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Radiology Midterm

Tri 2

X rays discovered by and when? Roentgen in 1895
what was first x ray? wifes hand nov 8 1895
1st Nobel prize in physics Roentgen in 1901
Pupin Intensifying screen
Edison first flourescope
Potter and Bucky 1921, moving grid
Full AP Spine radiograph 1935, Sausser
Cardinal rule always take at least two views taken at right angles
C1 ATLAS (blank)
C1 general no body, ring shaped, three ossification centers..2 in lateral masses, and 1 in anterior arch.
Posterior arch smiles..and i slarger and anterior
Anterior arch frowns..and has a larger tubercle
Superior facet face up and in to form atlantoccipital joint space
Inferior facet face down, slight medial and backward to form atlantoaxial joint space.
basion anterior margin of foramen magnum
opistion posterior margin of foramen magnum
C2 Axis (blank)
(blank) strongest cervical vertebrae
Five primary ossification centers body, 2 in neural arches, 2 in lateral part of dens
secondary ossification centers at apex of dens, inferion aspect of VB
dens height approx same as C2 bidy
Subdental synchondrosis!! area of fusion between base of dens and the C2 body, a slightly radiolucent line on plain film
other large pedicles & lamina, small angled inferiorly tvps, large irregular bifircated SP, lower lip like projection
Lower cervicals (blank)
general increase in size down, triangle shaped, IVD larger anteriorly creating curve, uncinate processes, (flat at newborn and full by 10 yrs), short bifid SPs.
Pedicles postereolateral about 45 degrees from body,
Articular pillar junction of pedicle and lamina
TVPs anterolateral inferior position about 60 degrees with 15 degree caudal angulation
IVFs anterolateral 45-60degrees 15 degrees caudally. C2/3 largest
Discovertebral Joints IVD w body above and below
Uncovertebral Joint Joint of Luschka
Z-joints facet joints
Radiography of Cervical Spine 3 routine views, 5 extended views, 7 Davis Series
Routine Views LCN, APLC, APOM
Extended series LCN, APLC, APOM, R & L Obliques
Davis Series LCN, APLC, APOM. R & L Obloques, Flexion and extension
normal flex/ext displacement 1-2 mm AP. can cause re bleeding of hematoma with increased prevertebral space, usually resolves within 3 weeks
LCN X ray (blank)
general upright, use 'Cross Table Lateral' for acute situations, all 7 must be seen..if not a SWIM LATERAL must be done for lower, R & L superimposed, sella tursica should be seen, look at sinuses, check 4 main lines
ADI Atlantodental Interspace, between C1 anterior tubercle and anterior dens. no greater than 3mm in adults and 5 in children.
Soft tissues of Anterior neck Prevertebral fat stripe ( paralleling ALL), Retropharyngeal soft tissue space (NO more than 7mm @ C2) Retrotracheal soft tissue space (No more than 22mm @ C6 adult and 14mm children)
Hyoid bone C3
Throid cartilage C4-C6
Densities order of least tissue density to most....air/gas, fat, water/soft tissue, bone, metal
Film ID clinic name/doctors name, name and location of which film was taken, Pt name, Pt DOB, Gender, Date, ID number, R or L
Mitchell Markers uses mercury or small metallic balls in center
Radiographic ID mitchell markers, Stenmark, Oblique markers, Clips
APOM (blank)
markers according to which side is closer to folm and behind the Pt .
primary view to view craniocervical junction in AP orintation
arches posterrior arch smiles, anterior arch frowns
Vertical radioleucency appears to slit odontoid in half..due to front incisors
Mach Effect linear line crossing base od dens
Paradontois space distance between lateral odntoid and the medal lateral mass. Should be equal on both sides. NO greater than 2mm difference.
APLC (blank)
(blank) you cannot see segments above C3 or C4 due to superimposition of mandible. Best view to see the uncinate processes
Lines to assess Center line connecting SP, Parallel lines connecting pedicles
calcification of thyroid is visible laterally to C4-C6 Hyoid seen at C3
Lung Apexes seen
Oblique Cervicals (blank)
Pt at 45 degree angle, mark film behind spine to indicate an anterior, infront spine to indicate posterior (blank)
(blank) best to see IVF
Anterior Cervical Obliques same side structures
Posterior cervical Obliques opposite structures
Cervical Anomoliies (blank)
Occipitalization Atlas fused to Occiput. NO normal motion on flexion/extension
Paracondylar process extra bony process extending downward from jugular process of occiput to TVP of C1. Can form an articulation
Epitransverse Process extra bony form TVP pf C1 extending upward
Third Condyle small bony ossicle near anterior margin of foramen magnum
Agenisis of Posterior arch of C1 partial or caomplete absence. May associate with other syndromes. often C2 has a megaspinous,
Absence of Transverse Ligament seen in up to 20% of Down Syndrome Pt
Agenisis of anterior arch rare
Hypoplasia thinning posterior arch
Posterior ponticle also called posticus posticus, calcification forming a foramen where the vertebral artery passes. In 15% of population
Os Odontoid only top of Dens forms,
SBO Spina Bifida Occulta-midline defect, cleft in posterior neural arch, most often inmales at L5-S1, tuft of hair,
Sponyloschisis SBO at C1
Stylohyoid ligament calcification long styloid processes, eagle symdrome,
Congenital Block Vertebrae failure of two segments to seperate, wasp waist, most often at C5/6 or C2/3 T12/L1 L4/5
Klippel Feil 2 or more blocked vertebrae in cervicals or upper thoracic. Clinical Triad--low hairline, webbed neck, low ROM
Omovertebral Bone extra bone
Sprengel's deformity high scapula, more in females, with klippel feil,
Cervical Ribs C7 usually, more in females, bilaterall, may result in thoracic outlet syndrome,
Nuchal Bone ossificationof nuchal ligament
Enlarged EOP can fracture with trauma
Cervical Lines of Mesuration (blank)
Sella tursica size LCN view, 16mm max horizantal, 12mm max vertical. Enlargement caused by pituitary neoplasm
Martin's Basialar Angle from nasion to center of sella tursica, and then to foramen magnum. no larger than 152 degrees, no smaller than 123 degrees
Mcgregors line hard palate to most inferior surface of accipital bone. Dens should not extend past 8mm above line
Chamberlains Line posterior hard palate to posterior foramen magnum, dens should not extend past 5 mm above.
