骨肌系統(tǒng)影像英文

1、Imaging of musculoskeletal systemNormal imaging and variation,骨肌系統(tǒng)影像學(xué)：正常及變異 醫(yī)學(xué)影像學(xué)教研室 吳仁華,What is Radiology. Radiation (uses and dangers) Types of imaging modalities Knowledge of Anatomy, physiology,

2、pharmacology, clinical medicine important. Physiology, pharmacology, anatomy, pathology to explain changes on X-rays Why do need to know about radiology You as a physician will need knowledge of all modalities for pat

3、ients 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 office. ?They will have all kin

4、ds of symptoms !,Several Years Later,http://imaging.med.stu.edu.cn,Visiting a physician for following reasons: 1: Yearly check up 2: Surveillance for detecting disease early (e.g – bone tumor) 3: Chronic symptoms

5、(e.g - chronic back pain) 4: Acute symptoms (e.g - fracture),Why patient visits a doctor,Investigating patient's symptoms,1: History taking 2: Physical examination 3: Laboratory tests (e.g. blood work)

6、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 investigations,“I have disc

7、overed 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 wavele

8、ngth (between 10-2 and 10 nm) X-rays are generated 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,Roentgen’s First

9、Lab,X-ray Lab of 2010,The Famous First Radiograph,Radiograph by Roentgen on 22 December 1985,1895 The radiograph of Mrs. Roentgen's hand.,Radiograph of hand 2010,Photograph of a hand during progressive radiation

10、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 unne

11、cessary studies Use non-radiation studies Ultrasound, MRI,? X-RAYS ? ULTRASOUND ? COMPUTED TOMOGRAPHY (CT) ? NUCLEAR MEDICINE ? ANGIOGRAPHY ? MAGNETIC RESONANCE IMAGING (MRI) ? POSITRON EMISSION SCANNING (PET)

12、,TYPES OF IMAGING IN RADIOLOGY DEPARTMENT,How is an X-ray Image obtained,The X-rays pass through the body and are detected on photographic film placed behind the patient,X-ray Tube,,X-ray photons,,How and why do radi

13、ographs 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 developed When no x-ray pho

14、ton 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,Wha

15、t is Ultrasound?,,Sound waves with frequencies above the range of human hearing ultra sound A narrow beam of high energy sound waves is directed into the patient’s body The manner in which the sound is reflected back f

16、rom 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 patients too sick or injured to be moved fro

17、m 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 PELV

18、IS,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

19、 a gamma camera,A technetium锝 -99 bone scan,What is Magnetic Resonance Imaging?,Involves measuring the behaviour of protons in different chemical environments when exposed to a magnetic field Patients are not exposed t

20、o 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 field to pro

21、tons,Magnetic Resonance Imaging,Basic principles,MRI: Femur & Quadriceps muscle,TRICKS OF THE TRADE IN RADIOLOGY,? Usually it’s all in BLACK & WHITE !,What do you see?,There are two women, a young and old o

22、ne “You see what you look for You recognise 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

23、 Important in interpreting radiographic studies You may want to become a radiologist,ANATOMY ! ANATOMY !ANATOMY !,Acute Conditions,Clinical Scenario Case,History: Young patient playing base ball injured elbow

24、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 di

25、slocation 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(dòng)脈 i

26、njury (Especially with fractures in the area),Treatment: Patient went straight to surgery The dislocation was reduced,Chronic Conditions,Clinical Scenario Case,History: Young weight lifter with sudden onset of n

27、eck pain,Possible Diagnosis: 1: Fractured cervical bone 骨折 2: Slipped vertebral disc 椎間盤(pán)滑脫3: Muscle sprain 扭傷 4: Spinal cord tumor 腫瘤,Next Investigations 1: See a sports specialist 2: X-ray of the spine 3: CT o

28、f 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,

29、Movie,tongue,Vertebral body,,,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: - Plai

30、n 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 ches

31、t,CT Abdomen,,,,,,,,,,,,,,,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

32、available for pt’s 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 musculoskelet

33、al systemNormal imaging and Variation,206 bones. five or four groups Long bones 長(zhǎng)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,

34、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 Island 骨島,,Accessory Bones 附骨,Accessory Bones,Fracture,,Bone Island,,Bone Island,,Lumbar Sacralization 腰

35、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 to be a radiologist.,FINAL P

36、EARL,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-Ra

37、ys?,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 ATO

38、MIC number of the substance the more x-rays it will absorb,Hounsfield CT Numbers,PHYSICS OF RADIOLOGY,Test your knowledge,You are provided with a CT scan of the abdomen What are the CT numbers of the various structu

39、res?,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 Upper Abdomen,,What are th

40、e 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 HODGKIN’S LYMPHOMA,NON HODGKIN’S LYMPHOMA,,Duodenal tu