Dr Mohamed El Safwany, MD.

Diagnostic Imaging for Rehabilitation Professionals

Intended Learning outcome and objectivesBecome familiar with various medical imaging modalitiesDemonstrate understanding of the advantages and disadvantages of different imaging modalitiesBe able to recommend the correct modality given a case studyIntegrate diagnostic imaging information into physical therapy practice

Why do physical therapist need to understand medical imaging?

• Clinical Reasons?How will it effect treatment?How will it effect prognosis?What about direct access?

• Research Implications?

Medical Imaging•Radiography

• Plain Film/ X-Ray/ Roentgen Rays• Computed Tomography (CT Scan)• DEXA• Bone Scan

•Magnetic Resonance Image (MRI)

Radiography

Basic ConceptsWhat is an X-Ray?

Electromagnetic Radiation - short wavelength

Professor Roentgen

Discovered accidentally in 1895

Experimenting with a machine that, unknown to him, was producing x-rays

Saw the bones of his hand in the shadow cast on a piece of cardboard in his lab

What Roentgen saw Today's ImageToday's Image

RadiodensityX-rays not absorbed,

screen produces photons when struck, and exposes the film, turning it dark

When an object absorbs the X-rays - fewer protons produced, film stays light

Radiopaque Radiolucent

A-B-C

A- Alignment- is the bone in good general alignment

B- Bone- general bone densityC- Cartilage- sufficient cartilage

spaceother stuff??

Muscles, fat pads and lines, joint capsules, miscellaneous soft-tissue findings, bullets

Alignment

Alignment

Bone

Bone

What do I need to look for in foot trauma?Distal tibia and fibulaF- fifth metatarsal base L- lateral process of the talus O- os trigonumA- anterior process of the

calcaneus T- talar dome

Cartilage

Viewing ImagesX-ray study named for the direction the

beam travelsAPPALateral

Orient film as if you were facing the patient, his/her Left will be on your Right

Views

Lateral Oblique

Superior articulating facetSuperior articulating facetTransverse processTransverse processPediclePedicleLaminaLaminaInferior articulating facetInferior articulating facet

Lumbar Spine, Oblique View

Lumbar Spine, Oblique View

“SCOTTY DOG”

Lumbar Spondylolysis

The defect‘lysis’ involves

the parsinarticularis

and can allowthe vertebra

above tosubluxforward

Still Alive?

…That was close

Viewing ImagesA radiograph is a two dimensional representation

Therefore, “One View is No View”Two views are needed, ideally at 90 degrees to one another for proper 3-D like interpretation

Radiograph revealed horizontal fracture of the lower patalla

To sum it upIt is however,

relatively much more important for a physical therapist to recognized the indications for diagnostic imaging, to select the most appropriate imaging study, and to image the appropriate areas

Computed Tomography (CT)•X-Ray beam moves 360 around the patient•Consecutive x-ray “slices” around the patient•Computer can recreate 3D image of the body•Best for evaluating bone and soft tissue tumors, fractures, intra-articular abnormalities, and bone mineral analysis

Computed Tomography (CT)

LV

VERTEBRAL BODY

SPINALCANAL

TRANSVERSEPROCESS

RIB

LUNGRA

LA

RV

AORTA

Magnetic Resonance Imaging (MRI)

What is a MRI?The use of a High Power Magnet (.3 -2.0 Teslas) To align hydrogen atoms in the body to which a radio wave frequency is applied to produce an image

Indications for MRI

Diagnosing multiple sclerosis (MS) Diagnosing tumors of the pituitary gland

and brain Diagnosing infections in the brain, spine or

joints Visualizing torn ligaments in the wrist, knee

and ankle Visualizing shoulder injuries Diagnosing tendonitis Evaluating masses in the soft tissues of the

body Evaluating bone tumors, cysts and bulging

or herniated discs in the spine Diagnosing strokes in their earliest stages

T1 Vs T2T1Tissue with high

water content will apear dark (grey)

T2Tissue with high

water content will appear white/ brighter

T1 vs. T2T1 image of knee T2 image of knee

Gastrocnemius

Semimembranosus

Popliteal vein

Quad Tendon

ACL

Knee - MRI Sagittal

ANTERIORCRUCIATE LIGAMENT

POSTERIORCRUCIATE LIGAMENT

PATHOLOGY

ACL Tear

Meniscus

Bow Tie Sign

Knee - MRI Sagittal

TORN POSTERIOR MEDIAL MENISCUS

Your MRI is showing

humerus

infrasp

inat

us

Scapula

Tere

s

min

or

supraspinatus

Deltoid

Clavicle

Glenoid labrum

Long Head of Triceps

Shoulder - MRI – Axial Plane

SupS

D

D

IS

Shoulder - MRI – Axial Plane

Shoulder - MRI – Coronal Plane

Supraspinatus

Rotator CuffSS Tendon

Fluid inJoint

Glenoid

Acr -- Clav

Shoulder

Supraspinatus Tear

Subdeltoid Bursa

Lumbar Spine - MRI

Coronal T1 Sagittal T1 Sagittal T2

Axial T1 body

Axial T1 disc

Axial T2 body

Axial T2 disc

Lumbar Spine – MRI Axial

Body

Psoas

Spinal Canal

Herniated disc

Lumbar Spine – MRI Sagittal T2

DEXA SCANLooks at bone mineral densities

The “image” however, is secondary the important information gathered is the bone mineral density

Skeletal Scintigraphy(Bone Scan)

Indication: Cancer, stress or hidden fractures

AssignmentTwo students will be

selected for assignment.

Text BooksDavid Sutton’s

Radiology

QuestionWhat are the basic

radiographic views needed for proper image interpretation?

Thank You