骨肌系统影像英文PPT课件

.,ImagingofmusculoskeletalsystemNormalimagingandvariation,骨肌系统影像学：正常及变异医学影像学教研室吴仁华,.,WhatisRadiology.Radiation(usesanddangers)TypesofimagingmodalitiesKnowledgeofAnatomy,physiology,pharmacology,clinicalmedicineimportant.Physiology,pharmacology,anatomy,pathologytoexplainchangesonX-raysWhydoneedtoknowaboutradiologyYouasaphysicianwillneedknowledgeofallmodalitiesforpatientssymptoms.Asasubspecialtycareer,Imagingofmusculoskeletalsystemimagingmodalities,.,YouallwillhavegraduatedandbecomephysiciansPatientswillvisityouinyournewoffice.Theywillhaveallkindsofsymptoms!,SeveralYearsLater,.,Visitingaphysicianforfollowingreasons:1:Yearlycheckup2:Surveillancefordetectingdiseaseearly(e.gbonetumor)3:Chronicsymptoms(e.g-chronicbackpain)4:Acutesymptoms(e.g-fracture),Whypatientvisitsadoctor,.,Investigatingpatientssymptoms,1:Historytaking2:Physicalexamination3:Laboratorytests(e.g.bloodwork)4:X-rayinvestigations5:Treatment(medicalorsurgical),.,X-rayInvestigations,1:WhatareX-rays2:Differenttypesofradiologictests3:Examplesofclinicalscenarios&radiologicinvestigations,.,“IhavediscoveredsomethinginterestingbutIdonotknowwhetherornotmyobservationsarecorrect”.,WilhelmConradRoentgen,1895ThediscovererofX-RAYS,.,WhatareX-Rays?,Aformofelectromagneticradiationwithshortwavelength(between10-2and10nm)X-raysaregeneratedbyusingahighvoltagecurrenttoaccelerateelectronswithinevacuatedglasstubes,towardsatungstentarget,.,1895,2010,TheX-rayLabThen&Now,RoentgensFirstLab,X-rayLabof2010,.,TheFamousFirstRadiograph,RadiographbyRoentgenon22December1985,1895TheradiographofMrs.Roentgenshand.,Radiographofhand2010,.,Photographofahandduringprogressiveradiationexposureresultinginnecroses.,EffectsofRadiation,Radiosensitiveorgans-Ovaries,testis软巢睾丸-Thyroid甲状腺-Fetus胎儿-GItract胃肠道RadiationdamageisDosedependentFactorstoreducedoseReduceunnecessarystudiesUsenon-radiationstudiesUltrasound,MRI,.,X-RAYSULTRASOUNDCOMPUTEDTOMOGRAPHY(CT)NUCLEARMEDICINEANGIOGRAPHYMAGNETICRESONANCEIMAGING(MRI)POSITRONEMISSIONSCANNING(PET),TYPESOFIMAGINGINRADIOLOGYDEPARTMENT,.,HowisanX-rayImageobtained,TheX-rayspassthroughthebodyandaredetectedonphotographicfilmplacedbehindthepatient,X-rayTube,X-rayphotons,.,.,Howandwhydoradiographsappearblack&whiteItstartedwiththeX-rayfilm(GELATINWITHSILEVRBROMIDEcyrstals)Filmhassilverhalide卤化物X-raybeamhitthesilverbromide溴化银turnsintoblackwhendevelopedWhennox-rayphotonstrikesthefilm,itremainswhite,TheBlackandWhiteofRadiographs,.,WHATFACTORSDETERMINETHEBLACK&WHITE,DifferentmaterialsabsorbX-raystodifferingdegreesDependsontheatomicnumberofelement,.,WhatisUltrasound?,SoundwaveswithfrequenciesabovetherangeofhumanhearingultrasoundAnarrowbeamofhighenergysoundwavesisdirectedintothepatientsbodyThemannerinwhichthesoundisreflectedbackfromvarioustissuesisrecorded,.,WhyUseUltrasound?,CheaperthanCTorMRI,Patientisnotexposedtoionizingradiation,Equipmentisveryportable,thereforecanbeusedonpatientstoosickorinjuredtobemovedfromtheirbeds,Ultrasoundofthefetalhead(inutero),.,WhatisComputedTomography?,AnX-raybasedtechnique,TheX-raytube,alongwithanarrayofdetectors,arerotatedinaplanearoundthepatient,.,CTSCANOFTHEPELVIS,.,WhatisNuclearImaging?,Aradioactiveisotopeandinjectedintothepatient,Theisotopeistakenupbytheorganortissueofinterest(physiologicexamination),Theisotopeemitsgammarayswhicharethendetectedbyagammacamera,Atechnetium锝-99bonescan,.,WhatisMagneticResonanceImaging?,InvolvesmeasuringthebehaviourofprotonsindifferentchemicalenvironmentswhenexposedtoamagneticfieldPatientsarenotexposedtoionizingradiation,Mid-saggitalMRscanofthehead,.,TheBenefitsofMRI,Theidealmodalityforimagingsofttissues,.,Protonpossesspositivecharge,Magneticfields,Applyingexternalstrongmagneticfieldtoprotons,MagneticResonanceImaging,Basicprinciples,.,MRI:Femur&Quadricepsmuscle,.,TRICKSOFTHETRADEINRADIOLOGY,UsuallyitsallinBLACK&WHITE!,.,Whatdoyousee?,Therearetwowomen,ayoungandoldone“YouseewhatyoulookforYourecognisewhatyouknow”,.,Whatdoyouseehere?,MRIScan,.,SHEEPDOG,WhatIsaw!,.,Glutealmaximusmuscle,Rectum,Sacrum,Lowerbackmuscles,MRIofthebuttocks,.,LearnyouranatomywellImportantininterpretingradiographicstudiesYoumaywanttobecomearadiologist,ANATOMY!ANATOMY!ANATOMY!,.,AcuteConditions,.,ClinicalScenarioCase,History:YoungpatientplayingbaseballinjuredelbowwhileslidingathomeplateWhattypeofX-raywouldyouorder?-CTscan-Plainfilmoftheelbow-MRI,.,PATIENTELBOW,Normalelbow,LATERALVIEWSOFELBOW,.,Humerus,Radius,Ulna,Humeralcondyles,Fracturedislocationoftheelbowjoint,.,Howwouldyoutreatthispatient?1:DoCTscanofelbow2:Putacast3:CallOrthopedicsurgeon4:Sendpatienthome,.,Complicationofelbowfracturedislocation,-Brachialartery臂动脉injury(Especiallywithfracturesinthearea),.,Treatment:PatientwentstraighttosurgeryThedislocationwasreduced,.,ChronicConditions,.,ClinicalScenarioCase,History:Youngweightlifterwithsuddenonsetofneckpain,.,PossibleDiagnosis:1:Fracturedcervicalbone骨折2:Slippedvertebraldisc椎间盘滑脱3:Musclesprain扭伤4:Spinalcordtumor肿瘤,.,NextInvestigations1:Seeasportsspecialist2:X-rayofthespine3:CTofthespine4:MRIofthespine,.,DoctorfirstorderedCervicalspinex-rayLateralviewoftheC-spine,.,LateralviewoftheC-spine,Spinousprocess,Discspace,Vertebralbody,C2,C3,C4,C7,C6,C5,Occipitalbone,mandible,.,Movie,tongue,Vertebralbody,Spinalcord,MRIoftheCervicalSpine,Smalldiscprotrusionsesp.atC5-6level,Discspace,Discprotrusion,C2,C3,C4,C7,C6,C5,.,CONCLUSIONS:,1:X-RAYexamswhichusesradiation:-Plainfilm-CT-Nuclearmedicine2:X-RAYstudiesthatDONOTuseradiation:-Ultrasound-MRI,.,0,5,10,15,20,25,Chest,Skull,BrainCT,Thoracicspine,KUB,Lumbarspine,IVP,UGI,BariumEnema,CTchest,CTAbdomen,APracticalApproach,EffectiveDose(mSv),EffectiveRadiationdosesinRadiologicexaminations,.au/radiology/principles/.au/radiology/principles/radsaftx.html,.,1:TherearemanyX-raytestsavailableforptssymptoms2:Choosetherightonethatwouldgivethediagnosisearly3:Alwaysconsultaradiologistforadviceonwhichtestisappropriateforyourpatient.,CONCLUSIONS:,.,ImagingofmusculoskeletalsystemNormalimagingandVariation,.,.,206bones.fiveorfourgroupsLongbones长骨Shortbones短骨Flatbones扁骨Sesamoidbones子骨Irregularbones不规则骨,.,.,.,.,2神经孔,6椎小关节,.,.,.,APview,Lateralview,4髂嵴,.,.,4肩峰突,5关节窝,6喙突,.,12滑车,13肱骨小头,7三角肌粗隆,8内上髁脊,15冠状窝,.,.,8豆9钩,.,.,.,Lateral,AP,Oblique,.,.,Normalvariation,.,Sesamoid子骨,.,Sesamoid,.,BoneIsland骨岛,.,AccessoryBones附骨,.,AccessoryBones,.,Fracture,.,BoneIsland,.,BoneIsland,.,LumbarSacralization腰椎骶化,.,Lumbarization骶椎腰花,.,PermanentOsteoepiphyte永存骨骺,.,DiseaseisabnormalandoralteredanatomyLEARNYOURANATOMYWELLNOW!Itwillpayofflater!Especiallyifyouplantobearadiologist.,FINALPEARL,.,PHYSICSOFRADIOLOGY,.,PHYSICSOFRADIOLOGY,Testyourknowledge,X-rayfilmsareblackandwhiteCTscanimagesaremadeupofmanydots,EachdotrepresentsaCTnumbercalledHOUNSFIELDnumber,.,WhatareX-Rays?,DifferentmaterialsabsorbX-raystodifferingdegrees,.,Lead,Barium,Bone,Muscle,Liver