PT106 even advanced technologies such as digital fluoroscopy

Topic 1: X-Ray to produce specialized imaging.

- are primarily responsible for:
PT and X-Ray ● Properly preparing patients.
● Verifying safety protocols are followed.
“For healthcare providers involved in management of ● Having the knowledge to operate a wide range of
patients with musculoskeletal disorders, the ability to imaging devices.
order diagnostic imaging is a beneficial adjunct to ● Producing quality x-rays and images to ensure the
screening for medical referral and differential diagnosis” right diagnosis can be made.
- Journal of Orthopedic and Sports Physical Therapy ● Following the supervision of a radiologist

APTA HOD P06-12-10-09: Diagnosis by Physical Imaging Modalities

Therapist ● Anatomical Imaging
- when indicated, physical therapists order appropriate ○ Radiographs (X-Rays)
tests, including but not limited to imaging and other → Conventional and digital
studies, that are performed and interpreted by other → Fluoroscopy
health professionals. → Mammography
- physical therapists may also perform or interpret ○ Ultrasound
selected imaging or other studies ○ Computed Tomography (CT) Scan
○ Magnetic Resonance Imaging (MRI)
Radiology ● Functional Imaging
- branch of medicine that uses imaging technology to ○ Nuclear Imaging
diagnose and treat disease → Diagnostic
1. Single Photon Emission Computed
● Diagnostic Radiology Tomography / Computed
- variety of imaging procedures to see the inside of the Tomography (SPECT/CT)
body, and the says or diagnose the patient’s conditions 2. Posiron Emission Tomography /
Computed Tomography (PET/CT)
● Interventional Radiology 3. PET/MRI
- diagnose and treats patients using image-guided, ○ Therapy
minimally invasive techniques → Radioactive Iodine (I-131) Therapy
- interventional radiologists can perform biopsy, medical → Radioimmunotherapy
device placements like stents, and tumor ablation ● Radiation Emitting Modalities
○ Radiographs (analogue, computed and
● Oncologic Radiology digital radiographs\)
- prescribe and oversee each cancer patients’ treatent ○ Fluoroscopy
plan ○ Mammography
- use radation therapy to treat cancer ○ Computed Tomography (CT) Scan
- example: radiotherapy for breast cancers, ○ Nuclear Medicine Imaging
brachiotherapy for cervical cancers ● Non-Radiation Emitting Modalities
○ Ultrasound
Two people involved in Radiology - uses high-frequency sound waves
○ Magnetic Resonance Imaging (MRI)
● Radiologist - uses magnetic field and radio waves
- medical doctors that specialize in diagnosing and
treating diseases using medical imaging and procedures.
- primarily concerned with providing imaging
interpretation.

● Radiographers
- medical professionals tasked with operating highly
specialized scanning machines that includes x-ray
machines, computed tomography (CT scanners) and
1
Summary Table of the Common Imaging Modalities - they are produced by an x-ray tube using high-voltage
Ultrasou to accelerate the electrons from cathode and interact
Factor CT MRI X-ray
nd with anode
30-45 - it passes through bones, tissues, and organs differently
Duration 3-7 min 2-3 min 5-10min
min which allows production of images
Cheape Expensiv - provide valuable information about your health nd help
Cost Cheap Cheap
r e your doctor to make an accurate diagnosis
Dimensio - used to help place tubes or other devices inn the body
3 3 2 2 or to treat disease
ns
Soft Poor Excellent Poor Poor - the radiologist is a specially trained physician who
Tissue detail detail detail detail usually interprets these images and perform procedures
Excelle Poor Excelle Poor with the guidance of x-ray
Bone
nt detail detail nt detail detail
0.15mS Poor X-Ray Tube
Radiation 10mSv None - where x-ray production starts
v detail
- situated in a protective housing that provides solid,
- x-ray offers lower dosage than CT scan stable, and mechanical support
- certain studies performed are relatively quickly such as ● Lead-lined - provides support, serves as an
chest exray. Used as initial screening to rule out any electrical insulator and thermal cushion
obvious pathologies before an advanced modality is ● Oil bath - draws heat away from the tube
used ● Cooling fans - help dissipate heat away from the
- x-ray procedures are being replaced by CT and MRI tube, protecting it from thermal damage
due to advancements in technology especially in first - absorbs most of the photos traveling in other directions
world countries (reducing leakage radiation to less than 100mR/hr)

Wilhem Conrad Roentgen

- German physicist; November 8, 1895
- was working with tubes similar to fluorescent light bulbs
- in this experience, he realized that he produced a
previously unknown invisible light or ray that was being
emitted from the tube
- in his discovery, he found that x-ray would pass
through the tissue of humans, leaving bones and metals
visible
- named it x-ray because he was not sure what kind of
ray he produced

November 22, 1895

- one of the first experiments following the discovery of
x-ray
- produced a photograph of his wife’s hand (Anna
Bertha) showing bones and a wedding ring (30 minutes
exposure time

X-Rays (Roentgen Rays)

- form of ionizing electromagnetic radiation

2
Glass Tube - target made of tungsten
- purpose is an electronic vacuum tube that consist of an - positively charged to attract electrons
anode, cathode, and induction motor all encased in a - set at angle to direct x-ray photon beam own towards
glass or metal enclosure patient (usual angle is 5-15 deg)
- to control the number and speed of the accelerated - two types of anode terminals:
electrons independently
- usually pyrex :
● Stationary Anode
- limited to dental radiology and radiotherapy systems
(smaller machines)
- anode fixed in position

● Rotating Anode
- used in most radiography (mobile sets and fluoroscopy)
- consists of tungsten disc where target rotates

Cathode Production of X-Ray Beam

- negative terminal of the x-ray tube
- composed of: 1. Thermionic Emission
● Filament - electrons released from cathode filamet are
○ Thin (0.2 mm) tungsten wire accelerated towards the positive anode by a high tube
- has high atomic number voltage (applied across the tube) to achieve high
- good thermionic emitter velocities before striking the target
- very high melting temperature (34222C) - 99% of energy from electrons is converted into heat
● Focusing Cup and only 1% into x-ray photons (at the anode)
○ made of molybdenum
- high melting point
- poor thermionic emitter
- negatively charged to focus the electrons towards the
anode and stop spatial spreading

