Ouhsc Advanced Imaging & Critique Test 1

Front 1

Congenital Bone Anomalies

Back 1

Transitional vertebrae, osteogenesis imperfecta, osteopetrosis, achondroplasia

Front 2

Transitional Vertebrae

Back 2

- takes on characteristics of vertebrae on either side of it
- usually occurs btw. T12-L1 or L5-S1

Front 3

Where are "cervical ribs" seen & why are they important?

Back 3

- C7-T1 junction
- may exert pressures on nerves (brachial plexus) & cranial artery

Front 4

Sacralization

Back 4

- a.k.a. transitional lumbosacral vertebra
- L5 fuses partially or totally w/ sacrum

Front 5

Osteogenesis Imperfecta (OI)

Back 5

- brittle bone disease
- lack of osteoblastic (bone forming) activity & abnormal collagen formation
- bones have thin cortices, can look like they have zebra stripes
- Technical factors = derease

Front 6

Osteopetrosis

Back 6

- deficiency of osteoclasts; fault bone reabsorption
- Marble Bone Disease
- Technical factors = increase (increased bone density)

Front 7

Achondroplasia

Back 7

- failure of cartilage that becomes bone to form properly; disrupts ossification process
- MOST COMMON CAUSE OF DWARFISM
- significantly affects long bones
- can also see: lordosis, bow legs, bulky forehead w/ saddle nose

Front 8

Osteoporosis

Back 8

- decrease in bone density due to osteoblastic insufficiency
- calcium deposition is normal
- caused by: disuse atrophy, menopause, steroids, Cushing Syndrome
- Technical factors = decrease

Front 9

Osteomalacia/Rickets

Back 9

- decrease in bone density due to lack of calcium & phosphorus
- softening of bones in adults despite normal amount of osteoid being present
- caused by: vitamin D deficiency, pregnancy

Front 10

Paget's Disease

Back 10

- Osteodystrophia Deformans
- inflammatory response to a virus that has 3 stages: 1) increase in osteoclasts (makes "holes") 2) osteoclast/osteoblast mix (create increased trabecular bone) 3) burnout
- Radiographic appearance: radiolucent osteolysis & radiopaque osteosclerosis; "COTTON WOOL" appearance
- technical factors: can't tell unless an x-ray has already been taken

Front 11

Acromegaly

Back 11

- hypersecretion of GH or HGH; leads to systematic overgrowth of organs & bones
- Patient: enlarged hands/feet, increase in bone size appearing as generalized swelling
- Radiographically: bone thickening on skull, large frontal sinuses, long phalanx

Front 12

Gout

Back 12

- cause: elevated levels of uric acid in blood which deposits into surrounding joints, tissues, & tendons
- most commonly associated w/ feet (1st digit)
- Radiographically: "RAT BITE" erosion associated w/ head of long bones @ joint

Front 13

Legg-Calve-Perthes (LCP)

Back 13

- common lesion of head of femur
- young males aged 5-10
- leads to ischemic necrosis of femoral head, typically unilateral
- Radiographically: flattened femoral head due to epiphysis fracture

Front 14

Benign Neoplastic Bone Changes

Back 14

Fibrous dysplasia, bone cyst, giant cell tumor, chondroma (exostosis & enchondroma)

Front 15

Malignant Neoplastic Bone Changes

Back 15

Chondroma (chondrosarcoma), Ewing Sarcoma, Multiple Myeloma, Osteogenic Sarcoma

Front 16

Fibrous Dysplasia

Back 16

- fibrous displacement of osseous tiusse; pathologic fracture are common b/c of expansion of bone causing thin eroded cortices
- involving usually long bones, ribs, & facial bones
- Radiographically: layer of thick, sclerotic bone termed as a rind ("RIND SIGN")

Front 17

Bone Cyst

Back 17

- develop beneath epiphyseal plate, migrate down shaft w/ bone growth; comprised of fibrous tissue containing clear fluid
- Typically occurs in proximal humerus & knee of <18
- may not be seen initially on radiograph, when they are seen they show a lucent focus w/ thin cortex creating a sharp boundary

