Diagnostic Rad Test #1

Front 1

The _________ between two ends of a path is the total energy required to move a small electric charge along that path, divided by the magnitude of the charge.

Back 1

VOLTAGE

Front 2

Voltage is a convenient way of measuring the ability to do work.

Back 2

Voltage: . In relation to "flow", the larger the "pressure difference" between two points (potential difference or water pressure difference) the greater the flow between them (either electric current or water flow).

Front 3

The usual source-to-distance receptor distance is 1 meter. How many millimeters is that?

Back 3

1 mm =1/1000 m or 10(-3), therefore 1000 mm = 1 m.

Front 4

4 facts of HISTORY of diagnostic imaging

Back 4

1895

William Conrad Roentgen

Crooks tube

First x-ray

Front 5

Roentgen did not invent the x-ray; he ________ it.

Back 5

discovered it

(remember- the flourescing material lit up on his workbench)

Front 6

the push

Back 6

voltage


the difference of electrical potential b/w 2 points
Volts

Front 7

what flows

Back 7

the current

flows from neg to positive
Amps

milliAmps for radiology

Front 8

how much IS ALLOWED to flow b/w the points

Back 8

resistance

Front 9

used to control resistance

Back 9

resistors!

Front 10

Resistors are used to control voltage and current levels. A very high resistance allows a ________ amount of current to flow. A very low resistance allows a ______ amount of current to flow. Resistance is measured in _______.

Back 10

high resistance = small amt allowed

low resistance = large amt allowed

Resistance measured in Ohms

Front 11

what is flowing x the push at any point = strength

Back 11

current x voltage = power (watts)

or

Amps x Volts = Watts

Front 12

resistance = push / what is flowing

Back 12

ohms = volts / amperes

Front 13

Amperes = Volts / Ohms

can also be written as ...

Back 13

I = V / R

where...
I = amperes/current (WHAT is flowing, measured in amperes)
V = volts (the PUSH/difference between 2 points)
R = resistance (how much is ALLOWED/current , measured in Ohms)

Front 14

OHM'S LAW:
What is flowing (________) matches the potential difference/ the push between the points (_________), but is always opposite in amount to how much (___________) current will flow through something.

Back 14

OHM'S LAW:

CURRENT - what is flowing

VOLTS - the push/ difference between 2 points

RESISTANCE -how much current will flow is based on resistance. High resistance = small current...Low resistance = high current

Front 15

restate ohms law

Back 15

the current matches (rises and falls with) the push/voltage, but is always opposite/inverse to the resistance

I = V / R

Front 16

J = ( σ) E

Back 16

where J is the current density at a given location in a resistive material

E is the electric field at that location

σ is a material dependent parameter called the conductivity.

This reformulation of Ohm's law is due to Gustav Kirchhoff.[4

Front 17

if current doubles then so does voltage. To make a current flow through a resistance there must be a voltage across that resistance. Ohm's Law shows the relationship between the voltage (V), current (I) and resistance (R). It can be written in three ways:

Back 17

If the amount of what is flowing doubles, then so does the push
There must be a push to get the flow from one point to the next in the face of resistance (control). If there is a high amount of resistance, there will be less flow/current. You would need to increase the voltage (push) and because they go together, this would increase the current (flow) to overcome the high resistance.

R = V/I

I = V/R

V = RI

Front 18

unit of measurement for x-ray voltage (push)

Back 18

kilovolt peak (kP)

Front 19

one kilovolt peak (kP) is equal to _______ V (push) of electric potential

Back 19

1 kP = 1000 V

Front 20

x-ray currents (what is flowing) are measured in __________

Back 20

milliampere (mA)

where the Ampere is a measure of electric current (flow)

the prefix milli stands for 1/1000 or 0.001

Front 21

COLLIMATOR

Back 21

device used to RESTRICT x-ray beam size and shape

Front 22

why cathode over Crooks tube?

Back 22

vacuum tube allowed x-ray intensity and E to be selected for separately and w/ great accuracy

Front 23

Always _____ toward the smallest field size appropriate for the examination

Back 23

collimate

*reduces scatter radiation, improves contrast, spares surrounding tissues

Front 24

intensifying screens

Back 24

on either side of film

reduce pt exposure by 95%

Front 25

why use calipers to measure thickness of body part x-rayed?

Back 25

determine the proper exposure factors

Front 26

only 3 quantities that matter

Back 26

mass
length
time

Front 27

the distance traveled by light in 1/299,792,468 second

Back 27

1 meter

Front 28

The meter is based on

Back 28

the speed of light

Front 29

the mass of 1000cm3 of water at 4*C

Back 29

the kilogram

Front 30

based on the vibration of atoms of cesium

Back 30

the second

Front 31

magnitude and unit

Back 31

2 parts of a measurement

SID is 100 (magnitude) cm (unit)

Front 32

4 SPECIAL QUANTITIES of radiologic science

Back 32

EXPOSURE C/kg or Air Kerma (Gy-a)

DOSE J/kg or Gray (Gy-t)

EQUIVALENT DOSE J/kg or Sievert (Sv)

RADIOACTIVITY s(-1) or Becquerel (Bq)

Front 33

A 9-inch thick patient has a coin placed on the skin. The SID is 100cm. What will be the magnification of the coin?

Back 33

Change in. to cm....
9 in. x 2.54 cm = 23 cm

The formula for magnification is...
M = SID/SOD
magnification = source to image receptor distance / Source to Object distance

M = 100 cm / 100 cm - (23 cm)
M = 100 cm / 77 cm
M = 1.3 cm

Front 34

static vs dynamic

Back 34

an object at rest vs an object in motion

Front 35

a measure of how fast something is moving or the rate of change of its position over time

Back 35

VELOCITY (speed)

unit: meters per second

Front 36

v = d / t

Back 36

velocity = distance / time

Front 37

what is the velocity of a ball that travels 60 m in 4 s

Back 37

v = d / t
v = 60 m / 4 s
v = 15 m/s

Front 38

c = 3 x 10(8) m/s

Back 38

the velocity of light (c)

Front 39

when finding avg velocity, what does Vf - Vo mean?

Back 39

v = Vf - Vo / 2

is final speed minus start speed divided by 2

Front 40

how quickly or how slowly the speed (velocity) of an object is changing

Back 40

acceleration

b/c acceleration is velocity/time, the unit is meters per sec(2)

Front 41

If velocity is constant, acceleration is

Back 41

ZERO!

Front 42

a constant acceleration of 2 m/s(2) means

Back 42

the velocity of the object INCREASED by 2 m/s each second

Front 43

the avg velocity is finish speed - start speed divided by 2. What is acceleration equation?

Back 43

same but divided by time instead of 2 so units are m/s(2)

Front 44

now you know acceleration is how quick or slow velocity (speed) changes - so what is Law of Inertia?

Back 44

If no force acts on a body at rest or a body in motion, here will be no change in acceleration (speed)

Front 45

can be thought of as a push or pull on an object

Back 45

Force

Front 46

The _______ that acts on an object is equal to the MASS of the object x the ACCELERATION (how slowly or quickly the velocity changes)

Back 46

FORCE


F = ma with Newtons as the unit

Front 47

For every action, there is ..

Back 47

an opposite and equal reaction.

*Action was Newton's word for Force

Front 48

If you push on a heavy block, the block will push back on you w/ the same force that you apply.

Back 48

Newton's 3rd law

Front 49

force on a body caused by the pull of gravity on it.

Back 49

WEIGHT

Front 50

Objects falling to Earth accelerate at a constant speed

Back 50

Acceleration DUE TO GRAVITY (g)

g = 32ft/s(2)
or
g = 9.8 m/s(2)

Front 51

Why is the value of gravity (g) zero on the moon?

