Download Osteopenia – loss of bone mass (used more of a descriptive word)

DX Imaging MT Notes
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Osteopenia – loss of bone mass (used more of a descriptive word)
 Lytic bone cancer, osteoporosis
Radiolucent – an object that allows x-ray to pass through readily (air is the most
radiolucent)
Contrast (image) – the number of the shades of gray (kVp controls this and helps when
taking images in different areas of the body)
Contrast (i.e. orally taken) – radiopaque medium (barium is the metal)
 Could also do a venogram or ateriogram (blood), angiogram, mylogram
(dura mater), airway distribution, digestive system,
Differential Absorption – the most radiolucent to most radiopaque things (attenuating
properties of an object)
 Air – most radiolucent
 Water
 muscle
 fat
 Trabecular or medullar bone
 Cortical bone
 Metal – most radiopaque
Attentuating technologies – what will help make the best picture in the area that you are
taking the picture. Go off of how much of the beam stays in the patient. Beam in less
beam out. Tomography, CT, x-ray plain film (pf).
Metastasis – primary process that has spread to a distant location (seen in infection,
cancer, and soft tissue calcification)
Hounsfield Units – CT unit measurement (how much makes it from the sender to the
receiver) these are used to decide what number each pixel gets. We will use these to
decipher a bone window from a soft tissue window
Hematopoiesis - making red blood cells, made in the bone marrow. Older patients will
have decreased RBC production capacity and normally have a 1 to 1 ratio. Younger
patients have a higher ratio. Red marrow stays the longest at the ends of the long bones.
Image based upon mapping protons – MRI, patient emission study. FM radio
frequency. Cortical bone = black, because no mobile hydrogen. CSF = black or white,
depending on T1 or T2.
 It all depends on when you listen. When fat is dark fluid is white.(T2)
When fluid is dark and fat is white. (T1)
Osteoblastic bone activity – bone scan, hot spot – increased blood flow, patient has
radioactive material present in them
Two types of bone production
* These notes are not all inclusive – make sure you read the assigned material and know
the cancer chart as gone over in class
DX Imaging MT Notes
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Intramembranous – one layer at a time with active bone growth out of
the endosteum and periosteum. This growth will add diameter to long
bones and flat bones except occiput, ribs, and portions of the pelvis. This
type of growth never ends
 Initiated by proliferation of mesenchymal cells about a network of
capillaries. Collagen fibers and ground substance join in forming a
mesh-like matrix. The cells enlarge and become arranged in layers.
Enchondral – the epipheseal plate (growth plate, phisis) normally below
the epiphysis. This type of production ends at a point in life. The phisis
will show up as a black line on x-ray.
 Formed around primary ossification centers. Use a non-ossified
matrix as a framework. Osteoblasts and osteoclasts form and
become imbedded. Cell death is followed by ossification.
 ZPC - zone of provisional calcification - the most mature layer of
the phisis or the least mature layer of the metaphysis
 Start with mesenchyme, then there is cell death and replacement.
From osteoid to completely ossifying. Blood supply comes from
the middle first through a nutrient foramen. Next, the ends will get
blood supply from the outside. (Before this direct blood supply the
blood went through the phisis.
 Skeleton of the newborn contains primary ossification
centers and non-ossified cartilage.
 FEMUR HEAD - there are 2 growth plates at the head. As the
child grows the apophysis and epiphysis grow. The apophysis has
muscles and tendons attached to it and is the tubercle at the top of
the femur bone. The epiphysis is the femur head and is known as
the articular cartilage.
 Epiphisis - articular cartilage
 Apophysis - where tendons and ligaments attach.
Joint
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The synovial joints first form as condensations of mesenchyme cavitation,
chondrification, synovial differentiation, and finally ossification
completing the joint.
Growth plate responsible for lengthening
Sutures
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Maxillary sinus - is small when you are young, but builds to make a sharp
edge as you get older
The mastoid is not developed in the young
5 Regulators of bone
1. Calcium regulators - parathormone, 1,25-dihydroxyvitamin D, calcitonin
i.
Parathormone
1. Directly acts on renal tubules and makes them more
conservative with urine
2. Acts on kidney to activate 1,25 dihydroxyvitamin D
* These notes are not all inclusive – make sure you read the assigned material and know
the cancer chart as gone over in class
DX Imaging MT Notes
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3.
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3. Goes to skeleton and weakens the bonds within the boney
matrix, this allows the osteoclasts liberate or withdraw
more calcium per unit time. (softens bone)
ii.
