Module 5 Advanced Diagnostics/ Sonography/Imaging
How will you know which one to use (linear or curved), appropriate transducer selection is based on what?
(1) Depth of the area on interest (2) anatomical region
When listing symptoms, make sure to include the following (9):
(1) Presence of redness, (2) swelling, (3) decreased range of motion compared with the contralateral side, (4) numbness, (5) tingling, (6) ability to bear weight, (7) duration, (8) aggravating and (9) alleviating factors
What two steps are appropriate if infection or malignancy is a concern?
(1) STAT MRI (2) Specialty Referral
How many and what views are required for Cervical and thoracolumbar spines?
2; -AP and Lateral
What type of areas are best for a Linear transducer?
Breast, testicles, thyroid (superficial imaging)
When should imaging be ordered?
After a thorough HPI and physical exam
Multiple joint involvement in bilateral extremities may indicate what?
An autoimmune disorder/involvement
What are the 3 types of resolution that pertain to US imaging?
Axial, Lateral, temporal
What is the standard image the screen displays?
B-mode (two dimensional or gray scale)
What is the first line treatment for patients with normal X-ray or X-ray indicating arthritis with chronic pain and abnormal range of motion?
Conservative Tx for 6 weeks
Reflections from body structures?
Echoes
Structure exhibits a relatively strong reflection appearing light gray to white?
Echogenic
Name the term for "Brighter echoes than surrounding tissue"
HYPERechoic
Name the term for "Not as bright as surrounding tissue"
HYPOechoic
What elements of the HPI are often omitted with MSK injuries?
Hand dominance for upper extremity conditions, prior injuries or surgeries, comorbidities, body mass index (BMI), tobacco use, and profession
Two structures producing the same reflection?
Isoechoic
The best transducer to image the thyroid gland is ______.
Linear
An example of a foot injury identified on X-ray that would require an MRI?
Lisfranc fracture (ligament disruption of midfoot as well as fractures/dislocation of the midfoot)
If an injury was caused by trauma, what is ALSO important to note (concerning the injury)?
Mechanism
What is the scale by which we document muscle strength?
Medical Research Council Scale (MRC scale), grades 0-5
An example of resolution measurement is
Millimeters
A type of reverberation artifact that occurs in highly reflective air with fluid interfaces such as the lung/diaphragm
Mirror-Image (the first image is in the right position, but a false image is shown on the other side of the reflector [air]- like a mirror)
____________ atrophy may indicate nerve compromise
Muscle
When the area behind an echo-weak or echo-free structure appears brighter (more echogenic) than its surrounding structures, this is know as?
Posterior Enhancement Artifact (happens with cysts or fluid-filled collections) (move the transducer to a diff position to avoid)
What are the 3 X-ray views you should obtain for wrist and hand complaints?
Posteroanterior, lateral, oblique views
What are next steps for acute fractures and Chronic Pain that does not improve with a trial of conservative management for 6 weeks?
Referral to Ortho
What are the 4 tendons of the shoulder that an MRI will show; and what is an indication for referral to an ortho for surgery?
Rotator Cuff Tendons: (SSIT) supraspinatus, subscapularis, infraspinatus, and teres minor; Acute complete tear of 1 or more of the above
What Dx should you consider for a patient with a normal X-ray with acute-onset shoulder pain and weakness caused by trauma? And what imaging would you order?
Rotator Cuff tear; MRI without contrast
Assumptions an Ultra Sound machine makes: (1) the ultrasound beam only travels in a _______
Straight line
What should the provider note when inspecting if swelling or rashes are present?
Whether it's generalized, localized to 1 extremity OR just the affected joint
Fluid-filled structures transmitting sound waves easily and appearing as a dark region on the image are _____ tissue. a. hyperechoic b. hypoechoic c. anaechoic d. isoechoic
c. Anechoic rationale: anechoic tissue or structures (which are echo free or lacking a signal) transmit sound waves easily and appear as the dark region on the image).
What type of rays does radiography utilize?
x-rays or gamma rays
When should you order an MRI for an elbow injury?
- Acute injury - Instability of the elbow joint on exam - no fracture or evidence of arthritis
Assumptions an Ultra Sound machine makes: (4) The speed of sound in all tissues is ______m/se
1,540
What frequency is too high for humans to hear?
20,000 hz
What is the first action for imaging for acute and chronic knee pain?