Back 51

Because there is no gravity! The weight of an object is its mass times the acceleration of gravity.
~no gravity, mass doesn't matter

Front 52

Wt = mg

Back 52

Weight = mass x acceleration due to gravity (g)

1 lb = 4.5 Newtons

Front 53

p = mv

Back 53

The MOMENTUM is represented by p.

momentum = mass x velocity

Front 54

momentum is always

Back 54

conserved

Front 55

Early uses of x-ray

Back 55

Dermatology (psoriasis, ringworm)

Hair restoration

Shoe fitting

Front 56

Why do chiros need to read x-rays?

Back 56

b/c you have to be able to take diagnostic films w/ minimal patient radiation exposure (pts are exposed to ionizing radiation)

Front 57

If you x-ray is not diagnostic

Back 57

you just lost the malpractice suit

Front 58

what happens when something is ionized

Back 58

it loses an electron

Front 59

two most radiation-sensitive tissues in body

Back 59

gonads

lens of eye

Front 60

benefit of CT scan

Back 60

Computerized Tomography lets us take views in many planes and high resolution. Better visualizations

Front 61

What's a good modality to envision a blow-OUT fx (force coming in at oblique plane allows eyeball to avulse)

Back 61

Coronal CT of facial bones (impact shows + Custer's sign w/ fx zygomatic arch due to amateur fist fight)

Front 62

Good way to see what's on someone's mind

Back 62

BLOW-UP LESION:
fist comes up directly over the globe (hook) and fx supraorbit so intractanial pressure inc and herniates the contents of eye into brain.

Front 63

3D recon

Back 63

bunch of CT pics put together

Front 64

2 soft tissue areas useful for CT scan

Back 64

ABDOMEN

CHEST

Front 65

What kind of modality is a VIRTUAL COLONOSCOPY

Back 65

CT scan w/ insufflation then 3D reconstruction

Front 66

soft tissue best modality

Back 66

MRI

downside is claustrophobic

Front 67

If pt claustrophobic of MRI, then

Back 67

send for ULTRASOUND

B/C now have 3D reconstruction
(vascular, abdomen, soft tissues)

Front 68

scan for bone DENSITY

Back 68

DEXA

Front 69

DEXA is NOT a bone _____.

Back 69

scan.
* DEXA does give us HIGHLY REPRODUCIBLE NUMBERS to cut down on poor interexaminer reliability

Front 70

A TRUE BONE SCAN only requires a ____% loss, as opposed to xray.

Back 70

3-5%

Front 71

how much bone loss before shows on xray?

Back 71

30-50%

poor intra-examiner reliability

Front 72

PET

Back 72

Positron Emission Tomography

*radiolabeled glucose

Front 73

Why is PET best for imaging the BRAIN & CANCER?

Back 73

b/c it uses radiolabeled glucose

Front 74

How was the structure of DNA determined?

Back 74

X-ray CRYSTALLOGRAPHY

Front 75

Besides biology (x-ray crystallography), 3 other diagnostic imaging areas

Back 75

COSMIC research
AIRPORT security
HEAVY EQUIPMENT testing

Front 76

What are the two big things we control that runs through our x-ray tube?

Back 76

VOLTAGE (the push/distance between two points)
&
AMPERAGE (the current/what is flowing)

Front 77

How do we change the characteristics of our x-ray beam?

Back 77

by changing the VOLTAGE & AMPS @ the control panel

Front 78

Where in the x-ray room do we change voltage and amps?

Back 78

CONTROL PANEL

Front 79

Connected to control panel, converts Amps to milliAmps (mA) and Volts to kiloVolts (kV)

Back 79

TRANSFORMER (generator)

Front 80

Always check this when setting your patients up for x-rays because Dr. Warshel will move it.

Back 80

TUBE STAND

*all x-rays are taken at certain standard distances

Front 81

First thing you should do on a positioning test?

Back 81

CHECK THE DISTANCE OF THE TUBE STAND!!!

Front 82

attached to tube stand, this is the business end.

Back 82

TUBE HEAD

Front 83

An x-ray tube is a 2000$ light bulb. On the bottom side of the tube head is a box called the ___________

Back 83

COLLIMATOR

Front 84

The light which is shone on pt. target field tells you where radiation/photons is going to go.

Back 84

COLLIMATOR

Front 85

BUCKY IS ALSO KNOWN AS THE

Back 85

UPRIGHT FILM HOLDER

Front 86

What goes inside the bucky/upright film holder?

Back 86

CASSETTE (that has a little thin strip of film)

Front 87

Puts the patient information on the film

Back 87

ID STAMPER

Front 88

Every x-ray produced on film has to have a _________ ID stamper

Back 88

Flash (so it can't be pulled off)

Front 89

Once film is out and run through ID stamper, it goes to the _________ WHERE CHEMICAL PORTION HAPPENS

Back 89

PROCESSOR

Front 90

How do you know a hand x-ray shows a barroom, not a boxer's, fracture?

Back 90

4-5th metacarpals for amateurs

2nd and 3rd for boxers

Front 91

Types of Radiation (2)*

Back 91

PARTICULATE (alpha/beta, nuclear medicine/bone scans)

ELECTROMAGNETIC (x-rays!)

Front 92

Balance between dose and

Back 92

picture quality

Front 93

What type of waves are electromagnetic, but stronger than x-rays (Incredible Hulk)?

Back 93

gamma

Front 94

radiation type used for nuclear medicine

Back 94

Particulate and gamma rays of electromagnetic

Front 95

radiation type used for CT, x-rays

Back 95

ELECTROMAGNETIC

Front 96

The wave-particle duality of x-rays...we describe x-rays as packets of ______.

What is the wave-particle duality w/ regard to x-rays??

Back 96

photons

VISIBLE light acts like a WAVE

X-RAYS act like a PARTICLE

Front 97

Quantum theory - the BOHR model**

Back 97

ATOM: nucleus + cloud of electrons

Front 98

Describe the BOHR atom

Back 98

~Nucleus

~ELECTRON CLOUD w/ different E levels (SHELLS)

Front 99

The higher the atomic number, the more

Back 99

ELECTRONS

*Periodic table tells us e- shell and #

Front 100

Out of the atomic Energy shells
K L M N O P Q

**which 2 are MOST IMPORTANT for x-ray?

Back 100

K & L (the inner two shells)

*because you are CLOSER TO THE NUCLEUS

Front 101

which two shells?

Back 101

K & L

because the electrons are most tightly bound to nucleus at K & L shells so if we can rip off an e- from there, we can harness that E.

Front 102

High ATOMIC # + High ELECTRON # = High ___________

Back 102

ELECTRON-BINDING ENERGY TO THE K & L SHELLS

(the more tightly the e- are bound. That's why we use tungsten - a very high # on periodic table. When we liberate those e- from tungsten, we create a lot of Energy!)

Front 103

electron binding energy depends upon

Back 103

the type of element

(ie, the more tightly the e- are bound. That's why we use tungsten - a very high # on periodic table. When we liberate those e- from tungsten, we create a lot of Energy!)

Front 104

the more e-, the higher the

Back 104

binding energies

Front 105

C = f (lambda)

Back 105

Velocity (C) = Frequency x Wavelength

Front 106

C = f (lambda)

Which one can we change?

Back 106

(lambda) WAVELENGTH

*can't change C

Front 107

Photon E is DIRECTLY PROPORTIONAL to?

Back 107

frequency

Front 108

photon energy is inverse to

Back 108

WAVELENGTH

Front 109

A LONG WAVELENGTH WILL HAVE A ___________ FREQUENCY.

Back 109

HIGH

*fold a wave into accordian shape and cram as many as possible in. This would take a very long piece of string! Many crests will pass by a certain point this way, ie, with a much higher frequency than would a short wave/piece of string all stretched out with its crests far apart. Those crests would pass by infrequently, or with a low frequency.

Front 110

photons with a high energy/frequency will have a long wavelength. Why?

Back 110

photon E and wavelength are opposite (in words)

high photon E frequency = long wavelength

Front 111

rise of the peak of a wave

Back 111

AMPLITUDE

Front 112

how do we modify the WAVELENGTH?

