Lecture 2 September 13th

1RADIOLOGY – SEPTEMBER 13TH, 2007 LECTURE 2 Start in notes, page 19. ***Search Pattern*** • Cartilage, don’t see this, but see the space between bones. Loss of cartilage? Narrowing of space. • If a pathology shows up on a film, even if it wasn’t what you were trying to capture, you are responsible for it. Page 20: • Picture of cervical spine shows abnormal curvature. • Picture of long bone in slide 3, there is high tissue density in shaft of bone. Medullary space is generally darker (less density). In this slide, see increased density in medullary space, could be calcifications. Varied pathologies associated with this. Monitor, look for condition to become more aggressive. Page 21: • Slide 1: 8 MT bones, may still only have 5 toes. • Slide 2: compare 2 sides of joint space: see narrowing on right side, widening on L side. Torn ligament on side of enlargement. Bone density is increasing on narrowed side. Page 22: • Slide 1: Asymmetrical, bulge on R side. Looks like fracture in femur (can’t see this on printed slides: look at ecollege). Soft tissue swelling is secondary sign of trauma. There are some soft tissues that are visible on radiograph when damaged – can’t usually see • Slide 2: see underwire and clasps from bra, also clips in pelvic area (surgery? Oopherectomy?). Patient also has cysts on kidney (L side). See calcifications. • Slide 3: fractures in tibia. Page 23: • CATBITES: mnemonic for bone disease (also VINDICATES) Page 26: Glasses. • Slide 3: probably ER patient: don’t want to take off all leads to do image. NOTE PACKAGE #2 Page 2: • Standard Series: 2 images at 90 degrees. A/P = anterior/posterior ; P/A = posterior/anterior. Put the anatomy that you are interested in as close to the film as possible. This will create the least amount of distortion. Think of hand in front of overhead projector: closest to the screen, image has least distortion. Closest to the projector: distorted, much bigger. Page 3: • Look at the pelvis to determine the direction of the beam. In the one on the right, the iliac wings look narrower. The beam is divergent and follows the direction of the bone, making them appear smaller on the film. This image was taken P/A. The image on the left is A/P. The image has been cut off, but the iliac wings are much larger than the sacrum. • Think in 3D: looking at vertebrae: see transverse processes, bodies all superimposed on top of each other. Facet joints (zygopophyseal joint). Beam goes through entire thickness of spinous processes, and they look thicker than laminae. • Horizontal arrows represent the coronal diameter of the vertebral canal, from pedicle to pedicle. As we go through the lumbar spine, the canal goes from a round shape to an oval shape. A/P diameter is smaller as you move downwards through the lumbar spine. Page 4: P/A view Items are • Vertebral body, RADIOLOGY SEPTEMBER 13TH 2007 – PAGE 1

• • • • • • •

Spinous process of L4, R transverse process of L4 Sacro-iliac joint (white line) Sacral Ala (blue line) R pedicle of L2 (purple line) Interlaminar space between L2, L3 (blue circle) Lumbar rib on L1(orange oval)

Slide 2: • Note narrowing of a/p diameter of vertebral canal as you descend to L5/S1 • See if vertebrae line up along anterior, posterior aspect of body. George’s line. Slide 3: • Lateral view, you can see the bodies clearly. Laminae are superimposed over each other. • Spinous processes were too thin to show up on film. • Superior and inferior articular facets are on sagittal plane. Superior facet looks pointed, inferior looks rounded. • See inferior and superior notches that form the intervertebral foramen. Page 5: Quiz: • George’s line • L4 vertebral body • Inferior articular processes (2!) of L4 (orange u-shaped mark) • Iliac crest • Sacral promontory • Intervertebral formena (2! Be sure to say this plural, or R+L on test) • There is an L on this film. Significant, even though this is a lateral view, to see which side of the patient was closest to the film. If • Superior articular processes of L5 Slide 2: • L4/L5 disk should be largest of spine. Page 6: • Beam is angled upwards about 30 degrees to parallel angle of sacral prominence. • To evaluate what parts of L5/S1 are abnormal Slide 2: obscured, superimposed. • First picture: spine. Slight narrowing at L5/S1, 1 of vertebral segments (L1) looks like it is out of George’s line white (retrolisthesis: posterior slippage d/t disk disease) Hyperostosis at anterior aspect of vertebral bodies. Diffuse Idiopathic Skeletal Hyperostosis (DISH). • Second picture: L5 has slipped off sacrum (spondyloptosis). See stent, holding aorta open. Page 7: LUMBAR OBLIQUES • RAO: right anterior oblique (named for the part that is closest to the film) • LAO: left anterior oblique • RPO: right posterior oblique • LPO: left posterior oblique; Left posterior and right anterior look very similar Slide 3: • See Scottie dog in RAO (or RPO, not sure from image) • Drawing shows angle of spinous process to beam. o Eye of Scottie dog is L pedicle o Nose is L TVP o Ear is L superior articular process RADIOLOGY SEPTEMBER 13TH 2007 – PAGE 2

o o o o

Front leg is L inferior process. Body: lamina and spinous process. Tail: Inferior articular process of opposite side (R) Hind leg: superior articular process of opposite side (R)

RADIOLOGY SEPTEMBER 13TH 2007 – PAGE 3