1. Roentgen Signs Flashcards
(136 cards)
1
Q
Advantages of conventional radiography
A
– Inexpensive – Easily obtained – Non-invasive – Demonstrates anatomy and osseous/ articular relationships
2
Q
Disadvantages of conventional radiography
A
– Poor soft tissue discrimination
– Change in bone density difficult to assess
– Poorly defines small lesions
– Exposure differences between facilities
– Technical and processing artifacts
– Ionizing radiation
3
Q
decrease in bone density needed to see lesion on conventional radiography
A
at least 30-50% and 1-5cm in size
4
Q
examples of underlying disease not detected on radiograph
A
Metastatic Disease, Multiple Myeloma, Lymphoma, Fracture,
5
Q
Time until a lesion is seen by plain film radiography
A
Radiographic Latent Period
6
Q
Radiographic Latent Period for Osteomyelitis in peripheral bone
A
10-14 days
7
Q
Radiographic Latent Period for Spinal osteomyelitis
A
21 days
8
Q
Radiographic Latent Period for Aggressive Tumors
A
4-6 weeks
9
Q
evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision
for a specific clinical condition.
A
ACR Appropriateness Criteria (AC)
10
Q
Injection of water soluble iodinated contrast into IVD’s nucleus pulposus via fluoroscopic control in order to determine pain
generator
A
Discography
11
Q
a provocational study for discogenic pain and guide for surgical intervention
A
Discography
12
Q
Pattern of Distribution of Contrast during discography
A
fissuring, extravasation and pooling
13
Q
Performed to visualize internal disc derangement
patterns (annular tears) that are not seen with MRI
A
CT Discography
14
Q
Disadvantages of discography
A
– Fluoroscopy increases radiation dose – Risk of infection (0.1-0.2%) – Risk of nerve root damage – Risk of dural trauma and tear – Chemical meningitis – Increased pain or exacerbation of pain – Allergic reactions to contrast (iodine) – Patient awake during procedure to give responses to physician performing examination
15
Q
Inject 15-20mCi of Technitium-99m-Methylene Diphosphate
(99mTc-MDP) intravenously and wait
30 min - 2 hours
A
Radionuclide Imaging (Bone Scan)
16
Q
3-Phase Bone Scan
A
- Blood Pool Phase
- Delayed Phase
- Delayed/delayed Phase
17
Q
Bone scan: scan 5 minutes after injection
A
Blood Pool Phase
18
Q
bone scan: scan 2-4 hours after injection
A
Delayed Phase
19
Q
bone scan: scan 24 hours after injection
A
Delayed/delayed Phase
20
Q
Isotope half-life for bone scan is _____ and is excreted by the _____
A
6 hours, kidneys
21
Q
View areas of bone where bones overlap e.g. pars
interarticularis
A
SPECT Scan: (Single-Photon Emission Computed Tomography)
22
Q
Takes about 45 – 60 minutes
A
SPECT Scan
23
Q
Bone Scan Applications:
A
Detection of: - Metastatic disease - Tumors - Infection - Arthritis - Fracture (occult, stress, recent fx) - Avascular Necrosis (AVN) - Normal plain film but pain of unknown origin
24
Q
Bone Scan Advantages
A
– can detect 3-5% bone destruction/production
– 10x more sensitive than plain film
– Great for early detection of many disease processes
25
Bone Scan Disadvantages:
– Measure of activity, quantitative image
– Sensitive, but not specific
– No uptake in Multiple Myeloma unless pathological
fx
– Tracer excreted within 1-3 days
– must stop breast feeding for 24 hours after tracer injection
26
(Bone Scan)
Multiple “Hot Spots” are seen on bone scan
throughout the skeleton
indicating
Metastatic Disease
27
uniform uptake of the tracer
normal bone scan
28
After you receive an injection of radioactive
tracer, a machine containing a ________
passes slowly over your body, recording the
pattern of tracer absorption in your bones.
gamma camera
29
bone scan takes about
30 minutes
30
Advantages of Diagnostic Ultrasound
```
– Abdominal and Pelvic imaging
– display of vascular
integrity/flow velocity
– MSK disorders
– masses (cystic,
solid, or mixed matrix)
– Guiding biopsy and joint aspiration
techniques
```
31
Disadvantages of US
– Operator Dependent
| – Long learning curve
32
advantages of computed tomography (CT)
- Excellent Bone Detail
- High Radiation Doses
- 3-dimensional imaging
33
Each cross sectional slice with CT is between
0.5-3.0 cm of body tissue
34
20-25 sequential slices for lumbar CT scan is how many RADS?
