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

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Medical Decision Making is a Triad

• History from patients/records
• Physical Examination
• Confirming Studies Imaging, Labs, etc.

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Imaging

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

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X-RAY

• Radiation Source
• Patient Exposed
• Capture Image
• Interpret Image

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X-RAY

• Ionizing Radiation
• Radiation damages cells
• No limit on medical radiation exposure
• Limits on non medical radiation exposure

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X-RAY

• Patient Blocks Transmission of Radiation
• Soft tissues Less
• Bones More

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X-RAY

• Capture Image
• Films
• Digital

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X-RAY

• Interpret Image
• Radiologist
• Orthopaedist

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X-RAY

• Best for
• Hard tissue
• Bones
• Often combined with other imaging

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X-RAY

• Fibula Fracture

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X-RAY

• Fibula Fracture

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X-RAY

• Fibula Fracture

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X-RAY

• Fibula Fracture

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X-RAY

• Femur Fracture

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ULTRASOUND

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

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ULTRASOUND

• Sound Source
• Sonar
• Cant hear
• Transducer

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ULTRASOUND

• Patient blocks some sound waves
• Transmits others

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ULTRASOUND

• Capture Image
• Film
• Digital

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ULTRASOUND

• Interpret image
• Radiologist

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ULTRASOUND

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

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ULTRASOUND

• Rotator Cuff

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ULTRASOUND

• Rotator Cuff

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ULTRASOUND

• Rotator Cuff

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CT SCAN

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

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CT SCAN

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

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CT SCAN

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

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CT SCAN
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CT SCAN

• Hip

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CT SCAN

• Hip

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CT SCAN

• Hip

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MRI

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

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MRI

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

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MRI

• Knee

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MRI
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MRI
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MRI

• Shoulder

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MRI
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MRI
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MRI
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NUCLEAR MEDICINE

• Physiology what is the body doing
• Ionizing Radiation Injected
• Patient emits radiation (delayed)
• Image captured

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NUCLEAR MEDICINE

• Technetium - binds to bones
• Indium- binds to white blood cells

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NUCLEAR MEDICINE

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

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NUCLEAR MEDICINE

• Dual Isotope Studies
• Technetium
• Indium
• Detection of Infection

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NUCLEAR MEDICINE
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NUCLEAR MEDICINE
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NUCLEAR MEDICINE
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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?