骨肌系统影像英文 PPT课件.ppt

骨肌系统影像学：正常及变异骨肌系统影像学：正常及变异 医学影像学教研室医学影像学教研室 吴仁华吴仁华What is Radiology.Radiation(uses and dangers)Types of imaging modalities Knowledge of Anatomy,physiology,pharmacology,clinical medicine important.Physiology,pharmacology,anatomy,pathology to explain changes on X-rays Why do need to know about radiology You as a physician will need knowledge of all modalities for patients symptoms.As a subspecialty career You all will have graduated and become physicians Patients will visit you in your new office.They will have all kinds of symptoms!Several Years Laterhttp:/Visiting a physician for following reasons:1:Yearly check up 2:Surveillance for detecting disease early(e.g bone tumor)3:Chronic symptoms(e.g-chronic back pain)4:Acute symptoms(e.g-fracture)1:History taking 2:Physical examination 3:Laboratory tests(e.g.blood work)4:X-ray investigations 5:Treatment(medical or surgical)1:What are X-rays 2:Different types of radiologic tests 3:Examples of clinical scenarios&radiologic investigations“I have discovered something interesting but I do not know whether or not my observations are correct”.Wilhelm Conrad Roentgen,1895 The discoverer of X-RAYSWhat are X-Rays?A form of electromagnetic radiation with short wavelength(between 10-2 and 10 nm)X-rays are generated by using a high voltage current to accelerate electrons within evacuated glass tubes,towards a tungsten targetcathodeAnode阳极evacuated glass tube真空球管X-rays X线tungsten target钨靶electron beam电子束18952010Roentgens First LabX-ray Lab of 2010The Famous First RadiographRadiograph by Roentgen on 22 December 19851895 The radiograph of Mrs.Roentgens hand.Radiograph of hand 2010Photograph of a hand during progressive radiation exposure resulting in necroses.1.Radiosensitive organs-Ovaries,testis 软巢 睾丸-Thyroid 甲状腺-Fetus 胎儿-GI tract 胃肠道 2.Radiation damage is Dose dependent 3.Factors to reduce dose Reduce unnecessary studies Use non-radiation studies Ultrasound,MRI X-RAYS ULTRASOUND COMPUTED TOMOGRAPHY(CT)NUCLEAR MEDICINE ANGIOGRAPHY MAGNETIC RESONANCE IMAGING(MRI)POSITRON EMISSION SCANNING(PET)TYPES OF IMAGING IN RADIOLOGY DEPARTMENTHow is an X-ray Image obtainedThe X-rays pass through the body and are detected on photographic film placed behind the patientX-ray cassette 暗盒(with film)X-ray TubeX-ray photonsHow and why do radiographs appear black&white It started with the X-ray film(GELATIN WITH SILEVR BROMIDE cyrstals)Film has silver halide卤化物 X-ray beam hit the silver bromide 溴化银turns into black when developed When no x-ray photon strikes the film,it remains whiteleadbarium sulfatebonemuscleliver(eg)fatairX-ray filmWHAT FACTORS DETERMINE THE BLACK&WHITE Different materials absorb X-rays to differing degrees Depends on the atomic number of elementWhat is Ultrasound?Sound waves with frequencies above the range of human hearing ultra sound A narrow beam of high energy sound waves is directed into the patients body The manner in which the sound is reflected back from various tissues is recorded Why Use Ultrasound?Cheaper than CT or MRI Patient is not exposed to ionizing radiation Equipment is very portable,therefore can be used on patients too sick or injured to be moved from their bedsUltrasound of the fetal head(in utero)What is Computed Tomography?An X-ray based techniqueThe X-ray tube,along with an array of detectors,are rotated in a plane around the patientgantryX-ray tubedetector arraydirection of rotationpatient(doesnt move)X-ray beamWhat is Nuclear Imaging?A radioactive isotope and injected into the patientThe isotope is taken up by the organ or tissue of interest(physiologic examination)The isotope emits gamma rays which are then detected by a gamma cameraA technetium锝-99 bone scanWhat is Magnetic Resonance Imaging?Involves measuring the behaviour of protons in different chemical environments when exposed to a magnetic field Patients are not exposed to ionizing radiationMid-saggital MR scan of the