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Skeletal Radiology II - 20130


Anomalies of the Thorax (pdf)

Measurements (pdf)

Imaging Modalities (pdf)

Congenital Anomalies of the Spine (pdf)

Part 4 Board Review (pdf)

 

 
Renée M. DeVries, DC, DACBR
2.5
30
2
1

Students will study an introduction to plain film radiography and advanced diagnostic imaging; mensuration and biomechanics, as they relate to plain films; and, normal variants and congenital anomalies of the skeleton.
Please select from the list on the right.

The Institution-wide learning goals define the common ground that unites the programs within the university. They are purposefully broad so that the various colleges and schools can continue to develop their unique identities through varying ways in which the goals are met.

  1. Effective Communication
    Graduates will demonstrate effective verbal, non-verbal, and written communication skills in a wide variety of contexts, including collaborative activities.
  2. Self Directed and Lifelong Learning
    Graduates will be aware of the limits of one’s personal knowledge and experience and have an intellectual interest in scholarly and creative endeavors. Graduates will actively set appropriate learning goals, pursue them, and apply the knowledge gained.
  3. Ethical Reasoning
    Graduates will demonstrate a willingness to recognize the values of others while maintaining one’s own integrity, and act ethically and professionally in all endeavors.
  4. Individuals, Communities and Cultures
    Graduates will demonstrate awareness and sensitivity to the cultural and health practices of individuals and communities. Graduates will be able to identify appropriate health related resources.
  5. Service to the Community
    Graduates will understand and value the benefits of service to the community.
  6. Influence of Mind, Body and Spirit on Health
    Graduates will recognize the inter-relationship of the mind, body and spirit and the influence of extrinsic factors on an individual’s health.
  7. Critical Thought and Knowledge Acquisition
    Graduates will acquire, appraise and apply scientific information. Graduates will contextually organize and synthesize relevant information to address an issue or problem.
  8. Competence in one's Discipline
    Graduates will demonstrate competence of appropriate depth and scope for one's discipline.

Course Objectives
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By the end of this course the student will be able to:
  1. Understand the role of plain film radiography in diagnosis in chiropractic practice, including an appreciation for the limitations of this diagnostic tool.
  2. Understand the basic concepts behind the various types of advanced diagnostic imaging modalities and their utility in the work-up of musculoskeletal conditions covered in this and other courses.
  3. Understand the roles and responsibilities of the chiropractic clinician and chiropractic radiologists(Diplomates of the American Chiropractic Board of Radiology) in the area of diagnostic imaging.
  4. Analyze plain film radiographs, describe radiographic findings and distinguish normal from abnormal appearances, recognizing the broad range of normal anatomy, as depicted on x-rays.
  5. Begin to utilize a systematic technique of examining and describing alignment, osseous and joint abnormality and soft tissue abnormality as they appear on plain films. Inherent to development of this skill is the development and application of an ability to visualize three-dimensional anatomy utilizing two-dimensional imaging studies. Also inherent is the recognition of the distortion created by variations in technical factors/positioning and the limitations that these variables impose on analysis of posture and pathology.
  6. Understand how to work up each case to the full extent of your ability as a portal of entry health care provider, to recognize when referral for further imaging or other consultation is indicated and to refer cases that are as complete as possible when this is indicated.
  7. Apply various analytical radiographic techniques in assessing posture/biomechanics, distinguishing between methods that are relatively more valid and those which have not demonstrated validity or clinical utility.
  8. Recognize and define the clinical significance of normal variants and congenital anomalies of the musculoskeletal system.
Materials
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A. Required Text(s):
  1. Yochum TR & Rowe LJ, Essentials of Skeletal Radiology, 2nd ed., Williams & Wilkins, 1995.
    OR
  2. Marchiori, DM, Clinical Imaging With Skeletal, Chest and Abdomen Pattern Differentials, Mosby, 1999.