2. X-Ray Production at Anode

- occurs when free electron traveling at high speed
interacts with a target atom
Anode - interaction generates 2 types of radiations:
3
● Bremsstrahlung or Breaking Radiation - both these x-ray production processes are inefficient
- happens with a inner shell interaction with only about one percent of electrical energy used by
- when a fast electron passes near the nucleus, it is tube is converted to x-rays
slowed down by the electric field around the nucleus, - most of electrical power consumed by the tube is
thereby deflecting its path released as waste
- deflecting electrons - shedding energy in the form of
Bremsstrahlung photon
- 80% of the x-rays generated in this way

Factors Affectng X-Ray Spectrum

● Characteristic Radiation 1. Effect of Tube Cuurrent (mA)

- involves removal of orbital electron out of inner electron - mA setting controls the number of electrons emitted by
shell of the target atom monitoring the heating of the filament
- vacancies in inner shell are filled by electrons from - controls the quantity of x-rays produced at the anode
higher energy levels - more mA, more electrons flow from cathode to anode
- produce spectral lines which are few discrete - increase mA will increase overall blackness of the film
frequencies
 Frequencies of this line depend on materials of 2. Effect of kVp (Peak kilovoltage)
the target and called characteristic lines - controls the energy and penetration quality of the x-ray
(important in considering the patient’s size, age, and
amount of movement)
- quality of the x-ray beam becomes enhanced by
increasing kVp allows x-ray beam to pass through more
dense tissue in large individual (pentrating ability)
- the quality of the x-ray beam becomes enhanced by
increasing the kVp
- it also controls the contrast

3. Exposure Time (mAs)

- determines the number of x-rays
- a longer exposure time increases the amount of x-rays
Typical X-Ray Spectrum
- for medical diagnosis, the x-rays typically used are 4. Others
composed of 70% Bremsstrahlung and 30% ● Filtration
characteristi radiation - removes low-energy x-rays from x-ray beam, thereby
- understanding the emission spectra is key to increasing average energy (quality) of x-ray beam
understanding how changes in kVP, mA, time and ● Collimation
filtration affects the optiical density and contrast of the - “beam direction” device
radiograph - does not change the energy or number of xrays in a
Doc Manila: beam; it just limits the size and shape of beam
- continuous Bremsstrahlung falling off to zero, a tube ● Distance from the object or source
voltage, and several spikes of charateristic lines ● Motion
● Anatomy/pathology of the target organ or body

4
 Formation of Image ● Image Display
- recorded as transparencies
X-Ray Film - can be viewed using a trans illuminator or a view box
- displays radiographic image ● Image Storage
- placed within the cassette and exposed to x-ray - film is a traditional medium for medical image storage
- composed of plastic base made up of polyester and and archiving
covered on both sides with
● Emulsion Cassette
- single or double layer of silver halide (98% silver - rectangle or square plastic or metallic container used to
bromide; 2% Silver Iodide hold x-ray films and intensifying screens
- surrounded by gelatin that keeps silver bromide grains - films are light sensitive so they are placed securely
evenly dispersed within the cassette to protect from exposure
- silver halide crystal are affected b x-rays and eventually - acts as a transporter of film
form image during film processing - used in conventional and computed radiography for the
● Base screen film system and imaging plate, respectively
- foundation of the film; 150-300 um - no cassette used in digital radiography
- mosty polyester (withstand heat and is fireproof)
- usually tinted blue to reduce light

Functions of Cassettte
1. Hold intensifying screens and protect them from
damage
2. Exclude all light from entering the cassette and
fogging the film
3. Maintain a close and uniform contact between the
film and screens
4. Exclude dust and dirt from the sensitive screens
5. Act as a medium from exposure up to further
processing of film

Image Processing
- production of film density and formation of visible
Film Functions image is a two-step process
● Image Recording 1. Exposure of film to light which forms invisible latent
- image converter image
- converts radiations, typically liht, into various shades of 2. Chemical process that converts the latent image into
gray or optical density values visible image
- records or retains an image
- exposure of a fraction of second can create a
permanent image

5
 Radiographic Densities

- the denser an object is, the more it absorbs x-rays and

the whiter it appears
After a film is exposed to an x-ray beam, it is generally
- the less dense an object, the fewer x-ray it absorbs and
developed in an automatic processor.
the blacker it will appear
The four components corresponds to four steps in film
● Air - blackest/ radiolucent
processing
● Fat - light shade of gray
● Soft tissue - less black than fat
In a conventional processor, the film is in the developer
● Calcium in bones - white
for 20 to 25 seconds. All four steps require total of 90
● Metal - whitest density/ radio opaque
seconds.
Characteristics of X-Ray Continuation
● X-rays are electrically neutral, cannot be
deviated or deflected
● X-rays travel in straight lines at the speed of light
- when inside an electric or magnetic or
combined field, a characteristic which can be
use to direct and focus the rays in order to
radiate the specific region of the body being
studied
● X-rays produce biological and chemical effects
- can affect an organism by producing ionization
and/or cellular changes that they may be
responsible for disorders of or further mutation
● X-rays span a section of the electromagnetic
● Underexposed - two white image lacking
spectrum and possess not only one frequency,
contrast
but several
● Overexposed - two black image with poor
● X-rays are not visible to the human eye or to
contrast
animals
Variations in processing conditions can produce
- their detection is impossible only by means of
significant differences in film sensitivity
instruments and photographic methods
- important consideration in undertaking
Important to have quality control so as to reduce
protective measures for the human body
exposure errors that cause either underexposed or
● X-rays produce images on photographic film and
overexposed film.
fluorescence on certain types of crystals
- x-rays are means to obtain x-ray films and
fluoroscopy images and medical monitors
● X-rays produce secondary radiation and
scattered radiation
- biological object receiving x-rays produces in
turn new rays with different characteristics

6
The Electromagnetic Spectrum - can alter molecules and cause harm
- example: ultraviolet radiation, x-rays, gamma rays

● Non-Ionizing Radiation
- low-energy; does not remove electrons from atoms
- example: visible light, infrared, radio and TV
broadcasts

Two types of x-rays used

Wave Properties

Wavelength Frequency Energy

Short High High
Long Low Low
- all parts travels at the same speed therefore,
wavelength and frequency have indirect relationship

● Wavelengths of x-rays and gamma rays = ● Non-mobile type of x-ray

nanometers (nm), where 1 nm = 10-9 m ● Mobile type of x-ray
● Frequency = hertz (Hz) where 1 cycle/sec = 1 sec -1
● Lights that have short wavelength: ultraviolet, x-ray, Radiation Protection
and gamma ray - x-ray is an ionizing radiation that potentially can cause
● Long wavelengths: radio, microwave, infrared harm if not used with caution
- primary aim of radiation protection: provide an
Electromagnetic Radiatino used in Diagnostic appropriat standard of protection for man without limiting
Imaging beneficial practices of radiation exposure
- the radiation protection fundamentals as recommended
Gamma Rays by the International Basic Safety Standards are intended
- emanate form within the nuclei of radioactive atoms to:
and are used to image the distribution of ● Prevent occurrence of deterministic effects
radiopharmaceuticals ● Minimize risk of stochastic effects

