Scans and imaging

Presentation from the WSHFT physiotherapy department on scans and ultrasound

1. Physiotherapy
Patient Information On
Scans & Ultrasound

2. Different Types of Imaging
•X-ray: Used to assess for fractures and bone condition.
•CT scans: produces detailed images of structures inside the
body, eg; internal organs, blood vessels and bones.
•Ultrasound: uses high-frequency sound waves to create an
image of part of the inside of the body and used for soft
tissues.
•MRI: a scan that uses strong magnetic fields and radio waves
to produce detailed images of the inside of the body.

3. Radiation
•There is exposure to radiation
with X-Rays & CT Scans
•This can be measured in the unit
millisievert (mSv)
•We are all exposed to natural
radiation depending on where
we live.
•X-Ray of Spine = Roughly 6
months of natural background
radiation (1.5mSv)
•CT Spine = Roughly 2 years of
natural radiation (6mSv)

4. Radiation
•The amount of radiation changes depending
on what body part is been scanned or X-Rayed
•E.g. CT Scans and X-rays are only indicated if it
will change the course of management as so
not to expose you to unnecessary radiation.
•There is no exposure to radiation with MRI
•Not everyone can have an MRI – E.G. those
who have certain types of pacemakers.

5. X-Rays
•They help to diagnose.
–Bone fractures / breaks
–Scoliosis
–Bone fusion
–Osteoarthritis
–Bone tumors
–Bone healing

6. •Osteoarthritis (OA) is the most common form of
arthritis.
•It is a normal age related process that can only
be diagnosed by x-rays or CT.
•Joint pain in older adults is not always due to OA,
even when radiographs show OA changes.
•Findings of OA on plain radiographs do not
correlate well with symptoms.
•People can have high grade Knee OA with little
pain versus people with low grade OA and high
pain.

7. CT Scan
•Combines a series of X-ray
images taken from
different angles.
•Then uses computer
processing to create cross-
sectional images, or slices
of:
–Bones
–blood vessels
–And soft tissues inside the
body.

8. CT Scan
•CT scan is a more sophisticated and powerful X-
ray that takes a 360-degree image of internal
organs, the spine and vertebrae.

•More detailed, high-quality images of the body in
comparison to an X-Ray

•Usually takes 5-20 mins.

•May be considered if the patient cant have an
MRI.

9. Ultrasound
•It helps to diagnose:
–Tendon tears or
tendinopathies
–Muscle tears,
masses or fluid
collections.
–Ligament sprains
or tears.
–Inflammation or
fluid (effusions)
within
the bursae and
joints.
–Early changes of
RA.
–Nerve
entrapments such
as carpal tunnel
syndrome.
–Benign and
malignant soft
tissue tumours.
–Ganglion cysts.
–Hernias.
–Foreign bodies in
the soft tissues

•Ultrasound imaging uses sound waves to produce pictures of muscles,
tendons, ligaments and joints throughout the body.

10. MRI Scanner

11. MRI scans
•They show structures
such as:
–Disc
–Spinal Cord/ Nerves
–Meniscus/Cartilage
–Ligaments and
Tendons
–Muscle
–Labrum
–Joints

•An MRI scan can be
used to examine almost
any part of the body,
including the spine,
shoulder, knee, hip and
elbow.
•To date there is no
known effects of MRI.

12. Indication For MRI
•May be considered if conservative non-invasive
treatment hasn’t helped and surgery or therapeutic
injections are been considered.

•They are sometimes used to assess for certain conditions
which may require urgent attention. E.g. Cauda equina
syndrome, stress fractures and hip fractures.

•Not routinely indicated within the first 6 weeks of
conditions like LBP. Better outcomes with conservative
management alone versus MRI & conservative
management.

13. MRI Findings

•The findings on a MRI scan is not always the reason
behind a persons pain.

•Studies have shown that patients with no pain often
show anatomic abnormalities on imaging in the back
shoulder, hip and knee.

14. Normal MRI Findings
Prevalence in PAIN FREE individuals:

Disk degeneration: Increased from 37% of 20 years old to 96% of
80 years old.
Disk bulge: Increased from 30% of those 20 years of age to 84%
of those 80 years of age.
Disk protrusion: increased from 29% of those 20 years of age to
43% of those 80 years of age.
Shoulder rotator cuff tear: 54% of people over the age of 60 and
40% of elite level baseball players
Shoulder Bursa: On Ultrasound 96% of had signs of bursal
thickening and other abnormalities.
Knee meniscal tears: 60% of people without knee pain have
meniscal tears.

15. Conclusion
•As we age so does our body.

•These changes can be detected with MRI and X-ray.

•They often do not correlate to pain.

•Most muscle and joint conditions can be managed
without a scan.