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Bone Path 3 > Final Quiz > Flashcards

Final Quiz Flashcards

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1
Q

What provides a general direction for clinicians when deciding to take images or not?

A

Mercy guidelines

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2
Q

What 2 questions should be asked before ordering images?

A

1: will it affect diagnostic certainty about a DDX
2: will it change my diagnostic thinking enough so that it will significantly affect my choice of treatment

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3
Q

High risks for low back pain that have a high probability for positive x-ray findings

A

Over 50, trauma, neuromotor deficits, weight loss, Ankylosing spondy, drug or alcohol abuse, history of cancer, corticosteroid use, fever over 100, DM, elevated ESR, akaline phosphatase, + RF, + hla-b27

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4
Q

CT scans are sensitive and specific for what?

A

Degenerative spinal stenosis

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5
Q

4 non-clinical reasons people take x-rays

A

Financial gain, habit, midicolegally advantageous, patient education

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6
Q

Back pain for how many weeks should be x-rayed?

A

7 weeks

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7
Q

How much bone destruction is needed to be visualized on x-ray and bone scan?

A

Xray: 30-50%, bone scan 3-5%.

Radiographs are specific but not sensitive
Bone scans are very sensitive but not specific

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8
Q

3 areas radiographs are used for biomechanical and posture?

A

Scholiosis, spinographic analysis, fuctional radiography

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9
Q

Are full spine radiographs for scoliosis diagnosticaly effective?

A

Yes

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10
Q

Is spinographic analysis clinically justifiable?

A

No

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11
Q

How clinically significant are functional radiographs (flexion/extension, lateral bending)

A

New research shows that are probably not that good

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12
Q

Should degenerative processes be monitored with radiographs?

A

No since it will not alter the treatment, besides with stenosis

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13
Q

CT is useful in evaluating what?

A

Apophyseal joint degeneration, bone hypertrophy, spine fx/dislocation, infection, bone neoplasms, complex congenital anomalies, spinal stenosis, metabolic disease, post operative spines, HNP.

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14
Q

When is CT superior to MRI, and when is MRI superior?

A

CT is superior in evaluating bone changes and MRI is superior in evaluating soft tissue changes.

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15
Q

What are the indications for CT?

A

Spinal stenosis, bone/joint/disease, complex anomalies, spinal trauma

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16
Q

What are the indications for CT with myelography?

A

Thecal sac, nerve root (if MRI is not available) MRI is better

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17
Q

What are the indications for MRI?

A

Direct visualization of soft tissues, joint and disc diseases, sensitive to bone marrow pathologies

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18
Q

What are the indications for MRI with gadolinium?

A

Postoperative fibrosis (since scars will have increase in vascularization), recurrent HNP.

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19
Q

What are the indications for radionuclide studies?

A

To identify metabolic activity benign vs. aggressive, acute vs chronic mets and infections.

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20
Q

What are the indications for diagnostic ultrasound?

A

Indirect causes of back pain like: AAA, pelvic neoplasms, neonatal spinal evaluations.

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21
Q

What is the best test for herniated nucleus pulposus?

A

MRI

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22
Q

What is the best test for spinal stenosis?

A

CT or CT with myelography.

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23
Q

What is the best test for spondylolisthesis?

A

Plain film

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24
Q

What is the best test for inflammatory arthropathies?

