quiz #1 – principles of orthopedic imaging

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quiz #1 – principles of orthopedic imaging
2011-01-24 19:54:14

principles of orthopedic imaging
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  1. what is considered medical imaging
    • X – Ray
    • CTscan
    • bone scan
    • MRI
    • ultrasound
    • myelogram
    • arthrography
  2. true or false – physical therapists are more cost effective than orthopedic doctors
  3. true or false – physical therapist had better patient satisfaction then orthopedic doctors when treating musculoskeletal injuries
  4. true or false –physical therapist used less imaging tools such as x-ray, MRI, CT scan, etc. then orthopedic doctors when treating musculoskeletal injuries
  5. which of the following are true statements
    a – regardless of whether or not physical therapist can order imaging, they need to be familiar with it
    b– physical therapist must understand, indications, contraindications, limitations, risk, and benefits of imaging tools
    c – physical therapist should be ready to provide a professional opinion suggesting the use of imaging in according to current practice guidelines
    D – whenever the response to intervention is not consistent with the prognosis, additional testing may be indicated
    E – all of the above
  6. what does CPR stand for
    clinical prediction rules
  7. what are clinical prediction rules
    • these are tools designed to improve decision making in clinical practice
    • they help us make a diagnosis, establish a prognosis, and match patients with optimal interventions
    • they helped limit practice variations, in other words it focus us
    • e
  8. what are the Ottawa ankle rules
    • indications for radiography if any of the following are present
    • bone tenderness at the base of the fifth metatarsal
    • bone tenderness at the navicular
    • inability to bear weight immediately and in the emergency department
  9. true or false – for physical therapists to be successful in differentiable diagnosisthey must have a working knowledge of sensitivity, specificity, PPV, NPV, and likelihood ratios
  10. what are some of the potential errors in diagnostic imaging
    • wrong population– asymptomatic
    • quality of the image, and interpretation
    • imaging of area of referred pain
    • timing
  11. true or false – radiologists are physicians that specialize in radiology
  12. true or false – radiographers are allied health professionals
  13. true or false – radiologist read diagnostic images wrong 20 to 40% of the time
  14. who invented the x-ray machine
    William Roentgen
  15. what did William Roentgen die from
  16. what are the three things that are needed to produce an x-ray
    • x-ray beam
    • patient
    • x-ray film
  17. true or false – x-rays used to be novelty attractions at
    circuses and fairs
  18. what kind of waves are used when using an x-ray
    Gamma waves
  19. how is radiograph performed
    • X – Ray beam emitted from cathode tube
    • beam strikes the body
    • x-ray beam is absorbed in different amounts depending upon the various densities of the tissue radiated
  20. what do the black parts or darker portions of an x-ray film represent
    total film exposure
  21. what do the white areas represent in an x-ray
    lack of film exposure
  22. which part of the bone will be the most white
    the diaphysis
  23. what are the four major densities noted on x-ray in the human body
    • Black – air
    • gray black – fat
    • gray – water-based substances – blood, muscle, cartilage, ligaments, nerves, fluid filled organs
    • white – bones
  24. heavy metal – THA
  25. true or false – when analyzing an x-ray it is sufficient to hold the image toward a light or window
  26. true or false – in general x-rays are viewed as if you are looking at the person in front of you
  27. explain how x-rays or images are viewed from the side
    lateral views are viewed in the same direction that the beam traveled
  28. true or false – hands and feet are viewed from the dorsal aspects, digits up
  29. where is this x-ray underexposed
    toward the top
  30. where is this x-ray underexposed
    where the AC joint is supposed to be
  31. what does INT mean
    internal rotation of limb
  32. what does EXT mean
    external rotation of limb
  33. what does Erect mean
    up right
  34. what does WTB mean
  35. what does Decub mean
    decubitis - recumbent
  36. what does INSP mean
  37. what does EXP mean
  38. what is radiographic density
    the amount of blackening on the radiograph or overexposure

    • the higher the amperage the higher the overexposure will be
    • the lower the amperage there will be underexposure
  39. what is radiographic contrast
    the difference among various adjacent radiographic densities

    High contrast favored over low contrast for bones
  40. what is the primary cause of blur in an x-ray
  41. why does this x-ray have a blurred spot and what is it caused from
    involuntary perstaltic motion
  42. what is radiographic distortion
    the difference between the actual size of the object and the recording image
  43. what is the percentage of radiographic distortion in x-rays
  44. what does ABCS stand for
    • alignment
    • bone density
    • cartilage spaces
    • soft tissue
  45. why is it important to perform the ABCS approach to radiographic evaluation
    to decrease the chance of error
  46. what kind of fracture is this
    boxer fracture
  47. what does this x-ray reveal
    a bone spur
  48. what are the structures
    growth plates
  49. what are the arrows pointing to
    screws that have been removed from the bone after surgery
  50. what is general bone density
    looks for distinct cortical edges (loss of distinct cortical image to soft tissue and bone = bone mass loss)
  51. what is local bone density
    looks for areas of increased density
  52. what are texture abnormalities
    when mineralization of the bone is changed the appearance of the trabeculae can look thin, delicate, coarsened, fluffy, smudged
  53. this is a normal bone density scan
  54. what does this x-ray/bone scan reveal
  55. what does this x-ray reveal
    osteopoikilosis (spotty areas of calcification)
  56. fluffy sclerosis – Paget's disease
  57. what is Paget's disease?
    disease that causes too much osteoblast activity– often seen in the skull

