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Bone & Joint > Intro to Imaging > Flashcards

Intro to Imaging Flashcards

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1
Q

What is the term for a defined condition, based on radiographic findings, frequently combined with clinical and/or laboratory information?

A

Diagnosis

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2
Q

What is the term for descriptive observations?

A

Findings

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3
Q

What is the term for a list of conditions with similar/identical findings that require unique characteristics to narrow down?

A

Differential diagnosis

DDx

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4
Q

What is meant by a “sign” of a pathology?

A

Finding strongly indicative of a particular diagnosis

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5
Q

VINDICATES helps build DDX

What do the following stand for?

  • V
  • I
  • N
A
  • Vascular
  • Infectious
  • Neoplastic
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6
Q

VINDICATES helps build DDX

What do the following stand for?

  • D
  • I
  • C
A
  • Degenerative/Drugs
  • Inflammatory/Iatrogenic
  • Congenital
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7
Q

VINDICATES helps build DDX

What do the following stand for?

  • A
  • T
  • E
  • S
A
  • Auto-immune
  • Traumatic
  • Endocrine/Nutritional/Metabolic
  • pSych
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8
Q

x-ray

Different tissue absorb more or less radiation based on their ___.

A

chemical composition

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9
Q

x-ray

What are the five radiographic densities in order from most radiolucent to most radiopaque?

A
  1. Air
  2. Fat
  3. Water
  4. Bone
  5. Metal
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10
Q

What two steps should occur with a patient prior to deciding to taking their x-rays?

A
  1. History
  2. Physical
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11
Q

X-ray/radiographs are good for ruling ___ conditions.

A

in

does not rule out

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12
Q

What are some conditions that x-ray is good at detecting?

A
  • Bony anomalies
  • Trauma/fractures
  • Arthritic changes
  • Biomechanical evaluation

biomechanical is not kinematic/motion-based, it’s alignment-based

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13
Q

What are some conditions that x-ray is poor at detecting?

A
  • Bone density changes
  • Marrow diseases
  • Bone malignancies
  • Bone/joint infections

marrow is soft tissue

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14
Q

How much change in bone density is required to become visible on x-ray?

A

30-50%

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15
Q

Why do chiropractors take x-rays?

A
  • They are licensed to do so
  • It is a screening tool for common MSK conditions
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16
Q

Which two imaging modalities are most likely to be seen/assessed by a chiropractor?

A
  1. X-ray
  2. MRI
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17
Q

What is MRI?

A

Magnetic resonance imaging not using ionizing radiation

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18
Q

For musculoskeletal issues, there should generally be ___ prior to ordering MRI.

A

radiographs

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19
Q

MRI is particularly useful for which musculoskeletal conditions/structures?

A

Internal derangements:

  • ligaments
  • menisci
  • tendons
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20
Q

What is the imaging modality of choice for chronic brain problems?

A

MRI

or >48 hours after incident

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21
Q

What are some possible difficulties/problems with taking MRI?

A
  • Cannot show moving structures e.g. intestines (peristalsis), patients with tremors
  • Presence of surgical hardware
  • Obesity
  • Claustrophobia
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22
Q

What is the biggest benefit of MRI when comparing to x-ray?

A

Greater tissue contrast

also gives biochemical information e.g. edema, blood products, etc.

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23
Q

Which conditions would MRI with contrast be utilized to visualize?

A
  • Tumors
  • Infections
  • Post-surgical back pain
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24
Q

MRI with different sequences helps rule ___ pathologies.

