true or false – physical therapists are more cost effective than orthopedic doctors
true
true or false – physical therapist had better patient satisfaction then orthopedic doctors when treating musculoskeletal injuries
true
true or false –physical therapist used less imaging tools such as x-ray, MRI, CT scan, etc. then orthopedic doctors when treating musculoskeletal injuries
true
which of the following are true statements
a – regardless of whether or not physical therapist can order imaging, they need to be familiar with it
b– physical therapist must understand, indications, contraindications, limitations, risk, and benefits of imaging tools
c – physical therapist should be ready to provide a professional opinion suggesting the use of imaging in according to current practice guidelines
D – whenever the response to intervention is not consistent with the prognosis, additional testing may be indicated
E – all of the above
e
what does CPR stand for
clinical prediction rules
what are clinical prediction rules
these are tools designed to improve decision making in clinical practice
they help us make a diagnosis, establish a prognosis, and match patients with optimal interventions
they helped limit practice variations, in other words it focus us
e
what are the Ottawa ankle rules
indications for radiography if any of the following are present
bone tenderness at the base of the fifth metatarsal
bone tenderness at the navicular
inability to bear weight immediately and in the emergency department
true or false – for physical therapists to be successful in differentiable diagnosisthey must have a working knowledge of sensitivity, specificity, PPV, NPV, and likelihood ratios
true
what are some of the potential errors in diagnostic imaging
wrong population– asymptomatic
quality of the image, and interpretation
imaging of area of referred pain
timing
true or false – radiologists are physicians that specialize in radiology
true
true or false – radiographers are allied health professionals
true
true or false – radiologist read diagnostic images wrong 20 to 40% of the time
true
who invented the x-ray machine
William Roentgen
what did William Roentgen die from
radiation
what are the three things that are needed to produce an x-ray
x-ray beam
patient
x-ray film
true or false – x-rays used to be novelty attractions at
circuses and fairs
true
what kind of waves are used when using an x-ray
Gamma waves
how is radiograph performed
X – Ray beam emitted from cathode tube
beam strikes the body
x-ray beam is absorbed in different amounts depending upon the various densities of the tissue radiated
what do the black parts or darker portions of an x-ray film represent
total film exposure
what do the white areas represent in an x-ray
lack of film exposure
which part of the bone will be the most white
the diaphysis
what are the four major densities noted on x-ray in the human body
true or false – when analyzing an x-ray it is sufficient to hold the image toward a light or window
false
true or false – in general x-rays are viewed as if you are looking at the person in front of you
true
explain how x-rays or images are viewed from the side
lateral views are viewed in the same direction that the beam traveled
true or false – hands and feet are viewed from the dorsal aspects, digits up
true
where is this x-ray underexposed
toward the top
where is this x-ray underexposed
where the AC joint is supposed to be
what does INT mean
internal rotation of limb
what does EXT mean
external rotation of limb
what does Erect mean
up right
what does WTB mean
weight-bearing
what does Decub mean
decubitis - recumbent
what does INSP mean
inspiration
what does EXP mean
expiration
what is radiographic density
the amount of blackening on the radiograph or overexposure
the higher the amperage the higher the overexposure will be
the lower the amperage there will be underexposure
what is radiographic contrast
the difference among various adjacent radiographic densities
High contrast favored over low contrast for bones
what is the primary cause of blur in an x-ray
movement
why does this x-ray have a blurred spot and what is it caused from
involuntary perstaltic motion
what is radiographic distortion
the difference between the actual size of the object and the recording image
what is the percentage of radiographic distortion in x-rays
30%
what does ABCS stand for
alignment
bone density
cartilage spaces
soft tissue
why is it important to perform the ABCS approach to radiographic evaluation
to decrease the chance of error
what kind of fracture is this
boxer fracture
what does this x-ray reveal
a bone spur
what are the structures
growth plates
what are the arrows pointing to
screws that have been removed from the bone after surgery
what is general bone density
looks for distinct cortical edges (loss of distinct cortical image to soft tissue and bone = bone mass loss)
what is local bone density
looks for areas of increased density
what are texture abnormalities
when mineralization of the bone is changed the appearance of the trabeculae can look thin, delicate, coarsened, fluffy, smudged
this is a normal bone density scan
true
what does this x-ray/bone scan reveal
osteomalacia
what does this x-ray reveal
osteopoikilosis (spotty areas of calcification)
fluffy sclerosis – Paget's disease
what is Paget's disease?
disease that causes too much osteoblast activity– often seen in the skull
They look big, strong, stocky, but the bone is easy to fracture
Decalcification and loss of cortical bone
Lacy– delicate appearance of trabeculae-Cooley's anemia
DJD Knee - Sclerotic Subchondral Bone
osteomyelitis of the promixmal tibia
is this an x-ray of an adult or child? And how can you tell?