3-view X-ray (AP, Lateral, Sunrise/Merchant View) weight bearing
MSK complaints account for ____% of all visits annually in the US 30%
30%
A BMI over ____ increases perioperative and postoperative complications
35
____% of all injury-related HC cost are from Musculoskeletal injuries 77%
77%
Example of a Heterogenous echoic structure
A normal Kidney (has multiple echotextures; cortex, medulla, sinus)
Example of Homogenous echoic finding
A normal liver or spleen
What X-ray views allow for visualization of the alignment, bony prominences, joint spaces, spondylolysis, and spondylolisthesis, and are ordered for the Cervical and thoracolumbar spine?
AP and Lateral
What 3 views are indicated for X-ray for Acute and Chronic Elbow Pain?
AP, Lateral, Oblique
Which 3 views are recommended for hand, wrist, ankle, foot, and toe complaints?
AP, Lateral, Oblique
Any structure in the ultrasound image that does not have a corresponding anatomic tissue structure is called?
ARTIFACTS
In diseased states, organ-specific echogenicity is ______
Abnormal
Why type of tendon injury typically occurs after an explosive jump and a sensation of being kicked from behind?
Achilles tendon
When the sound beam is unable to pass through an area posterior, or beyond, a strongly reflecting or attenuating structure, this is know as.
Acoustic Shadow
More solid object produce higher _____ _____
Acoustic impedance
The resistance for propagation of ultrasound waves
Acoustic impedance
A large difference in acoustic impedance is called ______ _______
Acoustic mismatch
There are two types of ROM you should test, they are: _____ & _____
Active & Passive
What ankle/foot condition identified on X-ray is an emergency?
Acute Dislocation
What condition of the knee identified on x-ray is an emergency?
Acute Dislocation
Difference in Acute pain versus Chronic Pain (Duration)?
Acute is < or = 3 months Chronic is > 3 months
Why is gel used for ultrasounds?
Air is an impenetrable barrier to ultrasound, fluid offers the least resistance
When is referral to ortho indicated for Knee injury?
All patients who fail a trial of conservative management
Which of the following are reasons the US is great for bedside/POC: (1) Life-threatening diagnosis/pathology (2) Precision enhancement for many procedures (3) Avoidance of transportation delays (4) Evasion of radiation (5) Potential aversion of costly additional imaging modalities
All true =) =p
What are contraindications for an MRI?
An implanted device (pacemaker, defibrillator, aneurysm clippings)
Echo free is defined as?
Anechoic
If suspected autoimmune involvement due to multiple joint/bilateral involvement, what is the appropriate next step?
Appropriate lab work and referral to rheumatologist
_____ is the loss of the sound wave caused by absorption of ultrasound energy by conversion to heat
Atenuation
Assumptions an Ultra Sound machine makes:(2) The US beam travels with a constant rate of _____
Attenuation
What should you not use to clean a transducer after each use?
Autoclave, gas, or other methods may damage your transducer.
The ability to recognize two different objects at slightly different depths from the transducer along the axis of the ultrasound beam
Axial (or longitudinal) resolution
The current medical standard for measuring bone health with a high degree of accuracy is? a. radiographs of the chest b. DEXA studies of the hip and lower spine c. sonography of the heel d. nuclear scans of the bones
B. DEXA scan it measures bone density and dx osteoporosis
Why should you consider x-ray over CT?
Because it's (CT) a higher dose of radiation
Why not do an MRI on a pt with Chronic shoulder pain shown on x-ray indicating severe arthritis?
Because we know the pain is caused by Arthritis and not by ligamentous injury
What produces a "white" image?
Bone
Example of HYPERechoic structure
Bone renal stone
For thoracolumbar spine injuries, what is the first line imaging modality?
CT
What imaging is used for the characterization of complex or occult fractures in and around joints, ligamentous injuries, and dislocations?
CT
A ____ _____ is helpful if a patient has continued pain in a joint or body part after radiographs are normal or if there is concern of a missed fracture (ex: a person is evaluated in the emergency department for hip pain after a fall, has no fractures on radiographs but has continued hip pain with weight- bearing, and comes to see their primary care provider)
CT scan
A high-resolution radiographic study that enables noninvasive views of a structure in multiple planes, allowing for compilation of many radiographic images via a rapidly spinning radiograph tube
CT scan
The ultrasound machine assumes that any object visualized originates from the _________ of the beam
Center
When is it appropriate to order an Urgent MRI with and w/o Contrast?
