Prosedur Diagnostik

PLAIN FILM RADIOGRAPHY

• Plain film X-ray examination is over 100 years
old
• This revolutionary discovery greatly improved medical and surgical
diagnosis and treatment in general, but especially in the
musculoskeletal system.
• The plain film provides information simultaneously on the size, shape,
tissue ‘density’ and bone architecture
• Xrays are a form of electromagnetic radiation similar to visible light
but of shorter wavelength
• Xray tube generates xrays and beams them toward the patient. Some
of the energy is absorbed; rest passes through patient and hits the
film plate
• A metal implant appears
intensely white

• Bone less so and soft tissues in

varying shades of grey
depending on their ‘density’

• Dark area between adjacent

bone ends; this ‘gap’ is usually
called the joint space
Radiographic interpretation
• Make sure that the name on the film is that of your patient

• Muscle planes are often visible and may reveal wasting or swelling
• Bulging outlines around a hip, for example, may suggest a joint effusion
• soft-tissue swelling around interphalangeal joints may be the first radiographic sign of rheumatoid
arthritis
• Tumours tend to displace fascial planes, whereas infection tends to obliterate them

• Soft tissue calcification, ossification, gas (from penetrating wound

or gas-forming organism) or the presence of a radioopaque foreign body
THE BONES
 Shape
 Generalized change
• Take note of changes in bone
‘density’ (osteopaenia or
osteosclerosis)
 Localized change
 Determine the lesion’s size, site,
shape, density and margins, as well
as adjacent periosteal changes and
any surrounding soft tissue changes
THE JOINTS

• The radiographic ‘joint’ consists of the articulating

bones and the ‘space’ between them
• The ‘joint space’
• The joint space looks much wider in children than in
adults  much of the epiphysis is still cartilaginous and therefore radiolucent

• Shape
• Note the general orientation of the joint and the congruity of the bone ends
• if necessary comparing the abnormal with the normal opposite side

• Erosions
• The position of erosions and symmetry help to define various types of arthropathy
Rule of twos

• Two views
• Two joints
• Two limbs
• Two injuries
• Two occasions
COMPUTED TOMOGRAPHY
• CT produces sectional images through selected tissue planes
• CT (Computed Tomography), provides a more detailed radiographic picture of the anatomical area that is
imaged
• It is often used as a follow-up to an abnormal radiograph or is requested when radiographs fail to
completely answer the clinical question
• CT scan provides very good bone detail and improved soft tissue resolution
COMPUTED TOMOGRAPHY
• CT uses a rotating X-ray beam to pass through “slices” of the body
• These are detected by a computer and recreated into axial images
• These images can be reconstructed in any plane or
three-dimensionally to demonstrate the anatomy and pathology.
MRI
• It is the “gold standard” of soft tissue imaging, and has the added advantage
of requiring no ionizing radiation
• The MRI machine creates a large external magnetic field, which causes the
protons (H+) in the body to polarize and align with the magnet
• Magnetic resonance imaging produces cross-sectional images of any body
part in any plane
MRI
• Advantages • Disadvantages
•Expensive
•Excellent soft tissue contrast •Poorly available as MRI scanners are not
available in all hospital imaging
•Multi-planar departments
•No radiation •Poor bone detail
•Uncomfortable procedure (long, noisy,
claustrophobic) for some patients
•Children may require general anesthetics
because of the need to lie still for
extended periods of time
•Cannot use if patient has certain metal or
electronic implants such as pacemakers,
heart valves, aneurysm clips. Check with
the MR technologist if uncertain.
•Safety in pregnancy has not been
established
Arthrocentesis
• A bedside procedur in which a steril needle and syringe are used to
drain fluid from the joint
• To diagnose and establist the cause of monoarthritis or polyarthritis
• To provide therapeutic relief for joint effusions
• Identification of hemarthrosis
• Identification of crystal arthropathy
Biopsy
• biopsy is essential for both diagnosis and planning of treatment.
• A biopsy is a medical test commonly performed by a surgeon,
interventional radiologist, or an interventional cardiologist involving
extraction of sample cells or tissues for examination to determine the
presence or extent of a disease.
Arthrography
• Arthrography is medical imaging to evaluate conditions of joints. It
can either be direct or indirect. Indirect arthrography is a medical
imaging technique in which contrast material is injected into the
blood stream and eventually absorbs into the joint.