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Orthopaedic Imaging: An Aid to Decision Making Thomas W

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Orthopaedic Imaging: An Aid to Decision Making Thomas W. Grossman, Jr., M.D., FACS Watertown Orthopaedics Medical Decision Making is a Triad History from patients ... – PowerPoint PPT presentation

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Title: Orthopaedic Imaging: An Aid to Decision Making Thomas W


1
Orthopaedic Imaging An Aid to Decision Making
  • Thomas W. Grossman, Jr., M.D., FACS
  • Watertown Orthopaedics

2
Medical Decision Making is a Triad
  • History from patients/records
  • Physical Examination
  • Confirming Studies Imaging, Labs, etc.

3
Imaging
  • X-ray
  • Ultrasound
  • CT Scan
  • MRI
  • Nuclear Medicine

4
X-RAY
  • Radiation Source
  • Patient Exposed
  • Capture Image
  • Interpret Image

5
X-RAY
  • Ionizing Radiation
  • Radiation damages cells
  • No limit on medical radiation exposure
  • Limits on non medical radiation exposure

6
X-RAY
  • Patient Blocks Transmission of Radiation
  • Soft tissues Less
  • Bones More

7
X-RAY
  • Capture Image
  • Films
  • Digital

8
X-RAY
  • Interpret Image
  • Radiologist
  • Orthopaedist

9
X-RAY
  • Best for
  • Hard tissue
  • Bones
  • Often combined with other imaging

10
X-RAY
  • Fibula Fracture

11
X-RAY
  • Fibula Fracture

12
X-RAY
  • Fibula Fracture

13
X-RAY
  • Fibula Fracture

14
X-RAY
  • Femur Fracture

15
ULTRASOUND
  • Sound Source
  • Patient Exposed
  • Image Captured
  • Interpret Image

16
ULTRASOUND
  • Sound Source
  • Sonar
  • Cant hear
  • Transducer

17
ULTRASOUND
  • Patient blocks some sound waves
  • Transmits others

18
ULTRASOUND
  • Capture Image
  • Film
  • Digital

19
ULTRASOUND
  • Interpret image
  • Radiologist

20
ULTRASOUND
  • Determines Solid or Not Solid
  • Limited Use
  • Rotator Cuff
  • Knee Cysts
  • Deep Vein Thrombosis (blood clots)
  • Pediatric hips (DDH)

21
ULTRASOUND
  • Rotator Cuff

22
ULTRASOUND
  • Rotator Cuff

23
ULTRASOUND
  • Rotator Cuff

24
CT SCAN
  • Computerized Axial Tomography
  • Similar to X-Ray except in slices

25
CT SCAN
  • Radiation source rotates around patient
  • Image capture rotates around patient
  • Computer collects and formats images
  • Reformatting after the exam is possible

26
CT SCAN
  • Best For
  • 3 dimension anatomy
  • Spine
  • Shoulder
  • Hip
  • Fractures in joints
  • Hard Tissues

27
CT SCAN
28
CT SCAN
  • Hip

29
CT SCAN
  • Hip

30
CT SCAN
  • Hip

31
MRI
  • Non Radiation cross section imaging
  • Rapid cycling of powerful magnetic field creates
    images (all atoms are weak magnets)
  • It finds water!

32
MRI
  • Images reflect water content
  • Bones OK
  • Soft Tissues Excellent
  • Muscle
  • Tendon
  • Ligament
  • Discs
  • Nerves
  • Blood vessels

33
MRI
  • Knee

34
MRI
35
MRI
36
MRI
  • Shoulder

37
MRI
38
MRI
39
MRI
40
NUCLEAR MEDICINE
  • Physiology what is the body doing
  • Ionizing Radiation Injected
  • Patient emits radiation (delayed)
  • Image captured

41
NUCLEAR MEDICINE
  • Technetium - binds to bones
  • Indium- binds to white blood cells

42
NUCLEAR MEDICINE
  • Detects Activity
  • Bone is a living structure
  • Fracture
  • Cancer
  • Infection
  • Does not always specify why activity occurs

43
NUCLEAR MEDICINE
  • Dual Isotope Studies
  • Technetium
  • Indium
  • Detection of Infection

44
NUCLEAR MEDICINE
45
NUCLEAR MEDICINE
46
NUCLEAR MEDICINE
47
Orthopaedic Imaging
  • What Studies?, When?
  • X-Ray common starting point
  • Imaging bones
  • Ultrasound
  • Solid or cyst
  • CT 3D anatomy joints spine
  • MRI soft tissue edema
  • Nuclear Medicine What are the cells doing?
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