Concern for INFECTION or MALIGNANCY
If a patient has decreased ROM, chronic elbow pain, negative x-ray or arthritis on x-ray, without instability, what is the treatment you will Rx and do they need further imaging at this time?
Conservative Tx before additional imaging
Why is CT imaging preferred over MRI?
Cost and accessibility
Do generated sound waves travel faster in dense or compressible materials?
Dense
What elbow Dx is an emergency? And where should you send them?
Dislocation; the ED
What type of fractures typically occur during a fall on an outstretched hand?
Distal Radial
Resolution is measures in units of _____
Distance
____ is the strength of sound waves reflected back to the transducer
Echogenicity
What is the best FIRST step for a Chief Complaint of acute traumatic injury to the cervical or thoracolumbar spine?
Emergent imaging and stabilization to avoid further injury
Why do you need to pay attention to the target joint in your HPI?
Essential for Tx, as well as authorization for testing by insurance, and so that the referral is accepted
What produces a "black" image?
Fluids
What should you evaluate (3 conditions) for Acute and Chronic Elbow Pain?
Fracture, dislocation, arthritis
What do X-rays of the foot and ankle reveal?
Fracture, dislocation, subluxation, arthritis
What are we looking for in patients with chronic foot and ankle pain, with pain with weight bearing and/or decreased range of motion?
Functional Alignment and joint space narrowing
Structures having varied echo characteristics
Heterogenous
The ______ the resolution, the ________ the distance that can be differentiated
Higher the resolution, the smaller the distance
AP and Frog-Leg lateral X-rays are indicated for what joint?
Hip
Imaged echoes of equal intensity
Homogenous
Tissue producing weak reflections that appear gray on image?
Hypoechoic
Name the term for "Same intensity as surrounding tissue"
ISOechoic
When is an MRI with Arthrogram indicated for Hip & Pelvis Injury in a young patient with negative radiographs?
If a labral tear is suspected
When is a Supine view of the knee indicated?
If the patient is unable to bear weight
Where would we see an acoustic shadow?
In areas of deep calcification such as STONES or BONES
What should you suspect if pt has repeated dislocations or instability of the shoulder joint?
Injury or tear to the glenoid labrum
What are the components of a physical exam? (5)
Inspection, palpation, range of motion, muscle strength, and sensory eval
Why should you order a CT if pt presents with posterior or midline cervical spine tenderness, evidence of intoxication, abnormal level of alertness, focal neurologic deficit, or painful distracting injury?
It can be done rapidly and the increased sensitivity can detect spinal fractures
Joint space loss, osteophyte formation, cysts, and subchondral sclerosis on X-ray are the hallmarks of what condition?
Joint Arthritis
AP, Lateral, sunrise or merchant are indicated for what body part?
Knee
For what injuries is an MRI especially useful?
Knee and Shoulder Injuries
The longitudinal plane does not demonstrate the organ in a _____ dimension
Lateral
Which has poorer resolution, axial or lateral?
Lateral
The ability to distinguish objects that are side by side or 2 points in the direction perpendicular to the direction of the sound wave
Lateral resolution
Why type of transducer would you use for small parts?
Linear
Example of an Isoechoic finding
Liver and right Kidney Cortex (normal)
What do you need to include in your location when describing pain?
Localize to the bone, joint, or muscle group involved or describe the location
Axial resolution is also referred to as
Longitudinal
Indicator is in the 12 o'clock position in relation to the organ or area of interest?
Longitudinal (sagittal)
An imaging modality that uses no ionizing radiation and the energy of radio waves and magnetic fields is? a. nuclear imaging b. thermography c. CVIT d. MRI
MRI
Provides a noninvasive study of bone, cartilage, and soft tissue using a strong magnetic field and radio waves to produce a 3-dimensional image without exposure to ionizing radiation.
MRI
The modality of choice to image the central nervous system is: a. CT b. MRI c. ultrasound d. PET
MRI
What type of imaging is useful for Dx of soft tissue pathology or osteonecrosis for Hip and Pelvis injury?
MRI
_____ is reserved for soft tissue evaluation of acute pain after a traumatic injury once fractures are ruled out with a plain radiograph.
MRI
What type of imaging provides cleaner images of muscle, tendon, and ligament integrity?
MRI (over a CT)
If you suspect an Injury or tear to the glenoid labrum, what test should you order (Gold standard)?
