Adv Img

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Author:
jcapri
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103135
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Adv Img
Updated:
2011-09-20 20:33:19
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LifeU
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Final Material
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  1. Ultrasound - Good for & NOT good for...
    • Not good for gas or air
    • Good for soft tissue: carotid aa, liver, etc
  2. Sequestered disc:
    chiropractic care not indicated
  3. disc fragmentation
    can potentially cause cauda equina
  4. Ionizing radiation:
    Which forms of Imaging use it?
    CT scans, xray, electron beam tomography, etc

    Ultrasound and MRI do not
  5. Management Annular tears?
    You can still adjust: this is not a contraindication
  6. spondylolytic (pars defect) or anterior spondylolisthesis:
    tight hamstrings, must stretch
  7. Posterior limbus bone:
    due to disc fragment
  8. Two indications to refer for MRI
    • Brain tumor
    • MS
  9. Vertebral artery aneurism/tortuosity:
    seen on arteriogram (not on US)
  10. Slurred speech:
    • drukenness
    • migraine
    • stroke
  11. Rovsings sign:
    appendicitis
  12. 71 yr old white mail, sciatica for 2 mo, worse at nightprostate CA, clinical & ortho tests equivocal, no improvement after 3 wks of care all imaging done (-)
    continue to adjust & refer out
  13. Cancer (CA) was Ruled Out (R/O) but disc lesion found does not correlate w/ level found on exam
    Concerned cause may actually be Piriformis Syndrome
    What test could help clarify discrepancy?
    SSEP
  14. 30 yr old asian male bartender, N & T in R hand, aggravated by work
    (+) Phalen’s & Tinel’s

    how to DDx b/w CTS & VSC?
    SSEP
  15. Pt not improving, suspect disc lesion

    How to R/O disc lesion?
    MRI
  16. 29 yr old male w/ ankle pain & ↓ ROM
    unresolved after inj. 4 wks prior,
    X-Ray shows DJD & ossicles
    suspect OCD, adjusted & rehab ongoing
    what imaging do you use to R/O joint mice, insidious processes, see joint space & surfaces, & ligaments?
    MRI
  17. 57 yr old male falls of 15’ ladder, strikes head, loses consciousness for <1 min., seekscare at your office 1st.
    Pt is dizzy, sluggish, has a headache
    which modality to quickly R/O fracture & internal bleeding?
    CT
  18. 35 yr old male “bad” hit in Rugby, dizziness, HA’s, vision changes, numbeness in Lshoulder, atrophy of L supraspinatus & fatigue
    4 wks prior grade 2 A-C separation, X-Rays of C-Spine neg.,Concerned for brain inj.
    To which MD do you refer & which tests are indicated?
    Neurologist & MRI
  19. 35 yr old male “bad” hit in Rugby, dizziness, HA’s, vision changes, numbeness in Lshoulder, atrophy of L supraspinatus & fatigue
    4 wks prior grade 2 A-C separation, X-Rays of C-Spine neg.,
    Importance of asking the right questions: If atrophy of supraspinatus is of concern, which instrument would you use to determine if muscle is denervated?
    Needle EMG
  20. 27 yr old male cheerleader
    (+) Lachman’s, Appley’s compression & Valgus Stress

    Which modality would you use to image the meniscus, medial collateral & ACL?
    MRI
  21. 38 yr old female w/ N & T in L forearm following MVAaggravated by computer wk, worsens w/ C-spine Rotation
    (+) foraminal compression on the L, no weakness
    X-ray – post. Spur & ↓ disc C5-C6
    DDx? Modality to visualize IVF during motion?
    • DDX:
    • Subluxation
    • TOS
    • foraminal encroachment

    • Visualization during motion:
    • Video Flouroscopy
  22. Modality for neurological component of VSC especially during rotation?
    SSEP (nerve signal should not change by motion)
  23. Pt develops weakness in L hand during care

    modality to R/O cervical herniation?
    MRI
  24. 56 yr old female w/ neck pain & history of RA
    X-rays show ↑ADI, which ligament is implicated?
    During VF, which movement would show ↑ in ADI?
    Transverse ligament

    Flex/Ext views would show ↑ in ADI
  25. 30 yr old male injured during Rugby, hyperflexion & “stinger” (head goes one way, bodygoes the other), numbeness lateral to aspect of both hands
    Davis series- ↓ curve, mild IVF encroachment, mild DDS, multiple fixations, previoushistory of similar inj.
    Which modality if symptoms persist & concern is radiculopathy?
    CT
  26. Which modality if more concerned about myelopathy w/ disc herniation &/or cordcontusion?
    MRI
  27. 12 yr old male Right elbow swollen & painful

    history: fell out of tree

    modality?
    Plain film X-ray
  28. gold standard for spine & extremity trauma?
    Plain film
  29. gold standard for disc ?
    MRI
  30. 20 yr old female volleyball player, complains of shoulder pain w. overhead movement,such as serving or spike
    (+) supraspiatus test, pain on Abduction
    how do you evaluate for a partial rotator cuff tear, impingement, or bursitis?
    MRI
  31. 42 yr old female, chronic thoracolumbar pain
    (-) plain film x-ray, family history of CA & previous smoker
    not resolving w/ care & want to R/O pathology
    What is the starting point, cheapest, & gives evidence of ↑ metabolic activity?
    Bone Scan
  32. 48 yr old male, heel pain, limps into office after a 1 story fall.
    Plain film equivocal
    modality to R/O fracture?
    CT
  33. Explain findings & recommendations
    Pt. says “ I don’t know if this is important of not, but..."
    Broke foot/ankle/lower leg 3 yrs before
    Hip/pelvis/groin/femur head/buttock?
    If NO new fractures, bone scan would most likely be (-) b/c?
    90% of Bone scans are neg after 2 yrs of injury
  34. 54 yr old female, transient pt., parent of student
    routine x-ray – portion of postior 7th rib is missing

