Diagnostic Imaging for Rehab

Doctors

Drive carefully, life is precious

Learning outcome and
objectives
1. Become familiar with various medical imaging
modalities
2. Understanding the advantages and disadvantages of
different imaging modalities
3. Be able to recommend the correct modality given a
case study
4. Integrate diagnostic imaging information into
physical therapy practice
Why do rehab doctors need to
understand medical imaging?

1. Clinical Reasons?
• How will it effect treatment?
• How will it effect prognosis?
• What about direct access?

2. Research Implications?
Clinical reasons:
1.not responding as expected,
2.possible undiagnosed fracture,
3.deg changes (joint space),
4.-assess status of hardware,
5.-make clinical decisions whether surgery vs. no
surgical treatment
Research reasons:
1.-biomechanical studies,
2.-correlate clinical tests with imaging findings,
3.-look at reliability and validity of imaging tools,
 Imaging modalities

Ionizing modalities Non-ionizing modalities

Radiography/Plain x-ray MRI
CAT Scan or CT scan US & Doppler
Isotope bone scan
Flouroscopy
Radiography
Basic Concepts
What is an X-Ray?
Electromagnetic Radiation -
short wavelength
An X-ray machine is essentially a camera.
Instead of visible light it uses X-rays to expose the film.
X-rays are like light in that they are electromagnetic
waves, but they are more energetic so they can penetrate
many materials to varying degrees.
When the X-rays hit the film, they expose it just as light
would.
Since bone, fat, muscle, tumors and other masses all
absorb X-rays at different levels, the image on the film
lets you see different (distinct) structures inside the body
because of the different levels of exposure on the film.
Professor Roentgen
Discovered accidentally in
1895
Experimenting with a
machine that, unknown to
him, was producing x-rays
Saw the bones of his hand
in the shadow cast on a
piece of cardboard in his
lab
What Roentgen
saw Today's Image
 Radiodensity
When an object X-rays not absorbed,
absorbs the X-rays - screen produces photons
fewer photons when struck, and exposes
produced, film stays the film, turning it dark
light

Radiopaque Radiolucent
 Principle components of x-ray tube:
Source of electrons
 Target
 Evacuated envelope
 High-voltage source
 The X-ray tube par ts:

 Cathode (-)
 Filament made of
tungsten
 Anode (+) target
 Tungsten disc that turns
on a rotor
 Stator
 motor that turns the
rotor
 Port
 Exit for the x-rays
 X-ray Production
X-rays are produced when high velocity electrons are
decelerated during interactions with a high atomic number
material, such as the tungsten target in an X-ray tube.

An electrically heated filament within the X-ray tube

generates electrons that are then accelerated from the
filament to hit the tungsten target by the application of a
high voltage to the tube.

The electron speed can exceed half the speed of light

before being rapidly decelerated in the target.
 X-ray production
Push the “rotor” or “prep”
button
Charges the filament –
causes thermionic emission
(e- cloud)
Begins rotating the anode.
Push the “exposure” or
“x-ray” button
e-’s move toward anode
target to produce x-rays
X-rays characteristics
Highly penetrating, invisible rays
Electrically neutral
Travel in straight lines.
Travel with the speed of light in vaccum:
300, 000 km/sec or 186, 400 miles/sec.
Ionize matter by removing orbital electrons
Induce fluorescense in some substances. Fluorescent
screen glow after being stricken with photons.
Can't be focused by lenses nor by collimators.
 CONCONVENTIONAL
CONcCCORADIOGRAPHY
PRODUCES STATIC IMAGES
Shielding
Therapeutic x-ray production, where mega
electron volts (MeV) are used, has a higher
conversion of electrons into photons.

In the diagnostic range (KeV), there is more

conversion of the electrons to heat.

Total number of electrons converted to heat is

99%.

Only 1% of the electrons are converted to photons

 Attenuation
Attenuation – reduction in the number of
photons as they pass through matter

Attenuation occurs in several different

ways:
Some photons are absorbed by matter they
pass through

Other’s change course in matter, called “scatter

A-B-C-D

A- Alignment- is the bone in good general

alignment
B- Bone- general bone density
C- Cartilage- sufficient cartilage space
D- Dee other stuff??
Muscles, fat pads and lines, joint capsules,
miscellaneous soft-tissue findings, bullets
Alignment
Alignment
Bone
Bone
Cartilage
The role of
imaging is to
confirm the
infection and
show extent.
Radiography will
show the
infection,
however usually
late. Radiography
has a high Dang
specificity but low
sensitivity.
 Viewing Images
X-ray study named for the direction the beam travels
1. AP 2. PA
3. Lateral
Orient film as if you were facing the patient, his/her Left
will be on your Right
Views

Lateral
Oblique
Views

Dens

AP Open Mouth
Lumbar Spine, Oblique View

Superior articulating facet

Transverse process
Pedicle
Lamina
Inferior articulating facet
Lumbar Spine, Oblique View