1,25-dihydroxyvitamin D - helps to capture more calcium in
digestion
iii. Calcitonin - works in opposition to parathormone (decreases
calcium in blood stream and allows calcium to be secreted through
urine, it also inhibits the production of 1,25-dihydroxyvitamin D
Maturation Hormones - glucocorticoids, insulin, thyroxin, androgen,
estrogen, ad growth hormone
i.
Estrogen - if this is too high the lady will go through premature
maturation and can cause a person to be shorter than normal, since
there is a premature closure of the growth plate
ii.
Growth hormone - responsible for the lengthening of the bone
1. Acromegaly - frontal bone, hands can still grow
iii. Androgen & Estrogen - control growth plate
Growth factors - somatomedin, epidermal growth factor, plateletderived growth factor
Somatomedin - major regulator in bone regulation
i.
Local factors - prostoglandinE2, interleukins
Ions-calcium and phosphate
i.
Calcium phosphate exist in a 2-1 ration and is responsible for the
building and breaking down of bone
Normal changes in the maturing skeleton
 pseudotumor of the growth pelvis…really a growth center
You must know basic x-ray anatomy - handout given on what is testable (outline)
The use of radiology in your practice
Documentation is the frame of mind that Dr. Kuhn would like you to have. There is some
risk around radiology. There is absorption of the x-ray in the body. From this there is
risk.
 First get to know them, find out what their goal is and possibly where I can help.
 New patient information form
o OPPQRST - this provides an easy way to learn a lot. This will provide
information that will make a difference, and if you can put it into a
conversation that is where you become very good at this.
 Orthopedic exam, Neurologic exam, and chiropractic specific
exam
 Having the above will give you the Differential Diagnosis - possible (probability),
you are taught this at Logan and this is so you get a fast and usually accurate
diagnosis
 We are in a cost containment health care system
* These notes are not all inclusive – make sure you read the assigned material and know
the cancer chart as gone over in class
DX Imaging MT Notes
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Overall
 Meet the NP, OPPQRST, Past medical history, family history, local information,
diff. Diagnosis, testing strategy, rule in or rule out diagnosis, treat, look for results
or changes
 Imaging is used for documentation and additional testing past the physical exam
of the patient
Another time to take a X-ray
 If there is a trauma you would not immediately x-ray, there are some other things
to look for, but usually a x-ray may still be warranted.
 A patient may request the x-ray too
Who owns the film?
 The patient does not own it. The doctor owns the film, unless a business has an
agreement with the doctor. If you let it out of your hands and you have to bring it
up for some reason and cannot, you are the one in trouble.
 The patient owns the information….that's what they pay for, which is usually 2
bills
o Technical
o Service
 X-ray report - where you document findings on the x-ray
o There should be some order to it all.
o Heading
 Stationary - this includes header of business name, location, and
how to get in communication and who actually read the film
 Patient information - name or identification, age of patient, date of
x-ray taken
 *optional* - Technique - kVp/MAS used
 Views - which ones did you use to get to the conclusion
o Body / Finding
 Use descriptive language (the femoral acetabular joint….) for the
picture you see
 Impression - DJD of the hip
 Differential Diagnosis - possibility or probability
o Recommendation
 What you think the doctor could do to resolve the problem
 Possible resolutions for what is present in the patient
o How do we use this report or what is it used for?
 Report of findings
 What is happening with the patient?
 Insurance coverage
 The patient may want to read or see this
 3rd party payers
 Lawyers
 Research
* These notes are not all inclusive – make sure you read the assigned material and know
the cancer chart as gone over in class
DX Imaging MT Notes
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This report can be used to replace a lost film. It is the only legal
way.
Any licensed health care professional can do a report. Every x-ray should
have a report, and the report is needed if you plan to bill for it.
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Why would you want to read your own films?
o If you read your own you can treat now. Convenience or make money?
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Why send the films out?
o So you do not miss something
o So the patient gets the best care possible.
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Accuracy in reading films
o 660 participants in this sampling
o 21 different standardize cases
o Different types of practices, yet the same
 71% accuracy is the top and Chiropractic Radiologists is that type
of person
 51% for General Medical Radiologist
 28% Chiropractic Students
 5.75% Medical Students
What is the patient’s best interest?
What type of liability is out there?