Front 18

Giant Cell Tumor (Osteoclastomas)

Back 18

- younger population (early 20s)
- common location: long bones arising from epiphysis after closure
- causes extensive local damage to bone, doesn't metastasize
- Radiographically: large bubbles separated by thin strips of bone, "SOAP BUBBLE" sign

Front 19

Chondroma - Exostosis

Back 19

- most common form arising from cortex of bone & growing parallel to bone
- seen as localized bone overgrowth @ a joint (common = knee)
- flat exostosis occurs @ pelvis & scapula

Front 20

Chondroma - Enchondroma

Back 20

- occurs anywhere cartilage is present (common area: hands, feet in adolescents)
- The more centrally located the tumor, the greater the possibility of malignancy
- bone slowly replaced by calcified & uncalcified hyaline cartilage
- Technical factors: decrease

Front 21

Chondroma - Chondrosarcoma

Back 21

- malignant tumor of cartilage
- typical sites: pelvis, long bones (axial skeleton)
- 3x more often in men over age 45

Front 22

Ewing Sarcoma

Back 22

- most common primary malignant tumor seen in children aged 5-15; occurs in diaphysis of long bone
- bone has stratified new bone formation, "ONION PEEL" (if seen radiographically, prognosis is very poor)
- After diagnosed, staging & follow-ups use MRI

Front 23

Multiple Myeloma

Back 23

- arises from bone marrow plasma cells (actively hemopoietic [blood-forming] marrow)
- most often seen in adults > 50
- Radiographically: "SWISS CHEESE" appearance (osteolytic lesions)
- invariably fatal within a few years (increased risk of paraplegia)

Front 24

Osteogenic Sarcoma/Osteosarcoma

Back 24

- most common histological form of primary bone cancer
- highly malignant @ 10-30 yrs, second high peak around age 60 if Paget's disease has already manifested
- occurs in: distal ends of femur, proximal ends of humerus & radius
- metastasizes to lungs early on
- Radiographically: "SUNRAY" appearance; dense areas & radiolucent areas creating an arc

Front 25

Bone Structure: Outer to Inner

Back 25

Periosteum, Cortical, Cancellous, Medullary Cavity Endosteum

Front 26

How many bones in the body?

Back 26

206 (Axial = 80, Appendicular = 126)

Front 27

Osteoblasts

Back 27

- reside in inner layer of periosteum
- mechanisms of bone growth

Front 28

Osteoclasts

Back 28

- resides in endosteum
- associated w/ resorption & removal of bone

Front 29

How do bones grow longer?

Back 29

Results of cells multiplying in the epiphyseal cartilage

Front 30

How do bones grow in diameter?

Back 30

By action of osteoblasts & -clasts' working together (as a layer gets cut on inside, layer added on outside)

Front 31

Diaphysis

Back 31

- long sections of long bone
- made up of cortical bone
- contains marrow within medullary cavity

Front 32

Epiphysis

Back 32

- round end of long bones
- main contact point for joints

Front 33

Metaphysis

Back 33

- section of growing bone at either end of diaphysis
- located btw. diaphysis & epiphysis
- contains epiphyseal growth plate (physis)
- completely ossifies by age 18-25

Front 34

Example of Gliding Joint

Back 34

Vertebrae

Front 35

Example of Hinge Joint

Back 35

Elbow, knee

Front 36

Example of Condylar/Ellipsoidal Joint

Back 36

Wrist or MCP joints in hand

Front 37

Example of Saddle Joint

Back 37

Thumb

Front 38

Example of Pivot Joint

Back 38

C1/C2 (Dens)

Front 39

Example of Ball & Socket Joint

Back 39

Hip, Shoulder

Front 40

GO TO SLIDE 14 OF BONE FX & HEALING POWERPOINT

Name the fractures left to right

Back 40

Transverse (Simple)
Longitudinal
Oblique
Spiral

Front 41

GO TO SLIDE 15 OF BONE FX & HEALING POWERPOINT

Name the fractures left to right

Back 41

Longitudinal
Spiral
Simple (not complete break of cortical outlines)
Compound

Front 42

GO TO SLIDE 16 OF BONE FX & HEALING POWERPOINT

Name the fractures left to right

Back 42

Oblique/Spiral
Communited (3 pieces or more)
Impacted Fracture
Compression Fracture

Front 43

Who are compression fractures most often seen in?

