Flashcards in Skel A- Advanced Imaging For Chiropractor (CT/Bone Scan Deck (45)
What are the types of advanced imaging for spinal evaluations?
CT w/ Myelography
Radionuclide bone imaging
Why do we use advanced imaging?
1. More accurate
2. Detects subtle injuries and pathologies
3. Radiographically in depth analysis needed
4. Failure of response of condition on plain film
Describe radionuclide bone imaging
Radionuclide bone imaging is a type of nuclear medicine that utilizes radioactive substances, injected intravenously to detect metabolic and physiologically changes in the body that proceed gross structural alterations.
Radionuclide bone imaging has(Poor sensitive/great specificity or Great sensitivity/poor specificity)
Great sensitivity/ poor specificity
*recall that it will show different disorders similarly but picks up subtle changes *
Radionuclide bone imaging is (non-ionizing/ionizing)
The most frequently used NM study that analysis bone, joint and soft tissue?
Radionuclide bone scan
A radiopharmacologic agent that distributes into organs and tissues and is carrier of radioactive substances into blood stream
Radioactive isotope used to emit gamma radiation that is sufficient enough to escape tissue and be detected by a gamma ray detector/camera during bone scans.
What is the term synonymous for NM scan?
In terms of uptake of radioactive isotopes in bone scans, what are hot and cold spots?
Hot spots- areas of increased uptake; increased blood flow in area
Cold spots- areas of decreased uptake; low blood flow in area.
Skeletal scintigraphy was introduced in the early 60’s to capture bone changes plain film couldn’t.
What are the isotopes that were use and why are they not used anymore ?
Scrontium-85 & 87
They emitted too much radiation or had too short of a half life (time it takes 50% of substance to be deactivated or flushed out of body)
What are the isotopes used today in NM/scintigraphy scans?
Technetium-99 -Methyline diphosphate
Describe the half life of technetium-99- Methyline diphosphate
Tc-99 Methyline diphosphate has a half life of 6 hours. Within 6 hours 50-60% of the isotope is excreted through urination and this continues by 50% each 6hr
What are the units to measure NM dose?
What is the first phase of the bone scan procedure?
Flow phase/ Radionuclide angiogram-rapid imaging every 2-3 seconds for 30 seconds
What is the second phase of the bone scan procedure?
Blood pool phase- when tracer is in soft tissue, takes about 5 minutes
What is the third phase of the bone scan procedure?
Delayed of bone phase- Tracer leaves soft tissue and vessels going into bone, takes 2-4 hours (as long as 24hrs)
A positive NM scan is largely based on what?
Rate of bone activity (osteoblastic)
Flow of isotopes in body during bone scan
MDP & Tc-99m, 2-3 sec of imaging for 30 second, Flow phase —> 5 minutes later, isotope in soft tissue, Blood pool phase —> 2-4 hours later, clearance of isotope into bone/skeleton, Delayed/Bone phase —> 24hrs later,in bladder then excreted
Which two organs will show exceptional activity of the isotope radioactive emissions?
Kidney & Bladder
Indications for use of bone scan
Benign bone lesion
Fractures not readily seen with plain film
Avascular necrosis (Cold Spots)
Myositis Ossificans (Hot Spots)
Spondylodiscitis (Hot Spots)
Contraindications of NM
NM scans have great (sensitivity/specificity) and poor (sensitivity/Specificity).
Nm is (full body/regional), is (less/more) expensive than MRI, and is (as / less/ more) sensitive as MRI.
Great sensitivity, Poor specificity
Is as sensitive as MRI (MRI can be more sensitive)
How does multiple myeloma show on bone scan
CT is a further progression from plain film that utilizes a thin slicing mechanism of anatomy through the coordinated motion of the source (tube) and the receptor (cassette) which results in great detail
Tube and cassette move in straight line
Plane in which CT image is captured
CT was invented by whom
Godfrey Hounsfield 1970s
Assisted by Allan Cormack
The first CT brain scan was done in what year