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Questions and Answers

What is formed at the interface between growing cartilage and bone during calcification in children?

Growth plate

Cartilage matrix

Bone marrow cavity

Zone of provisional calcification (correct)

What happens to the epiphyseal plate as a child grows older?

It becomes thinner until fusion occurs (correct)

It remains unchanged

It becomes thicker and more dense

It converts entirely to muscle tissue

What may persist as a thin white line if temporary cessation of growth occurs?

Growth line (correct)

Growth spur

Zone of provisional calcification

Cartilage band

What is the outcome of the calcified cartilage when cartilage growth transitions to bony formation?

It is converted to bone Signup and view all the answers

What does the presence of a ‘growth line’ indicate?

Temporary cessation of growth Signup and view all the answers

Who discovered X-rays?

Wilhelm Roentgen Signup and view all the answers

What type of radiation are X-rays classified as?

Ionizing radiation Signup and view all the answers

What is the function of the PACS system in digital radiography?

To archive, communicate, and store images Signup and view all the answers

Which of the following materials would appear white or dense on a radiograph?

Metal Signup and view all the answers

What physical characteristic of X-rays allows them to generate images?

Their high energy and short wavelength Signup and view all the answers

What do tissues with a smaller atomic number in radiography appear as?

Lucent or black Signup and view all the answers

Which of the following best describes the appearance of fat in a conventional radiograph?

It appears gray Signup and view all the answers

What prevents X-rays from passing through certain tissues?

The atomic number of the tissue Signup and view all the answers

What is the correct order of the central ray's path in antero-posterior (AP) x-ray projection?

From anterior to posterior Signup and view all the answers

Which imaging modality is considered the first line investigation for suspected compartment syndrome?

X-ray Signup and view all the answers

What is one main advantage of using plain radiographs in musculoskeletal imaging?

They are fast and readily available Signup and view all the answers

What should be included when following the Rule of Two's for imaging?

Two opinions about the diagnosis Signup and view all the answers

In which x-ray projection does the central ray travel from one side of the body to the other?

Lateral Signup and view all the answers

Which option best describes the use of MRI in musculoskeletal imaging?

It is better for viewing soft tissue injuries. Signup and view all the answers

What do the two joints in the Rule of Two's guideline refer to?

The joint above and below the injury site Signup and view all the answers

How does the length increase in long bones occur during childhood?

At the cartilaginous epiphyseal plate Signup and view all the answers

Study Notes

Wilhelm Roentgen

Discovered X-rays in 1895 while experimenting with cathode ray tubes.

X-rays

Part of the electromagnetic spectrum
High energy
Ionizing radiation

Digital Radiography

Replaces photographic film
Uses photosensitive cassettes or plates
Processed by an electronic reader
Stored in a digital format
Archived and communicated through PACS (Picture Archiving and Communications System)

Image Generation

Depends on interaction between x-rays and body tissues.
Tissues with low atomic number: X-rays pass through, appear black or lucent.
Tissues with high atomic number: X-rays are blocked, appear white or dense.
Tissues with medium atomic number: Partial passage resulting in variations of gray.

Five Basic Densities of a Conventional Radiograph

Air: black (most lucent).
Fat: gray.
Fluid/Soft tissue: gray (whiter than fat).
Bone: white (most dense).
Metal: white (most dense).

X-ray Projections

Antero-posterior (AP) - central ray passes from anterior to posterior perpendicular to the coronal plane.
Postero-anterior (PA) - central ray passes from posterior to anterior perpendicular to the coronal plane.
Lateral - central ray passes from one side of the body to the other perpendicular to the sagittal plane and parallel to the coronal plane.
Oblique - central ray passes through the body/body part at an angle to the transverse plane/coronal plane.
Axial - central ray passes through (or parallel) to the long axis of the body

Imaging of the Musculoskeletal System

Plain radiographs are the first choice for imaging the musculoskeletal system.
Advantages of plain radiographs: inexpensive, fast, readily available, reliable for bony abnormalities (fractures, tumors).
For soft tissue injuries (cartilage, ligaments, tendons): MRI is better than radiographs

Rule of Two's

Two views (AP and Lateral)
Two joints (Include the joint above)
Two sides (Compare with contralateral side)
Two occasions (Compare with old/previous imaging study)
Two opinions (Ask colleague if not sure)
Two investigations (Consider whether US, CT, or MRI would help in diagnosis)

Normal Long Bones

Increase in length takes place at the cartilaginous epiphyseal plate
In growing children: Calcification of cartilage occurs at the interface between the radiolucent growing cartilage and the bone.
Zone of provisional calcification: appears as a dense white line forming the ends of the shaft and surrounding the bony epiphyses. This calcified cartilage is converted to bone.
Growth line: A thin white line extending across the shaft of the bone, formed by the persistence of the zone of provisional calcification during temporary cessation of growth.
As the child grows older: The epiphyseal plate becomes thinner and eventually fuses with the shaft.