dacbr n .dombrowsky, dc · 2019. 3. 18. · web references 1. indrajit ik digital imaging in rad....
TRANSCRIPT
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DIGITAL TECHNOLOGY
• MARCH 22, 2019
• PINEHURST, NC
• N. Dombrowsky , DC DACBR
• © www.ProImaging.ws
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WET READ
• Place x-ray on
view-box
• Take pic of area
of interest
• Email – as jpeg
attachment.
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12/4/16
CASE – 34 F MVA 5.27.16
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6. 14. 2016 -PATIENT PRESENTS TO DC -
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DR. M. IOWA
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TELERADIOLOGY
jpeg
BOX.COM
CLOUD VENDOR
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d ARTIFACT
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dARTIFACT
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DR SYSTEMS
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dARTIFACT
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EXPOSURE INDICATORS
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d ARTIFACT
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FUTURE….
…DIAS in majority
-phosphors - structures
-tighter packing –
-↓ pixel size – SP
-faster processing – line x line
-archiving – “cloud”
- informed decision making
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WEB REFERENCES
1. Indrajit IK Digital imaging in rad. Practice J Radiol Imaging 2007; 17:
230-236
2. Digital Radiology. A comparison with modern conventional imaging
GJ Bansal Postgrad Med j. 2006; 82: 425-528
3. RadioGaphics 2007 ; 27-675:685 Advances in Digital
Radiography M.
4. Digital Radiography & PACS 2010 Mosby Elsevier
4. Merrill’s Atlas of Radiographic Positioning
& Procedures 11 Ed. Vol. 1 2007
5. https://en.wikibooks.org/wiki/Basic_Physics_of_Digital_Radiography/The
Image_Receptor
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LUMBAR SPINE
POSITIONING CHALLENGES….
TRANSITIONAL SEGMENTS
SPONDYLOLISTHESIS.
VASCULAR
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d Hints for Radiation Worker
• Merrill ‘s Atlas of Rad.
Positioning 11th. Ed. Vol. 1,
2007 p. 38
– Collimation!!
– Part centering
– Split cassette– Lead strips
– R/Left Markers
• X-raytees.com
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IMAGING TO THE LOWER EXTREMITY –HIP, KNEE & ANKLE
NCCA
PINEHURST, NC
MARCH 22, 2019
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HIP- FEMUR
Strongest
Gr.t – 4 facets
Ltr.
Anteverted
Spherical
Cartilage
Intertrochanteric region
fovea
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HIP JOINT - CAPSULE
12/4/16
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12/4/16
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12/4/16
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RESOURCES:
ANATOMY
https://primalpictures.com
-
https://www.netterimages.c
om
-https://www.imaios.com/en/e-
Anatomy
MRI
- http://freitasrad.net
- Xrayhead.com
- STANFORD
MSK MRI ATLAS
- Radassistant.nl
- Pocketradiologist.com
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NORMAL RADIOLOGY
12/4/16
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TOO MUCH TIME…
12/4/16
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2. DEVELOPMENTAL - Os acetabuli
3/16/2019
SEMINARS IN MSK RADIOLOGY – 2013; JUNE 2013:229-247
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2. DEVELOPMENTAL
12/4/16
Herniation pits in the femoral neck: a radiographic indicator of femoroacetabular impingement?
Skeletal Radiol. 2011 Feb;40(2):167-72.
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ANATOMY - MUSCLES
12/4/16
EXTENSORS, LAT. ROTATORS
ABDUCTORS
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NORMAL RADIOGRAPHIC POSITIONING
3/16.19
Auntminnie.com
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OSTEONECROSIS
◼ Trauma
◼ Steroids
◼ Alcohol
◼ Radiation therapy
◼ others
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LEGG-CALVE-PERTHES
- 4-10 range
-Possible growth arrest
growth arrest:
-physeal bridging
- signal change
6 yo/M - NC
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3. OSTEONECROSIS
Diffuse edema
Focal serpiginous low SI line with fatty center
Double line sign
= T2WI-
Center - ↑SI
Periphery- ↓SI
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http://www.physio-pedia.com
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4. FRACTURES
STRESS –
femoral neck
sacrum *
supra-acetabular *
pubic bones
INSUFFICENCY
OP patients
no sig. trauma
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3. FRACTURE
T1 Linear low SI
with low SI ( fracture
line)
T2 -↓SI = fx. line
T2 -↑
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12/4/16
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4. HIP: SOFT TISSUES - MUSCLE
⚫GRADE 1 – preservation
of morphology
⚫ GRADE 2 – 50% of fibers torn.
