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Orthopaedic Imaging: An Aid to Decision Making

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  • 1. Orthopaedic Imaging:Orthopaedic Imaging: An Aid to Decision MakingAn Aid to Decision Making Thomas W. Grossman, Jr., M.D., FACSThomas W. Grossman, Jr., M.D., FACS Watertown OrthopaedicsWatertown Orthopaedics
  • 2. Medical Decision Making is a TriadMedical Decision Making is a Triad  History – from patients/recordsHistory – from patients/records  Physical ExaminationPhysical Examination  Confirming Studies – Imaging, Labs, etc.Confirming Studies – Imaging, Labs, etc.
  • 3. ImagingImaging  X-rayX-ray  UltrasoundUltrasound  CT ScanCT Scan  MRIMRI  Nuclear MedicineNuclear Medicine
  • 4. X-RAYX-RAY  Radiation SourceRadiation Source  Patient ExposedPatient Exposed  Capture ImageCapture Image  Interpret ImageInterpret Image
  • 5. X-RAYX-RAY  Ionizing RadiationIonizing Radiation  Radiation damages cellsRadiation damages cells  No limit on medical radiation exposureNo limit on medical radiation exposure  Limits on non medical radiation exposureLimits on non medical radiation exposure
  • 6. X-RAYX-RAY  Patient Blocks Transmission of RadiationPatient Blocks Transmission of Radiation  Soft tissues LessSoft tissues Less  Bones MoreBones More
  • 7. X-RAYX-RAY  Capture ImageCapture Image  FilmsFilms  DigitalDigital
  • 8. X-RAYX-RAY  Interpret ImageInterpret Image  RadiologistRadiologist  OrthopaedistOrthopaedist
  • 9. X-RAYX-RAY  Best for:Best for:  Hard tissueHard tissue  BonesBones  Often combined with other imagingOften combined with other imaging
  • 10. X-RAYX-RAY Fibula FractureFibula Fracture
  • 11. X-RAYX-RAY Fibula FractureFibula Fracture
  • 12. X-RAYX-RAY Fibula FractureFibula Fracture
  • 13. X-RAYX-RAY Fibula FractureFibula Fracture
  • 14. X-RAYX-RAY Femur FractureFemur Fracture
  • 15. ULTRASOUNDULTRASOUND  Sound SourceSound Source  Patient ExposedPatient Exposed  Image CapturedImage Captured  Interpret ImageInterpret Image
  • 16. ULTRASOUNDULTRASOUND  Sound SourceSound Source  SonarSonar  Can’t hearCan’t hear  TransducerTransducer
  • 17. ULTRASOUNDULTRASOUND  Patient blocks some sound wavesPatient blocks some sound waves  Transmits othersTransmits others
  • 18. ULTRASOUNDULTRASOUND  Capture ImageCapture Image  FilmFilm  DigitalDigital
  • 19. ULTRASOUNDULTRASOUND  Interpret imageInterpret image  RadiologistRadiologist
  • 20. ULTRASOUNDULTRASOUND  Determines Solid or Not SolidDetermines Solid or Not Solid  Limited UseLimited Use  Rotator CuffRotator Cuff  Knee CystsKnee Cysts  Deep Vein Thrombosis (blood clots)Deep Vein Thrombosis (blood clots)  Pediatric hips (DDH)Pediatric hips (DDH)
  • 21. ULTRASOUNDULTRASOUND Rotator CuffRotator Cuff
  • 22. ULTRASOUNDULTRASOUND Rotator CuffRotator Cuff
  • 23. ULTRASOUNDULTRASOUND Rotator CuffRotator Cuff
  • 24. CT SCANCT SCAN  Computerized Axial TomographyComputerized Axial Tomography  Similar to X-Ray except in slicesSimilar to X-Ray except in slices
  • 25. CT SCANCT SCAN  Radiation source rotates around patientRadiation source rotates around patient  Image capture rotates around patientImage capture rotates around patient  Computer collects and formats imagesComputer collects and formats images  Reformatting after the exam is possibleReformatting after the exam is possible
  • 26. CT SCANCT SCAN  Best For:Best For:  3 dimension anatomy3 dimension anatomy  SpineSpine  ShoulderShoulder  HipHip  Fractures in jointsFractures in joints  Hard TissuesHard Tissues
  • 27. CT SCANCT SCAN
  • 28. CT SCANCT SCAN HipHip
  • 29. CT SCANCT SCAN HipHip
  • 30. CT SCANCT SCAN HipHip
  • 31. MRIMRI  Non Radiation cross section imagingNon Radiation cross section imaging  Rapid cycling of powerful magnetic field createsRapid cycling of powerful magnetic field creates images (all atoms are weak magnets)images (all atoms are weak magnets) It finds water!It finds water!
  • 32. MRIMRI  Images reflect water contentImages reflect water content  Bones OKBones OK  Soft Tissues ExcellentSoft Tissues Excellent  MuscleMuscle  TendonTendon  LigamentLigament  DiscsDiscs  NervesNerves  Blood vesselsBlood vessels
  • 33. MRIMRI KneeKnee
  • 34. MRIMRI
  • 35. MRIMRI
  • 36. MRIMRI ShoulderShoulder
  • 37. MRIMRI
  • 38. MRIMRI
  • 39. MRIMRI
  • 40. NUCLEAR MEDICINENUCLEAR MEDICINE  Physiology – what is the body doingPhysiology – what is the body doing  Ionizing Radiation InjectedIonizing Radiation Injected  Patient emits radiation (delayed)Patient emits radiation (delayed)  Image capturedImage captured
  • 41. NUCLEAR MEDICINENUCLEAR MEDICINE  Technetium - binds to bonesTechnetium - binds to bones  Indium- binds to white blood cellsIndium- binds to white blood cells
  • 42. NUCLEAR MEDICINENUCLEAR MEDICINE  Detects ActivityDetects Activity  Bone is a living structureBone is a living structure  FractureFracture  CancerCancer  InfectionInfection  Does not always specify why activity occursDoes not always specify why activity occurs
  • 43. NUCLEAR MEDICINENUCLEAR MEDICINE  Dual Isotope StudiesDual Isotope Studies  TechnetiumTechnetium  IndiumIndium  Detection of InfectionDetection of Infection
  • 44. NUCLEAR MEDICINENUCLEAR MEDICINE
  • 45. NUCLEAR MEDICINENUCLEAR MEDICINE
  • 46. NUCLEAR MEDICINENUCLEAR MEDICINE
  • 47. Orthopaedic ImagingOrthopaedic Imaging  What Studies?, When?What Studies?, When?  X-Ray – common starting pointX-Ray – common starting point - Imaging bonesImaging bones - UltrasoundUltrasound - Solid or cystSolid or cyst - CT – 3D anatomy – joints & spineCT – 3D anatomy – joints & spine - MRI – soft tissue & edemaMRI – soft tissue & edema - Nuclear Medicine – What are the cells doing?Nuclear Medicine – What are the cells doing?