this is an x-ray of a child because you can still see the growth plates
is this a child's x-ray or an adult x-ray
child
gout– 1st MTP joint erosion
Gross soft tissue swelling
atrophy of the quadriceps
heterotrophic bone
This is often found in the hip, gluteal region, etc. paraplegics have a tendency to develop this condition
myositis ossificans
this mostly happens in the elbow or thigh areas
what are the Ottawa rules for the knee; indications
patient is older than 55 years old
tenderness at the head of the fibula
isolated tenderness of the patella
inability to flex in the to 90°
inability to weight bare 4 steps immediately after the injury and in the emergency room
Ottawa rules
what are the exclusion criteria for the knee
age less than 18 years
isolated superficial skin injuries
injuries more than seven days old
recent injuries being reevaluated
patient with altered level of consciousness
paraplegia or multiple injuries
what are the Ottawa rules for the ankle
bone tenderness at the posterior edge or tips of the lateral malleolus
bone tenderness at the posterior edge or tips of the medial malleolus
inability to bear weight both immediately and in the emergency department
explain how an arthrography is performed
contrast material is injected into the joint
media extends capsule and surrounding soft tissue
outlines the joint capsule
the goal is to see if any fluid escapes from the capsule, this would indicate a capsular tear
what joints are arthrography often used
shoulder, elbow, wrist, knee, and ankle joints
how is a myelography performed
contrast is injected into the subarachnoid space which mixes with cerebral spinal fluid
produces a radiopaque column
an x-ray is taken
what is the purpose of myelography
to reveal ruptured disc, spinal cord compression, spinal stenosis, inter vertebral tumor, canal obstructions, or nerve root injury
true or false – a CT scan is able to move through a 360° arc
true
true or false – CT scans can be 2-D and 3-D
true
true or false – CT scans use less radiation than an x-ray does
false
Uses higher doses of ionizing radiation but more defined areas
what will you be able to see better in a CT scan; soft tissue or bone
soft tissue differentiation is limited, best for bone detail
true or false – MRI advances have challenged CT scans, but CT still is superior for cortical bone detail
true
true or false – a CT scan is basically an x-ray on steroids
true
what kind of image is this
3-D CT scan
what kind of image is this
2-D CT scan
true or false – a bone scan requires radiopharmaceuticals that are injected intravenously and the radiopharmaceuticals are tissue specific
true
in a bone scan which tissue will absorb more of the radio pharmaceutical; abnormal bone or normal bone
abnormal bone
on a bone scan what color does normal bone look like
great
what are the indications for a bone scan
subtle stress fractures, bone tumors, bone infections, AVN, or unexplained bone pain
what kind of image is this and what condition does the patient most likely have
bone scan – rheumatoid arthritis
located images this and what condition does the patient have
bone scan – myositis ossificans
true or false – MRIs use large magnetic coils to transmit radio waves into the body
true
how are MRI images recorded
produces images by recording various vibrations frequencies (resonance) of different tissues
true or false – bone, articular cartilage, fibrocartilage, tendons, and that all vibrate at different frequencies and MRIs are able to pick up on these frequencies and produce an image
true
true or false – if the patient has a metal object in their leg, you should always use MRI to identify the object
false – MRI is contraindicated for presence of ferrous metals, or electrical implants
true or false – orthopedic implanted appliances are not ferrous and thus are not contraindicated for MRI
true
true or false – in an MRI orthopedic hardware will distort the image and create a reflection like appearance
true
true or false – adding a contrast dye to MRIcan increase ability to see rotator cuff tears, labral injuries, capsule, and soft tissue
true
what does T1 weighted mean in reference to an MRI
is used to best see detailed anatomy a soft tissue not high in water content ( muscle, tendon, bone)
what does T2 weighted mean in reference to an MRI
best to see structures with high water content, bursa, inflamed tendon,tumor, abscess. Remember T-2 = H2O – the 2 in H2O
what kind of image is this?and is it normal
MRI
normal
what kind of images this and is it normal?
MRI
abnormal
true or false – when using ultrasound you are able to look at the muscle, tendon movement, and muscle size in real time
true
ultrasound is excellent for viewing _______
a – knee injuries
B – ankle injuries
C – shoulder injuries – rotator cuff injuries
c-rotator cuff injuries
true or false – ultrasound is not so good for mensci, AC, ACL, PCL injuries
true
the success and quality of ultrasound imaging is dependent upon _____________
the skill of the operator
what is the cost of a myelogram of the spine
$1100
what is the cost of an MRI
$2000 – $3000
what is the cost of the CT scan of the lumbar spine
