骨肌系统影像英文

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

医学影像学教研室吴仁华第1页WhatisRadiology.Radiation(usesanddangers)TypesofimagingmodalitiesKnowledgeofAnatomy,physiology,pharmacology,clinicalmedicineimportant.Physiology,pharmacology,anatomy,pathologytoexplainchangesonX-raysWhydoneedtoknowaboutradiologyYouasaphysicianwillneedknowledgeofallmodalitiesforpatientssymptoms.AsasubspecialtycareerImagingofmusculoskeletalsystem第2页☻Youallwillhavegraduatedandbeephysicians☻Patientswillvisityouinyournewoffice.☻Theywillhaveallkindsofsymptoms!SeveralYearsLater第3页Visitingaphysicianforfollowingreasons:1:Yearlycheckup2:Surveillancefordetectingdiseaseearly

(e.g–bonetumor)3:Chronicsymptoms

(e.g-chronicbackpain)4:Acutesymptoms

(e.g-fracture)Whypatientvisitsadoctor第4页Investigatingpatient'ssymptoms1:Historytaking2:Physicalexamination3:Laboratorytests(e.g.bloodwork)4:X-rayinvestigations5:Treatment(medicalorsurgical)第5页X-rayInvestigations1:WhatareX-rays2:Differenttypesofradiologictests3:Examplesofclinicalscenarios&radiologicinvestigations第6页“IhavediscoveredsomethinginterestingbutIdonotknowwhetherornotmyobservationsarecorrect”.WilhelmConradRoentgen,1895ThediscovererofX-RAYS第7页WhatareX-Rays?

Aformofelectromagneticradiationwithshortwavelength(between10-2and10nm)X-raysaregeneratedbyusingahighvoltagecurrenttoaccelerateelectronswithinevacuatedglasstubes,towardsatungstentargetcathodeAnode阳极evacuatedglasstube真空球管X-raysX线tungstentarget钨靶electronbeam电子束第8页18952023TheX-rayLabThen&NowRoentgen’sFirstLabX-rayLabof2023第9页TheFamousFirstRadiographRadiographbyRoentgenon22December19851895TheradiographofMrs.Roentgen'shand.Radiographofhand2023第10页Photographofahandduringprogressiveradiationexposureresultinginnecroses.EffectsofRadiationRadiosensitiveorgans

-Ovaries,testis软巢睾丸

-Thyroid甲状腺 -Fetus胎儿 -GItract胃肠道

RadiationdamageisDosedependentFactorstoreducedoseReduceunnecessarystudiesUsenon-radiationstudiesUltrasound,MRI第11页X-RAYSULTRASOUNDPUTEDTOMOGRAPHY(CT)NUCLEARMEDICINEANGIOGRAPHYMAGNETICRESONANCEIMAGING(MRI)POSITRONEMISSIONSCANNING(PET)TYPESOFIMAGINGINRADIOLOGYDEPARTMENT第12页HowisanX-rayImageobtainedTheX-rayspassthroughthebodyandaredetectedonphotographicfilmplacedbehindthepatientX-raycassette暗盒(withfilm)X-rayTubeX-rayphotons第13页第14页Howandwhydoradiographsappearblack&whiteItstartedwiththeX-rayfilm(GELATINWITHSILEVRBROMIDEcyrstals)Filmhassilverhalide卤化物

X-raybeamhitthesilverbromide溴化银turnsintoblackwhendevelopedWhennox-rayphotonstrikesthefilm,itremainswhiteTheBlackandWhiteofRadiographs第15页leadbariumsulfatebonemuscleliver(eg)fatairX-rayfilmWHATFACTORSDETERMINETHEBLACK&WHITEDifferentmaterialsabsorbX-raystodifferingdegreesDependsontheatomicnumberofelement第16页WhatisUltrasound?SoundwaveswithfrequenciesabovetherangeofhumanhearingultrasoundAnarrowbeamofhighenergysoundwavesisdirectedintothepatient’sbodyThemannerinwhichthesoundisreflectedbackfromvarioustissuesisrecorded第17页WhyUseUltrasound?

