1. Dr Mohamed El Safwany, MD. Diagnostic Imaging for Rehabilitation Professionals

2. Intended Learning outcome and objectives Become familiar with various medical imaging modalities Demonstrate understanding of the advantages and disadvantages of different imaging modalities Be able to recommend the correct modality given a case study Integrate diagnostic imaging information into physical therapy practice

3. Why do physical therapist need to understand medical imaging? Clinical Reasons? How will it effect treatment? How will it effect prognosis? What about direct access? Research Implications?

4. Medical Imaging Radiography Plain Film/ X-Ray/ Roentgen Rays Computed Tomography (CT Scan) DEXA Bone Scan Magnetic Resonance Image (MRI)

5. Radiography

6. Basic Concepts What is an X-Ray? Electromagnetic Radiation - short wavelength

7. Professor Roentgen Discovered accidentally in 1895 Experimenting with a machine that, unknown to him, was producing x-rays Saw the bones of his hand in the shadow cast on a piece of cardboard in his lab

8. What Roentgen saw Today's Image

9. Radiodensity X-rays not absorbed, screen produces photons when struck, and exposes the film, turning it dark When an object absorbs the X-rays - fewer protons produced, film stays light RadiopaqueRadiolucent

10. A-B-C A- Alignment- is the bone in good general alignment B- Bone- general bone density C- Cartilage- sufficient cartilage space other stuff?? Muscles, fat pads and lines, joint capsules, miscellaneous soft-tissue findings, bullets

11. Alignment

13. Bone

16. What do I need to look for in foot trauma? Distal tibia and fibula F- fifth metatarsal base L- lateral process of the talus O- os trigonum A- anterior process of the calcaneus T- talar dome

18. Cartilage

19. Viewing Images X-ray study named for the direction the beam travels AP PA Lateral Orient film as if you were facing the patient, his/her Left will be on your Right

20. Views LateralOblique

21. Superior articulating facet Transverse process PedicleLamina Inferior articulating facet Lumbar Spine, Oblique View

22. “SCOTTY DOG”

23. Lumbar Spondylolysis The defect ‘lysis’ involves the pars inarticularis and can allow the vertebra above to sublux forward

24. Still Alive?

25. …That was close

26. Viewing Images A radiograph is a two dimensional representation Therefore, “One View is No View” Two views are needed, ideally at 90 degrees to one another for proper 3-D like interpretation

27. Radiograph revealed horizontal fracture of the lower patalla

28. To sum it up It is however, relatively much more important for a physical therapist to recognized the indications for diagnostic imaging, to select the most appropriate imaging study, and to image the appropriate areas

29. Computed Tomography (CT) X-Ray beam moves 360 around the patient Consecutive x-ray “slices” around the patient Computer can recreate 3D image of the body Best for evaluating bone and soft tissue tumors, fractures, intra-articular abnormalities, and bone mineral analysis

30. Computed Tomography (CT)

31. LV VERTEBRAL BODY SPINAL CANAL TRANSVERSE PROCESS RIB LUNG RA LA RV AORTA

35. Magnetic Resonance Imaging (MRI) What is a MRI? The use of a High Power Magnet (.3 -2.0 Teslas) To align hydrogen atoms in the body to which a radio wave frequency is applied to produce an image

37. Indications for MRI Diagnosing multiple sclerosis (MS) Diagnosing tumors of the pituitary gland and brain Diagnosing infections in the brain, spine or joints Visualizing torn ligaments in the wrist, knee and ankle Visualizing shoulder injuries Diagnosing tendonitis Evaluating masses in the soft tissues of the body Evaluating bone tumors, cysts and bulging or herniated discs in the spine Diagnosing strokes in their earliest stages

38. T1 Vs T2 T1 Tissue with high water content will apear dark (grey) T2 Tissue with high water content will appear white/ brighter

39. T1 vs. T2 T1 image of knee T2 image of knee Gastrocnemius Semimembranosus Popliteal vein Quad Tendon ACL

40. Knee - MRI Sagittal ANTERIOR CRUCIATE LIGAMENT POSTERIOR CRUCIATE LIGAMENT

41. PATHOLOGY ACL Tear

42. Meniscus Bow Tie Sign

43. Knee - MRI Sagittal TORN POSTERIOR MEDIAL MENISCUS

44. Your MRI is showing humerus infraspinatus ScapulaScapula Teres minor supraspinatus DeltoidDeltoid Clavicle Glenoid labrum Long Head of Triceps

45. Shoulder - MRI – Axial Plane

46. SupS D D IS Shoulder - MRI – Axial Plane

47. Shoulder - MRI – Coronal Plane Supraspinatus Rotator Cuff SS Tendon Fluid in Joint Glenoid Acr -- Clav

48. Shoulder Supraspinatus Tear Subdeltoid Bursa

49. Lumbar Spine - MRI Coronal T1Sagittal T1Sagittal T2

50. Axial T1 body Axial T1 disc Axial T2 body Axial T2 disc Lumbar Spine – MRI Axial

51. Body Psoas Spinal Canal

52. Herniated disc Lumbar Spine – MRI Sagittal T2

53. DEXA SCAN Looks at bone mineral densities The “image” however, is secondary the important information gathered is the bone mineral density

56. Skeletal Scintigraphy (Bone Scan) Indication: Cancer, stress or hidden fractures

57. Assignment Two students will be selected for assignment.

58. Text Books David Sutton’s Radiology

59. Question What are the basic radiographic views needed for proper image interpretation?

60. Thank You