Orthopedics radiography sanil

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Orthopedics radiography sanil

  1. 1. Musculoskeletal Imaging – The Basics SANIL VARGHESE
  2. 2. Musculoskeletal Imaging Technology Advances in Imaging
  3. 3. MSK Imaging – Imaging Modalities • • • • • Plain Radiographs Nuclear Scintigraphy Ultrasound Computed Tomography Magnetic Resonance Imaging
  4. 4. Plain Radiographs • • • • • Widely available Reproducible Patient friendly ‘Inexpensive’ Usually the indicated primary imaging modality
  5. 5. Plain Radiographs • Standard protocols available • Consider the pathology in question – Image area of question, not the vicinity • “One view is No view” • Supplemental views possible in most locations
  6. 6. Plain Radiographs - Obvious
  7. 7. Plain Radiographs – 2 views
  8. 8. Plain Radiographs – 2 views Posterior Dislocation
  9. 9. Plain Radiographs – Extra views Radial Head Fx
  10. 10. Plain Radiographs – Extra views Scaphoid Fx
  11. 11. Nuclear Scintigraphy • • • • • Most common = Bone Scan Very sensitive for skeletal pathology Mildly sensitive for soft tissue pathology Usually nonspecific as an isolated test Mostly patient friendly; no significant environmental exposure • Small-moderate expense
  12. 12. Nuclear Scintigraphy • Excellent for specific pathologies – Osteomyelitis – Metastases – Not Multiple myeloma – Occult fracture • Reasonably reassuring – Normal is usually normal
  13. 13. Nuclear scintigraphy – Bone Scan • IV injection radioisotope (Tc-99m) bound to phosphate +/- dynamic imaging • Approx 3 hour delay • Delayed static imaging with a superficial detector
  14. 14. Nuclear Scintigraphy – Bone Scan Osteomyelitis
  15. 15. Nuclear Scintigraphy 2nd MT stress fracture
  16. 16. Ultrasound • Not available at all institutions • Reproducible in trained hands • Excellent for superficial soft tissue elements including tendons and muscle • Patient friendly • Small to moderate expense
  17. 17. Ultrasound • Routine exam room equipped with adequate imaging devices • Superficial gel (standard or aseptic) application with touch with transducer • Usually static exam of architecture +/vascularity assessment • Potential for dynamic imaging
  18. 18. Ultrasound Cephala d Ceph Caud Calcaneus Caudad
  19. 19. Ultrasound – Achilles Tendon Intrasubstance tear
  20. 20. Ultrasound – Patellar tendon Proximal patellar tendonitis – Jumper’s Knee
  21. 21. Computed Tomography (CT) • • • • Widely available Reproducible, although variety of techniques Excellent bone assessment Occasionally useful for soft tissue assessment • Patient friendly • Moderate expense • Interventional options
  22. 22. Computed Tomography • Usually supine axial exam, with some alternative positioning options • Can develop reformatted images after exam for alternative views • Imaging time in seconds, rarely minutes • Usually without IV or oral contrast
  23. 23. CT - Fractures Scaphoid fracture
  24. 24. CT - Dislocation Lis Franc Fx/Dislocation
  25. 25. CT – Bony anomalies Midsubtalar coalition
  26. 26. Magnetic Resonance Imaging • Widely available, but non-standardized imaging techniques • Reproducible • Excellent for soft tissue pathology • Good-excellent for bone pathology • NOT patient friendly • Large expense
  27. 27. MRI – Absolute Contraindications • • • • Cardiac Pacemakers Electronic stimulators Metallic foreign bodies in the orbit Body habitus beyond limits of physical unit • Huge listing maintained in MRI facility
  28. 28. MRI - Relative Contraindications • • • • • • • Penile prostheses IUD’s Cardiac valves Berry aneurysm clips Retained bullet fragments Claustrophobia Huge listing in MRI facility
  29. 29. MRI • Usually performed with patient supine • Multiplanar imaging obtained without changing position • One exam = one body part • Average exam time 45 minutes; most patients can’t last >2 hours • Strict guidelines for sedation • Optional contrast – Rad usually decides for body imaging
  30. 30. MRI – Trauma Osteochondritis dissecans
  31. 31. MRI – Trauma Femoral Neck Fracture
  32. 32. MRI - Trauma Tear vastus medialis
  33. 33. MRI – Internal Derangement
  34. 34. MRI – Internal Derangement Supraspinatus tear= Full thickness, Full width Coronal PD Coronal T2
  35. 35. MRI – Internal Derangement Sagittal NL Sagittal FT, FW Supra
  36. 36. MRI – Internal Derangement Sagittal, Meniscus NL Posterior Horn Tear
  37. 37. MRI – Internal Derangement Bucket handle meniscal tear
  38. 38. MRI – Internal Derangement Sagittal – Intact ACL Torn ACL
  39. 39. Imaging • Plain radiographs are usually the starting point • Most x-ray protocols work for most situations; Consider suppl. Views • Secondary imaging techniques have specific advantages and disadvantages • A specific question is more likely to get you a direct answer • When in doubt, ask a Radiologist
  40. 40. THANK YOU Sanil Varghese

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