Back 43

Postmenopausal women

Front 44

GO TO SLIDE 17 OF BONE FX & HEALING POWERPOINT

Name the displacement left to right

Back 44

Nondisplaced
Medial Displacement
Lateral Displacement
Distracted Displacement
Superior/Posterior Displacement
Distracted w/ Rotation Displacement

Front 45

When describing a displacement, we are describing a _____________ (proximal/distal) break

Back 45

Distal

Front 46

Plastic/Greenstick Fracture

Back 46

- Incomplete fracture w/ opposite cortex intact
- found exclusively in infants & children b/c of softness of cancellous bone

Front 47

Torus (Buckle) Fracture

Back 47

- 1 cortex is intact w/ buckling or compaction of opposite cortex

Front 48

Fatigue/March/Stress Fracture

Back 48

- result of repeated stresses to a bone that would not be injured by isolated forces of the same magnitude
- frequently occur in soldiers during basic ("march" fracture)
- Common sites: shafts of 2nd & 3rd metatarsals, calcaneus, proximal & distal shafts of tibia & fibula ischial & pubic rami

Front 49

Avulsion Fracture

Back 49

- small piece of bone rips away fro bone
- happens often w/ joint dislocation

Front 50

Pathologic Fracture

Back 50

- occur in bone that has been weakened by a preexisting condition
- most common sites: spine, femur, & humerus

Front 51

Colles/Smith Fracture

Back 51

- transverse fracture through distal radius w/ posterior angulation & often overriding of distal fracture fragment
- usually associated w/ avulsion fx of ulnar styloid process
- usually caused by fall on outstretched hand; most common fracture of wrist

Front 52

Boxer's Fracture

Back 52

- transverse fracture of neck of 5th metacarpal w/ palmar angulation
- result of a blow struck w/ the fist

Front 53

What's a good indication of a fracture around the elbow?

Back 53

Displacement of fat pads (Fat Pad Sign)

Front 54

Monteggia Fracture

Back 54

- isolated fracture of the shaft of the ulna associated w/ anterior dislocation of the radius @ elbow

Front 55

Galeazzi Fracture

Back 55

Combo of a fx of the shaft of the radius & a dorsal dislocation of ulna @ wrist

Front 56

Jones Fracture

Back 56

- transverse fracture of the base of 5th metatarsal
- similar S&S to avulsion fxs
- common fracture in foot; occur on short axis of bone

Front 57

How does cortical bone heal after a fracture?

Back 57

- formation of new bone (callus bridge)
- osseous layer forms new bone

Front 58

How does cancellous bone heal after a fracture?

Back 58

- directly through osteoblastic activity at fracture site

Front 59

Time Frame of Fracture Healing

Back 59

Inflammation 10%
Reparative 40%
Remodeling 70%

Front 60

Malunion of Fractures

Back 60

- occurs when bone ends haven't been properly reduce & are misaligned, impairing normal function
- fracture is united, but there's a degree of angular or rotary deformity

Front 61

Closed Reduction

Back 61

No surgery needed to repair

Front 62

Open Reduction

Back 62

Surgical fixation of a fracture

Front 63

Which fractures benefit from fixation?