1-3
35
advantages of Magnetic Resonance Imaging (MR)
- Excellent soft tissue contrast resolution
- No ionizing radiation
- Visualize pathologic tissue directly
- Extremely sensitive for detecting bone marrow disease
- Excellent detail of internal joint architecture
• Excellent for spinal disease, especially disc disease
36
examples of MR use for spinal disease, especially disc disease
```
– Disc herniation and degeneration
– Spinal cord
– Nerve roots
– Facets
– Epidural fat
– Ligamentum flavum
```
37
Disadvantages of MR
- Claustrophobia/Noisy
- Metallic clips may not be able to be imaged
- Intracranial and Aneurysm clips
- expensive
38
Do Not MR
* Pacemakers
* Cochlear implants
* Pregnan patients
39
No preformed cartilage stage
Intramembranous Ossification
40
examples of Intramembranous Ossification
- Skull
- Clavicles
- Mandible
41
Controls width of long bones via activity of periosteum
Appositional Bone Growth:
42
Controls width of long bones via activity of periosteum
Appositional Bone Growth
43
Chondroblasts and chondrocytes form and produce a cartilage cast of the definitive bone
Enchondral Ossification
44
Osteoblasts transform cartilage template into bone
Enchondral Ossification
45
examples of
Tubular bones and Vertebrae
46
Results in bone lengthening until skeletal maturity
Enchondral Ossification
47
Enchondral Ossification also occurs at
epiphyseal growth centers (physis)
48
surrounds bone except at ends of bone
Periosteum
49
Periosteum is seen on MRI but not seen on
x ray
50
Periosteum fracture healing via
callus
51
Located at ends of long bones and preformed in cartilage
Epiphysis
52
Epiphysis produces and supports
articular cartilage
53
Apophyses are like _______ that are sites of muscle
| attachment
epiphyses
54
Consists of layers of progressively maturing cartilage & developing
bone
physis
55
responsible for longitudinal growth of long bone (enchondral bone formation) and is
radiolucent during skeletal development
physis
56
Trauma to physis, and alteration of hormonal/vascular dynamics may alter
growth
57
Thin radiopaque line at junction of physis and metaphysis
Zone of Provisional
| Calcification (ZOPC)
58
what occurs at the Zone of Provisional
| Calcification (ZOPC)
Calcification of cartilagenous physis
59
growth arrest during systemic disease will cause
Harris Growth Arrest (Park) Lines
60
a dens ZOPC could indicate
scurvy
61
Most metabolically active region of a bone and therefore most common site for tumors and infection
Metaphysis
62
the metaphysis contains calcified weight-bearing
stress trabeculae
63
bones appear wider than usual
Undertubulation
64
bones appear slender
Overtubulation
65
Erlenmeyer Flask appearance indicates
Undertubulation of the metaphysis
66
Diaphysis is the
Shaft
67
- Longest part of bone
| - Thickened cortex and decreased medullary space
Diaphysis (shaft)
68
Provides mechanical strength and contains bone marrow
Diaphysis (shaft)
69
Marrow Diseases include
* Multiple myeloma
* Ewing’s sarcoma
* Non-Hodgkins lymphoma
* Adamantinoma (ameloblastoma)
* Infection
70
Densest and strongest part of bone
Cortex
71
Densely packed compact lamellar bone and osteons and is interconnected by Haversion canal systems
Cortex
72
cortex includes the
Periosteum and Endosteum
73
Always evaluate cortex for integrity/thickness to rule out
bone disease
74
Thin interconnecting trabeculae (spongiosa)
| which contains Bone Marrow
Medullary Cavity
75
Red marrow predominates in all bones in
children
76
Adults have red marrow in what 3 places?
1. axial skeleton
2. epiphyses
3. metaphyses
77
consists of a
lattice of thin threads of bone called
trabeculae and is less dense than compact
bone.
Spongy or cancellous bone
78
The orientation of the trabeculae is affected by
mechanical stress
79
surrounded by rings a concentric lamellae of calcified bone matrix
Haversian canal
80
The lamellae contain lacuni (holes) where
| _______ are located.
osteocytes
81
Thin membrane covering diaphysis and metaphysis
Periosteum
82
Doesn't cover epiphysis and doesn't enter synovial
| joint but forms synovial lining of synovial joint.