X-rays Three Main Principles of Radiation Protection

- produced outside the nucleus and used in radiography 1. Justification
and computed tomography - any decsion that alters the radiation exposure stuation
should do more good than harm
Visible Light
- produced in detecting x- and gamma rays; used for the 2. Optimization of Protection
observation and interpretation of images - likelihood of incurring exposure
- the number of people exposed
Radiofrequency - the magnitude of their individual doses (should all be
- in fm region; used as transmission and reception signal kept as as low as reasonably achievable (ALARA)
for magnetic resonance imaging (MRI)
3. Dose Limitation
X-Ray as Ionizing Radiation - the totall dose to any individual should not exceed the
● Ionizing Radiation appropriate limits recommended by the Commission
- higher frequency than the near-ultraviolet region of the
spectrum  Principles of Justification and Optimization are
- carries sufficient energy per photon to remove applicable to medical exposures. However, dose
electrons from atomic shells and molecules limitation is not applicable to patients who receive

7
 radiation exposure for a purpose of diagnosis or
therapy.
 It is important that medical exposures should be
justified by weighing expected diagnostic or
therapeutic benefits against risk that radiation
exposure might cause

As Low as Reasonable Achievable (ALARA)

- fundamental principle of radiation protection
- states that whenever ionizing radiation has to be
appliedto human, animals or materials, exposure should
be as low a reasonably achievable
- ICRP (International Commission in Radiological Exposed to:
Protection was the primary body created to advance for ● Cosmic rays from the sun
the public benefit the science of radiological protection ● Radon gas from radioactive gas from natural
breakdown of soil, rock, water, and building
Justification of Medical Practices materials
● Any radiological examination for occupational, legal
or health insurance purposes, undertaken without ● Average or typical natural radiation per year is
reference to clinical indications about 0.002 sievert per year
● Mass screening of population groups ● Chest x-ray is about 0.001 sievert per x-ray
● Exposure of humans for medical research ● Recommended limit with people working wit
● Radiological examinations for theft detection, radiation every five years is 0.10 sievert
detection of concealed objects for criminal acts or
for anti-smuggling purposes are not justified but Symptoms of Radiation Exposure
nevertheless be conducted.
Skin
Radiation Quantities and Units - first tissue that shows changes that shows prolonged
● Absorbed Dose exposure of radiation
- energy deposited in a tissue by the radiation eam per - shows erythema or redness of skin and epilation or hair
unit mass of matter loss
- measured in joules/kilogram with SI unit of Gray (Gy)
- 1 Gy = 1 J/kg = 100 Rad Effective Radiation Dose in Adults

● Effective Dose
- an estimate of the uniform, whole body equivalent dose
that would produce same level of risk for adverse effects
that result from the non-uniform irradiation
- unit is sievert (Sv)

● Unit of Exposure
- describes the amount of radiation traveling through the
ar
- Roentgen ( R ) and coulomb/kilogram (C/kg) unit of
measurement
- 1 R = 10 mSV

8
 Radiosensitive Organs

Illustrates some health effects of ionizing radiation see

atdiferent levels of exposure
The area of each square is prportinoal to the dose
● 0.5 Gy - approx. 50% develop cataract or circulator
● 0.2 Gy - on average 1 additional cancer seen in 100
people exposed
● 0.1 Gy - significant increase in cancers seen in
seen in 1– people exposed
High Sensitivity
● 20 mGy- annal dose limit for radiatio workers
- demonstrate high cell division and undifferentiated
● 10 mGy - typical dose for CT scan of chest
● 0.1 mGy- typical dose for chest x-ray
Biological Effects

Radiation and Pregnancy

Ionzing Radiation interacts with the

● Genetic
- interaction can produce deterministic effects on sperm
and eggs
● Somatic
- interaction can produce
○ Stochastic Effects
- due to cell changes (DNA) and proliferation
towards a malignant disease
- severity (example: cancer) independent dose
- no dose threshold-applicable also to very small
doses
- probability of effect increases with dose
 Does not occur to everyone exposed to
radiation

9
  Their severity of effect does not increase since we are in close proximity with they x-ray’s
with dose force.
 The probability of effect or occurrence is ● Apron, thyroid shield (middle, up), gonadal shields
proportional to the dose received for kids (middle, bottom), anti-radiation glasses,
 Can lead to production of cancer and lead gloves
heritable effects in the offspring
○ Deterministic Effects X-Ray Image Interpretation
- due to cell killing Always check the following:
- have a close threshold-typically several Gy ● Patient ‘s details
- specific to particular tissues ● Check orientation, position, and side description
- severity of harm is dose dependent ● Check for adequacy of inspiration (for chest x-ray)
 occurs when people exposed to radiation ● Check for film quality
exceeednig a certain level or threshold ○ Penetration
dose ○ Exposure
 the higher the dose, the more serious the ○ Adequate contrast
effects ○ Motion
 Includes sterility, decreased ○ Positioning
hematopoiesis, skin damage, hair loss,
cataracts, and damage to gastrointestinal Chest X-Ray
tract, lungs, kidneys and nervous system Left - radiology right side
 ICERP recommended that the minimum Right - radiologic left side
threshold dose is 100 mGy

Radiation Monitoring

Devices Used
● Film Badges
● Thermal Luminescent Dosimeter (TLD) Badges
● Pocket Dosimeter

Who should wear?