⚫ GRADE 3 – complete tearing
− +/- retraction
Pocket radiologist – TOP 100 DIAGNOSES - 2001
http://www.auntminnie.com/
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BURSA
Gr. Trochanteric bursa
• Hip flexion
• Ddx. Torn Gmed/min
• Middle age- elderly
• ?groin pain, mass
• Lat. To gr. trochanter
MRI
• ↑T2 – fluid paralling gr. Trochanter
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CASE
12/4/16
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http://www.scbtmr.org/Portals/9/Meetings/2010/Summer/STEINBACH_MRI%20of%20the%20Hip%20-%20Femoroacetabular%20Impingement.pdf
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12/4/16
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12/4/16
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12/4/16
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DDH-- COMPLICATIONS
12/4/16
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Clinical Sports Medicine.com 4th Edition (2012)
45 pts. with no history of hip
pain, symptoms, injury, or surgery.
73% -hip abn.
labral tears – mc (69%). chondral
defects (24%), fibrocystic changes of the femoral head/neck junction (22%),
osseous bumps (20%), sub-chondral bone cysts (16%), labral/paralabral cysts (13%), acetabular bone edema (11%), acetabular rim fractures (11%), and ligamentum teres
tears (2.2%)..
12/4/16
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PINEHURST 2019
• Did you learn?
• Did you enjoy?
• Is this helpful in
your clinical
practice?
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THE KNEE
• AP VIEW– PA VIEW
• LATERAL
• TUNNEL
• SUNRISE
http://eorif.com/knee-xray
http://www.diagnosticimaging.com/mri/weight-bearing-x-rays-knee-pain-preferable-mri
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http://www.diagnosticimaging.com/mri/weight-bearing-x-rays-knee-pain-preferable-mri
September 20, 2016
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MRI - normal
S-PDAXIAL – FAT SAT
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axial
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RESOURCES
• http://www.freitasrad.net
• X-rayhead.com– STANFORD - MSK MRI ATLAS
• http://radiologyassistant.nl/
• https://radiopaedia.org/
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MENISCOFEMORAL LIG. INSERTION
– 75% of knees
– Menisco-femoral ligament • Anterior portion =lig. Of
Humphrey
• Posterior portion = Wrisberg
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MENISCOFEMORAL LIG. INSERTION
– 75% of knees
– Menisco-femoral ligament • Anterior portion =lig. Of
Humphrey
• Posterior portion = Wrisberg
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RESOURCES
• http://www.freitasrad.net
• X-rayhead.com– STANFORD - MSK MRI ATLAS
• http://radiologyassistant.nl/
• https://radiopaedia.org/
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MENISCOFEMORAL LIG. INSERTION
– 75% of knees
– Menisco-femoral ligament • Anterior portion =lig. Of
Humphrey
• Posterior portion = Wrisberg
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RESOURCES
• http://www.freitasrad.net
• X-rayhead.com– STANFORD - MSK MRI ATLAS
• http://radiologyassistant.nl/
• https://radiopaedia.org/
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PITFALLS - MFL
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LIGAMENTS
• ANTERIOR CRUCIATE LIGAMENT– Straight, taut, parallel to
intercondylar notch
– Striated, some SI- esp. at insertion
– Torn= no normal fibers seen
– Flatter angle,
– cystic appearance/drumstick –mimics tear
– * discontinuity, abn.orientation, nonvisualization
Dreamtimes.com
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t ACL
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t ACL
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ACL
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POSTERIOR CRUCIATE LIGAMENT
• Hockey stick appearance
• Infreq. torn and less freq. surgically repaired.