MRI w/ Arthrogram
Pt presents back pain associated with weight loss, fatigue, weakness, or anemia, what imaging do you order and why?
MRI w/ and w/o contrast to R/O malignancy
Pt presents with back pain, fever, chills, erythema or night sweats- what imaging do you order and why?
MRI w/ and w/o contrast to R/O osteomyelitis
What is the first choice of imaging for radicular Sx (numbness, tingling, burning pain in extremity)?
MRI w/o contrast
What imaging is indicated if a suspected occult fracture or ligamentous injury (ex: capholunate ligament or triangular fibrocartilage complex injury) is suspected?
MRI with Arthrogram
If locking or catching of the knee joint is identified or ligamentous laxity is found on physical examination, what are next steps?
MRI, X-ray, Referral to Ortho
On examination of the patient with complaints of ankle pain, the provider suspects severe ligamentous injury of the ankle with instability, what imaging should the provider order? And who should they refer to?
MRI; ortho
____________ are NOT helpful for patients who have severe arthritis documented on radiography because this is usually sufficient imaging to diagnose arthritis
MRIs
Why is the mechanism of injury so important for trauma?
Many injuries have HALLMARK mechanisms
What is the frequency of diagnostic ultrasound?
Millions of hertz (MHz)
The high contrast resolution of a CT allows for the discrimination of tissues that have _____ _____ in density
Minute variances
How do you avoid Reverberation Artifact?
Move the transducer to a slightly different location and avoid the strong reflecting surface.
Example of a HYPOechoic structure
Muscle (less bright than fat)
Is MRI indicated for patients with Chronic foot/ankle pain where moderate to severe arthritis is noted on radiography?
NO
Is a description like "Back, upper and lower extremity" descriptive enough of the location of an injury?
NO
Should you do an MRI on a patient with Chronic Shoulder pain and an X-ray indicating SEVERE Arthritis?
NO
If all of the following criteria are met, is a CT scan recommended or not? No posterior or midline cervical spine tenderness No evidence of intoxication Patient has a normal level of alertness No focal neurologic deficit Patient does not have a painful distracting injury
NOT recommended
What view is recommended if a scaphoid fracture is suspected with anatomic snuffbox tenderness?
Navicular View
Is a positive straight leg raise on physical examination, an accurate tool in the guidance of a diagnostic workup?
No
grade = 0
No movement
Is an MRI indicated if conditions such as bursitis and tendonitis are suspected?
No, these conditions are usually self-limiting
Can you only order an MRI for a suspected Injury or tear to the glenoid labrum?
Nope, not sufficient
In normal pathology, echogenicity is ______
Normal
What is important patient education regarding types of imaging?
Not all MSK complaints require MRI or CT
When is a CT indicated for Hip and Pelvic Injury?
Occult fracture characterization or cases of severe trauma
If a fracture is identified on x-ray, who should you refer to?
Ortho
what is the name of they types of radiographs you need to take?
Orthogonal or Perpendicular to each other or the affected body part
In addition to conservative treatment for chronic foot or ankle pain, what may also be considered?
Orthotics like ankle braces, accommodative insoles, orthotic shoes
_____ in a systematic manner allows the provider to appreciate areas of tenderness, masses, fluctuance, crepitus, and temp changes (hot/cold/etc.)
Palpation
What is the sunrise or merchant view?
Patellofemoral joint w/ the knee flexed
Selecting appropriate imaging is essential to minimize _____ ____, expedite _____ and _____, and limit ____ ____ cost
Patient risk, expedite diagnosis and treatment, and limit patient cost
The Coronal plane does not demonstrate the organ in the _____ dimension
Posterior
What is the next step after Dx an acute elbow fracture?
Prompt referral to ortho
Why is a thorough physical examination necessary?
Provider can localize pain to a specific joint and MSK structure, and then order most appropriate testing
What is an example of the previous question?
Pt flexed elbow and supinated hand, attempt to straighten arm while patient resists
Palpation of _____ will provide info on peripheral perfusion
Pulses
When testing muscle strength how should you begin?
Put patient muscle in shortened/flexed position, ask pt to perform motion against resistance
What is the name of the material ultrasounds use, that will generate a sound wave when an electric current is applied?
Quartz or piezoelectric material
A high-energy electromagnetic radiation that passes through the body, creating an image of the internal tissues
Radiograph
What is the first-line imaging modality for most MSK complaints?
