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Tibia Fibia > Imaging I > Flashcards

Imaging I Flashcards

1
Q

Why do we study imaging as a PT?

A

Adds to exam and eval, assists with intervention, contributes to prognosis, and allows better communication of involved parties

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2
Q

What are some examples of interventions through imaging?

A
  • motion barriers - bone spur
  • weight bearing/ functional levels - bony callus
  • Location - Bone stimulator
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3
Q

What is the first imaging typically performed?

A

radiograph

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4
Q

What is a major advantage of a radiograph?

A

Most efficient for INITIAL assessment bone or joint abnormality

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5
Q

What is a major disadvantage of a radiograph?

A

limited for complex and subtle bony abnormalities

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6
Q

What are radiographs commonly referred to as?

A

Plain films, films, or x-rays

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7
Q

What is needed to view all three dimensions with a radiograph?

A

at least 2 images at 90˚

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8
Q

One view is ….

A

NO view

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9
Q

Why is there standardization of positions and views with a radiograph?

A
  • greatest visualization
  • minimize radiation exposure
  • projection of x-ray beams
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10
Q

What are the 3 ways we can project x-ray beams most commonly?

A
  • Anterior-Posterior > Posterior-Anterior
  • Lateral
  • Oblique
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11
Q

How does a radiograph work?

A
  • x ray beam enters body, absorbed by tissues at differing amounts to produce shades of gray
  • x- ray beam emerges from patient and onto an interpretation device or image receptor
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12
Q

What is the relationship between radiodensity and radiograph?

A

inverse

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13
Q

What color is air on a radiograph?

A

Black

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14
Q

What color is fat and bone marrow on a radiograph?

A

Black/gray

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15
Q

What color is water, muscle, and soft tissues on a radiograph?

A

gray

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16
Q

What color is bone on a radiograph?

A

White

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17
Q

What color are contrast dyes on a radiograph?

A

Bright white

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18
Q

What color is metal on a radiograph?

A

Solid white

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19
Q

How do we view a AP and PA projection radiograph?

A
  • place on viewer as if patient were facing you and in anatomical position
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20
Q

What is the exception to how we typically view AP and PA projection radiographs?

A
  • hands and feet viewed with toes or fingers pointing up
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21
Q

How do we a view a lateral radiograph?

A

In the path of a beam

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22
Q

What can help up when viewing a radiograph?

A

Identify at least 2 markers
- protected health info
- side of body with a R/L

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23
Q

What should we NOT do with the side of body markers on a radiograph?

A

Do NOT orient the slide marker to obtain the correct letter position

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24
Q

What are the ABCS of understanding a radiograph?

A

Alignment
Bone density
Cartilage Space
Soft tissue

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25
Q

What should we observe about alignment using a radiograph?

A
  • General architecture/anatomy - size, number of bones, etc.
  • General contour (spurs, breaks, markings)
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26
Q

What is cortical bone in context of imaging?

A

Outer layer of bone and predominately in appendicular skeleton
- denser and whiter

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27
Q

What is cancellous bone in context of imaging?

A

Interspersed within marrow and predominately in axial skeleton
- less dense and grayer

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28
Q

What should we look for concerning bone density on imaging?

A

Texture/local density such as sclerotic changes (increased bone density - may be abnormal or noramal)

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29
Q

What should we look for concerning cartilage spaces?

A
  • narrowing
  • subchondral bone sclerosis (body is trying to repair damaged bone) and erosion
  • Epiphyseal plates - position, size, and smooth margin
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30
Q

What should we look for concerning soft tissue with imaging?

A
  • muscle wasting / edema
  • fat pad displacement
  • capsular effusion
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31
Q

What is periosteum? What will it show up as?

A

Bone covering that shows up as a soft tissue shadow

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32
Q

What does a solid periosteum on imaging indicate?

A

A slow growth of healing or infection

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33
Q

What does a laminated or layered periosteum on imaging indicate?

A

Repetitive stress

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34
Q

What does a spiculated or pointed periosteum indicate on a radiograph?

A

breakthrough due to tumor

35
Q

What does codman’s triangle indicate on a radiograph?

A

Raised periosteum with any of the mentioned conditions

36
Q

What are some other common MSK imaging mechanisms aside from a radiograph?

A
  • CT (computed tomography)
  • MRI ( magnetic resonance imaging)
  • Ultrasound (US) imaging
37
Q

What is a CT scan?

A

Images generated by computerized and targeted x-rays passing through slices of tissue

38
Q

How thick are the slices on a CT?

A

.1-10 mm thick

39
Q

What are major advantages of a CT scan?

A
  • less overlap of structures due to slicing
  • able to locate subtle bone changes
40
Q

What are some major disadvantages of a CT scan?

A
  • greater radiation exposure but getting faster and safer
  • limited with soft tissue abnormalities
41
Q

What can be used for more detail on a CT scan?

A

Contrast agents

42
Q

What is CT the standard modality for? Why?

A

Standard modality for head and abdominal trauma, in the ER due to shorter scanning times and quick availability

43
Q

Is a CT quicker or slower than MRI and US?

