1、Imaging of musculoskeletal systemNormal imaging and variation,骨肌系统影像学：正常及变异 医学影像学教研室 吴仁华,What is Radiology. Radiation (uses and dangers) Types of imaging modalities Knowledge of Anatomy, physiology, pharmacology, clinical medicine important. Physiology, pharmacology, anatomy, pathology to explain ch
2、anges on X-rays Why do need to know about radiology You as a physician will need knowledge of all modalities for patients symptoms. As a subspecialty career,Imaging of musculoskeletal system imaging modalities, You all will have graduated and become physicians Patients will visit you in your new off
3、ice. They will have all kinds of symptoms !,Several Years Later,http:/,Visiting a physician for following reasons: 1: Yearly check up 2: Surveillance for detecting disease early (e.g bone tumor) 3: Chronic symptoms (e.g - chronic back pain) 4: Acute symptoms (e.g - fracture),Why patient visits a doc
4、tor,Investigating patients symptoms,1: History taking 2: Physical examination 3: Laboratory tests (e.g. blood work) 4: X-ray investigations 5: Treatment (medical or surgical),X-ray Investigations,1: What are X-rays 2: Different types of radiologic tests 3: Examples of clinical scenarios & radiologic
5、 investigations,“I have discovered something interesting but I do not know whether or not my observations are correct”.,Wilhelm Conrad Roentgen, 1895 The discoverer of X-RAYS,What are X-Rays?,A form of electromagnetic radiation with short wavelength (between 10-2 and 10 nm) X-rays are generated by u
6、sing a high voltage current to accelerate electrons within evacuated glass tubes, towards a tungsten target,1895,2010,The X-ray Lab Then & Now,Roentgens First Lab,X-ray Lab of 2010,The Famous First Radiograph,Radiograph by Roentgen on 22 December 1985,1895 The radiograph of Mrs. Roentgens hand.,Radi
7、ograph of hand 2010,Photograph of a hand during progressive radiation exposure resulting in necroses.,Effects of Radiation,Radiosensitive organs - Ovaries, testis 软巢 睾丸 - Thyroid 甲状腺- Fetus 胎儿- GI tract 胃肠道 Radiation damage is Dose dependent Factors to reduce dose Reduce unnecessary studies Use non-
8、radiation studies Ultrasound, MRI, X-RAYS ULTRASOUND COMPUTED TOMOGRAPHY (CT) NUCLEAR MEDICINE ANGIOGRAPHY MAGNETIC RESONANCE IMAGING (MRI) POSITRON EMISSION SCANNING (PET),TYPES OF IMAGING IN RADIOLOGY DEPARTMENT,How is an X-ray Image obtained,The X-rays pass through the body and are detected on ph
9、otographic film placed behind the patient,X-ray Tube,X-ray photons,How and why do radiographs appear black & white It started with the X-ray film (GELATIN WITH SILEVR BROMIDE cyrstals) Film has silver halide卤化物 X-ray beam hit the silver bromide 溴化银turns into black when developed When no x-ray photon
10、 strikes the film, it remains white,The Black and White of Radiographs,WHAT FACTORS DETERMINE THE BLACK & WHITE,Different materials absorb X-rays to differing degrees Depends on the atomic number of element,What is Ultrasound?,Sound waves with frequencies above the range of human hearing ultra sound
11、 A narrow beam of high energy sound waves is directed into the patients body The manner in which the sound is reflected back from various tissues is recorded,Why Use Ultrasound?,Cheaper than CT or MRI,Patient is not exposed to ionizing radiation,Equipment is very portable, therefore can be used on p
12、atients too sick or injured to be moved from their beds,Ultrasound of the fetal head (in utero),What is Computed Tomography?,An X-ray based technique,The X-ray tube, along with an array of detectors, are rotated in a plane around the patient,CT SCAN OF THE PELVIS,What is Nuclear Imaging?,A radioacti
13、ve isotope and injected into the patient,The isotope is taken up by the organ or tissue of interest (physiologic examination),The isotope emits gamma rays which are then detected by a gamma camera,A technetium锝 -99 bone scan,What is Magnetic Resonance Imaging?,Involves measuring the behaviour of pro
14、tons in different chemical environments when exposed to a magnetic field Patients are not exposed to ionizing radiation,Mid-saggital MR scan of the head,The Benefits of MRI,The ideal modality for imaging soft tissues,Proton possess positive charge,Magnetic fields,Applying external strong magnetic fi
15、eld to protons,Magnetic Resonance Imaging,Basic principles,MRI: Femur & Quadriceps muscle,TRICKS OF THE TRADE IN RADIOLOGY, Usually its all in BLACK & WHITE !,What do you see?,There are two women, a young and old one “You see what you look for You recognise what you know”,What do you see here?,MRI S
16、can,SHEEPDOG,What I saw !,Gluteal maximus muscle,Rectum,Sacrum,Lower back muscles,MRI of the buttocks,Learn your anatomy well Important in interpreting radiographic studies You may want to become a radiologist,ANATOMY ! ANATOMY !ANATOMY !,Acute Conditions,Clinical Scenario Case,History: Young patien
17、t playing base ball injured elbow while sliding at home plate What type of X-ray would you order? - CT scan - Plain film of the elbow - MRI,PATIENT ELBOW,Normal elbow,LATERAL VIEWS OF ELBOW,Humerus,Radius,Ulna,Humeral condyles,Fracture dislocation of the elbow joint,How would you treat this patient?