Back 112

change the VOLTAGE & AMPERAGE

and that has an effect on the frequency

Front 113

distance b/w the peaks of a wave is the wavelength. As the distance gets smaller, the energy of the wave gets

Back 113

higher

*again, length is how long that piece of string is - if it's long, you can fold it many, many times so the distance b/w folds is small.

Front 114

short wavelength means long

Back 114

wave, high energy!

This is what we want. High E to blow thru the patient and give us a view.

Front 115

size of the peak

Back 115

AMPLITUDE

Front 116

X-ray energy is measured in

Back 116

electron-Volts

*actually in kiloVolts (kVp or keV) = STRENGTH

Front 117

STRENGTH of x-ray depends on

Back 117

KiloVolts kVp


*1 kVp is 1000 V

Front 118

kiloVolt range of diagnostic x-rays

Back 118

30-150 kVp (the thing we control)

x-ray energy is measured in electron volts (eV) so they are the same

Front 119

If machine set at 100 kVp, what is the maximum energy I can create?

Back 119

100 kilo electron Volts (eV)
but I also create EVERYTHING ALL THE WAY DOWN TO ZERO eV.

It is not a uniform beam

Front 120

realistically, we work between ____-____kVp.

Back 120

60-120 kVp (and everything below)

*instead of 30-150

Front 121

Name the x-ray CHARACTERISTICS (6)

Back 121

moves at C (speed of light)
no reflection
no refraction
unaffected by electric or magnetic fields
affect photographic emulsion
can IONIZE matter

Front 122

6 x-ray characteristics:
1. Moves at ______ of ____
2. No _________
3. No __________
4. Unaffected by ___________ or ________ fields
5. Affect photographic __________
6. Can __________ matter

Back 122

1. moves @ C (speed of light)
2. no reflection
3. no refraction
4. not affected by electric, magnetic
5 affects photo emulsion
6. ionizes matter

Front 123

SID

Back 123

Source to FFDImage Distance

Front 124

FID

Back 124

Focal Film Distance

Front 125

TFD

Back 125

Target to Film Distance

Front 126

SOD

Back 126

Source to Object Distance

Front 127

OFD

Back 127

Object to Film Distance

Front 128

OID

Back 128

Object Image Distance

Front 129

3 acronyms meaning distance from x-ray tube to the film behind the person

Back 129

SID
FFD
TFD

source to image distance
focal to film distance
target to film distance

Front 130

lateral cervicals are shot at ___"

all others are shot at ____"

Back 130

lateral cervicals (exception) @ 72"

all others shot at 40"

Front 131

acronym meaning the distance from x-ray tube to person

Back 131

SOD

source to object (person) distance

Front 132

2 acronyms meaning distance from object (person) to film

Back 132

O-F D
O-I D

object to film distance
object to image distance

Front 133

AP, cervical, APOM
Thoracic
Lumbar
Extremities
Abdomen

all shot at what distance of SID/FFD/TFD?

Back 133

40" for x-ray tube to film

Front 134

Lateral cervicals
chest
full spine

all shot SID/FFD/TFD?

Back 134

72" for distance from x-ray tube to film (lateral cervical is only one to know for test)

Front 135

magnification is

Back 135

bad!!!

Front 136

Source to Image Distance (SID) is figured using the

Back 136

Inverse square law = SID

Front 137

State the Inverse Square Law with regards to the SID

Back 137

As the distance from the Source to Image receptor INCREASES, the radiation intensity DECREASES by the SQUARE of the distance.

I(1)/I(2) = d(2) sq./d(1)sq.

Front 138

Can be measured in R, rem, or mAs

Back 138

SID as the Inverse Square Law

Front 139

You perform an AP LS

- 40" SID, 80kVp, 40mAs
What is the intensity (mAs) at 72"?

Use Inverse Sq Law to figure:

Back 139

40" SID
80 kVp (push) is unaffected by distance.
40 mAs

I(1) = 40 mAs d(2)sq. = 72"sq
I(2) = x d(1)sq. = 40"sq.

rearrange:
(40"sq) (40mAs) / 72" = x

(1600') (40 mAs) / 5184" = 12.3 mAs

Front 140

To produce x-ray photons, we need

Back 140

thousands of kiloVolts and milliAmps

Front 141

what turns power into ENOUGH CURRENT for us?

Back 141

TRANSFORMER!

Front 142

Rather than create a moving magnet (which will break), create moving ?

Back 142

ELECTRICAL FIELD

Front 143

power from wall outlet is

Back 143

AC/DC

alternating so wrapping a wire around the metal core will create a changing magnetic field

Front 144

how to get extra photons with wire and iron core?

Back 144

Use a TRANSFORMER - the primary side from power company and secondary side is output. Same number of coils on both so same # of volts on both sides. MUST CHANGE NUMBER OF WINDINGS OF WIRE ON SECONDARY SIDE

Front 145

Increase voltage decreases

Back 145

amperage

Front 146

Because there are more windings on secondary side, we use a _________ transformer

Back 146

STEP-UP which ramps the voltage, decreases the amperage (or vice versa if step down)

Front 147

Kind of transformer that provides a steady, consistent power when dealing with power outlet

Back 147

AUTO-TRANSFORMER
single winding for small increases or decreases in voltage

used to ensure even power from power company since the voltage from wall can vary +/- 10V (ie, it's not always 110V or 220V)

Front 148

X-ray imaging system 3 parts

Back 148

1. Operating CONSOLE

2. High voltage GENERATOR

3. X-ray TUBE

Front 149

where is the autotransformer?

Back 149

built into the OPERATING CONSOLE

Front 150

What SWITCH on the control panel of the operating console is used to REGULATE THE LINE VOLTAGE TO PRECISE STANDARDS

Back 150

line voltage COMPENSATOR switch

"LINE ADJUST" button to take care of AUTOTRANSFORMER to guarantee the voltage of 110V from the power outlet

Front 151

autotransformer is also called

Back 151

LINE COMPENSATION

Front 152

set _________ and _________ on machine

Back 152

voltage and amperage

Front 153

kVp controls (2)?


********test question

Back 153

QUALITY & QUANTITY of x-ray beam

Front 154

old machines have 2 kVp knobs

Back 154

MAJOR kVp knob turns 10 clicks per

MINOR kVp know turns 1 click per

Front 155

mAs

Back 155

milliAmperage and Time

mA x time = mAs

Front 156

on older machines set the mAs _________!

Back 156

always set the mAs FIRST
then...
kVp

Front 157

mAs controls only?


*****test*****

Back 157

QUANTITY # of protons

mAs is your dose of buckshot, your amperage, your current/what is flowing

(while kVp controls QUALITY and some quantity)

ie if your patient's abdomen is 32cm, set mAs at 150 then kVp at 80
***always set the mAs first***

Front 158

mA time chart

Back 158

to set the mAs

Front 159

If on the mAs, kVp you don't have the mAs exactly (you need 170), then choose

Back 159

160

Front 160

Operating console has a large vs. small focal spot. Explain...

Back 160

small is for extremities,
large is thoracics and lumbars


small is higher resolution, small parts
large is lower res, large parts

Front 161

DEADMAN switch

******test

Back 161

rotor button gets rotor up to 600rpm ready to fire but the expose button MUST BE HELD DOWN...the EXPOSE BUTTON is the DEADMAN switch

Front 162

If I die during the middle of the exposure, there is no more x-ray. What is the button called...

Back 162

DEADMAN switch

(must deliver the entire mAs)

Front 163

Do not buy or waste your time on anatomic programming unless you are a complete __________, because you have NO CLUE as to how to run your x-ray machine.

