1、.,Imaging of musculoskeletal system Normal imaging and variation,骨肌系統(tǒng)影像學：正常及變異 醫(yī)學影像學教研室 吳仁華,.,What is Radiology. Radiation (uses and dangers) Types of imaging modalities Knowledge of Anatomy, physiology, pharmacology, clinical medicine important. Physiology, pharmacology, anatomy, pathology to expla

2、in changes 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

3、new office. They will have all kinds of symptoms !,Several Years Later,.,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 d

4、octor,.,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 & radi

5、ologic 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 gene

6、rated by using 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. Roentg

7、ens hand.,Radiograph of hand 2010,.,Photograph of a hand during progressive radiation exposure resulting in necroses.,Effects of Radiation,Radiosensitive organs - Ovaries, testis 軟巢 睪丸 - Thyroid 甲狀腺 - Fetus 胎兒 - GI tract 胃腸道 Radiation damage is Dose dependent Factors to reduce dose Reduce unnecessar

8、y studies Use non-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

9、and are detected on photographic 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鹵化物 X-ray beam hit the silver bromide 溴化銀turns into black when deve

10、loped When no x-ray photon 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 rang

11、e of human hearing ultra sound 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 port

12、able, therefore can be used on patients 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,

13、.,What is Nuclear Imaging?,A radioactive 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?

14、,Involves measuring the behaviour of protons 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

15、 fields,Applying external strong magnetic field 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 re

16、cognise what you know”,.,What do you see here?,MRI Scan,.,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 !,.,

17、Acute Conditions,.,Clinical Scenario Case,History: Young patient 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,Fractu

18、re dislocation of the elbow joint,.,How would you treat this patient? 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 動脈 injury (Especially with fractures in the area),.,Treatment: Patient went strai

19、ght to surgery The dislocation was reduced,.,Chronic Conditions,.,Clinical Scenario Case,History: Young weight lifter with sudden onset of neck pain,.,Possible Diagnosis: 1: Fractured cervical bone 骨折 2: Slipped vertebral disc 椎間盤滑脫 3: Muscle sprain 扭傷 4: Spinal cord tumor 腫瘤,.,Next Investigations 1

20、: See a sports specialist 2: X-ray of the spine 3: CT of the spine 4: MRI of the spine,.,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 bo

21、dy,Spinal cord,MRI of the Cervical Spine,Small disc protrusions esp. at C5-6 level,Disc 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,Ch

22、est,Skull,Brain CT,Thoracic spine,KUB,Lumbar spine,IVP,UGI,Barium Enema,CT chest,CT Abdomen,A Practical Approach,Effective Dose (mSv),Effective Radiation doses in Radiologic examinations,.au/radiology/principles/.au/radiology/principles/radsaftx.h

23、tml,.,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 radiologist for advice on which test is appropriate for your patient.,CONCLUSIONS:,.,Imaging of musculoskeletal system Normal imaging and Variation,.,.,206 b

24、ones. five or four groups Long bones 長骨 Short bones 短骨 Flat bones 扁骨 Sesamoid bones 子骨 Irregular bones 不規(guī)則骨,.,.,.,.,2神經(jīng)孔,6椎小 關(guān)節(jié),.,.,.,AP view,Lateral view,4髂嵴,.,.,4肩峰突,5關(guān)節(jié)窩,6喙突,.,12滑車,13肱骨小頭,7 三角肌粗隆,8 內(nèi)上髁脊,15冠狀窩,.,.,8豆 9鉤,.,.,.,Lateral,AP,Oblique,.,.,Normal variation,.,Sesamoid 子骨,.,Sesamoid,.,Bone

25、Island 骨島,.,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 LEARN YOUR ANATOMY WELL NOW ! ! ! It will pay off later ! ! ! Especially if you plan t

26、o 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 HOUNSFIELD number,.,What are X-Rays?,Different materials absorb X-rays to differing degrees,.,Lead,Barium,Bone,Muscle,Liver