    They look big, strong, stocky, but the bone is easy to fracture
  58. Decalcification and loss of cortical bone
  59. Lacy– delicate appearance of trabeculae-Cooley's anemia
  60. DJD Knee - Sclerotic Subchondral Bone
  61. osteomyelitis of the promixmal tibia
  62. is this an x-ray of an adult or child? And how can you tell?
    this is an x-ray of a child because you can still see the growth plates
  63. is this a child's x-ray or an adult x-ray
  64. gout– 1st MTP joint erosion
  65. Gross soft tissue swelling
  66. atrophy of the quadriceps
  67. heterotrophic bone

    This is often found in the hip, gluteal region, etc. paraplegics have a tendency to develop this condition
  68. myositis ossificans

    this mostly happens in the elbow or thigh areas
  69. what are the Ottawa rules for the knee; indications
    • patient is older than 55 years old
    • tenderness at the head of the fibula
    • isolated tenderness of the patella
    • inability to flex in the to 90°
    • inability to weight bare 4 steps immediately after the injury and in the emergency room
  70. Ottawa rules
    what are the exclusion criteria for the knee
    • age less than 18 years
    • isolated superficial skin injuries
    • injuries more than seven days old
    • recent injuries being reevaluated
    • patient with altered level of consciousness
    • paraplegia or multiple injuries
  71. what are the Ottawa rules for the ankle
    • bone tenderness at the posterior edge or tips of the lateral malleolus
    • bone tenderness at the posterior edge or tips of the medial malleolus
    • inability to bear weight both immediately and in the emergency department
  72. explain how an arthrography is performed
    • contrast material is injected into the joint
    • media extends capsule and surrounding soft tissue
    • outlines the joint capsule
    • the goal is to see if any fluid escapes from the capsule, this would indicate a capsular tear
  73. what joints are arthrography often used
    shoulder, elbow, wrist, knee, and ankle joints
  74. how is a myelography performed
    • contrast is injected into the subarachnoid space which mixes with cerebral spinal fluid
    • produces a radiopaque column
    • an x-ray is taken
  75. what is the purpose of myelography
    to reveal ruptured disc, spinal cord compression, spinal stenosis, inter vertebral tumor, canal obstructions, or nerve root injury
  76. true or false – a CT scan is able to move through a 360° arc
  77. true or false – CT scans can be 2-D and 3-D
  78. true or false – CT scans use less radiation than an x-ray does

    Uses higher doses of ionizing radiation but more defined areas
  79. what will you be able to see better in a CT scan; soft tissue or bone
    soft tissue differentiation is limited, best for bone detail
  80. true or false – MRI advances have challenged CT scans, but CT still is superior for cortical bone detail
  81. true or false – a CT scan is basically an x-ray on steroids
  82. what kind of image is this

    3-D CT scan
  83. what kind of image is this
    2-D CT scan
  84. true or false – a bone scan requires radiopharmaceuticals that are injected intravenously and the radiopharmaceuticals are tissue specific
  85. in a bone scan which tissue will absorb more of the radio pharmaceutical; abnormal bone or normal bone
    abnormal bone
  86. on a bone scan what color does normal bone look like
  87. what are the indications for a bone scan
    subtle stress fractures, bone tumors, bone infections, AVN, or unexplained bone pain
  88. what kind of image is this and what condition does the patient most likely have
    bone scan – rheumatoid arthritis
  89. located images this and what condition does the patient have
    bone scan – myositis ossificans
  90. true or false – MRIs use large magnetic coils to transmit radio waves into the body
  91. how are MRI images recorded
    produces images by recording various vibrations frequencies (resonance) of different tissues
  92. true or false – bone, articular cartilage, fibrocartilage, tendons, and that all vibrate at different frequencies and MRIs are able to pick up on these frequencies and produce an image
  93. true or false – if the patient has a metal object in their leg, you should always use MRI to identify the object
    false – MRI is contraindicated for presence of ferrous metals, or electrical implants
  94. true or false – orthopedic implanted appliances are not ferrous and thus are not contraindicated for MRI
  95. true or false – in an MRI orthopedic hardware will distort the image and create a reflection like appearance
  96. true or false – adding a contrast dye to MRIcan increase ability to see rotator cuff tears, labral injuries, capsule, and soft tissue
  97. what does T1 weighted mean in reference to an MRI
    is used to best see detailed anatomy a soft tissue not high in water content ( muscle, tendon, bone)
  98. what does T2 weighted mean in reference to an MRI
    best to see structures with high water content, bursa, inflamed tendon,tumor, abscess. Remember T-2 = H2O – the 2 in H2O
  99. what kind of image is this?and is it normal
    • MRI
    • normal
  100. what kind of images this and is it normal?
    • MRI
    • abnormal
  101. true or false – when using ultrasound you are able to look at the muscle, tendon movement, and muscle size in real time
  102. ultrasound is excellent for viewing _______
    a – knee injuries
    B – ankle injuries
    C – shoulder injuries – rotator cuff injuries
    c-rotator cuff injuries
  103. true or false – ultrasound is not so good for mensci, AC, ACL, PCL injuries
  104. the success and quality of ultrasound imaging is dependent upon _____________
    the skill of the operator
  105. what is the cost of a myelogram of the spine
  106. what is the cost of an MRI
    $2000 – $3000
  107. what is the cost of the CT scan of the lumbar spine
  108. what does a bone scan cost
    500 – $600
  109. what is the cost of an ultrasound
    $250 – $300