Back 63

All

Front 64

External Fixation

Back 64

Used to maintain closed reductions (ex. cast)

Front 65

Internal Fixation

Back 65

Used to maintain open reductions (ex. ORIF)

Front 66

Stress Sharing

Back 66

Transmits load across fracture, helps w/ healing process

Front 67

Stress Shielding

Back 67

- Protects vulnerable fracture from being further hurt in process
- transfers forces across fixator devices
- healing times longer

Front 68

Mesocephalic Skull

Back 68

Petrous pyramids form 47 degree angle w/ MSP

Front 69

Brachycephalic Skull

Back 69

Petrous pyramids form 45 degree angle w/ MSP

- more broad from side to side
- shorter from anterior to posterior

Front 70

Dolicocephalic Skull

Back 70

Petrous pyramids form 40 degree angle w/ MSP

- slimmer, longer skull
- taller, deeper vertex down to base of skull

Front 71

Basal Fracture

Back 71

Fracture @ base of skull

Front 72

Blowout Fracture

Back 72

Fracture in floor of orbit (usually involves maxilla & maxillary sinuses)

Front 73

Contra-coup Fracture

Back 73

Fx to 1 side of structure caused by trauma to other side

Front 74

Depressed Fracture

Back 74

Flat bones of calvarium are pressed into cranial cavit

Front 75

Tripod Fracture

Back 75

Fx of zygomatic arch & orbital floor w/ dislocation of frontozygomatic suture ("floating" zygoma)

Front 76

Mastoiditis

Back 76

- caused by acute otitis media (middle ear infection)
- mastoid fills w/ infected materials & delicate structure within it may deteriorate

Front 77

Skull Metastases

Back 77

- carcinomas reach brain by hematogenous spread
- most common metastases that reach brain come from lung or breast

Front 78

On a PA Skull, where should the petrous ridges be?

Back 78

Filling the orbit

Front 79

On a PA skull, if 1 side appears larger/wider, this is the side the patient is turned ______________ (toward/away from)

Back 79

Away from

(to correct, face must be rotated back in that direction)

Front 80

How would tilt be visualized on a PA Skull?

Back 80

By looking @ long axis of nasal septum w/ regard to long axis of IR OR if 1 orbital margin is above the other

Front 81

What does a too flexed PA/PA Axial Skull look like?

Back 81

If petrous ridges are seen superiorly to superior orbital margin (patient tucked too much)

To correct, patient needs to extend back

Front 82

What does a too extended PA/PA Axial Skull look like?

Back 82

Orbits not completely filled w/ petrous ridges

To correct, tuck their chin more

Front 83

What adjustments would need to be made to get a PA skull w/ a C-collar on?

Back 83

Put a caudal angle on tube allowing OML to be parallel to IR

Front 84

PA Axial Caldwell Angulation

Back 84

15 degrees caudal exiting nasion

Front 85

How is rotation detected on lateral skull?

Back 85

Sella turcica not seen in profile; mandibular rami not superimposed

Front 86

How is tilt detected on lateral skull?

Back 86

Orbital roofs & EAMs not superimposed

Can use magnified mandibular body to ID direction to correct

Front 87

AP Axial (Towne) Angulation

Back 87

30 degrees for OML
37 degrees for IOML
Enters 2.5" above glabella going through EAMs

Front 88

How is rotation detected on a Towne/Haas?

Back 88

Measure the space between posterior clinoid processes & lateral aspects of foramen magnum

Larger space = rotate towards that side to correct

Front 89

How is tilt detected on a Towne/Haas?

Back 89

Verified w/ MSP and/or nasal septum parallel to long axis of IR

Front 90

Which is seen more, not enough flexion or not enough extension, on a Towne?

Back 90

Not enough flexion (posterior clinoid processes seen superiorly to foramen magnum)

Front 91

PA Axial - Haas Method

Back 91

- 25 degree cephalic angle
- enters 1.5" inferior to inion (bump @ back of head)
- good method for hypersthenic or trauma

Haas is to Towne as PA Skull is to AP Skull

Front 92

Anatomy to be seen in Haas images

Back 92

Dorsum sellae, posterior clinoid processe within foramen magnum

Front 93

SMV (Schuller)

Back 93

(IOML parallel to IR)
- CR perpendicular to IOML directed through sella turcica (right in front of EAM)

Front 94

What anatomy should be seen in a SMV/Schuller image?

Back 94

Cranial base structures (foramen ovale & foramen spinosum)

Front 95

How is rotation detected in SMV/Schuller images?

Back 95

Nasal septum & mental point not parallel to long axis of IR

Front 96

How is tilt detected in SMV/Schuller images?