General practice
Specialist
3 types of people to interpret films
 D.C. only (level of liability is as a radiologist)
 Specialist only (level of liability is as a general practitioner)
 D.C. and specialist (level of liability is as a radiologist)
Anatomy can be used as a match part for the Exam
Basic rules for interpretation
Plain films are a 2 dimensional gray scale image of a 3 dimensional anatomical structure
4 basic densities
Metal
Air
Water
Bone
* These notes are not all inclusive – make sure you read the assigned material and know
the cancer chart as gone over in class
DX Imaging MT Notes
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Rule of thumb for radiographs: minimum of 2 views that are offset by 90 degrees for any
body part
ABCS search patterns
AP view of open mouth
 This is the most used recent film series
 Atlanto-occiptal joint, lateral masses of C-1, odontoid process, C2, atlantoaxial joint, dens, pedicle (attachment site of the posterior
element),
 Lateral Cervical - important assessment of this
 Cervical Oblique - taken to see the foramen
o Neuronal foramina, apophyseal joints, intervertebral disc space,
 Anterior or posterior oblique possible
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Anterior and posterior for cervical and do lumbar in positioning
Cervical Oblique
o LPO - looking at right foramen of the cervicals (left posterior oblique)
 15 degrees cephalid tube tilt
o LAO - looking at right foramen of cervicals (left anterior oblique)
 15 degrees caudal tube tilt
Posterior Anterior Chest
o The bigger the kyphosis the more we will superimpose ribs on top of each
other
o Check for the ribs. Once you think you found the 1st rib, check for any
other ribs above that.
o Also look for ribs superimposed under clavicle
AP lumbar
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Body, pedicle,
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Parallel ileum tells all
Scotty is always looking to the right
LAO
Normal Wrist (this could be on Comp Boards II)
o Some lovers tri positions that they can't handle (start at thumb)
o Scaphoid, lunate, triquetrum, pisiform, trapezium (at the base of the
thumb), trapezoid, capitate, hamate
Possible Questions
Which of the following is true regarding chamberlain's line?
 Dot on hard palate and back of foramen magnum
 Very good if you have tomography available
* These notes are not all inclusive – make sure you read the assigned material and know
the cancer chart as gone over in class
DX Imaging MT Notes
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It is harder to draw than McGreggor's line
McGreggors line - uses back of hard palate and you are looking for a sliver of bone that
divides the oropharynx and nasopharynx to the base of the occiput.
Never found an author that is not concerned about the odontoid being over 10cm above
McGreggors line.
Which of the following is true with regard to Hadley's "S" curve?
 Done on lumber films
 May be used for AP and oblique views
Some fill in the blank, short answer. MC, 4-5 hard ones, on the TEST coming soon.
Seven Categories of bone disease (VICTANE) *****
 V - (Vascular) Hematologic
 I - Infections
 C - congenital
 T - Trauma
 A - Arthritis
 N - Neoplasm (tumor)
 E - Endocrine, metabolic, nutritional
Predictor Variables (7.3 or 7.4)
 Analysis of the lesion
 Skeletal location
 Position within bone
 Site of origin
 Metaphyseal - tumor (do to slow blood flow) & infection
 Shape
 If round this is a bad thing
 Size
 Margination
 Sharply marginated lesion ( this usually means the thing is
benign
 Cortical integrity
 Behavior of the lesion
 Pain? Pattern?
