RADIOLOGY BASIC 0233

1. RADIOLOGYBASIC 0233 Final Revision

2. Why do physical therapist need to understand medical imaging? Clinical Reasons? How will it effect treatment? How will it effect prognosis? What about direct access? Research Implications?

3. Medical Imaging Radiography Plain Film/ X-Ray/ Roentgen Rays Computed Tomogaphy (CT Scan) DEXA Bone Scan Magnetic Resonance Image (MRI)

4. Viewing Images • X-ray study named for the direction the beam travels • AP • PA • Lateral • Orient film as if you were facing the patient, his/her Left will be on your Right

5. Views Lateral Oblique

6. Viewing Images • A radiograph is a two dimensional representation • Therefore, “One View is No View” • Two views are needed, ideally at 90 degress to one another for proper 3-D like interpretation

7. Radiograph revealed horizontal fracture of the lower patalla

8. It is however, relatively much more important for a physical therapist to recognized the indications for diagnostic imaging, to select the most appropriate imaging study, and to image the appropriate area(s) than it is to interpret the image

9. What is a Bone Fracture? “A bone fracture is a medical condition in which there is a break in the continuity of the bone. A bone fracture can be the result of high force impact or stress, or trivial injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, and bone cancer.”

10. * A fracture is a broken bone that depending upon physical pressure or stress that was exerted on the bone ,it can be a large or small fracture. • Symptoms of a fracture are: swelling, deformity, pain, and loss of function. • Treatment for fracture is to get an x-ray, reduction, fixation, surgery, and rehabilitation.

11. Types of Fractures There are several types of fractures such as closed, comminuted, compound, compression, fracture, greenstick, impacted, oblique, pathologic, spiral, stress, and transverse.

12. Types of Fracture** • Simple • Colles’ • Comminuted • Compound • Compression • Greenstick • Impacted • Oblique • Pathologic • Spiral • Stress • Transverse

13. Comminuted Fracture • Is a fracture that occurs in elderly people or people with weak bones. • People with cancer are prominent to have this kind of fracture due to weak bones. • Symptoms where fractured happens are: swelling, warm, and cant handle weight. • Complications of comminuted fracture can include compartment syndrome and necrosis when bone fails to join together.

14. Transverse Fracture

15. Skeletal Imaging • Majority are diagnosed by plain radiograph • AP and Lateral projections • Oblique views for trauma involving joints, hands and feet • CT - fine bone structure ( skull,spine and pelvis) • MRI - evaluation of soft tissue • Nuclear medicine - bone metastases, osteomyelitis and occult trauma (stress fractures)

16. Skeletal Imaging • Most bone lesions are obvious on clinical history • >95 % bone films are obtained for: • Evaluation of trauma • Eval. Arthritis • Eval. Degenerative conditions • Metastases

17. Terminology • Fractureis a break or loss of structural continuity in a bone. • it is important that fractures be described in a precise and detailed manner. • Dislocation and Subluxation alters the normal relationship between joint surfaces. • Dislocation :the normally apposing joint surfaces completelyloose contact • Subluxation :those surfaces are only partially separated.

18. Terminology • Fractureis a break or loss of structural continuity in a bone. • it is important that fractures be described in a precise and detailed manner. • Dislocation and Subluxation alters the normal relationship between joint surfaces. • Dislocation :the normally apposing joint surfaces completelyloose contact • Subluxation :those surfaces are only partially separated.

19. Fracture Pattern • The fracture pattern relates to fracture geometry, which suggests the type and amount of kinetic energy the bone has been subjected too. • A transverse fracture is a low-energy injury, usually the result of either a direct blow to a long bone or a ligament avulsion. • An example is a “night stick” fracture, which involves the ulna and occurs when the forearm is used to defend against an assault. • Stress and pathologic fractures usually have a transverse pattern.

20. Fracture Pattern • Spiral or obliquefractures result from a rotatory or twisting injury. • These fractures have a tendency to displace after reduction and immobilization. • Spiral or oblique fractures typically require ORIF. • A fracture with two or more fragments is termed comminuted.

21. Fracture Pattern • An impacted fracture is commonly seen in metaphyseal bone, such as the femoral neck, the distal radius or tibial plateau fractures. • These (impacted) are low-energy injuries in which two bone fragments are jammed together. • Fractured bone fragments can be displaced due to the force of the injury, gravity, or muscle pull. • Displacement is described in terms of angulation, rotation and length.

