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Orthopedic Imaging > Intro > Flashcards

Intro Flashcards

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1
Q

what are the different MR pulse sequences

A

spin echo t1 - SE

spin echo t2 - FSE

proton density - PD

gradient echo - GE

Short tau inversion recovery - STIR

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2
Q

what are the TR and TE values for spin echo T1

A

low TR - 380

low TE - 20

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3
Q

what are the TR and TE values for spin echo T2

A

high TR - >1500

high TE - > 80

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4
Q

what are the strengths of a T1 MR

what are the weaknesses

A

strengths - anatomic detail, fat subacute hemorrhage, meniscal pathology, gadolinium use to enhance, marrow pathology is better than other pulse sequences

weaknesses - poor detection of soft tissue edema, not as sensitive stir or T2 for marrow pathology

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5
Q

what are the strengths of a T2 MR

what are the weaknesses

A

strengths - detection of fluid and pathology, act as myelographic study without nee of intrathecal contrast administration

weaknesses - long imaging time (fast spin echo reduces T2 imaging times)

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6
Q

FSE and SE corresponds to what on MRI scans

A

FSE - fast spin echo - T2

SE - spin echo - T1

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7
Q

TR and TE correspond to what on MRI scans

A

TR - repetition time

TE - echo time

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8
Q

what are the TR and TE values for proton density pulse sequence for MR

A

high TR

low TE

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9
Q

what are the strengths of proton density MRI pulse sequence

what are the weaknesses

A

strengths - anatomic detail and meniscal pathology

weaknesses - poor detection of fluid and marrow pathology

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10
Q

what are the strengths of gradient echo MRI pulse sequence

what are the weaknesses

A

strengths - ligaments, tendons, loose bodies, subtle hemorrhage, 3D imaging

weaknesses - poor detection of marrow, metallic hardware increases artifacts on image

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11
Q

what are the strengths of short tau inversion recovery MRI pulse sequence

what are the weaknesses

A

strengths - marrow and soft tissue edema

weaknesses - DONT use with gadolinium, and doesnt perform well with large patients

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12
Q

what is the example used in the slide that proton density picks up

what is the example used in the slide that stir picks up

A

PD - bankhart lesion

STIR - stress fractures on calcaneus

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13
Q

what is specialized form of MR that allows non invasive imaging of the CV system

A

MRA

MR angiograpghy

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14
Q

when is MRA used

A

when angiography is conventional contraindicated

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15
Q

what is the best way to examine the vertebral, carotid, and cerebral arteries

A

MRA > doppler US > conventional angiography

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16
Q

what is the best way to detect arteriovenous malformations and aneurysms

A

MRA > conventional angiography

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17
Q

what is the contrast agent used in MR

A

gadolinium diethylene triamine pentaacetic acid

called gadolinium DTPA

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18
Q

what does gadolinium do to the image

A

enhances the MR signal intensity of tissues following intravenous or intra-articular injection

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19
Q

gadolinium is considered what

A

radioisotope

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20
Q

gadolinium (contrast agent) is useful for evaluating what

A

inflammatory, infection, and neoplastic lesions

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21
Q

what are adverse reactions associated with using contrast on MR

when should you not use contrast? values?

A

anaphylaxis may occur but rare - nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD) is a small but serious risk

patient with kidney disease or low GFR - avoid contrast

GFR < 60 - use caution
GFR < 30 - AVOID

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22
Q

when did we first start using CT scans

A

1972

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23
Q

CT is great for what

and bad for what

A

great for - bony anatomy, complex bones, subtle calcifications, emergency situations, complex areas where motion is an issue

bad for - bone marrow and internal derangement
(just not as good as MR)

