骨肌系统影像英文-课件

ImagingofmusculoskeletalsystemNormalimagingandvariation骨肌系统影像学：正常及变异

1WhatisRadiology.Radiation(usesanddangers)TypesofimagingmodalitiesKnowledgeofAnatomy,physiology,pharmacology,clinicalmedicineimportant.Physiology,pharmacology,anatomy,pathologytoexplainchangesonX-raysWhydoneedtoknowaboutradiologyYouasaphysicianwillneedknowledgeofallmodalitiesforpatientssymptoms.AsasubspecialtycareerImagingofmusculoskeletalsystemimagingmodalities2☻

Youallwillhavegraduatedandbecomephysicians☻Patientswillvisityouinyournewoffice.☻Theywillhaveallkindsofsymptoms!SeveralYearsLater3Visitingaphysicianforfollowingreasons:1:Yearlycheckup2:Surveillancefordetectingdiseaseearly

(e.g–bonetumor)3:Chronicsymptoms

(e.g-chronicbackpain)4:Acutesymptoms

(e.g-fracture)Whypatientvisitsadoctor4Investigatingpatient'ssymptoms1:Historytaking2:Physicalexamination3:Laboratorytests(e.g.bloodwork)4:X-rayinvestigations5:Treatment(medicalorsurgical)5X-rayInvestigations1:WhatareX-rays2:Differenttypesofradiologictests3:Examplesofclinicalscenarios&radiologicinvestigations6“IhavediscoveredsomethinginterestingbutIdonotknowwhetherornotmyobservationsarecorrect”.WilhelmConradRoentgen,1895ThediscovererofX-RAYS7WhatareX-Rays?

Aformofelectromagneticradiationwithshortwavelength(between10-2and10nm)X-raysaregeneratedbyusingahighvoltagecurrenttoaccelerateelectronswithinevacuatedglasstubes,towardsatungstentargetcathodeAnode阳极evacuatedglasstube真空球管X-raysX线tungstentarget钨靶electronbeam电子束818952010TheX-rayLabThen&NowRoentgen’sFirstLabX-rayLabof20109大家应该也有点累了，稍作休息大家有疑问的，可以询问和交流10TheFamousFirstRadiographRadiographbyRoentgenon22December19851895TheradiographofMrs.Roentgen'shand.Radiographofhand201011Photographofahandduringprogressiveradiationexposureresultinginnecroses.EffectsofRadiationRadiosensitiveorgans

-Ovaries,testis软巢睾丸

-Thyroid甲状腺 -Fetus胎儿 -GItract胃肠道

RadiationdamageisDosedependentFactorstoreducedoseReduceunnecessarystudiesUsenon-radiationstudiesUltrasound,MRI12X-RAYSULTRASOUNDCOMPUTEDTOMOGRAPHY(CT)NUCLEARMEDICINEANGIOGRAPHYMAGNETICRESONANCEIMAGING(MRI)POSITRONEMISSIONSCANNING(PET)TYPESOFIMAGINGINRADIOLOGYDEPARTMENT13HowisanX-rayImageobtainedTheX-rayspassthroughthebodyandaredetectedonphotographicfilmplacedbehindthepatientX-raycassette暗盒(withfilm)X-rayTubeX-rayphotons1415Howandwhydoradiographsappearblack&whiteItstartedwiththeX-rayfilm(GELATINWITHSILEVRBROMIDEcyrstals)Filmhassilverhalide卤化物

X-raybeamhitthesilverbromide溴化银turnsintoblackwhendevelopedWhennox-rayphotonstrikesthefilm,itremainswhiteTheBlackandWhiteofRadiographs16leadbariumsulfatebonemuscleliver(eg)fatairX-rayfilmWHATFACTORSDETERMINETHEBLACK&WHITEDifferentmaterialsabsorbX-raystodifferingdegreesDependsontheatomicnumberofelement17WhatisUltrasound?SoundwaveswithfrequenciesabovetherangeofhumanhearingultrasoundAnarrowbeamofhighenergysoundwavesisdirectedintothepatient’sbodyThemannerinwhichthesoundisreflectedbackfromvarioustissuesisrecorded18WhyUseUltrasound?CheaperthanCTorMRIPatientisnotexposedtoionizingradiationEquipmentisveryportable,thereforecanbeusedonpatientstoosickorinjuredtobemovedfromtheirbedsUltrasoundofthefetalhead(inutero)19WhatisComputedTomography?AnX-raybasedtechniqueTheX-raytube,alongwithanarrayofdetectors,arerotatedinaplanearoundthepatientgantryX-raytubedetectorarraydirectionofrotationpatient(doesn’tmove)X-raybeam20CTSCANOFTHEPELVIS21WhatisNuclearImaging?AradioactiveisotopeandinjectedintothepatientTheisotopeistakenupbytheorganortissueofinterest(physiologicexamination)TheisotopeemitsgammarayswhicharethendetectedbyagammacameraAtechnetium锝-99bonescan22WhatisMagneticResonanceImaging?InvolvesmeasuringthebehaviourofprotonsindifferentchemicalenvironmentswhenexposedtoamagneticfieldPatientsarenotexposedtoionizingradiationMid-saggitalMRscanofthehead23TheBenefitsofMRITheidealmodalityforimagingsofttissues24ProtonpossesspositivechargeMagneticfieldsApplyingexternalstrongmagneticfieldtoprotonsMagneticResonanceImagingBasicprinciples25MRI:Femur&Quadricepsmuscle26TRICKSOFTHETRADEINRADIOLOGYUsuallyit’sallinBLACK&WHITE!27Whatdoyousee?Therearetwowomen,ayoungandoldone“YouseewhatyoulookforYourecognisewhatyouknow”28Whatdoyouseehere?MRIScan29SHEEPDOGWhatIsaw!30GlutealmaximusmuscleRectumSacrumLowerbackmusclesMRIofthebuttocks31