● Healthcare or laboratory workers in nonemergency
environments that may contain radiation (Radiology, PA View
Nuclear Medicine, Radiation Oncology) - posteroanterior view
● Workers in industrial environments where radiation - patient is able to stand or do an upright positioning
is used (Nuclear power plant or Radiation Sterilizing wherein the source of the x-ray is focused at the back of
facility) the patient and the front chest area is near the film
● Scapula is seen in the periphery of the thorax
Lead Shields ● Clavicles is projected over the lung fields
● Posterior ribs are distinct

AP View
- patient is not able to stand up or position in an erect,
upright positioning
● Scapula is seen over the lung fields
● Clavicle is seen above the apex of the lung
fields
● Anterior ribs are distinct

● When performing any radiologic procedure, it is

very important to shield ourselves from radiation

10
Good Inspiratorion
Lateral View
- 8 to 10 posterior ribs visible
- to confirm a particular abnormality that is seen in the
initial chest PA/AP view
Poor Inspiration
- less than 8 intercostal spaces

Apicolordotic View
- used when a suspicious density is seen in the upper
lung area of the chest PA view
- to confirm whether it is from the apical area or bone
Underpenetrated structure
- intervertebral spaces are not seen
- mostly soft tissue structures are overly white

Overpenetrated
- dark lung fields with very distinct vertebra

Lateral Decubitus View

- let the patient lie on a particular side
- used to confirm if the density seen in the chest PA/AP
view is fluid or not
- fluid will gravitate towards the dependent portion of the
hemithorax
- the previously noted densities in the right lower lung
field and is now seen in the dependent portion of the
right hemithorax
- this confirms of the finding in the chest called pleural
effusion

11
Radio-opacities

1. Meniscal Radio-opacity Pulmonary Edema

- right lower hemothorax obscuring the right cardiac - batwing appearance in the perihilar area of the lungs
margin, right hemidiaphragms, and costophrenic sulci - there is a short tube (internal jugular catheter tube)
- usually this is pleural effusion in the right lung with a tip in the area of the superior vena
cava
2. Atelectasis - endotracheal tube - tube in the tracheal shadow
- right lung field is almost completely white/opaque while
the left is well-errated Pulmonary Arterial Hypertension
- right lung is collapsed - (arrow heads) prominent enlarged arteries depicting
pulmonary hypertension
3. Pulmonary Mass
- well-defined density in the left lung

Tubes and Lines

- to confirm the presence of a particular tube or line in a
correct anatomical area
Radiolucency
- abnormally positioned tracheal tube should be reported
- black findings in the lungs
since it will cause passive collapse of the contralateral
lung
1. Pulmonary Cavity
- left: correctly positioned endotracheal tube at the level
- small round lucency at the left hilar area
of T3 few centimeters above the carina
- right: abnormally located endotracheall tube in the right
2. Left Pneumothorax
major bronchus.
- air in the pleural space
- absent lung marking in the left hemithorax and they
collapse left lung with associated mediastinal shift to the
right

12
- left: correctly positioned internal jugular catheter used Head and Neck
in hemodialysis, the tip is at the right atrium
- right: (1) correctly placed nasogastric tube and the tip
should be at the left hemiabdomen where the stomach is
(2): incorrectly placed nasogastric tube seen within the
right lung where it can produce a reactive inflammatory
process which can cause pneumonia

- dual wired pacemaker ( R) and pulse generator on the

left chest and wired tips int he cardiac shadow

Skull X-Ray
- investigates skull vault and associated bony structures
- used in trauma imaging, skeletal surveys, surveys for
birth defects, infection, foreign bodes, pituitary tumors,
and other bone defects

13
Paranasal Sinuses X-Ray
- is requested primarily to examni the sinuses for injury
inflammation, signs of infection, hemorrhage, to more or
other masses

Maxillary Sinusitis
- there are opacitiesor air fluid levels within both
maxillary sinuses, and this air fluid suggests that
infection is acute

Tripod Fracture
- most common facial bone fracture
- involves separation of the zygomatical maxillary
complex involving zygomatic arc, lateral orbital and
inferior orbital walls

14
Neck/Cervical

Left: Cervical Spondylosis

- marginal spurring of cervical vertebral bodies
involving C4, C5, C6 with associated disc space
narrowing between C5 and C6
Neck/Cervical - findings: arthritis of the cervical neck
- interpretation of neck images involves evaluation of the
soft tissue structures Right: Reversed Curve
- to look for foreign boies and retropharyngeal abscess - opposed to a normal lordotic curve of the cervical spine
or upper airway infections, evaluation of the cervical
spine for fractice bone tumors and abnormality joint, disc Abdominal X-Ray
abnormality and spinal deformities

AP View and Lateral View

- are used in imaging

Abdominal X-Ray Interpretation

- AP supine and erect views
- make that the whole abdomen is visualized from the
abdomen to the pelvis, and to have systematic approach
Retropharyngeal Abcess
- left: shows normal width of pre-vertebral soft tissue at BBC Approach
various cervical levels - bowel and other organs, bones, presence of any
- right: soft tissue swelling with gas formation calcifications and artifacts
● Bowel
- 3-6-9 rule which represents the upperlimit for the
normal diameter of the small bowel, colon ,and cecum
- double diameters more than those limits signifies
dilatation

15
Abnormal Abdominal X-Ray Fidings
- left: free air underneath the right diaphragm delineating
the right diaphragm and liver margins
- there is air underneath the central tendon of the
diaphragm and the visual bowel loops are distended .

- left: findings for pneumoperitoneum or air within the

peritoneum
 When diagnosing this finding, rule out a post-
surgical or a recent post-surgical procedure
because surgery normally causes minimal air
colllection within the peritoneum
- center: specific densities that fills and conforms the
renal calyces assembling horns of deer or staghorn
calculi
- right: Gallbladder stones: shows a cluster of well-
defined radial peak
- structuse in the right upper quadrant area indicate Fracture
gallbladder stones and can be confirmed by ultrasound - note the following:
● Type
Musculoskeletal Images ○ Complete
- knowledge of normal bone, joint, and soft tissue → Transverse
appearances enables accurate description abnormalities → Oblique
in an x-ray → Spiral
→ Comminuted
ABCS of Musculoskeletal System ○ Incomplete
- A: alignment and joint spaces → Bowing
- B: bone texture → Buckle
- C: cortices → Greenstick
- S: soft tissue ○ Salter-Harris (children)
- review all views compare both sides and re-examine → I - Slipped
any previous injury → II - Above

16
 → III - Lower - middle: angulated fractue of the distal radius
→ IV - through or transverse or together complete fracture but there is ngulation noted in the area
→ V - ruined or rammed of an indistinct structure
● Location
○ Diaphysis Spine X-Ray
○ Metaphysis A - adequacy: make sure that the entire spine that needs
○ Epiphysis to be visualized is visible
○ Anatomical name for the bone A - alignment: check the vertebral bodies and spinous
● Displacement processes
○ Angulation B - bone: look for loss of vertebral height
○ Translation C - cartilage
○ Rotation D - disc
○ Distraction or impaction S - soft tissue
● Others - look for narrowing, wide, and interspinous or
○ Joint involvement interpedical distance and check for the spinous
○ Another fracture processes and transverse processes
○ Underlying bone lesion - check for any displacement or misalignment of the
spine
- know the anatomical structures of a particular spine