Radiograph
What is the most useful imaging for Dx fractures, dislocations, and arthritic joints?
Radiograph
The use of x-rays to create a medical image on patients is referred to as?
Radiography
Who discovered the Ultrasound?
Rene Laennec in 1816
The ability to identify objects or points as separate entities within a special plane
Resolution
What are the most common artifacts encountered during US?
Reverberation Artifact (transducer acts as a reflective surface, reflecting back the image at 2x the distance)
The imaging plane may be directed by the user in any anatomical plane on the patient or area of interest including:
Sagittal, coronal, transverse, or combination (oblique)
Each crystal (128 or more) on the probe produces what ?
Scan line
Why is skin color an important part of inspection?
Scars can indicate previous surgery, redness can indicate infection, bruising = trauma, dusky/varicosities = vascular compromise
When is surgical repair of a meniscal tear or cartilage damage caused by wear and tear not recommended?
Sever arthritis
AP, Axillary, Gershey, and Scapular Y are indicated for what body part?
Shoulder
What is the advantage of using the above views when evaluating acute or chronic knee pain?
Shows fracture, dislocation, subluxation and arthritis
Inspection should begin with noting ____ integrity
Skin
What does Nicotine use do to bone healing?
Slows bone healing and increases risk for infection
Why is it important to distinguish soft tissue swelling from joint effusion?
Soft tissue swelling = cardiac probs, cellulitis, or inflammation Joint effusion = increased fluid in an intra-articular surface associated w/ pain and stiffness (So, basically so you can differentiate possible etiologies and guide you examination)
What are the 4 descriptors we use for onset?
Sudden vs. insidious (gradual), traumatic vs. non-traumatic
In what positions can patients be evaluated in with US?
Supine, Prone, Left or Right lateral decubitus, erect or oblique
What is an indication for an MRI?
Suspicion of soft tissue pathology or tumor on physical examination
T/F For elbow injuries that result in fractures and ligamentous injury require a referral to Ortho is required.
TRUE
T/F: Ortho hardware is NOT a contraindication for MRI
TRUE- request metal suppression
Is the ability to detect that an object has moved over time and is dependent on frame rate.
Temporal resolution
When you test ROM, what MUST you do (hint do you have to do it on the other side too) and why?
Test contralateral joint; determine if there's restricted movement, hypermobility, or laxity
The "black" image on an US is produced by
The decreased acoustic impedance causing sound waves to travel through but not reflect back
What does the speed of an ultrasound depend on?
The medium or tissue it is traveling in
How does the ultrasound work to capture the image?
The quartz generate a sound wave when an electric current is applied, when the sound wave returns the material in turn generates a current, and this contains the data needed to produce an image!
What is the strongest position of the muscle?
The shortened or flexed position
Where is the most common site for osteomyelitis?
The spine
What are the "pinnacles" to treatment of MSK conditions (4)
Thorough History, Examination, Documentation, and Diagnostic Testing
What should be documented for a Chief Complaint of acute traumatic injury to the cervical or thoracolumbar spine?
Through exam documenting the patient's neurovascular status
Assumptions an Ultra Sound machine makes: (3) The depth of a reflector is accurately determined by the ____________
Time it takes for sound to travel from the transducer to the reflector and return
When is a pelvic CT helpful?
To ensure there is no occult fracture
Why should imaging be ordered?
To evaluate the skeletal system and assist in providing Dx
What would an image look like if it's over-gained?
Too BRIGHT
The device that converts energy from one form to another is called?
Transducer
What should be done/ordered if there is concern for spinal cord injury or in the setting of cauda equina syndrome, symptoms of saddle anesthesia, or loss of bowel or bladder function?
Transfer to ED; MRI
_____ can cause both soft tissue swelling AND joint effusion
Trauma
_____, ______, and ______ make up the majority of musculoskeletal reasons patients seek care at PCP offices, emergency departments, and hospital
Trauma Back pain arthritis
T/F: Profession and Comorbidities are important when deciding course of treatment True
True
T/F: two objects side by side cannot be distinguished if they are separated by less than the beam width.
True
The frequency above that which humans can hear, more than 20,000 hertz is defined as ?
ULTRASOUND
When is MRI not recommended for pts with chronic knee pain and pain with bearing weight?
When X-ray identifies moderate to severe arthritis
When is it the worst time to have an image overgained?
