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Flashcards in Roentgen Signs Deck (66):
1

5 Radiographic Densities

– Air
– Fat
– Water
– Bone
– Metal

2

______ determines if further imaging
is indicated

Plain film radiography

3

Need at least ______ decarse in bone density to see lesion in Conventional Radiography

30-50%

4

Need a lesion at least _____ in size to detect
Conventional Radiography

1-5cm

5

Time until a lesion is seen by plain film radiography

Radiographic Latent Period

6

Osteomyelitis in peripheral bone radiographic latent period

10-14 days

7

Spinal osteomyelitis radiographic latent period

21 days

8

Aggressive tumors radiographic latent period

4-6 weeks

9

– Trauma – Unexplained weight loss – Night pain – Motor deficit – Malignancy

red flag

10

– Inflammatory arthritis – Fever of unknown origin – Abnormal blood results – Deformity

red flag

11

– Failure to respond to therapy – Medicolegal concerns

red flag

12

– >50 yo – Drug or alcohol abuse – Corticosteroid use – Old or lost previous x rays – Research

yellow flag

13

– Systemic disease – Recent immigration – Rule out contraindications – Therapeutic response

yellow flag

14

– Patient education – Routine screening – Habit – Discharge status assessment – Routine biomechanical analysis – Pre-employment status

non indicators

15

– Physical limitations of patient – Inadequate equipment – Non-trained personnel – Financial gain – Recent high-level radiation exposure – Pregnancy

non indicators

16

evidence-based guidelines to assist referring
physicians and other providers in making the
most appropriate imaging or treatment decision for a specific clinical condition.

The ACR Appropriateness Criteria

17

Injection of water soluble iodinated contrast into IVD’s nucleus
pulposus via fluoroscopic control in order to determine pain
generator

Discography

18

Radionuclide Imaging

Bone Scan

19

used to identify pars fractures (gymnastic athletes)

SPECT Scan
"Single-Photon Emission Computed Tomography"

20

detects:
Metastatic disease
Tumors Infection Arthritis Fracture (occult, stress, recent fx) Avascular Necrosis (AVN)

bone scan

21

– Detects as little as 3-5% bone destruction/production
– 10x more sensitive than plain film radiography
– Great for early detection of many disease processes

bone scan

22

No uptake in Multiple Myeloma unless pathological
fracture

bone scan

23

vascular dz
msk disorders
abdominal and pelvic imaging

diagnostic ultrasound

24

high level of radiation dose
excellent bone detail

Computed Tomography (CT)

25

Mathematical Data from Axial Images is Reformatted rendering Sagittal Lumbar Spine Image

Computed Tomography (CT)

26

excellent for soft tissue resolution
very sensitive for detecting bone marrow dz
great for spinal dz, especially disc dz

MR

27

Model of bone structure formed by condensed mesenchymal cells after which bone is formed
• Skull
• Clavicles
• Mandible

Intramembranous Ossification

28

Controls width of long bones via activity of periosteum

Appositional Bone Growth

29

– Osteoblasts transform cartilage template into bone
• Tubular bones
• Vertebrae
– Chondroblasts and chondrocytes form and produce a
cartilage cast of the definitive bone

Enchondral Ossification

30

surrounds bone except at ends of bone

Periosteum

31

Located at ends of long bones

Epiphysis

32

Consists of layers of progressively maturing cartilage & developing bone

Physis

33

Harris Growth Arrest (Park) Lines

growth arrest during systemic disease

34

Thin radiopaque line at junction of
physis and metaphysis

Zone of Provisional Calcification (ZOPC)

35

• Most metabolically active region of a bone
• Most common site for tumors and infection

Metaphysis

36

(bones appear wider than usual)

Undertubulation

37

(bones appear slender)

Overtubulation

38

• Longest part of bone • Thickened cortex and decreased medullary space • Provides mechanical strength and contains bone
marrow

Diaphysis = Shaft

39

• Densest and strongest part of bone • Densely packed compact lamellar bone and osteons
and is interconnected by Haversion canal systems

Cortex

40

predominates in all bones in children

Red marrow

41

Adults have red marrow only in

axial skeleton,
epiphyses, and metaphyses

42

• Does not cover epiphysis; does not enter synovial
joint. Forms synovial lining of synovial joint.
• Thin membrane covering diaphysis and metaphysis