A

Quicker

44
Q

What do we start with when using a CT (image type)?

A

Scout image

45
Q

What should we locate with a CT scan?

A

Specific slice position and image

46
Q

What plane are CT slices in?

A

Transverse

47
Q

What position is the patient in for a CT?

A

Supine

48
Q

What should we remember about viewing a CT image?

A
  • patient is supine so anterior surface is at the top of each image
  • looking upward at the anatomic structures from below so your right is the patient’s left
49
Q

How are sagittal plane slices viewed with a CT scan?

A

Left to right

50
Q

What is tissue density like? (due to shades)

A

Like x-ray

51
Q

What is a MRI?

A

Strong magnetic fields with radiofrequency waves

52
Q

What are the similarities between a MRI and a CT?

A
  • generates thin slices
  • may also be used with contrast agents for even more detail
53
Q

What are major advantages of MRI ?

A
  • Less overlap like CT due to slicing
  • Excellent at soft tissue abnormailities, cancellous bone / bone marrow conditions; neoplasms and staging metastasis, osteochondral lesions, stress fxs
  • no radiation like with CT (high) and x-ray (low)
  • high resolution
54
Q

What are the major disadvantages of MRI?

A
  • contraindications with magnetic implants except for stable joint implants
  • precaution with claustrophobia
55
Q

How should we orient ourselves to understand a MRI?

A
  • orient to scout image to find slice
  • view as with CT
56
Q

What is diagnosis often based on differences between with a MRI?

A

t1 vs t2 images

57
Q

What should we look for first with a MRI?

A

Areas of normal fluid first - such as the bladder, synovial joints, cerebrospinal fluid

58
Q

If fluid is bright, likely a ….

A

T2 image

59
Q

If fluid is dark, likely a …

A

T1 image

60
Q

What is a T1 weighted image?

A

MRI
- bright signals from fat and bone marrow
- dark signals from cortical bone and fluid

61
Q

What is a T1 weighted image best for?

A

Demonstrating anatomical definition of structure

62
Q

What is a T2 weighted image?

A

Bright signal occurs from fluid and water

63
Q

What is a T2 weighted image BEST for?

A

Demonstrating swelling and neoplasms particularly in cancellous bone

64
Q

What structures are often gray in both T1 and T2 images?

A

Nerve and muscles - have an intermediate signal

65
Q

What is a ultrasound or sonography?

A
  • ultrasound waves are absorbed, reflected, and diffused differently from varying tissues to contruct an image
66
Q

What are major advantages of an ultrasound or sonography?

A
  • Offers real time information for SUPERFICIAL soft tissue
  • higher resolution for SUPERFICIAL tendon, ligament, and muscle than MRI
67
Q

What are major disadvantages in an ultrasound or sonography?

A
  • inability to scan deeper joint structures
  • image quality highly dependent on operator
68
Q

What does a brighter signal indicate on a US/sonograph?

A

Swelling, tendinosis (fibrosis/degeneration), aka hyperechoic appearance

69
Q

What do irregular borders or lack of structure indicate with a sonograph/US?

A

Tears

70
Q

What does a wider structure indicate with a US/sonograph?

A

Swelling, thickening

71
Q

What is imaging benefitted by?

A

A thorough hx and exam

72
Q

What are clinical decision rules for imaging?

A
  • following trauma based on supportive clinical findings
  • diagnostic and prognostic decisions
  • evidence based with research
73
Q

What is the appropriateness criteria?

A
  • foremost decision-making guideline
  • guides choice of best imaging tool
  • developed by expert radiologists
  • may use with or without trauma
74
Q

What are factors for decision making with MSK conditions regarding appropriateness criteria for imaging?

A
  • age: individual risk factors including PMH
  • trauma presence/absence
  • mechanism of injury
  • prior surgery/injury/imaging results
  • clinical findings, particularly p! provocation and function such as weight bearing ability
75
Q

If imaging is negative without clinical findings it is…

A

noramal/asymptomatic

76
Q

What happens when imaging is negative with clinical findings of a condition?

A
  • suspicious condition (i.e. acts like a fx but x-ray negative so consider a more advanced and specific image like a CT)
  • NO structural changes and MORE of a biomechanical or overuse etiology
77
Q

What can positive imaging without matching clinical symptoms do for a patient’s psychosocial status?

A
  • potential negative effect
  • fear of activity
  • failure to work
  • limit rehab potential
78
Q

What is Imaging BEST AT?

A

RULING OUT

79
Q

What is normal and abnormal about cortical bone?

A

Normal: hyper echoic, smooth, continuous
Abnormal: break in continuity, uneven surfaces

80
Q

Which view is the best to pick up stenosis?

A

Oblique - single side intervertebral foramen

81
Q

what would cause osteophyte formation both anteriorly and posteriorly?

A

age related disc changes

82
Q

what would cause narrowing of the joint spaces and sclerosis of the articular surfaces at all levels?z

A

age related JOINT changes

83
Q

what is used for assessment of fractures or dislocations of the PROXIMAL humerus

A

Scapular Y lateral view

84
Q

What can we use to assess dislocations?

A

Axillary view

Tibia Fibia (2 decks)

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