Orthopedics radiography sanil

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  • 1.Musculoskeletal Imaging The Basics SANIL VARGHESE

2. Musculoskeletal Imaging TechnologyAdvances in Imaging 3. MSK Imaging Imaging Modalities Plain Radiographs Nuclear Scintigraphy Ultrasound Computed Tomography Magnetic Resonance Imaging 4. Plain Radiographs Widely available Reproducible Patient friendly Inexpensive Usually the indicated primary imaging modality 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. Plain Radiographs - Obvious 7. Plain Radiographs 2 views 8. Plain Radiographs 2 views Posterior Dislocation 9. Plain Radiographs Extra views Radial Head Fx 10. Plain Radiographs Extra views Scaphoid Fx 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. Nuclear Scintigraphy Excellent for specific pathologies Osteomyelitis Metastases Not Multiple myeloma Occult fracture Reasonably reassuring Normal is usually normal 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. Nuclear Scintigraphy Bone Scan Osteomyelitis 15. Nuclear Scintigraphy 2nd MT stress fracture 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. 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. Ultrasound Cephala d CephCaudCalcaneusCaudad 19. Ultrasound Achilles Tendon Intrasubstance tear 20. Ultrasound Patellar tendonProximal patellar tendonitis Jumpers Knee 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. 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. CT - FracturesScaphoid fracture 24. CT - DislocationLis Franc Fx/Dislocation 25. CT Bony anomalies Midsubtalar coalition 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. 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. MRI - Relative Contraindications Penile prostheses IUDs Cardiac valves Berry aneurysm clips Retained bullet fragments Claustrophobia Huge listing in MRI facility 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 cant last >2 hours Strict guidelines for sedation Optional contrast Rad usually decides for body imaging 30. MRI TraumaOsteochondritis dissecans 31. MRI Trauma Femoral Neck Fracture 32. MRI - TraumaTear vastus medialis 33. MRI Internal Derangement 34. MRI Internal Derangement Supraspinatus tear= Full thickness, Full widthCoronal PDCoronal T2 35. MRI Internal DerangementSagittal NLSagittal FT, FW Supra 36. MRI Internal DerangementSagittal, Meniscus NLPosterior Horn Tear 37. MRI Internal Derangement Bucket handle meniscal tear 38. MRI Internal DerangementSagittal Intact ACL Torn ACL 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. THANK YOUSanil Varghese