Chapter 1: Radiology and Musculoskeletal Imaging

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dmshaw9
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297676
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Chapter 1: Radiology and Musculoskeletal Imaging
Updated:
2015-03-05 14:21:35
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Radiology
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NPTE,Chapter1
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NPTE: Chapter 1
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  1. Professionals
    • Radiologists: physicians that train and sub specialize in different types of imaging
    • Radiographers: technicians trained to perform specific types of imaging
    • Physical Therapists: receive basic training in interpretation of these studies and the type of studies indicated for their clients (better informs the PT when developing a diagnosis, prognosis, and plan of care)
  2. Radiography (X-Rays): Definition and Characteristics
    • Noninvasive test used to identify and screen for lung or heart disease, fractures, dislocations, bone growth, foreign objects, etc. 
    • X-ray photons pass through body and are captured on plain film or digitally
    • Radiodensity of anatomical structure determines whether the object is seen as white, black, gray-black, or gray
    • Structure that is radiodense (bone) will absorb more x-rays and leave film white; less radiodense (air) allows more penetration to film and turns it black 
    • 2-D view of a 3-D object
    • At least two views (often 3) are required
  3. Use ABCs to Interpret a Musculoskeletal Radiograph
    • A = Alignment (size, contour, alignment with adjacent bones)
    • B = Bone density (density and texture)
    • C = Cartilage spaces (joint space width, presence of subchodnral bone, epiphyseal plates)
  4. Radiography Advantages
    • Quick
    • Easy
    • Portable
    • Relatively inexpensive
  5. Radiography Disadvantages
    • Ionizing radiation
    • Poor at visualizing soft tissues and small fractures
  6. Magnetic Resonance Imaging (MRI): Definition and Characteristics
    • Noninvasive test that provides sectional imaging of anatomy 
    • Especially helpful for visualizing soft tissues
    • Can be configured into 3D models
    • Uses radio waves and magnetic fields to provide detailed imaging of the body
    • Functional MRIs are used to detect metabolic changes in the brain
  7. MRI: Types
    • TI: fat is brighter, helpful in defining anatomy
    • T2: fluid appears brighter and fat is suppressed; helpful for various joint pathologies
  8. MRI: Advantages
    • High quality imagine got almost any structure (organs, bone, soft tissue)
    • Does not rely on ionizing radiation
    • Contrasts can be used to increase detail
  9. MRI: Disadvantages
    • Expensive
    • Time-consuming
    • Must remain perfectly still to avoid artifacts
    • May not be able to distinguish between edema and cancer tissue
    • May cause implanted metal device to malfunction
    • Claustrophobic environment
    • Relatively non-portable
  10. Computed Tomography (CT) or CAT Scan: Definition and Characteristics
    • Noninvasive test that provides sectional imaging of bone and most soft tissues
    • Useful for chest and abdomen
    • Better anatomical resolution than x-ray
    • Able to measure bone density (predict fractures) and identify tumors
    • Special radiography device with advanced computer analysis configures images from x-rays at various angles to show high-quality cross-sectional and 3D imaging of body tissues and organs
  11. CT or CAT Scan: Advantages
    • Fast
    • Provides high-quality imaging of bone, soft tissue, and blood vessels all at the same time
    • Contrasts can be used to increase details
  12. CT or CAT Scan: Disadvantages
    • Large amounts of inning radiation
    • Not as good at soft tissue structures as MRI
    • Not portable
    • Expensive
    • May result in claustrophobic reaction
    • Has bariatric limits
  13. Bone Scan Or Bone Scintigraphy: Definition and Characteristics
    • Helps to diagnose fractures not detected by x-ray and areas of damage to bone caused by cancer, trauma, infection or other conditions 
    • Uses gamma ray emission to detect newly forming bone 
    • Radionuclide injected intravenously and distribution (uptake) is recorded on radiographic film
    • Increased areas of uptake equal increased metabolic activity -- show up on film as  black
    • Test has poor specificity and good sensitivity
  14. Bone Scan or Bone Scintigraphy: Advantages
    • Noninvasive
    • Small amounts of radiation
    • Improved detection of abnormal bone metabolism
  15. Bone Scan or Bone Scintigraphy: Disadvantages
    • Time-consuming (about 1 hours or whole body)
    • Ionizing radiation
    • Potential adverse reaction from contrast
  16. Angiography
    • Common procedure
    • Catheter and contrast material used in conjunction with x-rays, CT scan or MRI
    • Primary purpose is to examine blood vessels throughout the body 
    • Also may be used to guide intervention (i.e. stent placement)
  17. Bone Density Scan or Dual-Energy X-Ray Absorptiometry (DEXA) or Bone Densitometry
    • Measures bone mineral density
    • Used to delineate osteopenia from osteoporosis 
    • An enhanced x-ray technique
    • Gold standard for measuring bone mineral density
  18. Ultrasound (US): Purpose
    Helps diagnose partial tendon tears, soft tissue masses (tumor, hematoma) pockets o fluid, muscle development or activation
  19. Ultrasound: Description
    • Sound waves capture real-time images of various body structures and blood flowing through vessels 
    • Structures that have more collagen will create whiter image (hyperechoic) because they reflect the US better
    • Muscle appears darker (hypoechoic) relative to tendon
    • Structures that lack collagen (blood) will be dark and void of an echo b/c it allows the US to pass through the object -- results in an anechoic image
    • Reliable and valid method to examine muscle thickness and diagnose soft tissue injury
  20. Ultrasound: Advantages
    • Noninvasive
    • Quick and easy
    • Provides real-time imagery
    • Relatively low cost when compared to other diagnostic imaging equipment
    • Great resolution for soft tissue lesions when compared to MRI
  21. Ultrasound: Disadvantages
    • Unable to penetrate bone
    • Requires practitioner that is experience and well trained
  22. Protrusion Emission Tomography (PET) Scan
    • Used to detect non perfusing areas of the heart or evaluate the brain in cases of undetermined dementia, stroke, seizures, memory disorders, or suspected tumors
    • Captures positrons emitted from radioactive substance

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