骨肌系统影像英文

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)–Typesofimagingmodalities•KnowledgeofAnatomy,physiology,pharmacology,clinicalmedicineimportant.–Physiology,pharmacology,anatomy,pathologytoexplainchangesonX-rays•Whydoneedtoknowaboutradiology–Youasaphysicianwillneedknowledgeofallmodalitiesforpatientssymptoms.–Asasubspecialtycareer☻Youallwillhavegraduatedandbecomephysicians☻Patientswillvisityouinyournewoffice.☻Theywillhaveallkindsofsymptoms!SeveralYearsLater:Yearlycheckup2:Surveillancefordetectingdiseaseearly(e.g–bonetumor)3:Chronicsymptoms(e.g-chronicbackpain)4:Acutesymptoms(e.g-fracture)1:Historytaking2:Physicalexamination3:Laboratorytests(e.g.bloodwork)4:X-rayinvestigations5:Treatment(medicalorsurgical)1:WhatareX-rays2:Differenttypesofradiologictests3:Examplesofclinicalscenarios&radiologicinvestigations“IhavediscoveredsomethinginterestingbutIdonotknowwhetherornotmyobservationsarecorrect”.WilhelmConradRoentgen,1895ThediscovererofX-RAYSWhatareX-Rays?•Aformofelectromagneticradiationwithshortwavelength(between10-2and10nm)•X-raysaregeneratedbyusingahighvoltagecurrenttoaccelerateelectronswithinevacuatedglasstubes,towardsatungstentargetcathodeAnode阳极evacuatedglasstube真空球管X-raysX线tungstentarget钨靶electronbeam电子束18952010Roentgen’sFirstLabX-rayLabof2010TheFamousFirstRadiographRadiographbyRoentgenon22December19851895TheradiographofMrs.Roentgen'shand.Radiographofhand2010Photographofahandduringprogressiveradiationexposureresultinginnecroses.1.Radiosensitiveorgans-Ovaries,testis软巢睾丸-Thyroid甲状腺-Fetus胎儿-GItract胃肠道2.RadiationdamageisDosedependent3.Factorstoreducedose•Reduceunnecessarystudies•Usenon-radiationstudiesUltrasound,MRIX-RAYSULTRASOUNDCOMPUTEDTOMOGRAPHY(CT)NUCLEARMEDICINEANGIOGRAPHYMAGNETICRESONANCEIMAGING(MRI)POSITRONEMISSIONSCANNING(PET)TYPESOFIMAGINGINRADIOLOGYDEPARTMENTHowisanX-rayImageobtained•TheX-rayspassthroughthebodyandaredetectedonphotographicfilmplacedbehindthepatientX-raycassette暗盒(withfilm)X-rayTubeX-rayphotons•Howandwhydoradiographsappearblack&white•ItstartedwiththeX-rayfilm(GELATINWITHSILEVRBROMIDEcyrstals)•Filmhassilverhalide卤化物–X-raybeamhitthesilverbromide溴化银turnsintoblackwhendeveloped–Whennox-rayphotonstrikesthefilm,itremainswhiteleadbariumsulfatebonemuscleliver(eg)fatairX-rayfilmWHATFACTORSDETERMINETHEBLACK&WHITE•DifferentmaterialsabsorbX-raystodifferingdegrees•DependsontheatomicnumberofelementWhatisUltrasound?•Soundwaveswithfrequenciesabovetherangeofhumanhearingultrasound•Anarrowbeamofhighenergysoundwavesisdirectedintothepatient’sbody•ThemannerinwhichthesoundisreflectedbackfromvarioustissuesisrecordedWhyUseUltrasound?•CheaperthanCTorMRI•Patientisnotexposedtoionizingradiation•Equipmentisveryportable,thereforecanbeusedonpatientstoosickorinjuredtobemovedfromtheirbedsUltrasoundofthefetalhead(inutero)WhatisComputedTomography?•AnX-raybasedtechnique•TheX-raytube,alongwithanarrayofdetectors,arerotatedinaplanearoundthepatientgantryX-raytubedetectorarraydirectionofrotationpatient(doesn’tmove)X-raybeamWhatisNuclearImaging?•Aradioactiveisotopeandinjectedintothepatient•Theisotopeistakenupbytheorganortissueofinterest(physiologicexamination)•TheisotopeemitsgammarayswhicharethendetectedbyagammacameraAtechnetium锝-99bonescanWhatisMagneticResonanceImaging?•Involvesmeasuringthebehaviourofprotonsindifferentchemicalenvironmentswhenexposedtoamagneticfield•PatientsarenotexposedtoionizingradiationMid-saggitalMRscanoftheheadTheBenefitsofMRITheidealmodalityforimagingsofttissuesProtonpossesspositivechargeMagneticfieldsApplyingexternalstrongmagneticfieldtoprotonsBasicprinciplesUsuallyit’sallinBLACK&WHITE!Therearetwowomen,ayoungandoldone“YouseewhatyoulookforYourecognisewhatyouknow”MRIScanSHEEPDOGGlutealmaximusmuscleRectumSacrumLowerbackmusclesMRIofthebuttocks•Learnyouranatomywell•Importantininterpretingradiographicstudies•YoumaywanttobecomearadiologistHistory:YoungpatientplayingbaseballinjuredelbowwhileslidingathomeplateWhattypeofX-raywouldyouorder?-CTscan-Plainfilmoftheelbow-MRIPATIENTELBOWNormalelbowLATERALVIEWSOFELBOWHumerusRadiusUlnaHumeralcondylesFracturedislocationoftheelbowjointHowwouldyoutreatthispatient?1:DoCTscanofelbow2:Putacast3:CallOrthopedicsurgeon4:SendpatienthomeComplicationofelbowfracturedislocation-Brachialartery臂动脉injury(Especiallywithfracturesinthearea)Treatment:PatientwentstraighttosurgeryThedislocationwasreducedHistory:YoungweightlifterwithsuddenonsetofneckpainPossibleDiagnosis:1:Fracturedcervicalbone骨折2:Slippedvertebraldisc椎间盘滑脱3:Musclesprain扭伤4:Spinalcordtumor肿瘤NextInvestigations1:Seeasportsspecialist2:X-rayofthespine3:CTofthespine4:MRIofthespineDoctorfirstorderedCervicalspinex-rayLateralviewoftheC-spineLateralviewoftheC-spineSpinousprocessDiscspaceVertebralbodyC2C3C4C7C6C5OccipitalbonemandibleMovietongueVertebralbodySpinalcordMRIoftheCervicalSpineSmalldiscprotrusionsesp.atC5-6levelDiscspaceDiscprotrusionC2C3C4C7C6C51:X-RAYexamswhichusesradiation:-Plainfilm-CT-Nuclearmedicine2:X-RAYstudiesthatDONOTuseradiation:-Ultras