Back 163

dumbass

Front 164

shuts off the radiation flow

Back 164

TIMER

Front 165

what kind of TIMER do we use from the power company outlet

Back 165

SYNCHRONOUS single phase 60Hz (1/60)

Front 166

digital circuitry for timing, better control

Back 166

ELECTRONIC timer

Front 167

Idiot machine where ionization plate reads the number of photons striking the target and shuts off the exposure when sufficient

Back 167

AEC
Automatic Exposure Control

Front 168

Used to create the kVp needed for x-ray production

Back 168

HIGH-VOLTAGE GENERATOR

which is a STEP UP TRANSFORMER

Front 169

a step up transformer/high-voltage generator changes the wave form from

Back 169

short wave to long waveform

The AMPLITUDE (HEIGHT) of the voltage is INCREASED with a step up transformer

Front 170

Instrument used to convert AC to DC = ____________

This is called ___________.

Back 170

DIODE converts AC to DC

termed RECTIFICATION

*His switch from AC to DC damn near RECTum, killed'em! He DIODE eventually.

Front 171

rectification only accepts current that travels in _____ direction

Back 171

one (cuts the wave form in half) called HALF-WAVE RECTIFICATION
***test*** inefficient

Front 172

How to fix the half-wave rectification? (turn it to FULL-WAVE rectification)
***test***

Back 172

DIODE BRIDGE inverts current

Front 173

Problem with waves and x-rays because electrons gather at sharp edges...

Back 173

We only use the PEAK of waves. SINGLE phase power (sine wave) comes in, we change it to full-wave rectification for DOUBLE EFFICIENCY but still sucks. Now what? Go to 3-PHASE POWER!!!

Front 174

power co. sends 3 electrical impulses out of phase with each other to us so three wave forms superimposed...

Back 174

3-PHASE ELECTRICITY
is incredibly efficient system

*vs. single-phase
(row row row your boat in 3 phases)

Front 175

BEST power rectified

Back 175

THREE PHASE POWER

3 60Hz waveforms, 180 Hz (3x60) effectively

Front 176

Now put the 3 phase and get to 25,000 get a mesh work that looks like a straight line...use a ______________ generator.

Back 176

HIGH FREQUENCY generator w/ 3-phase power

Front 177

What if I only have 110V available?

Back 177

Get a CAPACITOR DISCHARGE GENERATOR that stores the electricity and releases it all at one time

(the "Prius" of generators)

Front 178

difference between PEAKS & TROUGHS in electrical waveform - affects quality of x-ray beam

Back 178

VOLTAGE RIPPLE

100% is bad efficiency
less than 1% ripple (high frequency) is BEST!

Front 179

Only buy a ____________ machine (vs. single phase)

Back 179

HIGH FREQUENCY

Front 180

DECREASED VOLTAGE RIPPLE results in _______ quality x-ray

Back 180

HIGHER

Front 181

HOW do we RATE an x-ray machine?

Back 181

in terms of KILOWATTS

must be over 30kW, best over 50kW (hospital-based system)

Front 182

30 kW single phase and a 30 kW high frequency DIFFERENCE:

Back 182

high frequency is 30% BETTER

Front 183

Ask what the ___________ is of a machine.

Back 183

KILOWATTAGE

Front 184

where does the magic happen?

Back 184

x-ray TUBE

Front 185

What is the modern tube called? <%{__,}~~


***test

Back 185

ROTATING ANODE TUBE

<%{RAT}~~

Front 186

<%{RAT}~~ . . has two sides:

Back 186

<%{RAT}~~ . .
beam travels from negative to positive...

cathode (-) side is a tungsten filament

anode (+) side is where actual x-ray photons happen (spins)

Front 187

How is x-ray widespread irradiation produced in the x-ray tube?

Back 187

ISOTROPIC FORMATION = radiation in ALL directions

so must be in TUBE HOUSING so photons can only exit in one direction

Front 188

PREVENTS electric shock
PREVENTS widespread irradiation by isotropic formatio of radiation
AIDS in tube cooling

Back 188

X-RAY TUBE

Front 189

Why is pyrex ground down (WINDOW)

Back 189

reduce ABSORPTION

Front 190

CATHODE side is also called the ________ side.

Back 190

FILAMENT

small focal spot small coil
large focal spot large coil

Front 191

PURPOSE of CATHODE side of tube

Back 191

create a BEAM

Front 192

what is the cathode side MADE OF?

Back 192

CAT TONGUE

TUNGSTEN

because it has an incredibly HIGH MELTING POINT - minimal thermal expansion
and
MINIMAL VAPORIZATION - doesn't gas off and create a metal coat, shortening the arc

Front 193

Heats the filament

Back 193

FILAMENT CURRENT heats the filament, BOILING OFF ELECTRONS creates an electron cloud. How to create DIRECTION? FOCUSING CUP

Front 194

tames the electron cloud by applying a negative charge

Back 194

FOCUSING CUP neg. charge drives electrons in ONE DIRECTION

Front 195

side that receives electron beam

Back 195

ANODE (TARGET) SIDE

electrons hitting anode creates photons

Front 196

ANODE must (3)

Back 196

conduct electricity

spin

dissappate heat effectively

Front 197

How to DISPERSE HEAT? (4)

Back 197

1. MANUFACTURE OF ANODE - target made of tungsten, base made of molybdenum, pulling heat and dispersing.
2. ROTATES so electron beam doesn't just hit one place on anode.
3. ANGLE THE TARGET increases surface area but decreases efficiency of resolution
4. OIL BATH in tube housing

Front 198

LINE FOCUS principle

Back 198

angling the anode...in a perfect world, all my radiation would be point source produced from one atom. Problem is the POINT SOURCE needs to be small as possible = we fix this by ANGLING THE TARGET

Front 199

LINE FOCUS PRINCIPLE

Back 199

x-ray tube is at 12 degree pitch creates a TRUE FOCAL SPOT and an EFFECTIVE FOCAL SPOT (the width of the photons I created)

Front 200

trade off between shallow anode angle and steep anode angle to get the best quality picture from a point source - use principle of

Back 200

LINE FOCUS

12 degree angle is our compromise

Front 201

What takes care of WANDERING OFF-CENTER PHOTONS?

Back 201

tube HOUSING

Front 202

problem created by ANGLING OF THE ANODE

Back 202

Problem of angling the anode = ISOTROPIC FORMATION

photons are created DEEP inside anode itself by electrons. We worry about the ones going through the window so distance traveled means more distance, more absorption.

Front 203

Entire span of beam is not homogenous. Photons have to travel through different thicknessness of beam so beam is stronger on CATHODE SIDE than anode side. Called the

Back 203

ANODE HEEL EFFECT

Used for parts of people with different thicknesses and burning out x-ray.
Put toes on anode side so less likely to burn out.
Put abdomen on cathode side so it will get through.

Front 204

Wedge stuck in cathode and decrease problem w/ anode heel

Back 204

compensation filter
collimate light
increase SID (shove bucky in)

Front 205

ALWAYS have x-ray machine installed _______-up.

Back 205

ANODE

to take advantage of anode heel effect

Front 206

Machinery is damaged by FRICTION, ie. ________.

Back 206

HEAT

depends on usage. Full spines wear machines out faster. Extremities last longer. 10-20 years.

Front 207

When you rotate a structure, it heats up via friction, expands and burns out the tube. The cathode will show ______

Back 207

tungsten vapor depositied on tube

Front 208

How to prevent tube failure?

Back 208

SLOW WARM-UP PROCEDURE any time machine hasn't been used for more than two hours (tube hours)

Front 209

What do you need to know about your tube?

Back 209

RATING of your bulb

Front 210

radiology report of findings exam 1, lecture 3

Back 210

A:mild right lumbar lean, leg length inquality, increased lumbar lordosis, subtle retrolisthesis.
B: lumbosacral transitional segment w/ a right unilateral accessory articulation. Density is adequate. Cortical margins are intact, traebecular margins normal. All pedicles are present. No severe anterior wedging.
C: discs, facets, SI's...Discs; moderate loss of IVD space with osteophystes at (name spaces). Hyperlordosis. SI: maintained. Hip joint spaces: subtle acetabular osteophyte formation. Large osteophyte ate L2, L1.
S: no soft tissue masses or swelling. Cholesystectomy clips located in upper right quadrant.
Impressions: lumbosacral transitional segment.