- left: shoulder dislocation or glenohumeral joint

dislocation: location of the humeral head is seen
inferiorly relative to the glenoid fossa
- right: displaced fracture fractures at the distal shaft of
the tibia
17
Scoliosis
- rightward curvature of the thoracic
spine/dextroscoliosis
- left curvature: levoscoliosis
- surgery is opted when the measurement or the degree
of the curvature is more than or equal 45 degrees
(Spinal Fusion) Mammography

Spondylolisthesis Breast Cancer Screening

- anterior displacement of the fourth vertebral body - most common type of cancer among women
relative to the fifth lumbar body with associated decrease - 3rd leading cause of cancer-related de
or narrowing of the intervertebral space ● Philippines has the highest breast cancer mortality
- patients complain of low back pain rate and lowest mortality to incidence ratio
● Breast cancer is diagnosed in later stage
Wedge Compression Fracture - American Cancer Society and American College of
- shortening of a particular vertebral body Radiology suggest that all women over 50 years should
- distinct shortening of the first lumbar vertebral body undergo annual mammography
- women between 40 and 49 should have one done
Foreign Bodies Seen in X-Ray Image every alternate year

Mammography
- specialized medical imaging that uses low-dose x-ray
system to examine the breast
- low contrast sensitivity and with high
resolution
- MAMMOGRAM aids in the early detection and
diagnosis of breast disease

18
- detection of minute calcifications and architectural - makes breast thickness uniform in film density
distortions - differentiates the easily compressible cysts and
fibrograndular tissue from the more rigid carcinomas
Mammogram Machine - separates superimposed breast lesions
- reduces radiation dose to the breast

Types of and Indications for Mammographic Exam

● Screening Mammography
- for early detection of breast cancer
- for women with no breast symptoms
- recommended for 50-74 yrs old; available for 40 years
and above
- no absolute contraindication v Relative
contraindications:
● Symptomatic patients
● Age less than 40 years old
● C-arm design: rotating gantry so that tube and ● Pregnancy
breast table remain opposite each other ● Women with breast implants
● Generator similar to conventional Xray except
for: lower power rating, different AEC circuitry, low ● Diagnostic Mammography
kVp used - in symptomatic patients
● Common target/filters include - 40 years and above
○ Mo/Mo (molybdenum) (thin breast) - correlated with ultrasound and needle biopsy
○ Mo/Rh (molybdenum and rhodium) (thicker, - no absolute contraindication
denser breast) - relative contraindications:
○ Rh/Rh (rhodium) (thickest, dense breast) ● 30 years old and below
● Pregnancy and lactating women

Mammography Views
● Craniocaudal
● Mediolateral Oblique
- angulation between 40 to 60 degrees
- significant volume of breast tissue in the upper outer
quadrant of the breast where most breast cancer are
usually found
- downside: it is not 90 degrees to the CC view
localization of lesion requires some thought

● Compression Device: standard compression force

between 100-200N
○ A flat paddle provides uniform density image
● Spot Compression: uses small paddle
○ Principal drawback is patient discomfort

Compression Device
- decreases the thickness of the breast, thus reduces
scattered radiation which imroves contrast
19
Additional Mammography Views

- standard descriptors used in mammography and

ultrasound to have uniform reports in breast imaging,
interpretation

BI-RADS for Mammography and Ultrasound 2013

- different densities of breast shown with mammographic

images
- A: fatty composition of the breast
- B: scattered fibroglandular with fatty composition of the
breast
- C: heterogeneous dense breast composition
- to standardize breast imaging reporting and to reduce - D: extremely dense breast composition
confusion in breast imaging interpretations
- facilitates outcome monitoring and quality assessment
- contains standard terminologies for mammography,
breast ultrasound, and MRI

20
 ● Placement of devices within the body, such as
stents
● Angiograms
● Urogynecologic procedures (Hysterosalpingogram)
● Orthopedic surgery

Barium Edema

- low incidence of breast cancer in males does not

warrant screening mammography
 Mammography in males is usually a diagnostic
study and when the patient usually comes for
mammography, they usually complain with breast
enlargement, tenderness, or presence of lump
- left: biliary duct is assessed using fluoroscopy after or
 Ultrasound is the first screening tool used for
post-surgical removal of the gallbladder
symptomatic males
- presence of stone and the tapering of a tubular structu
 Mammography is shown to be a useful imaging
which is the common bile duct representing stricture
modality especially with distinguishing breast lump
formation
or breast enlargement
- right: tapering of the esophagus which indicates
stricture formation (Bird’s Beak Sign)
Fluoroscopy
- continuous acquisition of a sequence of x ray images
over time
- essentially a real-time x-ray movie of a patient
- transmission projection imaging modality
Examples:
● Barium X rays and enemas (to view gastrointestinal
tract)
● Catheter insertion and manipulation

21
 Retrograde Urethrogram
- assess the urethra of a male patient
- show the abnormality through feeling defect indicative
of stricture formation

- stricture or a defect and tapering in the portion of the

large intestine after barium edema was done (Apple
Core Deformity)
- typically finding for cancer in the colon

Hysterosalipingogram
- reproductive system
- normal uterus, fallopian tubes, and spillage of the
contrast material in the pelvic area which would indicate
that there is no problem with the reproductive system

Right images:
- up: no passage of the contrast material which would
indicate stricture formation
- down: unusual dilatation of the bilateral fallopian tubes
with no spillage of contrast materia in the pelvic area
also indicative of stricture formation
- associated with infertility

22
 Diagnostic And Procedural Imaging In Physical ● Appropriate imaging information integration
Therapy Practice (Radiography) within decision making process
● Continuation of primary care role
Why Study Imaging?
● In physical therapy practice, physical therapists Clinical Decision Guidelines
often encounter musculoskeletal system conditions Every physical therapist in musculoskeletal practice
and are always exposed with musculoskeletal should know:
imaging as a tool for diagnosis
● Canadian C Spine Rule
Traditional Model - is a decision-making tool used to determine when
- clinicians has a limited role in interpreting diagnostic radiography should be utilized in patients following
imaging trauma
- applicable to patients who are in an alert (Glasgow
Evolving Model Coma Scale score of 15) and stable condition following
- due to the evolving practice and profession, there are trauma where cervical spine injury is a concern.
some countries especially in USA have been given an - not applicable in non-trauma cases, if the patient has
autonomous practice in physical therapy or direct unstable vital signs, acute paralysis, known vertebral
access disease or previous history of cervical Spine surgery and
age <16 years.
● Professional Collaboration to enhance the quality
of patient care is the single most important goal. Sensitivity = 99.4
- studies said that rehabilitation professionals with their Specificity = 45.1
extensive knowledge of anatomy can greatly benefit with Negative Likelihood ratio = >5%
improved knowledge in diagnostic imaging
- it further improves the collaboration between physical Process
therapists and rehabilitation doctors in creating health
care intervention plans for the patients
● A more comprehensive evaluation is obtained.
● The information the clinician seeks is often of a
different nature than the information the physician
seeks and of a different nature than may be
described in the radiologist’s report.