A

out

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25
What are the four basic MRI sequences?
* T1 * T2 * Proton density * Fat suppression techniques (STIR)
26
# MRI T1 is a ___-based imaging sequence.
fat | fat appears bright
27
# MRI T2 is a ___-based imaging sequence.
water | fluid appears bright
28
# MRI A T1 sequence would be ___ for visualizing bone marrow.
excellent ## Footnote bone marrow comparable to fat
29
# MRI A T1 sequence would be ___ for visualizing edema.
poor ## Footnote edema is fluid
30
# MRI Which sequence has higher resolution: T1 or T2?
T1
31
# MRI What anatomy is excellently visualized by T2 sequence?
* CSF (and intervertebral discs) * Synovial fluid * Soft tissue swelling * Bone marrow edema
32
When looking at a **T2** MRI, CSF will appear ___ while neural components appear ___.
CSF will appear **bright** neural components appear **dark**
33
When looking at a **T1** MRI, CSF will appear ___ while neural components appear ___.
CSF will appear **dark** neural components appear **bright**
34
Which MRI sequence is displayed?
T1
35
Which MRI sequence is displayed?
T2
36
# MRI weightings The left panel of this image displays ___. The right panel displays ___.
left panel: **T2** right panel: **T1**
37
Which imaging modality is a hybrid of T1 and T2 sequence MRI?
Proton density
38
# MRI Proton density imaging is ___ at visualizing fat and edema.
poor
39
# MRI Proton density imaging is best for visualizing which structures?
* Fibrocartilage * Tendons * Ligaments
40
# MRI T2 proton density imaging is ___ at visualizing the spine.
poor
41
# MRI Fat suppression techniques (STIR) are ___ at visualizing edema.
superb ## Footnote **much** more fluid sensitive than a standard T2 sequence
42
# MRI What will a fat suppression technique (STIR) image display?
Poor quality of roughly **where** the problem is | need other sequences to see **what** is going on
43
Does CT imaging use more or less radiation than radiographs?
Substantially higher dose of radiation
44
What is the gold standard for imaging bones of the chest and abdomen?
CT
45
What imaging should be used for a patient suspected to have had a stroke or sustained a subdural hematoma less than 48 hours ago?
CT | over 48 hours will mean MRI is more appropriate
46
Which form of nuclear medicine is most utilized by chiropractors?
Bone scan
47
Bone scans show the activity of which cells in the body?
Osteoblasts | shows metabolic activity
48
Bone scan has ___ sensitivity and ___ specificity.
**high** sensitivity **low** specificity | something is going on, but not sure what
49
Bone scans are the follow-up of choice for which types of conditions?
* Polyostotic diseases (e.g. metastasis, Pagets) * Early detection of bone disease (e.g. metastasis and primary malignancy, stress fractures, osteomyelitis)
50
How much bone destruction must occur to be visible on a bone scan?
3-5% ## Footnote radiographs require 30-50%
51
Metastatic disease loves to target the ___ region of the spine, destroying the ___ first.
**thoracolumbar** region of the spine, destroying the **pedicles** first
52
What does a DEXA scan evaluate?
Bone density ## Footnote best tool for osteoporosis
53
Which imaging modality is a "motion picture x-ray" allowing for assessment during full range of motion?
Fluoroscopy
54
Does ultrasound have more or less radiation than x-ray?
No radiation
55
What is ultrasound primarily useful for?
Soft tissue: * Babies * Solid organs * Blood vessels
56
Ultrasound is a growing field for musculoskeletal issues, but how so?
Predominantly extremities (superficially) | **not** useful for spinal imaging
57
What are the primary uses for a PET scan?
Neurology and oncology
58
Utilizing a search pattern, you should start with ___, then do ___, and don't forget ___.
start with **the big picture**, then do **an item by item search pattern**, and don't forget **all the film margins**
59
# search pattern What does ABCS stand for?
* Alignment/anatomy * Bone * Cartilage * Soft tissues
60
What views are in the minimal diagnostic series for a cervical spine?
* AP * APOM * Lateral
61
Is the frontal radiograph for the cervical spine AP or PA? Why?
AP The structures closest to the film will appear clearest | back against film
62
What two pieces of information does the marker provide?
* Which side * Standing vs laying
63
What is the normal measurement for the ADI?
≤3mm in adults ≤5mm in children
64
What are the normal measurements for the prevertebral soft tissues?
Retropharyngeal (C2-C4): **≤7mm** Retrolaryngeal (C4-C5): **7-20mm** Retrotracheal (C5-C7): **≤20mm**
65
What view is done when C7 cannot be seen on the lateral cervical spine view?
Swimmer's view
66
What is this view? Which structure does this view help visualize?
Swimmer's view Helps visualizing C7
67
What is the main anatomic structure(s) evaluated on cervical obliques?
Intervertebral foramen (IVF)
68
Which image demonstrates the right IVFs?
Can't tell; needs a marker
69
Which image demonstrates the right IVFs?
Right image
70
Which image demonstrates the right IVFs?
Left image
71
Does this film show the right IVFs or the left IVFs?
Right IVFs ## Footnote ASS-POOP rule
72
What views are in the minimal diagnostic series for a thoracic spine?
* AP * Lateral
73
What are 3 differences between a frontal radiograph of a thoracic spine vs a chest x-ray?
* T-spine picture is narrower; chest must go out to ribs * T-spine is AP; chest is PA * T-spine uses a bone technique/setting; chest uses soft tissue technique/setting
74
What views are in the minimal diagnostic series for a lumbar spine?
* AP * Lateral
75
Label the following structures: A: B: C:
A: **left pedicle of L2** B: **interlaminar space** C: **liver** ## Footnote note the right side marker
76
What are two names for this view?
* Ferguson's * AP angulated lumbosacral spot
77
Which two anatomic structures are better shown on the left radiographic view than the AP lumbar?
* Sacral base/LS junction * SI joints | Ferguson's view
78
What is the main anatomic structure evaluated on lumbar obliques?
Pars interarticularis
79
Which image demonstrates the right pedicles?
Right image
80
Which image demonstrates the right pedicles?
Right image
81
Which image demonstrates the right pedicles?
Right image
82
Which image demonstrates the right pedicles?
Both
83
What views are in the minimal diagnostic series for a pelvis?
AP
84
What views are in the minimal diagnostic series for a hip?
* AP * Frog leg
85
What is the patient's sex? What are all the lucent lines running through the pelvis and femora?
Female Lines display trabecular texture

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