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1

Roles of Imaging in PT Management: (7)

1. Improve understanding of anatomy
2. Improve understanding of pathology, trauma, healing
3. Inform interventions
4. Help you educate your patients
5. Support or refute PT Dx.
6. Improve ICD10 coding
7. Support PT as practitioners of choice for MS conditions

2

Large osteophyte at talar head

Talar beak

3

Fibrous or bony attachment in area of foot- causes pain

Talocalcaneal coalition

4

Rare human an atomic variant that usually affects lateral meniscus of knee
MRI used

Discoid meniscus

5

When is imaging needed? (4)
What are examples included within these categories?

1. Trauma: MVA, fall, blunt trauma
2. Cancer/malignancy/tumor: hx, age >55, weight loss, non-mechanical pain
3. Infection: fever of unknown origin
4. Miscellaneous: non-responsive to conservative care

6

American College of Radiology: Appropriateness Criteria
The _______ the rating number, the more appropriate the study is for that patient

HIGHER

7

ACR Appropriateness Criteria:
Perform variants _____-_____, then if they refer for x-ray, continue ACR rating

Variants 1-3

8

If MRI is not appropriate, then ____ may be more appropriate

CT

9

________ are tools used by clinicians to determine likelihood that patient is presenting with given disorder, based on number of variables that have been shown to have predictive ______ in revealing patients most likely to have specific disorders

Clinical prediction rules
Validity

10

Canadian C-Spine Rule:
What are the 3 questions?

1. Any high risk factor that mandates radiography?
2. Any low risk factor that allows safe assessment of ROM?
3. Able to rotate neck actively?

11

Canadian C-Spine Rule:
What is considered "high risk factor that mandates radiography"

Age >65
Dangerous mechanism/paresthesia in extremeties

12

Canadian C-Spine Rule:
What qualifies as low risk factor that allows safe assessment of ROM

-Simple rear end MVA
-sitting position in ER
-ambulatory at any time
-delayed (not immediate) onset of neck pain
-absence or midline cervical spine tenderness

13

Canadian C-Spine Rule:
What is meant by active neck rotation?

45 degrees L/R

14

Ottawa Knee Rules (5 things)

1. Age >55
2. Isolated patella tenderness
3. Tenderness at head of fibula
4. Inability to flex knee to 90 deg
5. Unable to bear weight immediately after and walk 4 steps in ER

15

Pittsburgh Knee Rule: 3 things

-Blunt trauma or fall is MOI and either of following is true:
1. Age <12 or >50
2. Inability to walk 4 steps in ED

16

Ottawa Ankle Rules (4)

1. Bone tenderness at posterior edge of distal 6cm of tip of medial or lateral malleolus
2. Unable both to bear weight immediately after injury and walk 4 steps in ER
3. Bone tenderness at base of 5th metatarsal
4. Bone tenderness over navicular

17

Pittsburgh Ankle Rules (2)

1. Age <12 or >50
2. Unable both to bear weight and walk 4 steps in ER

18

AROM after Acute Elbow Injury:
Limited ROM in all directions of flexion, extension, sup/pro predictive of ________.
Sensitivity _____%, Specificity ______%
Individuals with limitation in ____ or ____ directions had no signs of fx in x-ray

Elbow fx
90, 92
One or two

19

4 types of imaging modalities

1. Radiographs/X-rays
2. Computed tomography
3. Ultrasound
4. Magnetic resonance imaging

20

What is the most widely performed imaging exam?

X-ray

21

X-rays are emitted and detected in ______, which can generate either film or digital image.

Cassette

22

Films are kept on file or in digital archive called _____.

PACS (Picture archiving and communications system)

23

X-rays are a form of _____ ______ radiation (discovered in 1895)

Ionizing electromagnetic

24

X-rays are produced in tube and beamed out of collimator, which controls ______ and _____ of X-ray field

Size and shape

25

X-rays pass through patient and undergo _________

Attenuation

26

Reduction in number of X-ray photons in beam as result of photons interaction with matter and losing energy through either scattering, absorption, or beam divergence is known as _____

Attenuation

27

3 ways X-ray photons lose energy

1. Scattering
2. Absorption
3. Beam divergence

28

Combination of physical qualities of an object that determines how much radiation it absorbs from X-ray beam is _______

Radiodensity

29

4 shades of gray from radiolucent -----> radiopaque

1. Air: black
2. Fat: gray-black
3. Water: gray
4. Bone: white

30

What color is radiolucent

Black- nothing is blocking it