Front 211

read the reports on the

Back 211

portal

Front 212

TO produce X\RAY PHOTONS, we need large kilovoltage, millamperage as well as volts and amps. What do we get from local power company in a regular service?

Back 212

110V, 220V
Variable amps (100A)
60 Hz

Front 213

Electric current is induced if the circuit is in a changing _____________.

Back 213

magnetic field

(Instead of making a magnet that moves and might break, make a moving electric field)

Front 214

A magnet changes polarity 60 x a sec - this correlates to the frequency of household current. How?

Back 214

Using electromagnets, the 60Hz frequency of household current creates a CHANGING MAGNETIC FIELD

*by wrapping a metal wire

Front 215

Wrapped around an IRON core, a wire coil induces a magnetic field called a ____________

Back 215

TRANSFORMER

Front 216

In order to get a decrease or increase in voltage, change the NUMBER OF TURNS WRAPPED AROUND THE COIL on the ___________ side.

Back 216

SECONDARY

Front 217

SINGLE windings on the secondary side of the transformer are used for _________ increases or decreases in voltage

Back 217

SMALL

*the number of coils on 2nd side determines the voltage. Fewer means less voltage, more amperage and vice versa

Front 218

Again, voltage and amperage are _________

Back 218

opposite
inverse

Front 219

the AUTO-TRANSFORMER is in the operating console. How to access it?

Back 219

push LINE ADJUST button

*This IS the autotransformer control. Use it to increase the CONSISTENCY of the x-ray beam by small increases or decreases in LINE VOLTAGE

Front 220

On the old, single phase line adjust compensator units, the LINE ADJUST button controls

Back 220

the AUTO-TRANSFORMER:

consistency of the beam by making small increases or decreases in voltage (to balance out the power company's fluctuating voltage)

Front 221

control for QUANTITY & QUALITY of the x-ray beam

Back 221

kVp

*controls the voltage/amps
or 'how much gun powder is in the cannon'

Front 222

The reading in the console is actually in volts. _________kVp METER.

Back 222

PREREADING

Front 223

Controls the QUANTITY only of the x-ray beam

Back 223

mAs

milliamps per second are the NUMBER OF PHOTONS produced.
*similar to the cannon ball in the cannon. kVp is the gun powder, mAs is the ball

Front 224

When you change the mAs, you change the

Back 224

resistance

~mA "station" x time = mAs
~Always set the mAs first!

Front 225

When reading the Tech Chart, do/find 3 things in this order:

Back 225

Measure your patient in cm. and find cm. on VIEWS chart.
Go to that cm.'s mAs.
Now go to TIME (mAs station) chart and find that mAs - if necessary, round to closest mAs shown. Trace this mAs reading over to the TIME column.
Now you have Time, mAs and kVp between the two charts.
Set the mAs first!

Front 226

ELECTRON interactions happen _____ the xray tube and result in ________.

Back 226

inside,
photons

Front 227

photon interactions start at the tube and travel ______

Back 227

away

Front 228

photon rx result in ___________

Back 228

ionization

Front 229

2 factors to set on xray

Back 229

kVp
mAs

Front 230

control the characteristics of the x-ray beam

Back 230

kVp (voltage)
mAs (amperage)

Front 231

kVp (gunpowder)

Back 231

kinetic energy of electron which controls QUALITY and quantity of beam

Front 232

mAs (buckshot)

Back 232

number of electrons you produce, directly related to number of photons

controls QUANTITY ONLY

Front 233

low gunpowder won't give enough blast to photons to get them through the skin

Back 233

kVp has to be strong enough (voltage) to get through skin and muscle to bone

Front 234

too much gunpowder?

Back 234

burns all the way through skin, muscle, and bone = completely burned through all structures so black pictures
too much kVp

Front 235

OPTIMAL kVp for every exam balances the amount of ____________ (how hard you push determines how far in you go)

Back 235

PENETRATION

because there is a difference between cortical and medullary bone

Front 236

buckshot/quantity of photons striking patient

Back 236

mAs

the dileniation of a space with outline of buckshot

Front 237

mAs too low (quantity of buckshot too low) get

Back 237

quantum model

Front 238

mAs too high (too much buckshot) get

Back 238

darkens everything = dark x-ray
OVEREXPOSED

Front 239

kVp is PENETRATION

mAs is ____________

Back 239

EXPOSURE (DOSE)

Front 240

kVp is ___________

mAs is EXPOSURE

Back 240

PENETRATION

Front 241

When the electrodes hit the _____________, the converted energy becomes photons.

Back 241

anode

Front 242

2 types of electron interaction w/ matter

Back 242

Bremmststrahlung radiation

Characteristic radiation

Front 243

projectile electron comes out and hits anode, changes direction and changes energy. Since energy cannot be created or destroyed, the energy becomes a photon but there is only a MINIMAL DEVIATION (small arc swing around nucleus)

Back 243

BREMSSTRAHLUNG RADIATION: MINIMAL DEVIATION creating low energy, weak wimpy photons

small arc around the nucleus - not a lot of deviation around nucleus

Front 244

projectile electron comes in, loses energy and creates a photon, but has a MAXIMAL DEVIATION - creates a HIGH energy photon

Back 244

CHARACTERISTIC radiation

BEST!!!!!!!!

Front 245

why called CHARACTERISTIC radiation?

Back 245

the energy of the photon created reflects the difference in binding energies of the TARGET ATOM

ie, tungsten atom has a huge target energy and characteristically will produce a high energy photon with a K-SHELL EJECTION

Front 246

energy level of tungsten characteristic spike

Back 246

69 kV

Front 247

85% of y our beam is ______________ type radiation, whereas 15% is _______________ radiation.

Back 247

bremssthralung

CHARACTERISTIC (a lot of deviation resulting in high energy photons)

Front 248

MAXIMUM brensstralung energy is =

Back 248

kVp setting

max Brem radiation = kVp setting

Front 249

Brem PEAK = 1

Back 249

1/3 of kVp setting


Brem peak = 1/3 kVp

Front 250

Change the kVp QUALITY

Back 250

changes Brem peak to 1/3 of kVp setting
changes Brem maximum
Increase kVp results in RIGHT SHIFT because Brem maximum and Brem peak is moving to Right.
QUALITY CHANGE!

Front 251

Change kVp QUANTITY

Back 251

area under the curve
the quantity of photons produced

Front 252

If you change the mAs, you only change the _________ so there is no left or right shift of the area under the curve, just a increase or decrease in the _________ numbers.

*mAs is your buckshot!

Back 252

mAs = Quantity of Photon


***ONLY A CHANGE IN THE AREA UNDER THE CURVE
increase mAs = increase phton #
decrease mAs = decrease phton #

Front 253

Increase kVp by 15% has t he same affect as __________ the mAs

Back 253

doubling

because I am creating more photons
Since mAs is directly related to darkness of film, raising the kVp by 15% raises the mAs, darkening the film.

Front 254

Why can't your kVp be off by even as little as 5%?

Back 254

because it doubles the mAs/DOSE/buckshot.

Always set mAs first because the kVp will change if you set the kVp then the mAs.

Front 255

when changing factors on the fly, change the ___.

DO NOT CHANGE THE ------

Back 255

change the mAs

DO NOT CHANGE THE kVp! because it is based on the mass/thickness of the body part we are x-raying

Front 256

Brem x-rays are bad. How do we get rid of them?

Back 256

ALUMINUM FILTER to remove the weaker photons from the beam

Front 257

When adding ALUMINUM filter to get rid of Brem rays, it's called ___________ of the beam.

****test*****

Back 257

HARDENING

****test******

Front 258

Adding aluminum filter to get rid of Brem rays shifts the curve/peak to the ____________

Back 258

RIGHT,
so this DECREASES THE AREA UNDER THE CURVE
Doesn't matter that there are less photons because now you are SELECTIVELY removing the weak photons.