 Matrix
 Does it turn fibrous
 Periosteal response
 Periosteal lifting - in adult…not good
 Soft tissue changes
 Broad, displacement of muscle, sub periosteal bleed
 May lead to look at joints in RA
* These notes are not all inclusive – make sure you read the assigned material and know
the cancer chart as gone over in class
DX Imaging MT Notes
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Joint Changes
Preliminary Analysis
 Clinical data: age, sex, race, history
 Reiter’s syndrome - 50:1, Men:Women
 Number of lesions
 Symmetry of lesions
 Systems involved
Supplementary analysis
 Other radiologic procedures
 Laboratory examination
 Biopsy
Osteolytic, osteoblastic, or both
 Osteolytic Geographic lesion
 Solitary, greater than 1 cm, sharp margin
 Permeative lesion - pinhole destruction
 Multiple, lass than 1mm, imperceptible transition
 Motheaten lesion  Multiple, 2-5mm, ragged margins and coalescence (merge
borders)
Osteoblastic behavior
 Diffuse lesion
 Localized lesion
KNOW THE CHART ON AGES and CANCER (7.5) p695
Aggressive vs. Benign
Aggressive
 Primary vs. Secondary/metastasis
 Primary
 Larger size
 Monostotic
 Cortical destruction
 Spiculated (sunburst) periosteal rxns also…(solid, codmans,
laminated)
 Motheaten or permeative
 Imperceptible margins
 Soft tissue Mass
 Some matrix
 Secondary
 Larger size
 Polystotic
 Cortical destruction
 NO periosteal rxns
 Motheaten or permeative
 Imperceptible margins
 No matrix
* These notes are not all inclusive – make sure you read the assigned material and know
the cancer chart as gone over in class
DX Imaging MT Notes
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Benign
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Discovered early usually
Found incidentally usually
Smaller size
Monostotic
None, solid, laminated, codmans (all types of periosteal rxns)
Geographic lesion
Sharp Margins
Thick Matrix
Age, Size, Monostotic (one place), Polystotic (multiple places), Cortical destruction,
periosteal rxns (Solid, Laminated, Spiculated, Codman's), Destruction (geographic,
motheaten, permeative), Margins (sharp, imperceptible), Matrix, Soft tissue mass, Joint
space
Infections - do not respect anything, go through everything, effects joint space
Tumor - will respect some things and usually does not affect joint space
Panorex View
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a piece of film that has been curved
This used to only be found in the ER
Plain Film strengths
 Availability
 Relatively low cost
 Well known usage's
 Entry level diagnostic tool
 Search for contraindications to further imaging
 Quick assessment of gross osseous and soft tissue integrity
Plain film weakness
 Ionizing radiation
 Just be present that you are putting radiation into someone's body
 Relatively poor resolution (50% of bone must not be present to show on
the plain film as a loss of bone)
 Poor spatial localization
 Soft tissues generally not seen
 Frequently fail to document fractures, even under ideal conditions
Plain Film study may be limited by:
 Poor patient positioning
 Patient motion
 This is with any radiographic tech
 Incomplete series
* These notes are not all inclusive – make sure you read the assigned material and know
the cancer chart as gone over in class
DX Imaging MT Notes
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Trauma patients, the elderly may not be able to cooperate during the exam
C1-C2 region tough to evaluate
C6-C7 region also tough to evaluate
Lower lumbars are also hard to shoot through
Weak chemistry and additional errors can cause problems
Plain film proper use
 Introductory study
 Can evaluate intervertebral foramen well
 Use to rule out contraindications for advanced imaging
 Metal present…no MRI
 Not good for central canal stenosis
Tomography - this type of film is missing some of the anatomy that should normally be
present.
 Linear
 Circular
 Elliptical
 Hypocycloidal
 Trispiral
 9.5 is centimeters above the table (this number is on the lower corner of
the Tomography. This was not a CT though.
Myelography
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Air was the 1st contrast agent used
 This caused headaches if the air got into the brain.
Other materials include poppy seed oil, pantopaque
 Slow movement, thick oils. However, not soluble in water so all of
it had to be removed after study was completed.
In the 1940's water soluble products (very toxic)
 1970 metrizamide non-ionic, water soluble, in use today
 Arachnoiditis was a common effect of the very toxic products
Complications
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Arachnoiditis
Infections - if the inject site does not get better , then infection is a
probable cause
Arterial bleeding
Headache is the most common complication - due to puncture of the dura
and getting blood into the CSF
If they are getting a CT myelogram, make sure they take someone to go with them.
Image production
 Utilizes ionizing radiation
 Depends on displacement of contrast
* These notes are not all inclusive – make sure you read the assigned material and know
the cancer chart as gone over in class
DX Imaging MT Notes
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Differential absorption
Image Capture
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Video, plain film,
Proper use of myelography
 If CT or MR are not available
 Patient who cannot undergo MRI because of time, size, claustrophobia,
other contraindications (metal)
 May be used in conjunction with CT
 CT myelogram
 When injecting the fluid you would want to put it in the lumbar L4 or so to
avoid the conus medularis
 Most sensitive in finding the true positive in disc herniation
Myelography Weakness
 Ionizing Radiation
 Relatively Poor Resolution
 Soft Tissues Not Well Seen
 High Rate of False Negatives
 Potential Complications from Contrast Film
Bone Scan
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Use a phosphate compound of some kind (phosphate is integral to bone
formation and destruction
Osteoblastic activity is detected with this study
The hottest spots will be at the growth plates and at the sites of fracture
repair, fracture can be hot for up to 18 months
Whole body dose even if a regional bone scan
Phases of bone scan
 Radionuclide - providing a dose that is using a carrier molecule to the
place that you are looking at. In this case it is the bone.