Back 96

Distance btw. TMJ & lateral aspect of skull is skewed (patient is tilted toward side w/ biggest space btw. TMJ/lateral aspect; to correct, tilt away from that side)

Front 97

How many cranial bones are there?

Back 97

8 (Calvarium & Floor)

Front 98

Calvarium consists of...

Back 98

1 Frontal, 2 Parietal, 1 Occipitl

Front 99

Floor consists of....

Back 99

2 Temporal, 1 Sphenoid, 1 Ethmoid

Front 100

How many facial bones are there?

Back 100

14

Front 101

Tragus

Back 101

Anterior aspect of EAM (little flap of ear on inside of ear, hurts a lot to get pierced)

Front 102

How is rotation detected in lateral facial bone images?

Back 102

Sella turcica not in profile, mandibular rami not superimposed

Front 103

How is tilt detected in lateral facial bone images?

Back 103

Orbital roofs not superimposed

Front 104

Nasal Bone Image

Back 104

(IOML parallel to transverse axis of IR)
- CR 1/2" distal to nasion on bridge
- shows side nearest to IR
Want to see: acanthion (anterior nasal spine) & frontonasal suture

Front 105

What common imaging errors are seen in nasal bone images?

Back 105

- overpenetrated/overexposed (tech. factors too high)
- improper collimation
- make sure MSP is parallel to plane of IR

Front 106

Angulation of OML to IR for Waters

Back 106

37 degrees

CR perpendicular exiting the acanthion

Front 107

Where should the petrous ridges be in a Waters view?

Back 107

Immediately below maxillary sinuses

Front 108

What does an Open-Mouth Waters show that a normal Waters view doesn't?

Back 108

Sphenoid sinuses within oral cavity

Front 109

What does an Exaggerated Waters show that a normal Waters doesn't?

Back 109

Zygomatic arch fractures

Front 110

How is not enough extension detected in a Waters view?

Back 110

Petrosae visualized within maxillary sinuses

Front 111

How is rotation detected in Waters/Modified Waters views?

Back 111

Unequal distances from lateral border of orbit to lateral border of skull

Front 112

Modified Waters ("Shallow Waters")

Back 112

- OML is 55 degrees angled to IR (trying to place orbital floor perpendicular to IR & parallel to CR)
- CR perpendicular exiting acanthion
Want to see: petrosae below inferior orbital margin

Front 113

Reverse Waters (AP)

Back 113

- OML forms 37 degree angle w/ plane of IR
- CR perpendicular to IR, ENTERING acanthion
Want to see: superior facial ones (same as Waters but magnified)

Front 114

How would a reverse waters be performed in a trauma situation?

Back 114

CR parallel to MML (about 30 degrees), still entering acanthion

Front 115

SMV for Arches

Back 115

(IOML parallel to IR)
- CR perpendicular to IOML, entering MSP 1" posterior to outer canthi
Want to see: Symmetric arches (how they lay w/ respect to rest of face), no rotation

Front 116

What common imaging errors are seen in SMV for arches?

Back 116

- overpenetration/overexposure w/ high tech. factors
- too much tilt
- rotation (MSP not parallel to long axis of IR)

Front 117

Unilateral/Tangential for Arches

Back 117

- IOML parallel to IR, CR 1" posterior to outer canthus
- rotate 15 degrees towards affected side, tilt 15 degrees away (ex. if imaging left arch, extend back like normal, turn head left 15 degrees, tilt away 15 degrees)

Front 118

AP Axial (Modified Towne)

Back 118

- OML perpendicular to IR; CR 30 degrees caudal entering glabella 1" above nasion
Want to see: arches lateral to mandibular rami

Front 119

How is rotation corrected in a Modified Towne?

Back 119

Rotating away from the side w/ the larger gap between arch & mandible

Front 120

Axiolateral Oblique (Modified Law) for Mastoid

Back 120

- IOML parallel to IR, Interpupillary line perpendicular to IR
- CR 15 degrees caudal exiting downside mastoid tip 1" posterior to EAM; 15 degree head rotation
Want to see: downside EAM & mastoid air cells posterior to it

Front 121

What are common imaging errors for Modified Law images?