A

Plain film

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25
What is the best test for trauma?
CT
26
What is the best test for infections?
MRI
27
What is the best test for instability?
Plain film
28
What has replaced myelography?
MRI and CT
29
What 2 things will MRI be really good at imaging?
Infection and neoplasms?
30
How can you distinguish between post operative fibrosis pain or pain from a recurrent disc herniation?
Use gadolinium with the MRI. Fibrosis will take in the contrast within 15 min, and disc herniation will only take in a little contrast after 30 minutes.
31
What is the main reason now days for using discography?
Used as a provocative test
32
What will hot spots on a bone scan mean?
Areas of increased blood flow due to increased metabolism
33
What are SPECT bone scan used for?
Exact location of a lesion
34
When should bone scans be used?
After less expensive imaging and with red flags.
35
When would you use ultrasound to image the spine?
Only with neonates
36
Why would you take a CT or an MRI of the brain?
CT-SAH, acute subdural. MRI-MS, recent infarct, tumors, a VM’s, cerebral aneurysms.
37
Why would you take a CT or an MRI of the orbits?
CT: graves, pseudotumors, foreign bodies, Fx MRI: secondary evaluation of masses, tumors of optic nerve.
38
Why would you take a CT or MRI of the head and neck?
CT: tumors, adenopathy MRI: parathyroid tumors, problem solving after CT
39
Why would you take a CT or an MRI of the chest?
CT: CXR abnormalities, CA, fibrosis, PE MRI: problem solving after CT
40
Why would you take a CT or an MRI of the abdomen?
CT: liver diseases/tumor, lymphoma, pancreatic CA, real colic MRI: problem solving after CT
41
Why would you take a CT or an MRI of the pelvis?
CT: appendicitis and diverticulitis. MRI: uterine problem solving after US and prostate cancer staging.
42
Why would you take a CT or an MRI of the bones?
CT: Fx MRI: tumors, osteomyelitis, AVN, stress Fx, Marrow changes.
43
Why would you take a CT or an MRI of the joints?
CT: looose bodies, post-arthrogram studies MRI: most problems of the shoulder, hip, knee, ankle and wrist.
44
Why would you take a CT or an MRI of the spine?
CT: degenerative stenosis MRI: disc disease, bony metastasis, any cord pathology.
45
What are the 3 advantages of plain film radiography?
Cost effective, minimal radiation, widely available
46
Contrast resolution of CT is how much better than plain film radiography?
100 times better
47
Will CT have a based receptor?
No. Only numerical data is collected by a photon detector cell that is placed around the patient has the x-ray part rotates around the patient.
48
CT slices can be what sizes?
0.5m-10mm thick.
49
How much can the CT machine be angled?
15-30 degrees.
50
Typically what type of images are produced with CT?
Axial images. Other types will have a decreased detail.
51
CT image is made up of a ___ and each part of this is known as ____.
Matrix, voxel.
52
What are the 3 dimensions of a voxel?
Length, width, depth.
53
What is a pixel?
A two dimensional representation of a voxel which is length and width
54
What are the different types of units assigned to each voxel?
Hounsfield units from -1000 to 1000
55
What will bone and air be in hounsfield units?
Bone +1000, Air -1000, water 0.
56
What are the 2 types of contrast or windows used with CT?
1: bone window- better to see fine detail of bone (cortex and medullary bone are distinctly different) 2: soft tissue window- better for soft tissue (cortex and medullary bone have similar densities)
57
What are the contraindications of CT?
Metallic objects nearby can create artifacts. Radiation, clausrophobia and sensitivity to iodine contrast.
58
When would CT be better than MRI for infections?
With cortical involvement, but MRI is better with medullary and soft tissue involvement.
59
Why is CT better for chest and abdomen than MRI?
Faster and less motion artifacts.
60
Would you use MRI or CT for sinuses?
CT
61
What will a CT myelogram look like?
Like a soft tissue density with white contrast around the cord.
62
What has better soft tissue contrast CT or plain film radiography?
CT
63
How do you control contrast with CT?
Electronic manipulation of the digital info like using different windows.
64
What are the disadvantages of CT?
Relatively high radiation dosage, high cost, reformatted images not as good as original.
65
What is the cage used to shield extraneous radiofrequencies from MRI machines?
Faraday cage
66
The greater the ____ the better the image with MRI?
Magnetic strength
67
What do you need to do with an MRI magnet to maintain its magnetism and creat a homogenous field?
Keep it cooled.
68
What will the radiofrequency do for MRI?
Knock the nuclei out of alignment so they can re-align.
69
What is the spin density?
The number of hydrogen protons in tissues being imaged
70
How can you tell the difference between T1 and T2 MRI’s?
T1: fat will be white T2: water will appear bright
71
What will ligaments and tendons look like on T1 and T2
Both will be dark grey or black
72
What will cortical bone look like with T1 and T2 MRI images
Black
73
What is a high signal with MRI and what is a low signal?
What is high, black is low
74
T1 is used to better visualize what?
Fat, precise anatomy, medullary bone, spinal cord, low signal bone, SCF intermediate
75
T2 is used to better visualize what?
Water, discs
76
What has better detail: T1 or T2?
T1
77
What will the CSF look like with a proton density MRI?
Same as cord
78
Gadolinium is only used with what type of MRI?
T1 images before and after
79
What are the contraindications for MRI?
During first trimester of pregnancy, over 300lbs, ferromagnetic artifacts, surgical clips, pacemakers, cochlear implants
80
What are the limitations of MRI?
Claustrophobia, have to hold still for 30 min to 1 hour, loud tapping noises
81
Myelography is not used as much with plain film radiography anymore, but when is it used?
With CT to visualize indirectly a lesion in the spinal canal
82
Myelography has been largely replaced by what?
MRI
83
What are the indications for myelography?
When CT or MRI is not available and can be used with CT presurgically
84
When is CT-myelography the gold standard?
Pre-surgically for spinal stenosis
85
What are the disadvantages of myelography?
Pt needs to be monitored for 3 hours after, infection risk, invasive
86
What do radionuclides do with nuclear medicine?
They emit gamma radiation as they undergo radioactive decat
87
What is the most commonly used radionuclide used with nuclear medicine?
Technetium-99
88
What is scintigraphy?
A three phase scan commonly employed
89
What are the 3 phases of scintigraphy?
First: flow phase Second: blood pool Third: delayed or bone scan phase
90
What type of sensitivity and specificity will bone scans have?
High sensitivity and low specificity
91
Bone scan will uptake radionuclides when?
Tumors, infections, acute Fx, stress Fx
92
What are the advantages of bone scans?
Evaluate entire body, very sensitive, only need 3-5% bone destruction to be seen
93
What is discography?
Injection of radiopaque contrast agent into the IVD as a provocative test and may demonstrate dessicated discs and herniated discs.
94
What is SPECT?
Like a bone scan, but offers multiple imaging planes like CT
95
What are the benefits of SPECT?
Better localization of a lesion.
96
What is PET?
Positron emission tomography
97
What is PET used for?
To find soft tissue tumors like in lymph nodes, good for tumor grading, and used to monitor treatment success
98
PET has a greater resolution than what?
SPECT or scintigraphy
99
What is the major disadvantage of PET?
High cost and low availability

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