Role of Physical Therapist

- incumbent upon us to understand & act on ho imaging
integrates with our:
● Medical screening as primary contact clinicians
● Clinical decision making in routine care Dangerous Mechanism
- to improve those reasoning processes. ● Fall from elevation >/=3 feet or 5 stairs
- not to presume to be radiologist ● Axial load to head e.g. diving
● MVC High speed (>100km/hr), rollover, ejection
Clinical Decision Making ● Motorized recreation vehicles
● No physical therapy invention = refer ● Bicycle struck or collision
● Appropriate to treat
● Co-physical therapy intervention and MD/other Simple Rear end MVC excludes
healthcare professionals ● Pushed into incoming traffic
● Hit by bus or large truck
Rationale for Physical Therapists ● Rollover
● Improved medical screening with musculoskeletal ● Hit by high speed vehicle
complaints
● Appropriate imaging with musculoskeletal Rule Not Applicable if
complaints ● Non trauma cases
● GCS <15

23
● Unstable vital signs
● Age <16 years ● OTTAWA Knee Rule
● Acute paralysis - determine the need for radiographs in acute knee
● Known vertebral disease injuries.
● Previous C spine surgery - this screening tool was developed because of the need
● Pregnant for a rapid and accurate way to avoid unnecessary
imaging.
● Nexus Low Risk Rule "Plain radiographs of the knee are among the most
- is a set of validated criteria used to decide which commonly ordered radiographs in U.S. emergency
trauma patients do not require cervical spine imaging. departments; 60% to 80% of patients with knee pain
- NEXUS criteria have a sensitivity of 99.6% for ruling have a knee film at an estimated annual cost of $1
out cervical spine injury in the original study validating billion." 92% will not have a fracture.
the criteria (95% confidence interval, 98.6-100%).
- NEXUS criteria may not be reliable with patient >65 When the Ottawa Knee Rules are executed, the
years of age following assessments will be performed:
● Check for sensitivity of the proximal fibula
● Check for sensitivity of the patella - only examine
the patella, not the surrounding tissues
● Determine if the patient is able to flex his/her knee
to 90° - this will be measured with a goniometer as
follows:
a. the axis of the goniometer is placed on the lateral
epicondyle of the femur
b. the stationary arm is placed on the femur and points
towards the greater trochanter
c. the moving arm is placed on the fibula and points
towards the lateral malleolus

Examine if the patient is able to bear weight on the

● Ottawa Ankle and Foot Rule
affected leg.
- determine the need for radiographs in acute ankle
● First, ask the patient if he/she was able to weight
injuries.
bear and be able to take four steps immediately
- this screening tool was developed because of the need
after the injury.
for a rapid and accurate way to avoid unnecessary
● Then ask the patient to take four steps.
imaging.
● If the patient is unable to do this due to pain, it can
- have been found to have sensitivities of 1.0 (95%
be concluded that this part of the examination is
confidence interval (CI), .95-1.0) for detecting malleolar
positive.
fractures and 1.0 (95% CI, .82-1.0) for detecting midfoot
● If the patient is able to take at least four steps on
fractures.
the affected leg (without a limp), we can conclude
that this part of the examination is negative.

A positive test results when one or more of the following

occur:
● the patient indicates pain during palpation
● there is an increased sensitivity of the fibula
● the patient is unable to bring the knee in 90° flexion
● the patient in unable to carry his/her own body
weight (stepping is not possible)
● acute blunt injuries of the knee are present,
regardless of mechanism of injury

24
● American College of Radiology Appropriateness
Criteria
- are evidence-based guidelines to assist referring
physicians and other providers in making the most
appropriate imaging or treatment decision for a specific
clinical condition.
- by employing these guidelines, providers enhance
quality of care and contribute to the most efficacious use
of radiology.

Basis for Imaging Decision Making in ACR

Appropriateness Criteria
● Age
● Trauma presence/absence • Mechanism of injury
● Prior surgery
● Risk factors
● Appearance
● Pain provocation / physical function tests
● Other imaging results
● Weight-bearing ability
● Tenderness to palpation

25
Imaging in Diagnostic Context
● Only a portion of the entire patient presentation
● Weighted within context of all information
● Prevalence of apparent pathologies in
asymptomatic populations
● Sensitivity & specificity of imaging important

Imaging Decision Making

● What information is being sought?
● How likely is the imaging result to change the
course of care?
● How likely is that information to be decisive in
management of the pt?

Imaging in Diagnostic Context

● Completing detailed history & clinical exam
● Recognition of red flags
● Knowledge of evolving clinical decision “rules”
● Imaging does NOT lessen importance of history &
clinical exam
● Imaging magnifies their importance

26
 Topic 2: CT Scan

Neuroradiology

Computed Tomography
- provides radiographic image of slices of a living patient
- displays each imaged slice separately, without the
superimposition of blurred structures
- a narrow, well collimated beam of xrays is generated
on one side of the patient, the xray beam is attenuated
by absorption and scattere as it passes through the
patient
- sensitive detectors on the opposite side of the patient
measure xray transmission through the slice.
- these measurements are systematically repeated many Advantages
times from different directions while the xray tube is ● Rapid acquisition
pulsed as it rotates 360⁰ around the patient ● Superior bone detail
● Superior demonstrtion of calcifications

Radiation Dose
- CT now accounts for more than 40% of all radiation
exposure to patients from diagnostic imaging

Contrast Administration
- intravenous iodine based constrast agents are
adminstered in CT to enhance density differences
between lesions and surrounding parenchyma, to
demonstrate vascular anatomy and vessel patency, and
to characterize lesions by their patterns of contrast
enhancement

● Contrast Agent
○ Iodinated Contrast Agents
- ionic contrast agents
Hounsfield unit (H) - high osmolality
- named after Sir Godfrey N. Hounsfield, the inventor of - can cause significant hemodynamic, cardiac and
CT subjective effects
- water is assigned a value of 0 to 20
- bone: +400 to +1000 ○ Non-ionic Contrast Agents
- soft tissue: +40 to +80 - low osmolality
- fat: -60 to 1o -100 - significant decrease in adverse reactions
- air: -1000

27
Neuroanatomy

Spine

● Cervical
● Thoracic
● Lumbar
● Sacral

28
Midline
- should be in the middle of the patiens head and the two
sides should be symmetrical
- any shift of midline structures is presumed to represent
a mass lesion on the side from which the midline is
displaced.