“SCOTTY DOG”
Lumbar Spondylolysis
The defect
‘lysis’ involves
the pars
inarticularis
and can allow
the vertebra
above to
sublux
forward
Still Alive?
…That was
close
Bullet can be in
any of these places
(anterior to
posterior at same
level)
1 - spinal cord
2 - trachea
3 – Superior
Vena Cava
4 - aorta
Viewing Images
A radiograph is a two dimensional
representation
Therefore, “One View is No View”
Two views are needed, ideally at 90
degress to one another for proper 3-D
like interpretation
Radiograph
revealed
horizontal
fracture of the
lower patalla
To sum it up
It is relatively much more
important for a physical
therapist to recognize the
indications for diagnostic
imaging,
to select the most appropriate
imaging study, and
to image the appropriate
area(s) than it is to interpret
the image
Computed Tomography (CT)
1. Also called CAT scanning or “CT”
2. X-Ray beam moves 360 around the patient
3. Consecutive x-ray “slices” around the patient
4. Computer can recreate 3D image of the body or
Image “slices” reconstructed by computation
5. Best for evaluating bone and soft tissue tumors,
fractures, intra-articular abnormalities, and
bone mineral analysis
 Computed Tomography
6. The image formed is related to the subjects
density
7. Image display on computer or multiple films
8. New technology is multislice helical scanner
CT (by Picker)
Computed Tomography (CT)
 RV
LUNG
RA LV

LA
AORTA

SPINAL VERTEBRAL
CANAL BODY

RIB TRANSVERSE
PROCESS
Magnetic Resonance Imaging
(MRI)

What is a MRI?
• The use of a High Power Magnet (.3
-2.0 Teslas) To align hydrogen atoms in
the body to which a radio wave
frequency is applied to produce an
image

Higher Tesla level= increased resolution

 Magnetic Resonance Imaging
1. Also called “MRI”
2. Image formed by transmitting and receiving radio
waves inside a high magnetic field
3. Image “slices” reconstructed by computation
4. The image formed is related to:
1. Scanner settings
2. Patient hydrogen density
3. Patient hydrogen chemical/physical
environment
5. Image display on computer or multiple films
MRI by Picker
Indications for MRI

Diagnosing multiple sclerosis (MS)

Diagnosing tumors of the pituitary gland and brain
Diagnosing infections in the brain, spine or joints
Visualizing torn ligaments in the wrist, knee and
ankle
Visualizing shoulder injuries
Diagnosing tendonitis
Evaluating masses in the soft tissues of the body
Evaluating bone tumors, cysts and bulging or
herniated discs in the spine
Diagnosing strokes in their earliest stages
 T1 Vs T2
T1 T2
Tissue with high Tissue with high water
water content will content will appear
apear dark (grey) white/ brighter
Fat, edema, Tissue with low water
infection content will appear
Tissue with low darker (grey)
water content will World War II
appear white/ Water is white on
brighter T2
 T1 vs. T2
T1 image of knee T2 image of knee

Quad Tendon
Semimembranosu
s
Popliteal vein

GastrocnemiusSemitendonosu
s

Semimembranosu
s ACL
Knee - MRI Sagittal

ANTERIOR POSTERIOR
CRUCIATE CRUCIATE
LIGAMENT LIGAMENT
PATHOLOGY

ACL Tear
Knee - MRI Sagittal

TORN POSTERIOR MEDIAL MENISCUS

Meniscus

Torn Meniscus
MRI shoulder

Clavicle

supraspinatus

Glenoid labrum D
S
e
c
lt
a
humerus o
p
i
u
d
l
a
s
atu
spin
nf ra r
i i no
m
r es
Te Long Head
of Triceps
Shoulder - MRI – Axial Plane
Shoulder - MRI – Axial Plane

SupS

IS
Shoulder - MRI – Coronal Plane
Rotator Cuff
SS Tendon

r - - Clav
Ac

Supraspinatus

Glenoid

Fluid in
Joint
 Shoulder

Supraspinatus Subdeltoid Bursa

Tear
Lumbar Spine - MRI

Coronal T1 Sagittal T1 Sagittal T2

 Lumbar Spine – MRI Axial

Axial T1 Axial T1
body disc

Axial T2 Axial T2
body disc
 Bod
y

Psoa
s
Spinal
Canal
Lumbar Spine – MRI Sagittal T2

Herniated
disc
DEXA SCAN
Looks at bone mineral densities
 Nuclear Scintigraphy
Uses gamma rays to produce an
image, emitted from the patient
Radioactive nuclide given IV, per os,
per rectum etc.
Abnormal function, metabolic activity,
abnormal amount of uptake
Poor for anatomical information
www.upei.ca/~vetrad
Nuclear camera
 Skeletal Scintigraphy
(Bone Scan)

Indication
: Cancer,
stress or
hidden
fractures
 Ultrasound
1. Also called “sono” or “echo” or “US”
2. Image formed by transmitting and receiving
high frequency sound waves
3. Image “slices” reconstructed by
computation
4. The image formed is related to interfaces
between tissue areas of differing sound
transmission characteristics
5. Image display on computer or multiple films
 Ultrasound
examination

Convex 3.5 MHz

Ultrasound For abdominal and
machine OB/GYN studies

Micro-convex: 6.5MHz
For transvaginal and
transrectal studies
Text Books
David Sutton’s Radiology
THANK YOU