = bone
bright white = dye
solid white = metal

33
Q

how many markers should you identify with imaging

A

at least 2

34
Q

ABCS of radiographs

A

alignment = misalignment indicates fx/dislocation (with possible cord compromise)

bone density = outer cortical bone is brighter white than inner cancellous

cartilage space = narrowing, sclerosis, growth plates

soft tissues = muscle wasting/capsular distention/periosteal disruption

35
Q

routine radiographs for L/S

A

AP
lateral
R and L oblique
lateral L5,S1

36
Q

what are you looking for with a AP view of spine

A

vertically aligned vertebral bodies

preserved intervertebral spaces

midline spinous processes (larger in upper/smaller spacing in lower segments)

37
Q

what do the articular processes look like in AP view of spine

A

casts a butterfly shaped shadow on vertebral bodies

joints not specifically visible but alignment is noted

38
Q

what do pedicles look like on AP view of spine

A

oval densities

equidistance from SPs

39
Q

level of iliac crest indicates what

A

clinically = L3/4

imaging = L4/L5

40
Q

what are you looking for with lateral imaging of the spine

A

3 parallel lines
-anterior vertebral borders
-posterior vertebral borders
-spinolaminar line (junction of SP and lamina)

should remain constant regardless of position of spine

41
Q

what is Barge’s angle

A

angle between sacral base and vertical line

53 deg average

42
Q

what is ferguson’s angle

A

angle between sacral base and horizontal line

41 average

43
Q

what does a smaller barge’s and a larger ferguson’s angle indicate

A

more lordosis

greater facet compression

anterior shear forces

lateral foramen narrowing

44
Q

what does a larger barge’s and a smaller ferguson’s angle indicate

A

less lordosis

greater vertebral body and discal compression

45
Q

oblique view is best for picking up what

A

spondylolysis or spondylolisthesis

46
Q

major advantages of CT

A

less overlap

can locate subtle bone changes

47
Q

major disadvantages of CT

A

greater radiation exposure

limited with soft tissue abnormalities

48
Q

what should you understand about a transverse plane slice of CT

A

patient is supine so anterior surface is at the top of each image slice

look upward at tha anatomic structures from below so your right is the pts left

49
Q

how are sagittal plane CT slices viewed

A

from L to R

50
Q

major advantages of MRI

A

excellent for soft tissue abnormalities, cancellous/bone marrow conditions, or staging metastasis

no radiation like with CT or xray

high resolution

51
Q

major disadvantages of MRI

A

contraindications with magnetic implants except for stable joint implants

precaution with claustrophobia

52
Q

difference between T1 and T2 MRI

A

T2 image = bright fluid; shows inflammation

T1 image = dark fluid; better anatomically

53
Q

what is indicated on T1 imaging

A

brigth signals from fat and bone marrow

dark signals form cortical bone and fluid

best at demonstrating anatomical definition of structure

54
Q

what is indicated on T2 images

A

bright signals from fluid and water

best for demonstrating swelling and neoplasms; particularly in cancellous bone

55
Q

why would persistent IDD not have bright white on imaging

A

persistent becomes fibrotic

ClinMed II (12 decks)

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