Front 259

point of aluminum filter for Brem rays?

Back 259

removes weak photons, moves Brem peak right, decreases area under curve and leaves only the GOOD HIGH ENERGY PHOTONS left over

Front 260

Glass of the tube = 0.5 mm Al

Back 260

INHERENT filtration

Front 261

Al between tube and collimator = 1.0 mmAl

Back 261

ADDED filtration

Front 262

A collimator mirror=1.0mm Al

Back 262

The collimator mirror itself and the tube thickness don't change so...

in order to meet the standard 2.0 Al, use ADDED FILTRATION
of aluminum (1.0 mmAl)

Front 263

added aluminum filter for SPECIFIC examination

Back 263

COMPENSATION filtration

ie, AP thoracic, DP foot, and full spines due to changes in thickness of part

Front 264

What do you need in your office that velcros on to your collimator and accounts for changes in thickness of parts?

Back 264

add a SIMPLE WEDGE

Front 265

the kVp and the mAs are good but there is a darkened area, what did you forget?

Back 265

the COMPENSATION WEDGE that keeps you from burning out the thinner areas

Front 266

whole idea of filtration

Back 266

add aluminum to beam
selectivley remove weak E photons
~hardening the beam
~increase quality but decrease quantity

Front 267

Single vs. HIGH frequency x-ray is the same thing as increasing kVp by ______(why buy a high frequency single phase x-ray machine)

Back 267

16%

1. decreases the patient's dose because they are inverse (mAs = dose)
2. better quality picture

Front 268

mAs = ________

Back 268

DOSE of buckshot/photons

double the mAs, make the film 2x as black (OPTICAL DENSITY)

Front 269

INCREASE kVp results in huge changes in number of ______-

Back 269

photons

kVp = mAs2

inverse square
distance

Front 270

How do I measure the E of an xray beam?

Back 270

beam PENETRABILITY (kVP)

higher energy = more penetrability

Front 271

INSTRUMENT that measures the PENETRABILITY of an x-ray beam

Back 271

STEP WEDGE for kVp
measures penetration (kVp strength)

Front 272

How to INCREASE PENETRABILITY of x-ray?

Back 272

raise the kVp to penetrate more of the aluminum

Front 273

HVL

Back 273

HALF VALUE LAYER
the amount of aluminum necessary to cut the strength of beam in HALF

Front 274

as kVp goes up, _______ gets thicker

Back 274

HVL

Front 275

distance has no effect on

Back 275

kVp (quality)

Front 276

can change 4 things:

Back 276

1. kVp
2. mAs
3. filtration
4. distance

Front 277

why write a radiology report anyway?

Back 277

Represents a record that images were taken and evaluated

If you didn't write it down, it didn't happen!

Front 278

Code 72100 is global code with 2 components:

Back 278

1. technical 60-70% global fee
2. professional 30-40% global fee

Front 279

bill x-ray CPT code 72100 technical only?

Back 279

SUBSTANDARD CARE

Front 280

bill x-ray CPT code 72100 global but no report?

Back 280

INSURANCE FRAUD

Front 281

3 types of imaging reports:

Back 281

Standard narrative format **** best****

Checkbox (too generic)

Impressions in SOAP notes (can lack info or be hard to find)

Front 282

If you have imaging w/o a report

Back 282

Imaging > 1-2 years, SOAP note findings

Imaging < 1 year, complete report

sometimes this can be billed for

Front 283

If you have imaging AND a report

Back 283

Date and initial, copy in patient's file

SOAP note as 'agree/disagree with report' and add things that might be missing (eg, postural findings)

Front 284

Why should your viewbox be in a dark room?

Back 284

CONTRAST better in low light

Front 285

Why buy a commercial viewbox?

Back 285

Homemade boxes don't illuminate well

Front 286

What should you have available to view OVEREXPOSED film?

Back 286

HOTBOX (hot light)

Front 287

Computer generated reported techniques:

Back 287

EMR, Word, OpenOffice, etc.
Manually type
Transcription
voice recognition - DRAGON

*always spell check and proofread

Front 288

Difference between RADIOLOGY standard film hanging and CHIROPRACTIC film hanging?
Which one do we use in this class?

Back 288

Radiology film hanging is as though the person is facing you.

Radiology! FRONTAL FILMS FACE YOU.

Front 289

LATERAL FILM hanging rule

Back 289

always hang to same direction, ie, hang laterals FACING LEFT

MRI sagittal orientation

Front 290

How do you hang frontal and oblique proximal extremity films?

knee, hip, shoulder

Back 290

Like you are examining the patient:

anatomically UPRIGHT
Laterals - dealers choice but be consistent

Front 291

How do you hang frontal and oblique DISTAL EXTREMITIES?

hands and feet

Back 291

with toes or fingers pointed upward usually LIKE YOU WOULD LOOK AT YOUR OWN HANDS OR FEET

Front 292

Format:

what kind of paper and what's included on every page?

Back 292

your LETTERHEAD

Page #

Front 293

Format:

PATIENT DEMOGRAPHICS

(2 dates)

Back 293

Name, age, gender
Date of exam report
Patient DOB

Front 294

format:

HISTORY

Back 294

Short and sweet!

Rule out compression fracture
LBP w/ R leg radiation

Front 295

format:

what does format include besides the x-ray?

EXAMINATION

Back 295

MODALITY & BODY PART
includes MRI and CT!

examples:
Upright Lumbar Spine X-ray
Recumbent Thoracic Spine X-ray

Front 296

format:

VIEWS

Back 296

AP, medial oblique, lateral

AP, lateral

Avoid JARGON such as 'Davis series' - (7 view series)

Front 297

format:

FINDINGS (5 components)

Back 297

DESCRIPTIONS, not diagnoses!

COMPLETE SENTENCES

PARAGRAPH FORMAT

PERTINENT NEGATIVES

FOLLOW YOUR SEARCH PATTERN

ie: "Moderate loss of intervertebral disc height with spondylophyte formation is seen at L2-L5."

Front 298

subformat of Findings:

PARAGRAPH format

Back 298

P1 = alignment
P2 = bone and cartilage
P3 = soft tissues

in other words, A-BC-S (ABC's)

Front 299

format:

IMPRESSIONS

Back 299

CONCLUSIONS

-Diagnoses or differentials
-brief, to the point sentences, not just a list of diagnoses!!!!

WORST FIRST formatting in NUMBERED LIST

Front 300

Regarding format for IMPRESSIONS, what are two most important guidelines?

Back 300

WORST FIRST formatting in a NUMBERED LIST

in complete sentences, please...

Front 301

format:

RECOMMENDATIONS

Back 301

ONLY if 1 of the following is indicated:
1. additional imaging
2. labwork
3. referrals

***DO NOT INCLUDE CHIROPRACTIC MGMT. recommendations, ever.****

Front 302

- Moderate degenerative disc disease, L2-L5.
- Grade 2 spondylolytic anterolisthesis, L5.
- Bubbly lytic expansile lesion in the distal radius. Differential possibilities include: aneurysmal bone cyst, giant cell tumor, brown tumor.

Back 302

Examples of format IMPRESSIONS

Worst first of diagnoses or differentials in complete sentences.

Front 303

If there are no RECOMMENDATIONS in your format, what should you do?

Back 303

leave it blank!

Front 304

An MRI of the lumbar spine is recommended to evaluate for central canal stenosis.
Patient should be transported to the emergency room for evaluation of the 8cm abdominal aortic aneurysm.

Back 304

examples of format RECOMMENDATIONS

Front 305

format

SIGN AND FILE...you signature should be?

Back 305

unique

Front 306

Regarding handwritten material, use only __________ ink

Back 306

black (only one that copies on xerox)

Front 307

What do you do if the film is doo doo?

Back 307

Input:
"Does not meet diagnostic criteria due to:
1....
2....
3...

@ the beginnings of the FINDINGS section. Just write the report to the best of your ability.