When evaluating for stones
When are orthotic devices indicated for patients (has to do with surgery)?
When they want to avoid surgery or are not surgical candidates
When does medium attenuation occur?
When ultrasound waves interact with the tissue
If a patient has chronic neck or back pain w/o acute trauma, what imaging should be ordered?
X-ray
What imaging is indicated for Acute and Chronic Elbow Pain?
X-ray
What should be first line injury for ACUTE or CHRONIC shoulder pain?
X-ray
What other imaging would you order for the above?
X-ray (3 views), and referral to ortho
What imaging should be ordered for patients with chronic foot and ankle pain, with pain with weight bearing and/or decreased range of motion?
X-ray w/ Weight bearing views
What type of imaging should you first do when a patient complains of foot or ankle pain?
X-ray; 3 views (AP, Lateral, Oblique)
What type of imaging reveals fractures, arthritis, or dislocation, and what views are used?
X-ray; AP view of Pelvis, Frog Leg Lateral view
What is a cost-effective way to monitor healing and guide treatment?
X-rays
Do you include BOTH foot and ankle in x-ray views if only one is the Chief Complaint?
YES
Is "Distal wrist over radius" or "over patella" a good description of location"?
YES
Should you also follow the National Emergency X-radiography Utilization Study criteria guide for thoracolumbar spine injuries?
YES
If a cervical fracture is detected on x-ray should you also order a CT?
YES (to characterize the fracture and identify others that may have been overlooked)
Should you order a CT scan If the patient presents with posterior or midline cervical spine tenderness, evidence of intoxication, abnormal level of alertness, focal neurologic deficit, or painful distracting injury?
YES PLEASE !!
Should smoking cessation and weight loss be initiated before ortho visit?
Yes
Is a shoulder dislocation on X-ray an emergency?
Yes - send to ED
The major advantage of ultrasound is? a. no adverse effects on human tissue b. ability to image anatomy in cross-section c. ionizing radiation is used to produce an image d. only low energy gamma radiation is used to produce an image
a. no adverse effects on human tissue. **** it is a very safe modality!!
Which of the following specialized imaging techniques provides cross-sectional images at a low cost, is readily available, and has the ability to differentiate cystic, solid, and complex tissue? a. sonography b. CT c. MRI D. PET
a. sonography rationale: widely accepted method because its low cost, readily available, and has ability to recognize cystic, solid and complex
Which modality is capable of producing images without the use of ionizing radiation? a. ultrasound b. magnetic resonance imaging c. nuclear medicine d. computerized tomography
a. ultrasound
Echo free appearing as a dark region on the image?
anechoic
In ultrasound the high-frequency sound waves are produced by a. sound waves b. electrical stimulation of a specialized crystal c. magnets and pulse radiogrequencies d. radiopharmaceuticals
b. electrical stimulation of a specialized crystal
_____ transducers are used for Abdominal imaging
convex (curved)
Reflections in ultrasound produced by tissue interaction are called:
echoes
Cardiac transducer characteristics?
have a small footprint in order to be used in intercostal acoustic windows.
Linear transducers offer high or low frequency?
high
______ transducers use a higher frequency
higher
Lower frequency ultrasound provides better ______ but does not visualize _____ structures
images deep
Particular care must be taken when using radiation for medical imaging. This is the result of radiation's ability to create __________ in human tissue and possible biochemical changes.
ionizations
grade = 2
muscle can only move w/o resistance of gravity
grade = 5
muscle contracts normally against full resistance
grade= 3
muscle strength can be moved ONLY against gravity
grade = 4
muscle strength can move against SOME resistance
If a fracture is detected on shoulder x-ray, what type of referral may be indicated?
refer to Ortho
The coronal also has the indicator in the 12 o'clock position but transmits the sound waves from?
right or left surface
Normal tissue and structure have a characteristic appearance relative to _____
surrounding structures
What is the criteria that guides the selection of patients who require imaging?
the National Emergency X-radiography Utilization Study criteria guide
How is the scan line used ?
to create an image or frame ***The images are refreshed as many times per second as needed to produce a moving image across the screen***
grade = 1
trace/flicker or muscle
Where are the quartz crystals located?
transducer (probe)
How many radiographs are taken/needed for eval of MSK complaints?
two
To best increase the exam specificity in MRI, the technologist must?
use contrast enhancement change pulse sequences