 You inject this into a vein, starting the vascular phase.
 It will then start going into the bone after it goes through the heart and into
the arteries.
 Anywhere there is osteoblastic activity this is laid down.
 Lytic Cancers will show up as a hot spot
 When a hot spot there is positive osteoblastic activity
Computerized Tomography Technical Aspects
 Ionizing radiation
 Image based on absorption differentials
 Computer generated pictures
 Hounsfield Unit (the color that the pixel takes)
 Pixels (surface)
* These notes are not all inclusive – make sure you read the assigned material and know
the cancer chart as gone over in class
DX Imaging MT Notes
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Voxel (true representation of the anatomy)
Volume Averaging
Slice Thickness Scout Films (first film shot to determine thickness)
16 shades of grey in the CT scan
CT Strengths
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Widely Available
Improved Visualization of Soft Tissues
Can Provide three dimensional Imaging
Image Manipulation possible
May be combined with myelography
Accurately measure a variety of structures
CT Weakness
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Higher cost
Ionizing radiation
Intracranial artifacts
Artifacts secondary to metallic
Dose is a consideration
CT Proper use
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Very good axial images
Some application in the neurology work up
Excellent bone detail
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Although MR imaging is fast becoming the dominant modality for cross
sectional musculoskeletal imaging, the availability, speed, and versatility
of CT continue to make it a mainstay in emergency NMS imaging.
When a plain film isn't enough, CT can often delineate additional findings
that lead to the correct diagnosis and triage
Helical CT
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SPECT / Pet Scan
 Single photon emission computerized tomography (SPECT)
 This makes layers out of a bone scan image
 Positron emission tomography (PET)
MRI Technical Aspects
 Magnetic Resonance Imaging Technologies developed from nuclear
resonance which is used to Evaluate Chemical Composition of Laboratory
Samples
 Raymond Damadin First produced a Full body MR image in 1976
Radiofrequency (RF) coils
 Placed on or near the area of interest
 Used to excite target tissue
* These notes are not all inclusive – make sure you read the assigned material and know
the cancer chart as gone over in class
DX Imaging MT Notes
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Also receives information regarding Hydrogen Nuclei Relaxation
There are different kinds for each body part. They are expensive too.
Image Production
 Hydrogen is a charged particle representing 80% of all the atoms in the
body
 Hydrogen behaves like a small bar magnet
 They are randomly orientated and their charges cancel out
 The MR scanner can spatially locate hydrogen within the body
 In the strong magnetic field of the MR Unit, the hydrogen molecules tend
to align with (or less often against) the field
 Dr. Kuhn does not really see any issues with using MR, but does not agree
totally that there is no risk. There is no such thing as a free lunch.
 The hydrogen molecules are not held static, but are induced to
demonstrate precession (wobble)
 They are aligned with the magnetic field
 A strict linear relationship between the MR magnetic field
 The larmor equation forms the foundation for MR imaging
Resonance
 Energy must be added to the system RF identical to the larmor frequency
is pulsed into the patient. This is the concept of resonance. This causes the
aligned hydrogen atoms to precess in phase. The RF pulse is turned off
and the "excited" hydrogen atoms undergo "relaxation". This release of
excess energy is in the form of RF and specialized antenna (surface coils)
receive the input. Tremendous computer power is now brought to bear and
an image is reconstructed.
Imaging techniques
 The appearance of the image on an MR study is directly related to the
signaling hydrogen. High signal intensity appears bright and Dark areas
represent areas of low signal intensity.
 Intensity of the signal is determined by the quantity of mobile hydrogens
and two magnetic relaxation times. T1 and T2
 Manipulating the repetition of administered RF pulses (repetition times,
TR)
 And collection of the emitted RF signal (echo time TE)
 This is how we recognize the difference between T1 and T2
MR pulsing sequences
 T1 = Short TR and Short TE
 T2 = Long TR and Long TE
 Proton = Long TR and Short TE
T1 protocols utilized
 TR's of 200-600 milliseconds approximately
 TE's lasting approximately 25 milliseconds
 T2 images are very time consuming protocols and have long TR's and
long TE's
* These notes are not all inclusive – make sure you read the assigned material and know
the cancer chart as gone over in class
DX Imaging MT Notes
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Hybrid images have been developed to take advantages of T2 type images
with greater economy of time
MRI strengths
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Superior resolution
Superior tissue contrast
Images soft tissue very well
Non contrast enhancement in the spinal canal
Axial images OK
Coronal, sagittal, etc. Images are superior
MRA can produce Non contrast visualization of major and minor vessels
Measurements may be accomplished
MR reports on the physiology as well as anatomy
Not reliant on attenuation of ionizing radiation
No known harmful effects
Cheat Sheet handed out.