McRae's line basion to opisthion,
Digastric Line two lines joining digastric grooves medial to mastoid processes.
Atlantodental Interspace adult no more than 5mm. child no more than 3mm
Georges line down spine at mid vertebral body.
Spinolaminar junction line (blank)
Atlanto axial alignment (blank)
Angle of cervical curvature atlas to C7 at 90 degrees/angle should be 30-45 degrees. less than 30 is hypolordoses. more than 45 is hyperlordosis.
Ruth Jackson's Cervial Stress Lines flexion extension lines intersecting
Retropharyngeal soft tissue space no more than 7mm
Retrotracheal soft tissue space no more than 22mm adults, 14mm child
MRI (blank)
physics review H atom used to make image, , at a fixed location the H atom vector will be there or wont creating a change in osillations. FOURIER TRANSFORMATION.(when a coil antennae recieves the oscllations from the H)The stronger the magnetization, the more current.
Bright Areas tissue with a lot of magnetization, high signal intensity
time 20-60 min
Signal the amount of information on an image
Noisy signal poor
Field of View formed by pixels, determined by matrix size. The smaller the matrix, the larger the pixel.
Voxel small 3D cube of tissue
NEX number of excitations, signal averages,
High signal strength high FOV, high slice thickness, low matrix size, high NEX
Image resolution voxel size inversley proportionate. Smaller voxel=high resolution/
High resolution low FOV, low slice thickness, high matrix size
Contrast ability to differentiate diff. tissue om their signal intensities. Known as weighting the image.
Relaxation time protons need to realign themselves
TE (echo time) time elapsed b/tw 90 degree RF pulse and the echo. Long TE=low signal (water bright. fat dark), Short Te water dark, fat bright
TR (repetition time) amount o ttime elapsed b/tw successive 90 degree pulse sequence applied to the same slice.
Flip angle FA=amount of rotation
T1 weighted image great anatomical detail, high signal for fat, poor detection of edemas, fluid pathology. TR<1000 TE<30 FA=30
T2 WEIGHTED IMAGE great fluid detection, tumor, infection, long image time. TR>2000 TE>60 FA=90
proton density spin echo TR>1000 TE<30 FA=90
Inversion recovery (STIR) TR>2000 TE>60 FA=180-90 TI=120-150, water signal increased, fat removed, sensitive to soft tissue pathology, cannot be used with contrast
T2 GRASS TR variable, TE<30 FA=5-20 noisy.
Thoracic spine (blank)
12 segments, kyphotic curve, heart shaped, typical=2-8 demifacets are articulations with rib head. T9 may or may not have inferior facets. , Long SPs inferiorly pointed, IVFs are lateral, Articular processes at 60 degrees, Superior facets Back , up and lateral.
Thoracic Stnd Series AP thoracic, Lateral Thoracic
AP thoracic all 12 must be visible, see blockhead(eyes=pedicles, nose=SP, ears=TVP), right pedicle clearer than left, lung field seen in medial 1/3,
Lateral Thoracic must identify normal kyphosis. swim lateral may be needed, count be locating lowest rib, hemidiaphram crosses at 11 IVD, scapula over T7
Big rib sign Rib cage furthest from film will be magnified
Angle of thoracic kyphosis lines at sup. endplate of T1 and inferior endplate of T2. Should not exceed 55 degrees
Chest Projection P-A to decrease heart shdow. FFD of 6-10 ft at full inspiration.
lateral chest projection with left closest to film, arms held up
Diaphrams right side higher than left about 4 cm. usually at 9-10th posterior rib on PA projection
costophrenic sulci cardiophrenic sulci
cardiovascular borders (blank)
right atrium RIGHT BORDER of heart, not visible on lateral
left atrim upper third left heart borderon PA
Right Ventricle not visible on PAb/c it is on front
Left Ventricle lower 2/3 leaft heart border on PA
Descending thoracoc aorta overlies eft of spine, , should not ovelor on lateral
trachea lies on midline, bifurcates at T5/6. Right stwm bronchusis more vertical. SUBCARINAL ANGLE formed by inferior margins of main stem bronchi 70-90 degrees
Normal heart size less than or equl to 50% of greatest maximal internal diameter of chest. 1;2
Left lung sup amd inf lobes by oblique fissure. lingula,
RIGHT LUNG sup,inf, middle by oblique and horizontla fissure,
Azygous lobe on the right lung,
inferior accessory fissure 35%
Created by: hwhite