Medical imagery for the field therapist Medical Imagery for the Field Therapist Therapist ● ● ● Traumatic Conditions Charlen Berry B.Sc., CAT(C), DO(Qc) Certified Athletic Therapist / Osteopath EATA Buffalo 2013 EATA Buffalo 2013 2 Charlen Berry, January 2013, EATA Conference, Buffalo 1
Medical imagery for the field therapist Why do we need to know ? Why do we need to know ? Pertinent information about the patient, past Pertinent information about the patient, past and present history and present history p p y y Safety (2 aspects) Safety (2 aspects) Better understand the tests, the views, the Better understand the tests, the views, the healing processes and prescription guidelines healing processes and prescription guidelines Which tests are most appropriate? Which tests are most appropriate? Post Post- -concussion symptoms concussion symptoms Communication and collaboration Communication and collaboration EATA Buffalo 2013 EATA Buffalo 2013 3 What do we need to know ? What do we need to know ? 80% of imaging in MSK conditions are 80% of imaging in MSK conditions are basic radiographs, b basic radiographs, b i i di di h h Basic reading of X Basic reading of X- -Rays Rays Implications of different fractures Implications of different fractures Basic knowledge on available tests Basic knowledge on available tests Knowledge of prescription guidelines Knowledge of prescription guidelines EATA Buffalo 2013 EATA Buffalo 2013 4 Charlen Berry, January 2013, EATA Conference, Buffalo 2
Medical imagery for the field therapist How do we get the knowledge How do we get the knowledge Presentations Presentations Books & articles Books & articles Internet Internet Specific courses Specific courses References References at the end of the presentation at the end of the presentation EATA Buffalo 2013 EATA Buffalo 2013 5 EATA Buffalo 2013 EATA Buffalo 2013 6 Charlen Berry, January 2013, EATA Conference, Buffalo 3
Medical imagery for the field therapist Why ? Why ? To have pertinent information in To have pertinent information in To have pertinent information in To have pertinent information in the patient file at the beginning the patient file at the beginning of the season of the season Read the reports Read the reports See the images (radiology) See the images (radiology) EATA Buffalo 2013 EATA Buffalo 2013 7 Patient’s file: Patient’s file: Read the reports / See the images Read the reports / See the images EATA Buffalo 2013 EATA Buffalo 2013 8 Charlen Berry, January 2013, EATA Conference, Buffalo 4
Medical imagery for the field therapist HISTORY OF THE PAST HISTORY OF THE PAST Imagery was done W 5 R W 5 R Imagery was done � Why? � What for? � When? � Where? � Who? � Who? RESULTS ? EATA Buffalo 2013 EATA Buffalo 2013 9 HISTORY OF THE PRESENT HISTORY OF THE PRESENT Foot or ankle ? Foot or ankle ? Standard views? Standard views? – What are they? What are they? – Ankle: AP, LAT, Ankle: AP, LAT, – Knee: AP, LAT, Knee: AP, LAT, Specialised views? Specialised views? – Oblique views of the fibula? Oblique views of the fibula? – Plantar flexion Plantar flexion – Dorsiflexion Dorsiflexion EATA Buffalo 2013 EATA Buffalo 2013 10 10 Charlen Berry, January 2013, EATA Conference, Buffalo 5
Medical imagery for the field therapist WHAT IS MEDICAL WHAT IS MEDICAL WHAT IS MEDICAL WHAT IS MEDICAL IMAGING IMAGING EATA Buffalo 2013 EATA Buffalo 2013 11 11 RADIOLOGY RADIOLOGY Branch of medicine Branch of medicine concerned with concerned with radioactive substances radioactive substances di di ti ti b t b t including X including X- -Rays, Rays, radioactive isotopes radioactive isotopes and the application of and the application of this information to the this information to the prevention, diagnosis prevention, diagnosis and treatment of and treatment of and treatment of and treatment of disease. disease. EATA Buffalo 2013 EATA Buffalo 2013 12 12 Charlen Berry, January 2013, EATA Conference, Buffalo 6