MT known what is MR or CT
Final and next TRI known T1 T2 and so forth
Fat bright on T1 and not really available on T2
Nucleus pulposes is blank on T1
Air is black on both
Cortical bone will be black on T1 and T2
THE STUFF ABOVE IS SOME STUFF FROM THE CHART, BUT DO NOT
MEMORIZE THE CHART.
MRI Contraindications
 Pace makers - not that it is made of ferris metal, but can it operate under
the magnetic field
 Ear implants  Miscellaneous implanted electronic devices - insulin pumps
 Cerebrovascular clips
 Machine shop workers
 Claustrophobia
 Orthopedic implants (distorts Gaussian field)
MRI contrast
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Non-iodinated: adverse reactions very rare
Magnetic contrast agents
 Gadolinium is the most common agent
 Works as a T1 shortening agent which causes tissue
containing gadolinium to appear bright on T1
 Very useful in cases of
 CNS Tumor
 Multiple sclerosis
 Disc herniation vs. Scar tissue
* These notes are not all inclusive – make sure you read the assigned material and know
the cancer chart as gone over in class
DX Imaging MT Notes
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Fasting imaging protocols in MRI IMPROVE
o Until recently the utility of MR in trauma has been limited by cost,
availability, and the data acquisition time
o Rapid imaging is now more available and these units are increasingly
being located near the ER. Improved software and hardware threaten to
alter current practices despite the stranglehold of insurers
o 1.5 Tesla magnet is considered the minimum
o More widely accepted in extremity trauma
o Many authors believe that MR should be used with more regularity in the
acutely injured spine
 ST injury more likely to be identified
o Any case presenting with neurological signs should be examined by MR
 This is the best use for MR
Know that MRA is for head injury and vascular stuff
MRA (Magnetic Resonance Angiogram)
 NO contrast
 HUGE ADVANTAGE
fMRI (functional MRI)
 Blood Oxygenated Level Dependent (BOLD) imaging
 Physiologic Processes may be observed
 Cortical activation
 Look at how the brain responds to stimulation
 Retinoptic organization of the visual cortex
 Saw how the back of the cortex lights up when using the
eyes
 Cerebral basis for language
 Mapping of the motor cortex
 Memory
 Study psychiatric disorders
 fMRI advantages over PET scan
 Lack ionizing radiation
 Less expensive
 Widely available
 Studies can be frequently repeated
ABC's of Quality Control
 Anatomy - is the entire region depicted on the radiograph
 Bone - search for signs of patient motion and evaluate technique
 Cartilage - reminds us to look into the various joint spaces which may
become obscured by positioning errors
 Arthritis, lines, joint spaces
 Soft tissues - helps evaluate technique and signs of injury or pathology
* These notes are not all inclusive – make sure you read the assigned material and know
the cancer chart as gone over in class
DX Imaging MT Notes
16 of 16

Collection of blood, tumors
ABC's of interpretation
 Anatomy - look closely at the vertebrae subinventory
 Bone - cortical and trabeculae destruction
 Cartilage - decreased joint space, arthritis
 Soft tissue - looking for things that are obliterated or mass objects such as
cancer
Know background thinking of where X ray will fit into your practice.
 Could I use X-ray to help determine the diagnosis
What view do we use to look at IVF's = oblique view
1. Which of the following imaging modalities allows for manipulation of the image
to enhance or suppress bone detail using the information stored on a computer
disc?
2. Which of the following is a feature of benign lesions?
3. Which of the following is true regarding hadley's S curve?
4. Which is most likely to be associated with lesions in multiple areas
5. Which imaging modalities uses the patient as the emitter?
a. Photons - bone scan
b. Protons - MRI
6. 3D imaging best done in the coronal plane - MRI
7. CT - best for bone and taken in sagittal position
8. Bone scan - infection, fracture, pathology (osteoblastic activity)
9. How do you tell MRI from CT? Look at the cortex of bone
Slide Exam is timed and in the first hour
NO QUESTIONS
25 questions
15 MC
10 Fill in the blank
X-ray anatomy, structure, types, lines and what they mean
Written Exam 4th hour Tuesday
* These notes are not all inclusive – make sure you read the assigned material and know
the cancer chart as gone over in class