Periosteum

43

produced due to pus, blood or tumors
produced due
irritation or elevation from bone

Periosteal Reactions

44

Trabeculae and inner cortical margins are
covered by ______ that has osteogenic
properties

endosteum

45

– May be separated from bone by a thin layer of soft tissue
– Originates in muscle, nerve, arterial, or synovial tissue
– May see pressure erosion of bone with sclerotic margin
– Do not originate in bone

Extraosseous Lesions - bone dz

46

– Lytic lesions such as fibrous
dysplasia, and cartilaginous
lesions
the endosteal surface of the medullary cavity
– Thinning of the cortex along

Endosteal Scalloping - bone dz

47

– Poor, hazy, ill defined margins,
long zone of transition
– Gradation between normal and
abnormal bone occurs gradually
– Indicates aggressive bone
destruction
• Infections • Malignancy

Imperceptible Margination - bone dz

48

– Definite and sclerotic margins
– Narrow zone of transition
– Clear identification between normal and abnormal bone
– Usually slow growing lesion

Sharp Margination - bone dz

49

Loss of bone density and structure

Osteolytic Lesions

50

– Circumscribed lesion – Uniformly lytic lesion – Usually solitary – >1cm – Sharp margin – Usually slower growing
and are usually benign – May be septated or soap
bubbly

Geographic Lesion

51

– Multiple, poorly defined, small radiolucent
lesions – 2-5mm in size – Ragged irregular margins of lesions – Confluence of lesions occurs – Aggressive lytic lesions
• Multiple myeloma • Metastatic disease • Infection

Moth-Eaten Lesion

52

– Numerous, tiny, pinhole size
lesions
– < 1.0mm in size
– Wide zone of transition
– Most rapidly aggressive bone
tumors
– Easily missed on conventional
radiography

Permeative Lesion

53

– Increased density due to
overproduction of bone or calcium laden tissue
– Blastic Metastasis – Osteosarcoma – Paget’s Disease

Osteoblastic Lesions

54

– Continuous layer of new bone that attaches
to outer cortex – Usually benign process – Slow disease process – Elliptical, undulating, continuous

Solid Periosteal Reaction

55

– Slow and aggressive tumors – Infection – Ewing’s Sarcoma
– Alternating layers of lucent and opaque densities on external cortical surface
– Radiolucent zones contain loose
connective tissue and dilated blood
vessels that have not ossified

Laminated: Lamellated, Onionskin

56

– Perpendicular, brushed whiskers, hair on
end
– Sunburst: radiating spicules of bone
from a point source
– Aggressive tumors
– Fine linear spiculations of new bone
perpendicularly oriented away from
cortex

Spiculated Periosteal
Reactions

57

Periosteal new bone at the
peripheral lesion – cortex junction
as result of subperiosteal
extension of lesion
• Primary malignant bone tumors • Benign bone tumors • Infections

Codman’s Triangle

58

Increased soft tissue density

Synovial Sarcoma

59

Soft Tissue Calcification

Synovial Sarcoma

60

– Increased tendency of rbc’s to precipitate out due to
increased concentrations of fibrinogen
– Nonspecific index for disease
– Especially good for Inflammatory Diseases

ESR: Erythrocyte Sedimentation Rate

61

– Due to inflammatory changes or tissue necrosis – Released by liver – Nonspecific

CRP: C - Reactive Protein

62

– Normally within strict limits – Disorders of bone destruction – Disorders of increased parathormone
activity

Serum Calcium

63

– Indicator of bone destruction – Important indicator of bone activity – Inverse relationships to calcium levels

Serum Phosphorus

64

– Reflects an increase in osteoblastic activity
– Paget’s disease – Metastatic disease – Healing fractures – Lymphoma

Alkaline Phosphatase

65

• Metastatic lesions in bone and soft tissue liberate acid phosphatase
– Located in prostate gland
– Increased in Prostate metastasis
and Gaucher’s disease
– Capsule of prostate must be
disrupted

Acid Phosphatase

66

– Multiple Myeloma:
• IgG spike
• IgA spike
• Bence Jones proteinuria (40%) of patients with MM
– Elevated total serum protein often indicates metastatic disease or multiple myeloma

Total Protein