Periosteum
83
In Children the Periosteum is only attached to the
metaphysis
84
In adults the periosteum is firmly attachment to the
metaphysis and
| diaphysis via Sharpe’s fibers
85
Fibrous layer attaches
| to bone by Sharpe fibers
Outer Layer of the Periosteum
86
Has osteoblastic and osteoclastic
| properties
inner Layer of the Periosteum (Cambium)
87
produced due
| irritation or elevation from bone due to pus, blood or tumors
Periosteal Reactions
88
has osteogenic
properties and helps maintain cortical thickness with
periosteum
endosteum
89
Trabeculae and inner cortical margins are
| covered by
endosteum
90
"CATBITES" stands for
* Congenital
* Arthritis
* Trauma
* Blood
* Infection
* Tumor
* Endocrine, Nutritional, Metabolic
* Soft tissue
91
diaphyseal lesions usually related to
marrow disease
92
Thinning of the cortex along the endosteal surface of the
| medullary cavity
Endosteal Scalloping:
93
Originates in muscle, nerve, arterial, or synovial tissue and may see pressure erosion of
bone with sclerotic margin
Extraosseous Lesions
94
Poor, hazy, ill defined margins, long zone of transition and the gradation between normal and abnormal bone occurs gradually
Imperceptible Margination
95
Imperceptible Margination
Indicates aggressive bone destruction from Infections or Malignancy
96
Definite sclerotic margins and narrow zone of transition
Sharp Margination (slow growing)
97
Loss of bone density and structure
Osteolytic Lesions
98
• Pressure from tumor
• Hyperemic stimulation of osteoclastic bone destruction
- osteoblastic/osteoclastic
stimulating factors
Neoplastic Bone Destruction
99
```
– Circumscribed lesion
– Uniformly lytic lesion
– Usually solitary >1cm
– Sharp margin
– Usually slower
- usually benign
– May be septated or soap
bubbly
```
Geographic Lesion
100
– Multiple, poorly defined, small radiolucent
| lesions aound 2-5mm in size with ragged/irregular margins
Moth-Eaten Lesion
101
Aggressive lytic lesions are seen in disease such as
* Metastatic disease
* Infection
* Multiple myeloma
102
Numerous, tiny, pinhole size lesions, < 1.0mm in size, with a wide zone of transition
Permeative Lesion:
103
Most rapidly aggressive bone tumors and are easily missed on conventional
radiography
Permeative Lesion
104
Increased density due to overproduction of bone or calcium laden tissue
Osteoblastic Lesions
105
Osteoblastic Lesions are seen in
- Blastic Metastasis
- Osteosarcoma
- Paget’s Disease
106
Both Lytic and
| Blastic Lesions are called
Mixed Lesions
107
Frequently Calcified with
stippled or punctate calcification
• Flocculent Calcification
• Arc and Ring Calcification Matrix
Cartilage Matrix
108
Smoky or hazy internal density with ground glass appearance and Fibrous dysplasia
Fibrous Tissue Matrix:
109
Latent period for periosteal reactions
10-21 days
110
Subperiosteal extension of
blood, pus or tumor
111
3 types of Periosteal Reactions
Solid, Laminated, and Spiculated
112
elliptical, undulating, and continuous layer of new bone that attaches
to outer cortex
Solid Periosteal Reaction
| slow and benign
113
Alternating layers of lucent and opaque
| densities on external cortical surface
Laminated Periosteal Reaction
| Onionskin
114
Radiolucent zones contain loose connective tissue and dilated blood
vessels that have not ossified
Laminated Periosteal Reaction
115
Laminated Periosteal Reaction is seen in
- Slow and aggressive tumors
- Infection
- Ewing’s Sarcoma
116
multiple concentric
| layers of periosteal proliferation
Laminated periosteal reaction
117
Perpendicular, brushed whiskers, hair on end
Spiculated Periosteal
| Reactions
118
Sunburst; radiating spicules of bone
| from a point source
Spiculated Periosteal
| Reactions
119
Spiculated Periosteal
Reactions are linear spiculations of new bone
oriented _________ from the cortex
perpendicular
120
Periosteal new bone at the peripheral lesion–cortex junction
as result of subperiosteal
extension of lesion
Codman’s Triangle:
121
Codman’s Triangles are seen in
- Primary malignant bone tumors
- Benign bone tumors
- Infections
122
elevation of
distal anterior and posterior distal
humeral capsular fat pads by
intraarticular effusion due to Fx
123
a synovial sarcoma will cause an Increased
soft tissue density and calcification
124
Articular Changes
| Tumors typically do not
break the
articular cortex, or spread into the joint,
or invade the apposite articular cortex,
in contrast to infection
125
Increased tendency of rbc’s to precipitate out due to increased concentrations of fibrinogen and serves as a good lab for inflammation
ESR: Erythrocyte Sedimentation Rate
126
Released by liver due to inflammatory changes or tissue necrosis
C-Reactive Protein (CRP)
127
Disorders of bone destruction and increased parathormone
| activity will elevate
Serum Calcium
128
Indicator of bone destruction and bone activity
| Inverse relationships to calcium levels
Serum Phosphorus
129
Reflects an increase in
| osteoblastic activity...like seen in Paget’s, Metastates, Healing fractures, and Lymphoma
Alkaline Phosphatase
130
Increased in Prostate metastasis and Gaucher’s disease
Acid Phosphatase
131
metastatic lesions in bone and soft tissue liberate
acid phosphatase
132
often indicates metastatic disease or multiple myeloma
Elevated total serum protein
133
which proteins are elevated in multiple myeloma?
- IgG. IgA, and Bence Jones proteins
134
what % of patients with MM have Bence Jones proteinuria
(40%)
135
Bone Marrow Biopsy and Aspiration is usually from
sternum or ilium
136
disadvantage of aspiration
does not reprepsent all cells