Front 308

What if there is something there, but I don't know what it is?

Back 308

1. Describe it
2. Differential it and
3. Have your films read by a radiologist

Front 309

What if there are previous radiographs?

Back 309

The first sentence in findings section comments on the comparison. Make the appropriate call on progression of changes in the body of findings.

"Comparison is made with [insert exam and views] performed on [date of exam at [facility]."

Front 310

"In the intervening 2 years, the degenerative changes of the right hip have advanced mildly. This finding is consistent with normal degenerative progression."

Back 310

example of 2nd opinion radiologist report

what to do if previous radiographs - use first sentence of FINDINGS section to comment on comparison then put progression of changes in the body of the FINDINGS.

Front 311

a systemAtic way of viewing films

Back 311

seArch pattern

Front 312

How does utilizing a search pattern decrease the likelihood of missing pathologies?

Back 312

overlooking regions
"satisfaction of search" (the smug factor)

Front 313

How should you start a search pattern?

Back 313

Use a gestalt...sit back, look over the whole series

Front 314

Best kind of search pattern for film?

Back 314

item by item


ie, cervicothoracic, thoracolumbar

Front 315

Do you report your search pattern? Why?

Back 315

Yes, because you are responsible for every inch of the radiograph, so don't forget ALL the film margins.

Front 316

ABCS search pattern

Back 316

Alignment
Bone
Cartilage/Joint
Soft tissue

Front 317

A-lignment

CORONAL PLANE CURVES

Back 317

list
lean
shift
Pelvic unleveling
Scoliosis (should be measured)
~covexity
~rotation

Front 318

Regarding the coronal plane curve (A-lignment) SCOLIOSIS, the COVEXITY points ____ the side you call it.

Back 318

TO

The covexity of a scoliosis points TO the side you call it. Also mention rotation.

Front 319

If I have a convexity on the right side, T7-8, how do I say it?

Back 319

Standing AP and lateral views of the entire spine demonstrate an arcuate thoracolumbar scoliosis with a RIGHTWARD CONVEXITY.
No associated vertebral abnormalities are noted. (U.W.rad)
A mild dextrorotary right midthoracic convexity is seen.
A moderate non-rotary left thoracolumbar list is noted (NYCC-Warshel)

Front 320

Again, regarding scoliosis, the _________ points TO the side you call it.

Back 320

convexity


*try to mention rotation as levorotary or dextrorotary, as well

Front 321

As the disease progresses, the vertebrae and spinous processes in the area of the major curve rotate toward the concavity of the curve

Back 321

scoliosis


~UWrad

Front 322

Scoliosis and others are ___________ plane curves.

Back 322

SCOLIOSIS, listing, leaning, shifting, pelvic unleveling = CORONAL plane

Front 323

Lordosis and kyphosis are ___________ plane curves.

Back 323

Lordosis, kyphosis = SAGITTAL plane

Front 324

A-lignment in the sagittal plane:

When describing lordosis or kyphosis, ___________ increased, decreased, focal changes as ______, ________, or ________.

Back 324

QUANTIFY as mild, moderate or severe.

"The lumbar lordosis is markedly increased, with approximation of the spinous processes."

Front 325

"The cervical lordosis is flattened with mild anterior shift of weight bearing."

Back 325

A-lignment in the sagittal plane and in the coronal plane

Front 326

A-lignment that gives DIRECTION

Back 326

LISTHESIS

"A grade 3 anterolisthesis of L5 is noted, with associated bilateral defects of the pars interarticularis."

Front 327

LISTHESIS components for A-lignment:
1.
2.
3.

Back 327

1. DIRECTION: antero, retro, latero

2. QUANTIFY the degree: grade 1, 6mm

3. ETIOLOGY (due to): spondylolytic degenerative, etc.

Front 328

"A grade 3 anterolisthesis of L5 is noted, with associated bilateral defects of the pars interarticularis."

Back 328

A-lignment - LISTHESIS:
antero, retro, latero
Grade 1-6
1-? mm
Etiology (due to)

Front 329

scoliotic spinous processes tend to point to the _______ side

Back 329

concave

*this means the vertebral body rotates towards the convex, scoliotic side

Front 330

Listheses' should be listed under both _______ and ________ in the generalized report.

Back 330

findings & impressions (conclusions)

Front 331

A-lignment: Measurements are pertinent to the

Back 331

area being evaluated

Include both SIGNIFICANT measurements & PERTINENT NEGATIVES (but not trivial measurements)

Front 332

For non-standard measurements, such as McGregor's line, only include in A-lignments category if?

Back 332

they are POSITIVE

*be sure to QUANTIFY - otherwise, what's the point of including a measurement line?

Front 333

The atlantodental interval measures 8.5mm on the flexion lateral.

Back 333

A-lignment: Measurement which is significant

Front 334

The atlantodental interval is within the normal accepted range.

Back 334

A-lignment: Measurement which is a pertinent negative

*vs. trivial shit no one wants to hear about just because you measured it.

Front 335

ABCS:
Bone regarding what is visible parts-wise

Back 335

Extra or missing parts (can also be in the alignment section)

Front 336

transitional ribs
cervical ribs

Back 336

B of ABCS

extra or missing parts

Front 337

ABCS

Most important aspect of BONE

Back 337

Overall bone DENSITY
Note whether GENERALIZED OR LOCAL

*because 30-50% bone loss before visible on xray

Front 338

Osteopenia is a ______
vs.
Osteoporosis is a _________-

Back 338

osteopenia is a FINDING
vs.
osteoporosis is a DIAGNOSIS

Front 339

No decrease in bone density is appreciated
Mild generalized osteopenia is appreciated

Back 339

Bone of ABCS regarding DENSITY

*remember to write a FINDING, (like diffuse osteopenia) and not a diagnosis, like osteopetrosis.

Front 340

ABCS of B:

density + (disruptions, sclerosis, missing structures, shapes, endplates)

Back 340

CORTICES
TRABECULAR PATTERNING
PEDICLES

Front 341

ABCS of Bone:

alignment, apposition, rotation for Fx cases

Back 341

= disruption

(cortices, trabecular patterning, pedicles)
Cortical margins are intact. Trabecular patterns are normal.

Front 342

ABCS of Bone:

whitening or lucencies

Back 342

= Sclerosis, lysis

(cortices, trabecular patterning, pedicles)
Cortical margins are intact.
Trabecular patterns are normal.

Front 343

ABCS of Bone:

Is anything missing?

Back 343

= missing structures

(cortices, trabecular patterning, pedicles)
Cortical margins are intact.
Trabecular patterns are normal.

Front 344

ABCS of Bone:

vertebrae descriptors

Back 344

= shapes and sizes of vertebrae

(cortices, trabecular patterning, pedicles)
Cortical margins are intact.
Trabecular patterns are normal.

Front 345

"anterior wedging"

"trapezoidal shape"

Back 345

Bone shapes and sizes

Front 346

ABCS of Bone:

vertebral ends

Back 346

=endplate irregularities

(cortices, trabecular patterning, pedicles)
Cortical margins are intact.
Trabecular pattern is normal.

Front 347

The cortical margins of the endplates from T8--T12 demonstrate sclerotic thickening suggestive of rugger jersey spine

Back 347

ABC of Bone = sclerosis or lysis
(cortices, trabecular patterning, pedicles)

hyperparathyroidism would be a diagnosis, not an observation

Front 348

A geographic, lytic, soap-bubble expansile lesion with a narrow zone of transition is seen in the distal radial metaphysis, extending to a subarticular location.

Use FOGMACHINES

Back 348

FOGMACHINES:

Fibrous dysplasia
Osteoblastoma
Giant cell tumor
Multiple myeloma/plasmacytoma,Metastasis
Aneursymal bone cyst
Chondroblastoma
Hyperparathyroid brown tumor, Hemophiac pseudotumor
Infection
Non-ossifying fibroma/Fibrous cortical defect
Eosinophilic granuloma
Simple bone cyst

Front 349

What is the acronymn for d/dx of bone lesion resembling anerysmal bone cyst?