Symmetry
- generally, sulcal pattern should be symmetric
- anterior hemispheric fissure should b visualized
- sulci should extend towards the inner table of the skull

29
 Fourth Ventricle

Ventricles
- overall size is asessed
- symmetry or shift of the ventricles may be the only sign
of intracranial pathology
- composed of
● Lateral Ventricles
● 3rd Ventricle
● 4th Ventricle

Lateral Ventricle

Neuroimaging Options
- ultrasound may be used as the first test in infants
- as a general rule in brain imaging, CT is performed in
acute neurological illness
● If the CT or MRI suggests a primary vascular lesion,
do a CTA
● If the CT or MRI, suggests a tumor, do a contrast
enhanced study
● If CT or MRI fails to demonstrate an acute infarct
and symptoms would suggest a transient ischemic
attack, do a carotid Dopple ultrasound, MRA or CTA

Clinical CT CT with MRI MRI with

presentation (Plain) contrast (Plain) contrast
Trauma XX
Stroke XX
Third Ventricle Seizure X
Infection X X X XX
Acute X X X XX
Headache
Chronic XX X X XX
Headache
Dementia XX
Coma XX XX
XX - best study
X - acceptable

30
Analysis of the Abnormality - MRI, lesions tend to enhance in a ring-like manner or
irregular fashion
Mass - in general, intra-axial mass tend to have more
- recognized by displacement of the normal structures surrounding edema
away from the abnormality ● Extra-axial
- normal midline structures may be shifted contralateral – outside the brain and compressing it
to the mass - to distinguish, the interface between the mass and the
- the sulci adjacent to the mass may be effaced surrounding brain
- ipsilateral ventricle may be compressed, thus causing - usually has a broad surface
asymmetry

- in the posterior fossa, the most reliable sign is widening

of the ipsilateral subarachnoid space.

● Intra-axial
- inside the brain and expanding it
- usually surrounded by the brain. - buckling of the gray and white matter interface
- the cerebellum and the brainstem are displaced away
from the bony margins are of the calvarium by the mass.

Atrophy
- recognized by widening of the ipsilateral sulci or
widening of the ventricle adjacent to the lesion.
- no shifting of the midline structures
- in the supratentorial region, the adjacent gyri are
expanded and and CSF spaces are compressed

Solitary or Multiple
- single lesion is more likely to be the result of isolated
- in the posterior fossa, demonstrates a narrow ipsilateral primary cerebral disease
subarachnoid space - multiple lesions, are more likely manifestations of
systemic disease

31
 Subdural vs Epidural Hematoma

- follows inner
layer of dura
- “rounds the
bend” to follow
falx or tentorium
- not affected by
sutures of skull
Contrast Enhancement
- tendency for
- enhancement of the brain parenchyma means that the
crescentic
blood brain barrier has been broken and that the process Subdural
shapes
is biologically active
- more mass
effect than
expected for
their size
- typical source
of SDH: cortical
vein

- follows outer
layer of dura
Must Knows
(periosteum)-
- crosses falx or
Imaging Time Course After Brain Infarction tentorium
Time CT MRI
- limited by
Absent flow void
sutures of skull
Arterial
Minutes No changes Epidural (typically)
enhancement
High signal (DWI) - tendency for
Brain swelling lentiform shapes
Hyperdense artery
(T1W1) - typical sources
2-6 hours sign
Subtle T2W1 of EDH: skull
Insular ribbon sign
hypertensity fracture with
Sulcal effacement arterial or sinus
T2WI
6-12 hours Decreased laceration
hyperintensity
attenuation
Decreased
12-24 hours T1 hypointensity
attenuation
3-7 days Maximal swelling Maximal swelling
Gyral
Gyral enhancement
3-21 days enhancement (peak 3-21 days)
(peak 7-14 days) Petechial
methemoglobin
Encephalomalacia Encephalomalacia
Loss of Loss of
30-90 days enhancement enahancement
Resolution of Resolution of
petechial blood petechial blood

32
Epidural Hematoma CT Scan: PT Applications

Principles of Computed Tomography

- CT merges x-ray technology with the computer to
provide detailed digital crosssectional images of the
body relatively free from superimposition of the different
tissues.
- radiodensities of the body tissues are represented in
the image as shades of gray.
- CT creates images based on cross-sectional (axial)
slices, created by up to 1,000 projections from different
angles.

Subdural Hematoma Elements of CT Scan

- a CT scanner has three components
● The gantry, into which the patient slides during the
examination
● The operator’s console
● The computer(s)

Subarachnoid Hemorrhage

Gantry
- contains the x-ray tube, its high-voltage generator, a
collimator assemby, a detector array, and a data
acquisition system

Diagnosis

X-Ray Source
- CT employs a highintensity x-ray tube in order to
provide uniform penetration of the tissues and reduce
attenuation by bone relative to soft tissue.

33
Collimators
- fan-shaped x-ray beam must be tightly collimated. Scanning Process
- are apertures through which the x-rays pass on the ● X-ray tube and detectors rotate around the patient,
way to the patient and serve the following functions: with the axis of rotation running from the patient’s
● Control radiation scatter head to toe.
● Create a narrow, fan-shaped beam of x-rays, ● Detectors measure the average linear attenuation
determining the field of view coefficient, µ, between the tube and detectors.
● Determine the slice thickness ● Attenuation coefficient reflects the degree to which
the X-ray intensity is reduced by the material it
passes through
● 2D measurement are taken in a helical manner all
around the patient
● Attenuation data is summed up from thousands of
angles used in a process called reconstruction
● Contrast dye is sometimes used to make the
internal organs more visible in the image
● Bone appears white; gases and liquids are black;
tissues are gray
● Measurements taken in Hounsfield units (Hu
● The same study data can show bone structure or
soft tissue detail, simply by altering the window and
leveling (ie, which Hu range will the 0-255 greyscale
Detectors values will correspond to)
- x-rays are attenuated by body tissues and then exit
the patient’s body as remnant radiation, similarly to Different Forms of CT Scan
conventional radiography.
- up to 1,000 detectors are arranged in an array, Three Dimensional CT Scan
encircling the patient, for the purpose of measuring this - creates three-dimensional (3D) presentations of body
remnant radiation. parts that can be rotated in “in space” on the computer
- modern units commonly have 4 to 16 rows of detectors. screen; a process called multiplanar reconstruction
(MPR).
Data Acquisition System - able to convey complex anatomic information in a
- data acquisition system amplifies the signal from the manner not previously possible
detectors. - can be challenging for radiologist, and other clinicians
- incoming signal is in the form of a varying electrical used to two-dimensional imaging studies, with many
current, known as an analog signal. challenges.
- data acquisition system converts it from analog to - these images are not adequately viewed in the printed
digital form and then sends it to the computer. format (hard copy);
- they reveal their potential only when viewed in the
digital format (soft copy), using software that allows free
3D rotation of the examined body part.