22. Principles of fracture management: • Patients with fractures should be managed as trauma patients. • always check for associated injuries. • Next, assess the neuro-vascular status. • Remember to check : • distal pulses and capillary refill. • sensory and motor function (distal to the fracture )

23. Fracture management • The three principles of fracture care involve: 1) Reduction of deformity 2) Maintenance of reduction 3) Rehabilitation of function

24. Anterior dislocation • (Much more common than posterior dislocation)

25. Posterior dislocation

26. Hill-Sachs Deformity

27. Knee Effusion • MRI Sagittal T2 weighted image

28. Menisci • Crescent shaped fibrocartilagenous structures that are triangular in cross section. • These structures deepen the articular surface of the tibial plateau adding stability to the joint

29. Meniscal Tear • Most Common injury to the knee requiring surgery • Medial meniscal tears occur 3 times more frequently than lateral meniscal tears • Locked knee requires urgent intervention

31. Hip fractures • Femoral neck - Osteoporotic • Unable to walk after a fall • Little deformity • Intertrochanteric - post traumatic • Shorter leg in internal rotation • Stress fracture is difficult to detect in elderly • Non displaced fracture is better seen • MRI • Bone scan ( may take several days to show)

33. Slipped Capital Epiphysis • Cause unknown • Does not occur before age 9 y • Overweight teenage male • Radiographic diagnosis • Thickened epiphyseal plate • Medial displacement of the femoral head relative to the femoral neck • Lateral and frog leg views used for diagnosis

34. Slipped Capital Epiphysis

35. Osgood - Schlatter disease • Traumatic tibial lesion in children • Avultion fracture of the anterior tibial tuberosity • Frequent in active boys participating in sports • Pain • Age 10-15 y • Heals with rest

36. Indications for C-spine Films • Tenderness • Neurologic defecit • Forceful Mechanism of injury • Distracting injury • Altered sensorium

37. Modalities • Plain films – Lateral, AP, and Odontoid • CT • MRI

38. Interpretation of Lateral Plain Film • Adequacy • Alignment • Bones • Cartilage • Soft Tissue

39. Interpreting lateral Plain Film • Alignment • Anterior vertebral line • Formed by anterior borders of vertebral bodies • Posterior vertebral line • Formed by posterior borders of vertebral bodies • Spino-laminar Line • Formed by the junction of the spinous processes and the laminae • Posterior Spinous Line • Formed by posterior aspect of the spinous processes

40. Alignment

41. Bones

42. Fractures • Mechanisms of injury • hyperflexion i.e. diving in shallow water • axial compression i.e. landing directly on head • Hyperextension i.e. hitting dashboard in MVC

43. Fractures • Jefferson Fracture • Compression fracture of C1 ring • Most common C1 fracture • Unstable • Commonly see increase in predental space on lateral if transverse ligament is damaged and displacement of C1 lateral masses on odontoid. • Obtain CT

44. Fractures

45. What is a neuroradiologist? • A neuroradiologist is a radiologist who specializes in the use of x-rays and other scanning devices for the diagnosis and treatment of diseases of the nervous system. • A neuroradiologist must be concerned with the clinical imaging, therapy, and basic science of the central and peripheral nervous system, including but not limited to the brain, spine, head and neck.

46. Goals/Objectives • Review basic anatomic landmarks in the brain • Learn the three different orientations neuroradiologists use to view images of the brain • Be able to distinguish between a CT scan, T1-weighted MR image, and a T2-weighted MR image of the brain

47. The two most common types of MR images are… • T1-weighted MR images- useful to look at normal anatomy of the brain • T2-weight MR images - useful to look at abnormal processes (or pathology) in the brain

48. What is bright/dark on T1? • Fat is bright • White matter (inner part of brain) is brighter than gray matter (cortex or outer part of the brain) • Water (CSF) is dark

49. What is bright/dark on T2? • Water is bright • Blood is bright • White matter is darker than gray matter

50. CERVICAL CORD INJURY • Mostly involve cervical spine, include fracture dislocations • 5% of TOTAL Roadside accidents (RSA). • Cervical cord injury have lasting, neurological deficit & disability • The prognosis of cord injury has direct relation with mode of injury.