    Modality for extent of metastasis?
    Bone Scan
  35. Breast 1° site of CA
    Metastasis suspected to R kidney
    Which imaging modality to image kidney, knowing the pt can not lay still for long?
    Which modality to image kidney if pt is morbidly obese?
    Can't lay still? CT

    Morbidly Obese? Open MRI
  36. 24 yr old female falls in grocery store 2 wks before & complains of LBP
    compression fracture of L2 seen on film
    pt has legal counsel & seems to be looking for a “free Lunch”
    You suspect it's an old fracture, how do you age the break & why do you choose that modality?
    MRI, b/c bone marrow edema will show for 6 wks
  37. Wellness practice wants to quanify components of VSC on a routine basis. How?
    • Physiology & ANS - thermography
    • Kinesiopathology - VF
    • Neurological, motor division - surface EMG
  38. 61 yr old female, severe LBP, progressive low extremity weakness, pain aggravated by neck flex
    X-Ray – facet arthrosis, poss. Tropism & central canal stenosis.
    Modality to evaluate these bony elements?
    CT
  39. 75 yr old male w/ LBP
    x-rays look like young spine
    ortho & neuro disc herniation
    marked palpable abdominal pulse, large area of artherosclerosis on LL
    Modality to R/O or R/I disc & aneurysm?
    MRI
  40. 30 yr old female, LBP w/ L sciatica
    (+) well leg raiser, SLR & valsalva’s
    responds well but slowly, 50% in 3 wks
    which modality?
    None (but probably should have done film on initial visit)
  41. 42 yr old female, R leg pain to foot w/ N & T
    unable to stand on Rt toes,
    previous disc surgery w/ similar S & S, probable “failed back surgery”
    Modality to DDx scar & recurrent disc?
    MRI w/ contrast
  42. 21 yr old female, whiplash from MVA,
    very slow progress over 3 wks
    ROM improved but not the pain
    Concern for occult fract./IVF encroachment.
    Modality to R/O concerns?
    CT
  43. 68 yr old female w/ L shoulder pain,
    fell on elbow,
    shoulder ROM is ↓ & painful,
    painful lock when attempting flexion
    Plan of action?
    X-ray & refer out
  44. 43 yr old male w/ R hip pain, correlates w/ exercise,
    already seen MD, extensive imaging already done,
    care yields no improvement,
    concern for underlying pathology, especially AVN.
    Plan at this point?
    Adjust & refer out
  45. Axial loading with nerve root compression
    increased likelihood for pain
  46. Cross sectional area of dural/thecal sac
    canal open when pt is in flexion
    Significance?
    Less Pain (closes in extension)
  47. Transient synovitis
    • Most common cause of pain in 12 y/o age group
    • Resolved with rest and adjusting
  48. Dessication
    drying out of the IVD
  49. T1 = CSF appears...
    dark
  50. T2 = CSF appears...
    bright
  51. Myelomalacia:
    • Associated with stenosis and DJD
    • Adjust these patients
  52. Ligamentum flavum hypertrophy (redundancy)
    • associated with Canal Stenosis
    • Common cause of back & leg pain in the elderly
  53. Microdisectomy:
    • removal of small portion of the disc
    • procedure to stabilize the segment
  54. Which motions open and close the IVF?
    • IVF opens in flexion
    • IVF closes in extension
  55. When do you order contrast w/ MRI?
    Post surgery for scar tissue identification and to look for tumors/growths/etc
  56. Modic Endplate Changes
    Type 1: Decreased T1, Increased T2

    Type 2: Most common – Increased T1, slightly hyper-intense T2

    Type 3: Bony proliferation – osteophytes – Hemispherical spondylosclerosis
  57. T1 weighted SE (spin echo) image =
    Fat Image
  58. Why do initial CT and not MRI with acute head trauma?
    CT is much faster
  59. Why CT vs MRI for children?
    Would have to sedate child with MRI (dangerous)
  60. Stork Test is evaluating for...
    spondylolisthesis
  61. Active spondylolysis –
    no pars defect yet
  62. Technetium bone scan:
    sensitive but not specific
  63. Stark Law
    Not allowed to refer patients to offices in which you have vested financial interest
  64. ACA & ICA guidelines on imaging:
    full spine radiography
    • AP can be done on 14x36
    • Lateral should be taken in sections due to pt exposure
  65. ACA & ICA guidelines on imaging:
    Computer assisted mensuration
    Do a separate pathology report
  66. Discogram:
    Controversial
  67. Stages of Disc Herniation
  68. Disc Protrusion
    • Commonly called a disc bulge, a disc protrusion occurs with the spinal disc and the associated ligaments remain in tact, but form an outpouching that can press against the nerves.
    • OR
    • the greatest distance, in any plane, between the edges of the disc material beyond the disc space is less than the distance between the edges of the base in the same plane.
  69. Disc Extrusion
    • A disc extrusion occurs when the outer part of the spinal disc ruptures, allowing the inner, gelatinous part of the disc to squeeze out. Disc extrusions can occur with the ligaments intact, or damaged.
    • OR
    • in at least one plane, any one distance between the edges of the disc material beyond the disc space is greater than the distance between the edges of the base in the same plane, or when no continuity exists between the disc material beyond the disc spaceand that within the disc space.
  70. Disc Sequestration
    • A disc sequestration occurs when the center, gelatinous portion of the disc is not only squeezed out, but also separated from the main part of the disc.
    • OR
    • Extrusion disc material has lost completely any continuity with the parent disc

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