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Orthopedics radiography sanil
This document provides an overview of common musculoskeletal imaging modalities. It discusses plain radiography as usually the primary modality due to its wide availability, low cost, and ability to assess bone. Nuclear scintigraphy is described as sensitive for skeletal pathology but nonspecific. Ultrasound is noted to be useful for superficial soft tissues. CT is presented as excellent for bone assessment. MRI is outlined as the best modality for soft tissues but more expensive and less patient-friendly. Specific clinical examples are given to illustrate findings on each imaging type.
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Orthopedics radiography sanil
- 1. Musculoskeletal Imaging – TheBasics SANIL VARGHESE
- 2.
- 3. MSK Imaging –Imaging Modalities • • • • • Plain Radiographs Nuclear Scintigraphy Ultrasound Computed Tomography Magnetic Resonance Imaging
- 4. Plain Radiographs • • • • • Widely available Reproducible Patientfriendly ‘Inexpensive’ Usually the indicated primary imaging modality
- 5. Plain Radiographs • Standardprotocols available • Consider the pathology in question – Image area of question, not the vicinity • “One view is No view” • Supplemental views possible in most locations
- 10. Plain Radiographs -Obvious
- 11. Plain Radiographs –2 views
- 12. Plain Radiographs –2 views Posterior Dislocation
- 13. Plain Radiographs –Extra views Radial Head Fx
- 14. Plain Radiographs –Extra views Scaphoid Fx
- 15. 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
- 16. Nuclear Scintigraphy • Excellentfor specific pathologies – Osteomyelitis – Metastases – Not Multiple myeloma – Occult fracture • Reasonably reassuring – Normal is usually normal
- 17. 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
- 19. Nuclear Scintigraphy –Bone Scan Osteomyelitis
- 20. Nuclear Scintigraphy 2nd MTstress fracture
- 21. Ultrasound • Not availableat all institutions • Reproducible in trained hands • Excellent for superficial soft tissue elements including tendons and muscle • Patient friendly • Small to moderate expense
- 22. Ultrasound • Routine examroom 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
- 24.
- 25. Ultrasound – AchillesTendon Intrasubstance tear
- 26. Ultrasound – Patellartendon Proximal patellar tendonitis – Jumper’s Knee
- 27. Computed Tomography (CT) • • • • Widelyavailable Reproducible, although variety of techniques Excellent bone assessment Occasionally useful for soft tissue assessment • Patient friendly • Moderate expense • Interventional options
- 28. Computed Tomography • Usuallysupine 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
- 30. CT - Fractures Scaphoidfracture
- 31. CT - Dislocation LisFranc Fx/Dislocation
- 32. CT – Bonyanomalies Midsubtalar coalition
- 33. 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
- 34. MRI – AbsoluteContraindications • • • • Cardiac Pacemakers Electronic stimulators Metallic foreign bodies in the orbit Body habitus beyond limits of physical unit • Huge listing maintained in MRI facility
- 35. MRI - RelativeContraindications • • • • • • • Penile prostheses IUD’s Cardiac valves Berry aneurysm clips Retained bullet fragments Claustrophobia Huge listing in MRI facility
- 36. MRI • Usually performedwith 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
- 38.
- 39. MRI – Trauma FemoralNeck Fracture
- 40. MRI - Trauma Tearvastus medialis
- 41. MRI – InternalDerangement
- 42. MRI – InternalDerangement Supraspinatus tear= Full thickness, Full width Coronal PD Coronal T2
- 43. MRI – InternalDerangement Sagittal NL Sagittal FT, FW Supra
- 44. MRI – InternalDerangement Sagittal, Meniscus NL Posterior Horn Tear
- 45. MRI – InternalDerangement Bucket handle meniscal tear
- 46. MRI – InternalDerangement Sagittal – Intact ACL Torn ACL
- 47. Imaging • Plain radiographsare 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
- 48.