Back 121

Superimposing auricle (needs to be taped forward), lack of collimation (decreases contrast, increases dose)

Front 122

Stenvers Axiolateral Oblique - Posterior Profile

Back 122

- MSP of head makes 45 degree angle w/ IR (placing petrous ridges parallel to IR)
- CR 12 degrees cephalic entering 3-4" posterior & 1/2" inferior to upside EAM
Want to see: profile of petromastoid portion closest to IR, petrous ridges 2/3 up the lateral border of orbit

Front 123

Arcelin Axiolateral Oblique - Anterior Profile

Back 123

- IOML perpendicular to IR, patient's head forms 45 degree angle to IR (Rotate away from side being imaged)
- CR 10 degrees caudal, entering temporal region 1" anterior to EAM & 3/4" above it
Want to see: Petrous portion of temporal bone farthest from IR, petromastoid portion in profile

Front 124

What's a common pathology of the mastoid?

Back 124

Mastoiditis: occurs in mastoid antrum which communicates w/ tympanic cavity (prone to infections)

Front 125

What's the largest movable facial bone?

Back 125

Mandible

Front 126

PA Mandibular Rami

Back 126

- OML perpendicular to IR, CR exits acanthion
- mental point & nasal septum parallel to long axis of IR
Want to see: for a rami fx, demonstrates lateral/medial displacement

Front 127

PA Axial Mandibular Rami

Back 127

- same positioning as normal PA, 20-25 degree cephalic CR angulation
- Want to see: rami w/ less distortion, slight elongation of body

Front 128

Axiolateral Oblique Mandible

Back 128

- mandibular body parallel w/ transverse axis of IR (preventing superimposition of Cspine)
- for RAMUS: head in true lateral
- for BODY: head 30 degrees towards IR
- for SYMPHYSIS: head 45 degrees toward IR
- CR 25 degrees cephalic passing through region of interest

Front 129

What adjustment should be made for muscular/hypersthenic patients for Axiolateral Oblique Mandible images?

Back 129

Adjust MSP of skull 15 degrees, open inferiorly, reduce CR angle to 10 degrees

Front 130

AP Axial TMJ (Bilateral)

Back 130

- obtain both closed & open mouth images
- OML perpendicular to IR
- CR 35 degrees caudal entering midway btw TMJs, 3" above nasion
Want to see: condyles of mandible & mandibular fossae of temporal bones

Front 131

Axiolateral Oblique TMJ (Bilateral)

Back 131

- obtain both closed & open mouth images
- AML parallel w/ transverse axis of IR, center 1/2" anterior to downside EAM
- CR 15 degrees caudal exiting through TMJ closest to IR, 1.5" superior to upside EAM
Want to see: condyles & necks of mandible

Front 132

What anatomy should be seen in closed mouth Axiolateral Oblique TMJ?

Back 132

Condyle within mandibular fossa

Front 133

What anatomy should be seen in an open mouth Axiolateral Oblique TMJ?

Back 133

Condyle inferior & anterior to mandibular fossa

Front 134

What's the main purpose for imaging the orbits?

Back 134

Foreign body localization or fracture identification

Front 135

Parietoorbital Oblique (Rhese Method)

Back 135

3 POINT LANDING: zygoma, nose, & chin rest against IR
- AML perpendicular to IR, CR perpendicular entering 1" superior & posterior to upside TEA
Want to see: optic canal @ end of sphenoid ridge ("on end"), lying in inferior & lateral quadrant of orbit

Front 136

What's the most common positioning error for orbits?

Back 136

Insufficient extension (optic canal too far superior)

Another one: insufficient rotation from midline (orbit too medial)

Front 137

Parietoacanthial (Modified Waters) for Eye

Back 137

- OML forms 50 degree angle w/ IR (center IR to orbits, rest patient's chin on IR)
- CR perpendicular through mid-orbits (have patient clos eyes & keep closed to keep from moving)
Want to see: petrous ridges below orbital shadows, orbital margins free of superimposition