LearnyouranatomywellImportantininterpretingradiographicstudiesYoumaywanttobecomearadiologistANATOMY!ANATOMY!ANATOMY!32AcuteConditions33ClinicalScenarioCaseHistory:YoungpatientplayingbaseballinjuredelbowwhileslidingathomeplateWhattypeofX-raywouldyouorder? -CTscan -Plainfilmoftheelbow -MRI34PATIENTELBOWNormalelbowLATERALVIEWSOFELBOW35HumerusRadiusUlnaHumeralcondylesFracturedislocationoftheelbowjoint36Howwouldyoutreatthispatient?1:DoCTscanofelbow2:Putacast3:CallOrthopedicsurgeon4:Sendpatienthome37Complicationofelbowfracturedislocation-Brachialartery臂动脉

injury(Especiallywithfracturesinthearea)38Treatment:PatientwentstraighttosurgeryThedislocationwasreduced39ChronicConditions40ClinicalScenarioCaseHistory:Youngweightlifterwithsuddenonsetofneckpain41PossibleDiagnosis:1:Fracturedcervicalbone骨折2:Slippedvertebraldisc椎间盘滑脱3:Musclesprain扭伤

4:Spinalcordtumor肿瘤42NextInvestigations1:Seeasportsspecialist2:X-rayofthespine3:CTofthespine4:MRIofthespine43DoctorfirstorderedCervicalspinex-rayLateralviewoftheC-spine44LateralviewoftheC-spineSpinousprocessDiscspaceVertebralbodyC2C3C4C7C6C5Occipitalbonemandible45MovietongueVertebralbodySpinalcordMRIoftheCervicalSpineSmalldiscprotrusionsesp.atC5-6levelDiscspaceDiscprotrusionC2C3C4C7C6C546CONCLUSIONS:1:X-RAYexamswhichusesradiation: -Plainfilm -CT -Nuclearmedicine

2:X-RAYstudiesthatDONOTuseradiation: -Ultrasound -MRI470510152025ChestSkullBrainCTThoracicspineKUBLumbarspineIVPUGIBariumEnemaCTchestCTAbdomenAPracticalApproachEffectiveDose(mSv)EffectiveRadiationdosesinRadiologicexaminations..au/radiology/principles/radsaftx.html481:TherearemanyX-raytestsavailableforpt’ssymptoms2:Choosetherightonethatwouldgivethediagnosisearly3:Alwaysconsultaradiologistforadviceonwhichtestisappropriateforyourpatient.CONCLUSIONS:49ImagingofmusculoskeletalsystemNormalimagingandVariation5051206bones.fiveorfourgroupsLongbones

长骨

Shortbones短骨

Flatbones

扁骨

Sesamoidbones

子骨

Irregularbones不规则骨525354552神经孔6椎小关节565758APviewLateralview

4髂嵴59604肩峰突5关节窝6喙突6112滑车13肱骨小头7三角肌粗隆8内上髁脊15冠状窝62638豆9钩646566LateralAPOblique6768Normalvariation69Sesamoid子骨70Sesamoid71BoneIsland骨岛72AccessoryBones附骨73AccessoryBones74Fracture75BoneIsland76BoneIsland77LumbarSacralization腰椎骶化78Lumbarization骶椎腰花79PermanentOsteoepiphyte永存骨骺80

Diseaseisabnormalandoralteredanatomy

LEARNYOURANATOMYWELLNOW!!!

Itwillpayofflater!!!

Especiallyifyouplantobearadiologist.FINALPEARL81PHYSICSOFRADIOLOGY82PHYSICSOFRADIOLOGYTestyourknowledge X-rayfilmsareblackandwhite

CTscanimagesaremadeupofmanydots

EachdotrepresentsaCTnumbercalledHOUNSFIELDnumber83leadbariumsulfatebonemuscleliver(eg)fatairX-rayfilmWhatareX-Rays?DifferentmaterialsabsorbX-raystodifferingdegrees84LeadBari