head The Benefits of MRIThe ideal modality for imaging soft tissuesProton possess positive chargeMagnetic fieldsApplying external strong magnetic field to protonsBasic principles Usually its all in BLACK&WHITE!There are two women,a young and old one“You see what you look for“You see what you look for YouYou recognise recognise what you know”what you know”MRI ScanSHEEPDOGGluteal maximus muscleRectumSacrumLower back musclesMRI of the buttocks Learn your anatomy well Important in interpreting radiographic studies You may want to become a radiologistHistory:Young patient playing base ball injured elbow while sliding at home plate What type of X-ray would you order?-CT scan-Plain film of the elbow-MRIPATIENT ELBOWNormal elbowLATERAL VIEWS OF ELBOWHumerusRadiusUlnaHumeral condylesFracture dislocation of the elbow jointHow would you treat this patient?1:Do CT scan of elbow 2:Put a cast 3:Call Orthopedic surgeon 4:Send patient homeComplication of elbow fracture dislocation-Brachial artery臂 动脉 injury (Especially with fractures in the area)Treatment:Patient went straight to surgery The dislocation was reduced History:Young weight lifter with sudden onset of neck painPossible Diagnosis:1:Fractured cervical bone 骨折 2:Slipped vertebral disc 椎间盘滑脱3:Muscle sprain 扭伤 4:Spinal cord tumor 肿瘤Next Investigations 1:See a sports specialist 2:X-ray of the spine 3:CT of the spine 4:MRI of the spineDoctor first ordered Cervical spine x-ray Lateral view of the C-spineLateral view of the C-spineSpinous processDisc spaceVertebral bodyC2C3C4C7C6C5Occipital bonemandibleMovietongueVertebral bodySpinal cordMRI of the Cervical SpineSmall disc protrusions esp.at C5-6 levelDisc spaceDisc protrusionC2C3C4C7C6C51:X-RAY exams which uses radiation:-Plain film-CT-Nuclear medicine 2:X-RAY studies that DO NOT use radiation:-Ultrasound-MRI0510152025ChestSkullBrain CTThoracic spineKUBLumbar spineIVPUGIBarium EnemaCT chestCT AbdomenEffective Dose(mSv)Effective Radiation doses in Radiologic examinationshttp:/qmec.herston.uq.edu.au/radiology/principles/radsaftx.html1:There are many X-ray tests available for pts symptoms 2:Choose the right one that would give the diagnosis early 3:Always consult a radiologist for advice on which test is appropriate for your patient.l206 bones.lfive or four groups Long bones 长骨 Short bones 短骨短骨 Flat bones 扁骨 Sesamoid bones 子骨 Irregular bones 不规则骨不规则骨2神经孔6椎小关节AP viewLateral view 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 APObliqueNormal variationSesamoid 子骨SesamoidBone Island 骨骨岛Accessory Bones 附骨Accessory BonesFractureBone IslandBone IslandLumbar Sacralization 腰椎骶化Lumbarization 骶椎腰花Permanent Osteoepiphyte 永存骨骺 Disease is abnormal and or altered anatomy LEARN YOUR ANATOMY WELL NOW !It will pay off later!Especially if you plan to be a radiologist.Test your knowledge X-ray films are black and white CT scan images are made up of many dotsEach dot represents a CT number called HOUNSFIELD numberleadbarium sulfatebonemuscleliver(eg)fatairX-ray filmWhat are X-Rays?Different materials absorb X-rays to differing degreesLeadBariumBoneMuscleLiverFatAir+1000 HU The range of Hounsfield Units -1000HUA HINT A HINT The Higher the ATOMIC number of The Higher the ATOMIC number of the substance the more x-rays it will absorbthe substance the more x-rays it will absorbTest your knowledgeYou are provided with a CT scan of the abdomen What are the CT numbers of the various structures?A HINT The Higher the ATOMIC number of the substance the more x-rays it will absorb,therefore a higher the CT number2GallbladderTissue around kidneyPlain Non contrast CT of the Upper AbdomenWhat are the approximate HU numbers of 1:Fluid in Gallbladder 2:Tissue around kidney 3:Air in colon3Air in colon1FATFATGallbladderGallbladderAir in ColonAir in ColonCT Number AnswerNON HODGKINS LYMPHOMANON HODGKINS LYMPHOMADuodenal tumor causing gastric outlet obstructionLiverLiverStomachStomachSpleenSpleenKidneyKidney