Musculoskeletal Imaging 09
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Transcript of Musculoskeletal Imaging 09
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Normal Musculoskeletal Imaging
Prof. S. Sager, MPAS, PA-C
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Normal Musculoskeletal Imaging
Upon satisfactory completion of this lecture, and in conjunction with textbooks, lecture handouts, WebCT, and recommended internet web sites, the student will be able to:• Recognize normal X - ray anatomy of
the skeletal system
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X - Ray Basics: Radiopaque vs. Radiolucent
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X - Ray basics:The four basic densities
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Normal Bone Imaging
An X-Ray is a three dimensional summation of densities, seen as a two dimensional image
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Normal Musculoskeletal Imaging
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How to study radiographs
Be systematic. Compare densities. If in doubt, order a
contralateral view.
Is this an adult or child? What was the gender? What was the social
status?
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Normal Musculoskeletal Imaging
Most common views:• anteroposterior (AP)• lateral (Lat)
An oblique view of the lumbar spine exposes the patient to 5 times as much radiation as the AP and lateral views.• “Do I really need this test?”
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Normal Musculoskeletal Imaging
The Skull & Face
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AP View
Frontal sinuses
Ethmoid sinuses
Orbital floor
Nasal septum
Maxillary sinuses
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Skull(lateral view)
Maxillary sinuses
Frontal sinuses
Sella turcica
Nasopharyngeal airway
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Face(lateral view)
Maxillary sinuses
Frontal sinuses
Sella turcica
Nasopharyngeal airway
Sphenoidal sinuses
Temporomandibular joint
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Nose (frontal) Nose (lateral) Zygomatic arch
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Maxilla
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Mandible
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Sella Turcica (lateral view)
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Base of the skull
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CT head
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Normal Musculoskeletal Imaging
The Spine
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Normal Musculoskeletal Imaging
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Normal Musculoskeletal Imaging
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Cervical spine imaging
You must see all seven vertebrae
“Portable cross-table” is the most common initial X-ray taken in ED
Used to “clear” possible neck injuries
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Cervical spine imaging
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Thoracic spine imaging
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Lumbar spine imaging
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Normal Musculoskeletal Imaging
The Pelvis
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Normal Musculoskeletal Imaging
The Chest & Ribs
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Specifics of CXR assessment
Airway and adenopathy: • assess the airway, inspecting the trachea and mainstem bronchi and looking for
deviation or evidence of luminal obstruction• assess adenopathy (either peritracheal or hilar)
Bones and breast shadows: • inspect the bones for radiographic density, fractures, lytic lesions, or bony deformity• evaluate the breast shadows for gross symmetry, evidence of prior surgery, and any
gross calcifications
Cardiac silhouette: • assess the cardiac silhouette for general size and contour
Diaphgram: • assess the hemidiaphgrams with attention to the contour and costaphrenic angle
Everything else: • review everything else around the lung fields including the subcutaneous soft tissues
and pleural boundaries
Fields: • assess the lung fields themselves looking for evidence of infiltrate, mass, and pattern of
vascularity
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Normal Musculoskeletal Imaging
Upper Extremity
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Shoulder joint (A/P view)
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Shoulder joint (Erect view)
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Scapula (AP view)
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Scapula (lateral view)
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MRIShoulder
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Upper arm (AP view)
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Upper arm (lateral view)
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Elbow Joint (AP view)
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Elbow Joint (lateral view)
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Forearm (AP view)
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Forearm (lateral view)
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Wrist (AP view)
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Wrist (lateral view)
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Hand (AP view)
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Hand, Oblique view
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Navicular (Scaphoid views)
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Normal Musculoskeletal Imaging
Lower Extremity
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Proximal femur
fovea capitis femoral neck greater
trochanter lesser
trochanter epiphyseal line intertrochanteri
c line
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Hip (AP view)
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Hip (lateral view)(Lauenstein’s view)
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Femur (AP view)
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Femur (lateral view)
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Knee joint (AP view)
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Knee Joint (lateral view)
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Lower leg (AP view)
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Lower leg (lateral view
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Ankle Joint (AP view)
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Ankle joint (lateral view)
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Foot (AP view)
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The X-ray in photo C belongs to which of the following patients?
0%
0%
0%
0%
0% 1. 2-year-old 2. 6-year-old3. 10-year-old4. 15-year-old5. 20-year-old
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The arrow is pointing to which of the following structures?
0%
0%
0%
0%
0% 1. Scaphoid2. Talus3. Calcaneus4. Fibula5. Lateral malleolus
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Thought for the day…
We can’t direct the wind…but we can adjust our sails!