Back 349

FOGMACHINES

Front 350

"Mild 15% loss of anterior vertebral body height is seen at L1, with a corresponding step defect in the anterior cortex and white line of condensation."

Back 350

ABCS of Bone

(Density + cortices, trabecular patterning, pedicles)

Front 351

Usually these two ABCS overlap

Back 351

Bone & Cartilage

subchondral scleroses, osteophytes, ~stage IV avascular necrosis with articular collapse and DJD

Front 352

Joint changes lead to _______ changes and vice versa.

Back 352

bone

Front 353

Joint changes lead to changes and ?

Back 353

vice versa = bone changes lead to joint changes

Front 354

subchondral sclerosis, osteophytes

Back 354

instance of JOINT CHANGE leading to bone change

Front 355

Stage IV AVN with articular collapse and DJD

example of?

Back 355

BONE CHANGES leading to joint changes

Front 356

Regarding CARTILAGE, always

Back 356

1. GRADE changes as mild, moderate, severe

2. Note changes in DISC HEIGHT or spondylophyte formation

3. FACET JOINTS as hypertrophy, sclerosis, osteophytic

4. SPINE:
a. uncinates
b. costovertebral/costotransverse
c. sacroiliac joints

5. EXTRA-AXIAL mild, moderate, severe

Front 357

Regarding CARTILAGE, always discuss changes in disc height with the descriptors:

Back 357

mild
moderate
severe

Front 358

Stage IV AVN with articular collapse and DJD

example of?

Back 358

BONE CHANGES leading to joint changes

Front 359

Regarding CARTILAGE, always remark on 5 things:

Back 359

Grade/Disc height/Facet joints/Spinal regions/Extra-axial

1. GRADE changes as mild, moderate, severe

2. Note changes in DISC HEIGHT or spondylophyte formation

3. FACET JOINTS as hypertrophy, sclerosis, osteophytic

4. SPINE:
a. uncinates
b. costovertebral/costotransverse
c. sacroiliac joints

5. EXTRA-AXIAL mild, moderate, severe

Front 360

Regarding CARTILAGE, always discuss changes in disc height with the descriptors:

Back 360

mild
moderate
severe

Front 361

Regarding ABCS of Cartilage:

Uncinates may develop

Back 361

sclerosis
hypertrophy
osteophytes

depending on patient sx, may need obliques

Front 362

Regarding ABCS of Cartilage:

Costovertebral/costotransverse

Back 362

Ribs DJD can mimic lung diseases

Front 363

ABC's of Cartilage

3 things

Back 363

grade changes
disc heights & spondylophyte formation
facet joints esp. osteophytes

Front 364

Regarding ABCS of Cartilage:

Sacroiliac joints

Back 364

cortical margins
irregularities
sacroilitis
sclerosis

might rec. AP spot

Front 365

Regarding ABCS of Cartilage:

Extra-axial

Back 365

always grade changes

mild, moderate, severe

Front 366

Regarding ABCS of Cartilage EXTRA AXIAL:

evaluate what?

Back 366

joint spaces
subchondral scleroses, osteophytes
erosions
loose bodies
cartilage calcification (CPPD, gout)
enthesopathy

Front 367

Always evaluate cartilage ____________

Back 367

bilaterally

Front 368

What might you decide to do after you finish the bone/cartilage evaluation?

Back 368

MEASUREMENTS
AC joint space
anterior humeral line for supracondylar fx
Scapholunate space, VISI/DISI in wrist
3 joint spaces of the hip
Boehler's angle for calcaneal fx

Front 369

The part overlooked by chiropractors in a report

Back 369

SOFT TISSUE

Front 370

ABCS of Soft tissue

what to look for?

Back 370

~Masses
~Calcifications (HADD, stones)
~Displacement of fascial planes
~Organ shadows

Front 371

ABCS of Soft tissue:

include pertinent negatives = CERVICAL SPINE

Back 371

Adenoidal hypertrophy
Prevertebral soft tissue (rule of 2's and 4's)
Midline Trachea
Lung Apices
Calcifications in the carotids

Front 372

gas density noted in the prevertebral soft tissue

Back 372

ABCS of Soft tissue

Front 373

ABCS of Soft tissue

include pertinent negatives = THORACIC

Back 373

Trachea on midline?
Upper abdomen (meganblasse, spleen, liver)?
Cardiomediastinal silhouette
Lung fields, hila, clear spaces ?
Paravertebral tissue stripe?
Hemidiaphragm

Front 374

ABCS of Soft tissue

include pertinent negatives = LUMBAR

Back 374

Hemidiaphragms, lung bases
Psoas shadows (ascites)
Solid organ patterns (presence, lateral situs inversus)
Bowel (contents, contour, presacral space on lateral view)
Bladder
Vascular (abdominal aorta)

Front 375

ABCS of Soft tissue

EXTREMITIES (3)

Back 375

FAT PADS / JOINT EFFUSION / CALCIFICATIONS:

1. Capsular FAT PADS (scaphoid, posterior elbow, hip)

2. Joint EFFUSION (suprapatellar pouch, FBI sign)

3. Tendon/ligament/muscle CALCIFICATIONS ( HADD, myositis ossificans, HPT or diabetic vascular necrosis)

Front 376

Tie the findings into a cohesive whole; numbered list of brief synopsis using short sentences.

Back 376

IMPRESSIONS

**WORST FIRST
***give a diagnosis or differential list, but DO NOT EXCEED 3 D/DX usually
****if you are uncertain, say so and recommend a follow up

Front 377

Impressions are also called

Back 377

conclusions

Front 378

Findings
-Mild loss of intervertebral disc space with spondylophyte formation is seen at L4-S1.

Back 378

Impression
-Mild degenerative disc disease, L4-S1

Front 379

Findings
-A 5mm (grade 1) anterolisthesis of L5 is noted with bilateral defects of the pars interarticularis. The L5 vertebral body does not demonstrate trapezoidal shape, there is no rounding of the sacral promontory, and sacral buttressing is not present.

Back 379

Impression
-Grade 1 spondylolytic anterolisthesis, L5. Radiographic findings do not suggest instability. If there is clinical concern for instability, a flexion/extension series should be performed.

Front 380

Findings
- Multiple foci of dense sclerosis are noted throughout the lumbar spine, sacrum, and ilium. These foci are not expansile, demonstrate a wide zone of transition.

Back 380

Impression
-Findings suggestive of blastic metastasis. See recommendations.

Front 381

Findings
-A geographic, lytic, soap-bubble expansile lesion with a narrow zone of transition is seen in the distal radial metaphysis and epiphysis, extending to a subarticular location.

Back 381

Impression
- Findings suggestive of giant cell tumor. Additional differential possibilities would include but are not limited to aneurysmal bone cyst or hyperparathyroid brown tumor. See recommendations.

Front 382

These are for follow up studies.
DO NOT INPUT YOUR CLINICAL TREATMENT!!!!

Back 382

Recommendations

1 of 3 things:
Additional imaging (what kind) = Lab = Referrals (what goes to who)

Front 383

Recommendations represent additional work up necessary for narrowing the _________ list, confirmation of ________ findings, or clarification of _________.

Back 383

differentials

suspicious

uncertainties

Front 384

Impression
-Findings suggestive of blastic metastasis. See recommendations.

Back 384

Recommendation
-Patient should be referred to PCP for evaluation. An MRI of the lumbar spine and/or a bone scan is recommended in order to further evaluate the possibility of blastic metastasis. Laboratory evaluation should also be performed.

Front 385

Impression
-Findings suggestive of giant cell tumor. Additional differential possibilities would include but are not limited to aneurysmal bone cyst or hyperparathyroid brown tumor. See recommendation.

Back 385

Recommendation
-An MRI of the distal radius is recommended for more thorough examination of this lesion.