Musculoskeletal Imaging 09

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Musculoskeletal Imaging 09

  1. 1. Normal Musculoskeletal Imaging Prof. S. Sager, MPAS, PA-C
  2. 2. Normal Musculoskeletal Imaging  Upon satisfactory completion of this lecture, and in conjunction with textbooks, lecture handouts, WebCT, and recommended internet web sites, the student will be able to: • Recognize normal X - ray anatomy of the skeletal system
  3. 3. X - Ray Basics: Radiopaque vs. Radiolucent
  4. 4. X - Ray basics: The four basic densities
  5. 5. Normal Bone Imaging  An X-Ray is a three dimensional summation of densities, seen as a two dimensional image
  6. 6. Normal Musculoskeletal Imaging
  7. 7. How to study radiographs  Be systematic.  Compare densities.  If in doubt, order a contralateral view.  Is this an adult or child?  What was the gender?  What was the social status?
  8. 8. Normal Musculoskeletal Imaging  Most common views: • anteroposterior (AP) • lateral (Lat)  An oblique view of the lumbar spine exposes the patient to 5 times as much radiation as the AP and lateral views. • “Do I really need this test?”
  9. 9. Normal Musculoskeletal Imaging The Skull & Face
  10. 10. AP View Frontal sinuses Ethmoid sinuses Orbital floor Nasal septum Maxillary sinuses
  11. 11. Skull (lateral view) Frontal sinuses Maxillary sinuses Sella turcica Nasopharyngeal airway
  12. 12. Face (lateral view) Frontal sinuses Sella turcica Sphenoidal sinuses Maxillary sinuses Temporomandibular joint Nasopharyngeal airway
  13. 13. Water’s view
  14. 14. Caldwell Projection
  15. 15. Nose (frontal) Nose (lateral) Zygomatic arch
  16. 16. Maxilla
  17. 17. Mandible
  18. 18. Sella Turcica (lateral view)
  19. 19. Base of the skull
  20. 20. CT head
  21. 21. Normal Musculoskeletal Imaging The Spine
  22. 22. Normal Musculoskeletal Imaging
  23. 23. Normal Musculoskeletal Imaging
  24. 24. Cervical spine imaging  You must see all seven vertebrae  “Portable cross-table” is the most common initial X-ray taken in ED  Used to “clear” possible neck injuries
  25. 25. Cervical spine imaging
  26. 26. Thoracic spine imaging
  27. 27. Lumbar spine imaging
  28. 28. Normal Musculoskeletal Imaging The Pelvis
  29. 29. Normal Musculoskeletal Imaging The Chest & Ribs
  30. 30. Specifics of CXR assessment Airway and adenopathy:  • assess the airway, inspecting the trachea and mainstem bronchi and looking for deviation or evidence of luminal obstruction • assess adenopathy (either peritracheal or hilar) Bones and breast shadows:  • inspect the bones for radiographic density, fractures, lytic lesions, or bony deformity • evaluate the breast shadows for gross symmetry, evidence of prior surgery, and any gross calcifications Cardiac silhouette:  • assess the cardiac silhouette for general size and contour Diaphgram:  • assess the hemidiaphgrams with attention to the contour and costaphrenic angle Everything else:  • review everything else around the lung fields including the subcutaneous soft tissues and pleural boundaries Fields:  • assess the lung fields themselves looking for evidence of infiltrate, mass, and pattern of vascularity
  31. 31. Normal Musculoskeletal Imaging Upper Extremity
  32. 32. Shoulder joint (A/P view)
  33. 33. Shoulder joint (Erect view)
  34. 34. Scapula (AP view)
  35. 35. Scapula (lateral view)
  36. 36. MRI Shoulder
  37. 37. Upper arm (AP view)
  38. 38. Upper arm (lateral view)
  39. 39. Elbow Joint (AP view)
  40. 40. Elbow Joint (lateral view)
  41. 41. Forearm (AP view)
  42. 42. Forearm (lateral view)
  43. 43. Wrist (AP view)
  44. 44. Wrist (lateral view)
  45. 45. Hand (AP view)
  46. 46. Hand, Oblique view
  47. 47. Navicular (Scaphoid views)
  48. 48. Normal Musculoskeletal Imaging Lower Extremity
  49. 49. Proximal femur  fovea capitis  femoral neck  greater trochanter  lesser trochanter  epiphyseal line  intertrochanteric line
  50. 50. Hip (AP view)
  51. 51. Hip (lateral view) (Lauenstein’s view)
  52. 52. Femur (AP view)
  53. 53. Femur (lateral view)
  54. 54. Knee joint (AP view)
  55. 55. Knee Joint (lateral view)
  56. 56. Lower leg (AP view)
  57. 57. Lower leg (lateral view
  58. 58. Ankle Joint (AP view)
  59. 59. Ankle joint (lateral view)
  60. 60. Foot (AP view)
  61. 61. The X-ray in photo C belongs to which of the following patients? 2-year-old 1. 0% 6-year-old 2. 0% 10-year-old 3. 0% 15-year-old 4. 0% 20-year-old 5. 0%
  62. 62. The arrow is pointing to which of the following structures? Scaphoid 1. 0% Talus 2. 0% Calcaneus 3. 0% Fibula 4. 0% Lateral malleolus 5. 0%
  63. 63. Thought for the day… We can’t direct the wind…but we can adjust our sails!

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