CT Myelogram
- using CT, the radiodense column created by contrast
material in the spinal fluid can be visualized in every
plane while simultaneously gathering accurate
Operator Console and CT Computer information about what structures impinge on the thecal
- operator console is the desk from which the CT sac and nerve roots.
technologist controls the scanning process and selects - CT myelography is better able to distinguish between
slice thickness, reconstruction algorithms, and other osteophytes, ligament infolding, and annular material
specifications than is MRI.

Making the CT Image

34
- where there is history of symptomatic lumbar stenosis, the muscle surrounding it may be missed because
CT myelography is considered the definitive the computer assigns the same shade of gray to the
preoperative investigation tumor as to the muscle.
● High radiation exposure
Cone Beam Computed Tomography (CBCT)
- CBCT acquires all the data in a single sweep of the Summary and Future Development
scanner employing a large, cone-shaped x-ray beam ● CT is the modality of choice for detailed imaging of
matched with a flat-panel detector for volume acquisition cortical and trabecular bone.
of data. ● The capability of CT to scan large volumes of tissue
- Images in a CBCT scanner are not constructed from a in very short periods of time has made CT the
large number of slices but rather based on one volume modality of choice for cardiac and pulmonary
of data imaging
- shorter scanning times and lower radiation exposure.
- spatial resolution is greater than with conventional CT Imaging in Common Conditions Encoutered in
scanners. PT Setting
- 3 CBCT scanners have been used in areas suited for
this type of scanning, such as dentistry— including Traumatic Brain Injury
imaging of the temporomandibular joint—and imaging of - is an insult to the brain, not of a degenerative or
the breast congenital nature but caused by an external physical
force, that may produce a diminished or altered state of
Clinical Uses of CT consciousness, which results in an impairment of
cognitive abilities or physical functioning.
What Does Ct Image Best? - on CT, traumatic brain injuries are usually evaluated
For evaluating bone, CT is usually the imaging modality with two computer-generated window settings:
of choice. At present: ● Brain Window Setting
1. CT is best for identifying subtle fractures and/or - is useful in evaluating the anatomic structures of the
complex fractures brain to see if there is any evidence of pneumocephalus,
2. CT is best for evaluating degenerative changes, such hydrocephalus, cerebral edema, midline shift, or
as spinal arthritic changes. compression of the ventricular system of the brain.
3. CT may be the first imaging choice in serious trauma, - an epidural hematoma will appear with the
since multiple injuries to both osseous and soft tissue characteristic biconvex-shaped hematoma.
structures can be determined from one imaging series. ○ Acute stage
4. CT excels in the evaluation of spinal stenosis - the hematoma will appear bright or hyperdense.
especially if performed as CT myelography. ○ Subacute stage
5. Combined with a diskogram, it may give invaluable - the hematoma will appear isodense to surrounding
information on the condition of the intervertebral disk brain tissue.
6. CT is the best modality for the evaluation of loose ○ Chronic stage
bodies in a joint. -the hematoma will appear dark or hypodense
7. CT is less time-consuming than MRI or ultrasound.
8. CT allows for accurate measurements of osseous ● Bone Window Setting
alignment in any plane. - is useful to visualize bony factures of the skull and
9. CT is usually less expensive than MRI. facial area, as well as bony fragments that may be
10. CT is less problematic for patients with scattered within the impacted area.
claustrophobia

Limitations of CT Scan
● CT has limited capabilities for determining the
histological makeup of the imaged tissues because
it identifies tissues primarily on the basis of
radiodensity.
● Different tissues may be assigned the same shade
of gray if their radiodensities are similar. For
example, a tumor that has the same radiodensity as
35
Epidural Hematoma (EDH)
- is a traumatic accumulation of blood that is located
between the inner table of the skull and the dura mater.
- often the result of a blunt force to the head.
- most commonly occur in:
● Temporoparietal region of the skull (80% or higher).
● 90 percent of EDHs involve the meningeal arteries
● 10 percent may result in tearing the dural sinuses
and veins that course through the impacted area.
- appear biconvex on either CT or MRI examinations

Points to Remember for CT Scan

1. The images are axial slices, based on multiple

radiographic projections from different angles.
2. Modern CT scanning collects volumetric data and
allows display in any plane.
3. Images display the radiodensities of the tissues.
4. Slices can contain different tissues within single pixels,
Ischemic Stroke
giving rise to volume averaging.
- caused by emboli, vasospasm, loss of cardiac output,
5. Three-dimensional CT and CT myelography are
or atherosclerosis.
valuable variants of CT.
- lesions may be small and round.
6. By setting the radiodensities (windowing), it is
- lesions are frequently located in the brainstem, basal
possible to select what tissues are best displayed.
ganglia, or thalamus.
7. Thinner slices and smaller pixels improve spatial
- in thrombosis in a large vessel, the vessel itself may be
resolution
more radiodense and thus brighter on CT than the
8. Thicker slices and larger pixels improve contrast
surrounding brain tissue.
resolution.
- cerebral lesions are dark, because of the ensuing
9. CT has the advantage of fast scanning, thin slices,
edema.
and superior osseous detail but the disadvantage of
relatively high radiation.
Cerebral Hemorrhage/Hematoma
10. Modern neuroimaging consists of CT, MRI, and
- caused by the rupture of a blood vessel.
variants of the two employed to depict metabolic activity.
- on CT in the acute stage, the parenchyma is bright and,
11. CT is the modality of choice for neuroimaging in
if there is blood in the CSF, its radiodensity is also
acute settings and in case of trauma.
increased.
12. Imaging characteristics of the brain for CT and MRI
- in the subacute phase, the hemorrhagic area becomes
follow patterns familiar from musculoskeletal imaging,
less radiodense on CT than the surrounding brain matter.
based on cell density, fat, and fluid content

36