18、 1: Do CT scan of elbow 2: Put a cast 3: Call Orthopedic surgeon 4: Send patient home,Complication of elbow fracture dislocation,- Brachial artery臂 动脉 injury (Especially with fractures in the area),Treatment: Patient went straight to surgery The dislocation was reduced,Chronic Conditions,Clinical Sc
19、enario Case,History: Young weight lifter with sudden onset of neck pain,Possible Diagnosis: 1: Fractured cervical bone 骨折 2: Slipped vertebral disc 椎间盘滑脱3: Muscle sprain 扭伤 4: Spinal cord tumor 肿瘤,Next Investigations 1: See a sports specialist 2: X-ray of the spine 3: CT of the spine 4: MRI of the s
20、pine,Doctor first ordered Cervical spine x-ray Lateral view of the C-spine,Lateral view of the C-spine,Spinous process,Disc space,Vertebral body,C2,C3,C4,C7,C6,C5,Occipital bone,mandible,Movie,tongue,Vertebral body,Spinal cord,MRI of the Cervical Spine,Small disc protrusions esp. at C5-6 level,Disc
21、space,Disc protrusion,C2,C3,C4,C7,C6,C5,CONCLUSIONS:,1: X-RAY exams which uses radiation: - Plain film - CT - Nuclear medicine 2: X-RAY studies that DO NOT use radiation: - Ultrasound - MRI,0,5,10,15,20,25,Chest,Skull,Brain CT,Thoracic spine,KUB,Lumbar spine,IVP,UGI,Barium Enema,CT chest,CT Abdomen,
22、A Practical Approach,Effective Dose (mSv),Effective Radiation doses in Radiologic examinations,http:/qmec.herston.uq.edu.au/radiology/principles/radsaftx.html,1: There are many X-ray tests available for pts symptoms 2: Choose the right one that would give the diagnosis early 3: Always consult a radi
23、ologist for advice on which test is appropriate for your patient.,CONCLUSIONS:,Imaging of musculoskeletal systemNormal imaging and Variation,206 bones. five or four groups Long bones 长骨 Short bones 短骨 Flat bones 扁骨 Sesamoid bones 子骨 Irregular bones 不规则骨,2神经孔,6椎小关节,AP view,Lateral view,4髂嵴,4肩峰突,5关节窝,
24、6喙突,12滑车,13肱骨小头,7 三角肌粗隆,8 内上髁脊,15冠状窝,8豆 9钩,Lateral,AP,Oblique,Normal variation,Sesamoid 子骨,Sesamoid,Bone Island 骨岛,Accessory Bones 附骨,Accessory Bones,Fracture,Bone Island,Bone Island,Lumbar Sacralization 腰椎骶化,Lumbarization 骶椎腰花,Permanent Osteoepiphyte 永存骨骺, Disease is abnormal and or altered anatomy
25、 LEARN YOUR ANATOMY WELL NOW ! ! ! It will pay off later ! ! ! Especially if you plan to be a radiologist.,FINAL PEARL,PHYSICS OF RADIOLOGY,PHYSICS OF RADIOLOGY,Test your knowledge, X-ray films are black and white CT scan images are made up of many dots,Each dot represents a CT number called HOUNSFI
26、ELD number,What are X-Rays?,Different materials absorb X-rays to differing degrees,Lead,Barium,Bone,Muscle,Liver,Fat,Air,+ 1000 HU The range of Hounsfield Units -1000HU,A HINT The Higher the ATOMIC number of the substance the more x-rays it will absorb,Hounsfield CT Numbers,PHYSICS OF RADIOLOGY,Test
27、 your knowledge,You are provided with a CT scan of the abdomen What are the CT numbers of the various structures?,A HINT The Higher the ATOMIC number of the substance the more x-rays it will absorb, therefore a higher the CT number,2,Gallbladder,Tissue around kidney,Plain Non contrast CT of the Uppe
28、r Abdomen,What are the approximate HU numbers of 1: Fluid in Gallbladder 2:Tissue around kidney 3: Air in colon,3,Air in colon,1,FAT,Gallbladder,Air in Colon,CT Number Answer,NON HODGKINS LYMPHOMA,NON HODGKINS LYMPHOMA,Duodenal tumor causing gastric outlet obstruction,Liver,Stomach,Spleen,Kidney,The First X-ray image,X-ray (CT Scan) Lab 2003,Thank you,