Medical imagery for the field therapist MEDICAL IMAGING MEDICAL IMAGING Radiographs (simple films) Radiographs (simple films) Contrast enhanced radiographs Contrast enhanced radiographs Computerized tomography Computerized tomography Nuclear imaging Nuclear imaging Magnetic resonance imaging (MRI) Magnetic resonance imaging (MRI) Sonography Sonography (US) (US) EATA Buffalo 2013 EATA Buffalo 2013 13 13 RADIODENSITY RADIODENSITY composite composite shadowgrams shadowgrams representing the sum of the densities representing the sum of the densities SquireLF SquireLF, , Novelline Novelline RA, RA, Physical qualities of an object Physical qualities of an object that determine how much that determine how much that determine how much that determine how much radiation it absorbs from the X radiation it absorbs from the X- - Ray beam. Ray beam. Determined by its composition Determined by its composition (anatomical weight) and (anatomical weight) and thickness thickness Radiopaque Radiopaque / / Radiodense Radiodense Radiotransparent Radiotransparent / / Radioluscent Radioluscent EATA Buffalo 2013 EATA Buffalo 2013 14 14 Charlen Berry, January 2013, EATA Conference, Buffalo 7
Medical imagery for the field therapist MAJOR PHYSICAL DENSITIES MAJOR PHYSICAL DENSITIES AIR : AIR : Black (lungs, stomach, digestive tract) Black (lungs, stomach, digestive tract) FAT: Gray FAT: FAT FAT Gray- -Black (more Black (more radiodense radiodense than air) than air) WATER: WATER: Grey (fluids, blood, muscles, tendons…) Grey (fluids, blood, muscles, tendons…) BONE: BONE: White (the most White (the most radiodense radiodense substance of substance of the body, teeth are whiter because to their the body, teeth are whiter because to their calcium content) calcium content) ) CONTRAST MEDIA: CONTRAST MEDIA: Bright white outline Bright white outline HEAVY METAL: HEAVY METAL: Solid white Solid white EATA Buffalo 2013 EATA Buffalo 2013 15 15 MAJOR DENSITIES MAJOR DENSITIES EATA Buffalo 2013 EATA Buffalo 2013 16 16 Charlen Berry, January 2013, EATA Conference, Buffalo 8
Medical imagery for the field therapist EXTERNAL DENSITIES EXTERNAL DENSITIES BARIUM BARIUM METAL METAL EATA Buffalo 2013 EATA Buffalo 2013 17 17 SYSTEMATIC APPROACH TO SYSTEMATIC APPROACH TO READING AN X READING AN X- -RAY RAY A : A : Alignment Alignment Alignment Alignment B: B: Bone density Bone density C: C: Cartilage Cartilage spaces g spaces S: S: Soft Soft tissues tissues EATA Buffalo 2013 EATA Buffalo 2013 18 18 Charlen Berry, January 2013, EATA Conference, Buffalo 9
Medical imagery for the field therapist ALIGNEMENT ALIGNEMENT General architecture General architecture Size Size Appearance Appearance Accessory bones Accessory bones Congenital & growth Congenital & growth anomalies anomalies Post Post- -traumatic traumatic modifications modifications EATA Buffalo 2013 EATA Buffalo 2013 19 19 AP- AP - ALIGNEMENT ALIGNEMENT spinous process spinous process 1 facet sub-luxation Anterior dislocation EATA Buffalo 2013 EATA Buffalo 2013 20 20 Charlen Berry, January 2013, EATA Conference, Buffalo 10
Medical imagery for the field therapist LAT CERVICAL LAT CERVICAL Alignment, 3 lines Alignment, 3 lines EATA Buffalo 2013 EATA Buffalo 2013 21 21 BONE BONE DENSITY DENSITY Normality: Sufficient contrast between the Normality: Sufficient contrast between the skeleton and soft tissues and between skeleton and soft tissues and between cortex and cortex and medullary medullary center center Lost: Lost: osteopenia osteopenia, osteoporosis, , osteoporosis, osteomalacia osteomalacia Increase: Increase: osteopoikilosis osteopoikilosis, , osteopetrosis osteopetrosis EATA Buffalo 2013 EATA Buffalo 2013 22 22 Charlen Berry, January 2013, EATA Conference, Buffalo 11
Medical imagery for the field therapist DISTORTION DISTORTION shape or size shape or size The pathology should The pathology should The pathology should The pathology should be be right in the middle right in the middle of the film of the film X- -rays will rays will increase increase the size from 0 to the size from 0 to the size from 0 to the size from 0 to 30% 30% EATA Buffalo 2013 EATA Buffalo 2013 23 23 OTHER RADIOLOGIC EXAMINATIONS OTHER RADIOLOGIC EXAMINATIONS With contrast With contrast – Arthrography Arthrography, A th A th h h , myelography myelography, l l h h , arteriography arteriography… t t i i h h … CAT scan, CT scan CAT scan, CT scan – Axial tomography assisted by computer Axial tomography assisted by computer Nuclear imaging Nuclear imaging – Bone scan, ‘’ Bone scan, ‘’scintigraphie scintigraphie osseuse osseuse’’ ’’ EATA Buffalo 2013 EATA Buffalo 2013 24 24 Charlen Berry, January 2013, EATA Conference, Buffalo 12
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