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Orthopedics radiography sanil
- 1. Musculoskeletal Imaging – The Basics SANIL VARGHESE
- 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
- 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 • Excellent for 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 MT stress fracture
- 21. 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
- 22. 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
- 25. Ultrasound – Achilles Tendon Intrasubstance tear
- 26. Ultrasound – Patellar tendon Proximal patellar tendonitis – Jumper’s Knee
- 27. 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
- 28. 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
- 30. CT - Fractures Scaphoid fracture
- 31. CT - Dislocation Lis Franc Fx/Dislocation
- 32. CT – Bony anomalies 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 – 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
- 35. MRI - Relative Contraindications • • • • • • • Penile prostheses IUD’s Cardiac valves Berry aneurysm clips Retained bullet fragments Claustrophobia Huge listing in MRI facility
- 36. MRI • Usually performed with 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
- 39. MRI – Trauma Femoral Neck Fracture
- 40. MRI - Trauma Tear vastus medialis
- 41. MRI – Internal Derangement
- 42. MRI – Internal Derangement Supraspinatus tear= Full thickness, Full width Coronal PD Coronal T2
- 43. MRI – Internal Derangement Sagittal NL Sagittal FT, FW Supra
- 44. MRI – Internal Derangement Sagittal, Meniscus NL Posterior Horn Tear
- 45. MRI – Internal Derangement Bucket handle meniscal tear
- 46. MRI – Internal Derangement Sagittal – Intact ACL Torn ACL
- 47. 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