musculoskeletal imaging 09
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TRANSCRIPT
Normal Musculoskeletal Imaging
Prof. S. Sager, MPAS, PA-C
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
X - Ray Basics: Radiopaque vs. Radiolucent
X - Ray basics:The four basic densities
Normal Bone Imaging
An X-Ray is a three dimensional summation of densities, seen as a two dimensional image
Normal Musculoskeletal Imaging
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?
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?”
Normal Musculoskeletal Imaging
The Skull & Face
AP View
Frontal sinuses
Ethmoid sinuses
Orbital floor
Nasal septum
Maxillary sinuses
Skull(lateral view)
Maxillary sinuses
Frontal sinuses
Sella turcica
Nasopharyngeal airway
Face(lateral view)
Maxillary sinuses
Frontal sinuses
Sella turcica
Nasopharyngeal airway
Sphenoidal sinuses
Temporomandibular joint
Caldwell Projection
Nose (frontal) Nose (lateral) Zygomatic arch
Maxilla
Mandible
Sella Turcica (lateral view)
Base of the skull
CT head
Normal Musculoskeletal Imaging
The Spine
Normal Musculoskeletal Imaging
Normal Musculoskeletal Imaging
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
Cervical spine imaging
Thoracic spine imaging
Lumbar spine imaging
Normal Musculoskeletal Imaging
The Pelvis
Normal Musculoskeletal Imaging
The Chest & Ribs
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
Normal Musculoskeletal Imaging
Upper Extremity
Shoulder joint (A/P view)
Shoulder joint (Erect view)
Scapula (AP view)
Scapula (lateral view)
MRIShoulder
Upper arm (AP view)
Upper arm (lateral view)
Elbow Joint (AP view)
Elbow Joint (lateral view)
Forearm (AP view)
Forearm (lateral view)
Wrist (AP view)
Wrist (lateral view)
Hand (AP view)
Hand, Oblique view
Navicular (Scaphoid views)
Normal Musculoskeletal Imaging
Lower Extremity
Proximal femur
fovea capitis femoral neck greater
trochanter lesser
trochanter epiphyseal line intertrochanteri
c line
Hip (AP view)
Hip (lateral view)(Lauenstein’s view)
Femur (AP view)
Femur (lateral view)
Knee joint (AP view)
Knee Joint (lateral view)
Lower leg (AP view)
Lower leg (lateral view
Ankle Joint (AP view)
Ankle joint (lateral view)
Foot (AP view)
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
The arrow is pointing to which of the following structures?
0%
0%
0%
0%
0% 1. Scaphoid2. Talus3. Calcaneus4. Fibula5. Lateral malleolus
Thought for the day…
We can’t direct the wind…but we can adjust our sails!