Medical Imagery for the Field Therapist Traumatic Conditions - PDF document

Medical imagery for the field therapist Medical Imagery for the Field Therapist ● ● ● Traumatic Conditions T ti C diti Charlen Berry B.Sc., CAT(C), DO(Qc) Certified Athletic Therapist / Osteopath EATA Buffalo 2013 EATA Buffalo 2013 2 Why do we need to know ? Why do we need to know ? What do we need to know ? What do we need to know ? Pertinent information about the patient, past Pertinent information about the patient, past 80% of imaging in MSK conditions are 80% of imaging in MSK conditions are and present history and present history basic radiographs, basic radiographs, Safety (2 aspects) Safety (2 aspects) Basic reading of X Basic reading of X- -Rays Rays Better understand the tests, the views, the Better understand the tests, the views, the e e u de s a d e e u de s a d e es s, e es s, e e e s, e s, e e healing processes and prescription guidelines healing processes and prescription guidelines Implications of different fractures Implications of different fractures Which tests are most appropriate? Which tests are most appropriate? Basic knowledge on available tests Basic knowledge on available tests Post- Post -concussion symptoms concussion symptoms Communication and collaboration Communication and collaboration Knowledge of prescription guidelines Knowledge of prescription guidelines EATA Buffalo 2013 EATA Buffalo 2013 3 3 EATA Buffalo 2013 EATA Buffalo 2013 4 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 at the end of the presentation References at the end of the presentation EATA Buffalo 2013 EATA Buffalo 2013 5 5 EATA Buffalo 2013 EATA Buffalo 2013 6 Charlen Berry, January 2013, EATA Conference, Buffalo 1

Medical imagery for the field therapist Patient’s file: Patient’s file: Why ? Why ? Read the reports / See the images Read the reports / See the images 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 7 EATA Buffalo 2013 EATA Buffalo 2013 8 HISTORY OF THE PRESENT HISTORY OF THE PRESENT HISTORY OF THE PAST HISTORY OF THE PAST Foot or ankle ? Foot or ankle ? Imagery was done W 5 R W 5 R Imagery was done Standard views? Standard views? – What are they? What are they? � Why? – Ankle: AP, LAT, Ankle: AP, LAT, � What for? – Knee: AP, LAT, Knee: AP, LAT, � When? � Where? Specialised views? Specialised views? � Who? – Oblique views of the fibula? Oblique views of the fibula? – Plantar flexion Plantar flexion RESULTS ? – Dorsiflexion Dorsiflexion EATA Buffalo 2013 EATA Buffalo 2013 9 9 EATA Buffalo 2013 EATA Buffalo 2013 10 10 RADIOLOGY RADIOLOGY Branch of medicine Branch of medicine WHAT IS MEDICAL WHAT IS MEDICAL concerned with concerned with radioactive substances radioactive substances IMAGING IMAGING including X including X- -Rays, Rays, radioactive isotopes radioactive isotopes and the application of and the application of d th d th li li ti ti f f this information to the this information to the prevention, diagnosis prevention, diagnosis and treatment of and treatment of disease. disease. EATA Buffalo 2013 EATA Buffalo 2013 11 11 EATA Buffalo 2013 EATA Buffalo 2013 12 12 Charlen Berry, January 2013, EATA Conference, Buffalo 2

Medical imagery for the field therapist RADIODENSITY RADIODENSITY MEDICAL IMAGING MEDICAL IMAGING composite shadowgrams composite shadowgrams representing the sum of the densities representing the sum of the densities SquireLF, SquireLF , Novelline Novelline RA, RA, Radiographs (simple films) Radiographs (simple films) Physical qualities of an object Physical qualities of an object that determine how much that determine how much Contrast enhanced radiographs Contrast enhanced radiographs radiation it absorbs from the X- radiation it absorbs from the X - Computerized tomography Computerized tomography Ray beam. Ray beam. Nuclear imaging Nuclear imaging Determined by its composition Determined by its composition (anatomical weight) and (anatomical weight) and Magnetic resonance imaging (MRI) Magnetic resonance imaging (MRI) thickness thickness Sonography Sonography (US) (US) Radiopaque / Radiopaque / Radiodense Radiodense Radiotransparent / Radiotransparent / Radioluscent Radioluscent EATA Buffalo 2013 EATA Buffalo 2013 13 13 EATA Buffalo 2013 EATA Buffalo 2013 14 14 MAJOR PHYSICAL DENSITIES MAJOR PHYSICAL DENSITIES MAJOR DENSITIES MAJOR DENSITIES AIR : AIR : Black (lungs, stomach, digestive tract) Black (lungs, stomach, digestive tract) FAT: Gray 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 EATA Buffalo 2013 EATA Buffalo 2013 16 16 SYSTEMATIC APPROACH TO SYSTEMATIC APPROACH TO EXTERNAL DENSITIES EXTERNAL DENSITIES READING AN X- READING AN X -RAY RAY BARIUM BARIUM METAL METAL A : Alignment Alignment B: B: B: B: Bone density Bone density Bone density Bone density C: C: Cartilage spaces Cartilage spaces S: S: Soft tissues Soft tissues EATA Buffalo 2013 EATA Buffalo 2013 17 17 EATA Buffalo 2013 EATA Buffalo 2013 18 18 Charlen Berry, January 2013, EATA Conference, Buffalo 3