• Stretches…
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tPCL
• ↑SI all sequences
• PD
• > 6 mm. thick
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MEDIAL COLLATERAL LIGAMENT
• Fibers connected to
joint capsule
• mMEN – attachment
• NOT intrasynovial
– Grade 1 – ↑SI. soft
tissues medial to MCL
– Grade 2 –
hSI+disruption within
MCL
– Grade 3 – complete
tear
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LCL
• Bf-fcl – prox.fibula
• -iliotibial band –G. tubercle
• Not as frequent as MCL
• Posterior corner inj. *– LCL inj.
– + pop.tendon tears
– Arculate lig.
– Popliteal-fib.ligament
– +/- ACL OR PCLcFAT-SAT
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POSTERIOR CORNER INJURY
J. Magn. Reson. Imaging 2007.
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JUMPER’S KNEE
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BURSAE
• POPLITEAL
– Between med. Gastroc
& SM
– >5 ml. fluid abn.
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OSSEOUS STRUCTURES
• Contusions = microfractures
• May progress if:
– A. geographic
– B. reticulated *
• ACL tear
– Bone contusion – posterior lateral portion of
tibial plateau
– Pivot shift phenomenon
– “kissing” contusion
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OSTEOCHONDRAL LESION
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PINEHURST 19
• Did you learn?
• Did you enjoy?
• Is this helpful in your clinical practice?
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IMAGING TO THE LOWER EXTREMITY –ANKLE
PINEHURST, NC
MARCH, 22 2019.
N. DOMBROWSKY, DC DACBR
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http://www.radiologyassistant.nl
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MRI – too expensive
- clinical examination
LIGAMENTOUS INJURIES
MSK MRI – 2ND. EDITION – 2009 P. 395
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IMAGING OF THE LOWER EXTREMITY –
• OS TRIGNOUM • Post. Ankle impingment• Forced plantar flexion
– BB, hill running, ballet
• 1. BME/fx. Of trigonal process or
• 2. talocalcaneal
• MRI– ↑ si – talus– si – fx. Of
synchondrosis– S. tenosynovitis- FHL
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IMAGING OF THE LOWER EXTREMITY –
• Os naviculare
• BME, bursitis, deg.
• +/- PTT tears– B, hill running,
ballet
• MRI– ↑ si – T2- all abn.
• .
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IMAGING OF THE LOWER EXTREMITY
– PLANTAR FASCITIS• Obese F, runners, SSA
–
• Chronic rep. stressors
• Tears, myxoid deg. ,
infl.
• RUPTURE:– Forced dorsiflexion
– Thicken. Disrupt. In
midportion
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s-FAT SAT
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Morton’s neuroma
- F- high heels
- plantar N. entrapment- - 2’
perineural fibrosis.
- tear – drop shaped mass
-T1W – low
-T2W- dependant upon fibrosis
present
- +/- bursal fluid
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IMAGING OF THE LOWER EXTREMITY –TRAUMA
• Pf –inconclusive
• Osteochondritis dess.=
osteochondral lesion
• Med. Or lat. Talar
dome
• +/- lig. Injuries
ePainAssist.com
HELMS MSK MRI 2ND. ED.
P. 413
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IMAGING OF THE LOWER EXTREMITY –TRAUMA
• MRI– Stable– ↑T2W – around
fragment.– Absent or displaced fr.– Cartilage fr.– Subcondral cysts.
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Magnetic resonance imaging features of osteochondral lesions of the talus.Hembree WC1, Wittstein JR, Vinson EN, Queen RM, Larose CR, Singh K, Easley ME.
BACKGROUND: Foot Ankle Int. 2012 Jul;33(7):591-7. doi: 10.3113/FAI.2012.0001
CONCLUSION:
This study refutes traditional teachings regarding the location of OLT and supports recent
studies showing that most lesions are located medially and centrally on the talar dome..
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IMAGING OF THE LOWER EXTREMITY –STRESS FRACTURES
• STRESS FRACTURES
Gen. perpendicular
to long axis
• EXCEPT:
• Med. Mall - vertical
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JANUARY 2017
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CASES
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PINEHURST 19
• Did you learn?
• Did you enjoy?
• Is this helpful in
your clinical
practice?