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24
Q

which imaging system acquires axial image slices

A

CT

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25
what are the contraindications of CT
- utilizing ionizing radiation - limit use on children - pregnancy - contrast - hypersensitivity reaction - metallic objects - claustrophobia - risk of raditaiton vs need for diagnostic information
26
what are the four basic types of contrast used for CT scans
intravenous oral rectal intra-articular
27
what are hounsfield units used for
CT
28
what is an easy way to differentiate the make up of any lesion on a CT scan
hounsfield units
29
what tissue has the highest hounsfield unit
bone - 1000
30
what is a quick and easy way to look at subcutaneous anatomy and certain MSK anatomy
ultrasound
31
what is a bone scan also called
bone scintigraphy
32
what are the indications of a bone scintigraphy
- eval for skeletal metastasis - early detection of osteomyelitis - diagnosis of stress and occult fracture - staging of pagets disease - diagnosis of osteonecrosis - eval of fracture and healing - assess complications of total joint athroplasty - assess activity of RA and seronegative arthritis
33
what is injected intravenously for a bone scintigraphy
99m tc-mdp technetium
34
what determines the amount of radiopharmaceutical deposited at the site for a bone scan
based on vascular permeability, blood supply, and osteoblastic activity - increased bone turnover generally means increased uptake
35
how do you decide between ordering a MRI and bone scan
MRI - is done more quickly (1 hour), scheduled for a sooner date, no radiation, better soft tissue detail, expensive bone scan - takes longer (4 hours), conveys wider area of the body (bilateral or diffuse symptoms), easier to interpret, cheaper
36
compare bone scan and MRI based on sensitivity and specificity
bone scan - sensitive but not specific MRI - sensitive and specific
37
what are the 3 basic forms of imaging? what are these forms based on?
based on how the image is formed transmission imaging reflection imaging emission imaging
38
what are the types of transmission imaging reflection imaging emission imaging
transmission - radiography, fluoroscopy, CT reflection - US emission - MR and nuclear medicine
39
attenuation occurs in what type of imaging
transmission imaging
40
what is attenuation
a decrease in the intensity of beam as it transverses through matter
41
attenuation decreases the intensity of the beam how so and due to what
absoprtion - photoelectric effect deflection - compton scatter
42
increase in density of tissue does what to attenuation
increase attenuation meaning fewer particles make it to the film
43
what is a permanent film record of differential attenuation of xray beams by various tissues
radiograph
44
what transmission method is used in facet joint injection that allows placement of needle directly in the facet joint
fluoroscopy
45
fluoroscopy produces what
still image
46
what is based on sound waves that are sent to the body and then are sent back to the sound head similar to an echo
reflection imaging
47
how does reflection imaging work with low and high densities of matter in the body
low density - water - does NOT reflect sound waves back to sound head high density - bone - reflects back sound waves back to sound head
48
low density on ultrasound appears? and is considered what high density on ultrasound appears? and is considered what
low density appears DARK --> low echogenicity or hypoechoic high density appears BRIGHT --> high echogenicity or hyperechoic
49
what type of imaging method is based on various tissues emitting a particular frequency that is detected and mapped by a computer to generate an image
emission imaging
50
what imaging method uses natural magnetic properties of atoms to produce a image
MRI
51
what imaging method detects gamma ray emissions from the body after radioisotope is injected
nuclear medicine
52
what are the definite clinical indicators of imaging
red flags ``` trauma new or old weight loss night pain neuromotor defecit inflammatory arthritis hx of malignancy fever of unknown origin abnormal blood work deformities of the spine failure to respond to therapy medicolegal complications ```
53
what are the possible clinical indications of imaging
yellow flags ``` >50 years old pediatric patient with pain and no trauma drug and alcohol abuse corticosteriod use unavailable imaging lost or outdated imaging dated previous studies research - need IRB constitutional systemic DZ recent immigration therapeutic risk assessment - downs syndrome ```
54
what are the non indicators of medical imaging
``` patient education routine screeening habitual screening discharge status assessment pre employment screening inadequate equipment non trained person CA financial gain recent hx of radiation pregnancy ```
55
who do you consult to know what type of imaging to order in any given situation
american college of radiology appropriateness criteria
56
in many circumstances what is the first step in the diagnostic imaging process why
plain film radiography cheap, easy, available, quick, high diagnostic yield
57
what imaging method is good for MSK, abdominal, and chest pathology
xray
58
what are xray contraindications
children and pregnancy
59
what is the ALARA principle
as low as reasonably achievable
60
what are the ABCS
alignment bone cartilage space soft tissue
61
xray use is declining because it has been proven to have little use for the following.... ``` spine assessment for LBP sinus infections kidney stones kidney function abdominal pain skull injuries ``` what methods are better for each
spine assessment for LBP - MR sinus infections - CT kidney stones - CT kidney function - US, MR, nuclear medicine abdominal pain - CT or MRI skull injuries - CT
62
when should you order advanced imaging
failure to respond to therapy need more specific diagnosis documentation of subtle injury or pathology pre surgical planning or assessment if evaluation suggests further imaging if $ can be saved for the patient
63
MRI is great for what and bad for what
great for - internal joint derangement, MSK soft tissues, bone marrow bad for - calcification, bony fragments, anatomy that can be obscured by motion (gut)
64
what are the characteristics of MRI radiation? used for what? how many planes? cosst?
no radiation soft tissue and bone detail multiplanar imaging expensive
65
what are MR contradindications
1st trimester pregnancy >300 lbs clasutrophobia ferromagnetic artifacts pacemakers, defibrillators, implanted NTs or tens units implants and prosthetic heart valves breast feeding women - may be ok but must pump 24 hours before feeding child
66
how does MRI work
atomic nuclei spin randomly in the body magnet aligns the H nuclei parallel with the magnetic field radio signal activated, nuclei misalign, radiosignal stops, nuceli realign, nuclei release a signal coil recieves the signal like a radio atenna computer generates an image

Orthopedic Imaging (3 decks)

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