Medical imagery for the field therapist ALIGNEMENT ALIGNEMENT AP AP- - ALIGNEMENT ALIGNEMENT General architecture General architecture spinous spinous process process Size Size Appearance Appearance Accessory bones Accessory bones Accessory bones Accessory bones Congenital & growth Congenital & growth anomalies anomalies Post- Post -traumatic traumatic modifications modifications 1 facet sub-luxation Anterior dislocation EATA Buffalo 2013 EATA Buffalo 2013 19 19 EATA Buffalo 2013 EATA Buffalo 2013 20 20 LAT CERVICAL LAT CERVICAL BONE DENSITY BONE DENSITY Alignment, 3 lines Alignment, 3 lines Normality: Sufficient contrast between the Normality: Sufficient contrast between the skeleton and soft tissues and between skeleton and soft tissues and between cortex and medullary cortex and cortex and medullary cortex and medullary center medullary center center center Lost: osteopenia Lost: osteopenia, osteoporosis, , osteoporosis, osteomalacia osteomalacia Increase: Increase: osteopoikilosis osteopoikilosis, , osteopetrosis osteopetrosis EATA Buffalo 2013 EATA Buffalo 2013 21 21 EATA Buffalo 2013 EATA Buffalo 2013 22 22 DISTORTION DISTORTION OTHER RADIOLOGIC EXAMINATIONS OTHER RADIOLOGIC EXAMINATIONS shape or size shape or size With contrast With contrast The pathology should The pathology should – Arthrography Arthrography, , myelography myelography, , arteriography arteriography… … be right in the middle be right in the middle of the film of the film CAT scan, CT scan CAT scan, CT scan – Axial tomography assisted by computer Axial tomography assisted by computer X- -rays will rays will increase increase Nuclear imaging Nuclear imaging the size from 0 to the size from 0 to – Bone scan, ‘’ Bone scan, ‘’scintigraphie scintigraphie osseuse osseuse’’ ’’ 30% 30% EATA Buffalo 2013 EATA Buffalo 2013 23 23 EATA Buffalo 2013 EATA Buffalo 2013 24 24 Charlen Berry, January 2013, EATA Conference, Buffalo 4

Medical imagery for the field therapist WITH CONTRAST WITH CONTRAST Computer assisted tomography Computer assisted tomography (CAT Scan) (CAT Scan) X- -Ray merged with computer Ray merged with computer technology technology Provides geography of body structures Provides geography of body structures Provides geography of body structures Provides geography of body structures with much greater sensitivity than plain with much greater sensitivity than plain films films X- -Ray beam and detector system is Ray beam and detector system is housed in a circular scanner (arc of housed in a circular scanner (arc of Arteriography Arteriography 360º) 360 º) Arthro MRI Myelography Myelography EATA Buffalo 2013 EATA Buffalo 2013 25 25 EATA Buffalo 2013 EATA Buffalo 2013 26 26 CAT Scan / CT Scan CAT Scan / CT Scan EATA Buffalo 2013 EATA Buffalo 2013 27 27 EATA Buffalo 2013 EATA Buffalo 2013 28 28 CAT SCAN EATA Buffalo 2013 EATA Buffalo 2013 29 29 EATA Buffalo 2013 EATA Buffalo 2013 30 30 Charlen Berry, January 2013, EATA Conference, Buffalo 5