CheaperthanCTorMRI

Patientisnotexposedtoionizingradiation

Equipmentisveryportable,thereforecanbeusedonpatientstoosickorinjuredtobemovedfromtheirbedsUltrasoundofthefetalhead(inutero)第18页WhatisComputedTomography?AnX-raybasedtechniqueTheX-raytube,alongwithanarrayofdetectors,arerotatedinaplanearoundthepatientgantryX-raytubedetectorarraydirectionofrotationpatient(doesn’tmove)X-raybeam第19页CTSCANOFTHEPELVIS第20页WhatisNuclearImaging?AradioactiveisotopeandinjectedintothepatientTheisotopeistakenupbytheorganortissueofinterest(physiologicexamination)TheisotopeemitsgammarayswhicharethendetectedbyagammacameraAtechnetium锝-99bonescan第21页WhatisMagneticResonanceImaging?InvolvesmeasuringthebehaviourofprotonsindifferentchemicalenvironmentswhenexposedtoamagneticfieldPatientsarenotexposedtoionizingradiationMid-saggitalMRscanofthehead第22页TheBenefitsofMRITheidealmodalityforimagingsofttissues第23页ProtonpossesspositivechargeMagneticfieldsApplyingexternalstrongmagneticfieldtoprotonsMagneticResonanceImagingBasicprinciples第24页MRI:Femur&Quadricepsmuscle第25页TRICKSOFTHETRADEUsuallyit’sallinBLACK&WHITE!第26页Whatdoyousee?Therearetwowomen,ayoungandoldone“YouseewhatyoulookforYourecognisewhatyouknow”第27页Whatdoyouseehere?MRIScan第28页SHEEPDOGWhatIsaw!第29页GlutealmaximusmuscleRectumSacrumLowerbackmusclesMRIofthebuttocks第30页LearnyouranatomywellImportantininterpretingradiographicstudiesYoumaywanttobeearadiologistANATOMY!ANATOMY!ANATOMY!第31页AcuteConditions第32页ClinicalScenarioCaseHistory:YoungpatientplayingbaseballinjuredelbowwhileslidingathomeplateWhattypeofX-raywouldyouorder? -CTscan -Plainfilmoftheelbow -MRI第33页PATIENTELBOWNormalelbowLATERALVIEWSOFELBOW第34页HumerusRadiusUlnaHumeralcondylesFracturedislocationoftheelbowjoint第35页Howwouldyoutreatthispatient?1:DoCTscanofelbow2:Putacast3:CallOrthopedicsurgeon4:Sendpatienthome第36页Complicationofelbowfracturedislocation-Brachialartery臂动脉injury(Especiallywithfracturesinthearea)第37页Treatment:PatientwentstraighttosurgeryThedislocationwasreduced第38页ChronicConditions第39页ClinicalScenarioCaseHistory:Youngweightlifterwithsuddenonsetofneckpain第40页PossibleDiagnosis:1:Fracturedcervicalbone骨折2:Slippedvertebraldisc椎间盘滑脱3:Musclesprain扭伤

4:Spinalcordtumor肿瘤第41页NextInvestigations1:Seeasportsspecialist2:X-rayofthespine3:CTofthespine4:MRIofthespine第42页DoctorfirstorderedCervicalspinex-rayLateralviewoftheC-spine第43页LateralviewoftheC-spineSpinousprocessDiscspaceVertebralbodyC2C3C4C7C6C5Occipitalbonemandible第44页MovietongueVertebralbodySpinalcordMRIoftheCervicalSpineSmalldiscprotrusionsesp.atC5-6levelDiscspaceDiscprotrusionC2C3C4C7C6C5第45页CONCLUSIONS:1:X-RAYexamswhichusesradiation: -Plainfilm -CT -Nuclearmedicine

2:X-RAYstudiesthatDONOTuseradiation: -Ultrasound -MRI第46页0510152025ChestSkullBrainCTThoracicspineKUBLumbarspineIVPUGIBariumEnemaCTchestCTAbdomenAPracticalApproachEffectiveDose(mSv)EffectiveRadiationdosesinRadiologicexaminations第47页1:TherearemanyX-raytestsavailableforpt’ssymptoms2:Choosetherightonethatwouldgivethediagnosisearly3:Alwaysconsultaradiologistforadviceonwhichtestisappropriateforyourpatient.CONCLUSIONS:第48页Imagingofmusculoskeletalsystem第49页第50页206bones.fiveorfourgroupsLongbones长骨

Shortbones短骨

Flatbones扁骨

Sesamoidbones子骨Irregularbones不规则骨第51页第52页第53页第54页2神经孔6椎小关节第55页第56页第57页APviewLateralview

4髂嵴第58页第59页4肩峰突5关节窝6喙突第60页12滑车13肱骨小头7三角肌粗隆8内上髁脊15冠状窝第61页第62页8豆9钩第63页第64页第65页LateralAPOblique第66页第67页Normalvariation第68页Sesamoid子骨第69页Sesamoid第70页BoneIsland骨岛第71页AccessoryBones附骨第72页AccessoryBones第73页Fracture第74页BoneIsland第75页BoneIsland第76页LumbarSacralization腰椎骶化第77页Lumbarization骶椎腰花第78页PermanentOsteoepiphyte永存骨骺第79页

Diseaseisabnormalandoralteredanatomy

LEARNYOURANATOMYWELLNOW!!!

Itwillpayofflater!!!

Especiallyifyouplantobearadiologist.FINALPEARL第80页PHYSICSOFRADIOLOGY第81页PHYSICSOFRADIOLOGYTestyourknowledge X-rayfilmsareblackandwhite

CTscanimagesaremadeupofmanydots

EachdotrepresentsaCTnumbercalledHOUNSFIELDnumber第82页leadbariumsulfatebonemuscleliver(eg)fatairX-rayfilmWhatareX-Rays?DifferentmaterialsabsorbX-raystodifferingdegrees第83页LeadBariumBoneMuscleLiverFatAir