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Musculoskeletal Imaging 09
- 1. Normal Musculoskeletal Imaging Prof. S. Sager, MPAS, PA-C
- 2. 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
- 3. X - Ray Basics: Radiopaque vs. Radiolucent
- 4. X - Ray basics: The four basic densities
- 5. Normal Bone Imaging An X-Ray is a three dimensional summation of densities, seen as a two dimensional image
- 7. 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?
- 8. 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?”
- 9. Normal Musculoskeletal Imaging The Skull & Face
- 10. AP View Frontal sinuses Ethmoid sinuses Orbital floor Nasal septum Maxillary sinuses
- 11. Skull (lateral view) Frontal sinuses Maxillary sinuses Sella turcica Nasopharyngeal airway
- 12. Face (lateral view) Frontal sinuses Sella turcica Sphenoidal sinuses Maxillary sinuses Temporomandibular joint Nasopharyngeal airway
- 13. Water’s view
- 15. Nose (frontal) Nose (lateral) Zygomatic arch
- 16. Maxilla
- 17. Mandible
- 18. Sella Turcica (lateral view)
- 19. Base of the skull
- 20. CT head
- 21. Normal Musculoskeletal Imaging The Spine
- 24. 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
- 37. Normal Musculoskeletal Imaging The Pelvis
- 42. Normal Musculoskeletal Imaging The Chest & Ribs
- 43. 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
- 49. Normal Musculoskeletal Imaging Upper Extremity
- 55. Shoulder joint (A/P view)
- 59. MRI Shoulder
- 62. Elbow Joint (AP view)
- 66. Wrist (AP view)
- 68. Hand (AP view)
- 71. Normal Musculoskeletal Imaging Lower Extremity
- 72. Proximal femur fovea capitis femoral neck greater trochanter lesser trochanter epiphyseal line intertrochanteric line
- 73. Hip (AP view)
- 74. Hip (lateral view) (Lauenstein’s view)
- 75. Femur (AP view)
- 77. Knee joint (AP view)
- 83. Ankle joint (lateral view)
- 84. Foot (AP view)
- 87. The X-ray in photo C belongs to which of the following patients? 2-year-old 1. 0% 6-year-old 2. 0% 10-year-old 3. 0% 15-year-old 4. 0% 20-year-old 5. 0%
- 88. The arrow is pointing to which of the following structures? Scaphoid 1. 0% Talus 2. 0% Calcaneus 3. 0% Fibula 4. 0% Lateral malleolus 5. 0%
- 89. Thought for the day… We can’t direct the wind…but we can adjust our sails!