B. Recommended Text(s):
  1. Keats T., Atlas of Normal Roentgen Variants.

C. Required Materials for Lab:
  1. Radiographs in Radiological Learning Lab (RLL) and Images on University Website.
  2. Library Resources.
Assignments
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  1. Reading handout materials and applicable textbook material.
  2. Lecture and lab materials.
Attendance
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Your attendance is expected at all class sessions
Grading Criteria
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The final grade is calculated on the basis of scores on two major examinations(midterm and final), each with written and lab components. These are cumulative and comprehensive. Material from Skeletal Radiology I and non-radiology courses may be included, but emphasis on both the midterm and final will be on "new" material. For example, the final will emphasize material from the second half of course, but questions from all course work previously covered, including the first half of Skeletal Radiology II may be included. Each test will be worth approximately 100 points.

Guaranteed grades are as follows:

A = 90-100%
B = 80-89%
C = 70-79%
D = 60-69%
F = < 60%
Course Competencies
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-

COGNITIVE DOMAIN


Students will be able to construct and follow a rational diagnostic process in evaluating plain film radiographs demonstrating the following:

  1. biomechanical/postural alterations of the spine and pelvis
  2. intersegmental disrelationships of the spine and pelvis
  3. scoliosis
  4. measurable structural abnormalities that may indicate pathology
  5. normal variants of the skeleton and supporting soft tissues
  6. congenital anomalies of the skeleton and supporting soft tissues

In addition, students will be able to construct a rationale for the use of diagnostic imaging modalities based upon current practice standards and current literature and to explain the basic concepts behind these imaging modalities to patients:

  1. plain film radiographs
  2. magnetic resonance imaging (MRI)
  3. computed tomography (CT)
  4. radionuclide imaging (nuclear medicine)
  5. myelography
  6. diagnostic ultrasound
  7. other


Conditions:
Students will be able to recognize on plain film radiographs the following conditions and to make clinical decisions based upon findings related to these conditions:
Clinical Condition Etiol. & Epidem Patho-physiology Nat. History & Course Exam & Diagnosis Rx/Mgmt
Expansion of the sella turcica 2 - - 6 -
Platybasia 2 - - 6 -
Basilar impression 2 - - 6 -
Atlanto-axial subluxation/instability 2 - - 6 6
Cervical spine subluxation/dislocation 0 - - 6 -
Cervical spine instability 2 - - 6 -
Thoracic and lumbar spine subluxation 0 - - 6 -
Cervical, thoracic and lumbar spine postural alterations 0 - - 6 -
Scoliosis 2 -2 6 1,6
Torticollis 0 - - 6 -
Pelvic obliquity/subluxation 0 - - 6 -
Anisomelia (lower extremity deficiency) 0 - - 6 -
Spondylolisthesis 0 - - 6 -
Pectus excavatum/carinatum 0 - - 6 6
"Straight-back syndrome" 0 - - 6 6
Central spinal canal stenosis 2 2 2 1,6 6
Normal variants of the calvarium 0 - - 6 -
Wormian bones 2 - - 6 -
Benign cranial hyperostosis 2 - 2 6 -
Sinus and mastoid process variants 0 - - 6 -
Physiologic intracranial calcifications 0 - - 6 -
Occipitalization of C1 2 2 - 6 6
"Occipital vertebrae" 0 2 - 6 -
Posterior ponticle 2 - - 6 -
Posterior arch anomalies of C1 (including spina bifida occulta) 2 - - 6 -
Transverse ligament of C1 anomaly 2 - - 6 6
Physiologic calcifications of the cervical paraspinal soft tissues 2 2 - 6 -
Variants of the C1 lateral masses 0 - - 6 -
Mach effects 0 - - 6 -
"Pseudo-Jefferson's fracture" of C1 2 2 2 6 -
Odontoid process anomalies 0 - - 6 -
Congenital non-segmentation of the cervical, thoracic and lumbar spine 2 2 - 6 -
Persistent apophyses of the spine 0 - - 6 -
Spina bifida occulta of the spine and upper sacrum 0 - - 6 -
"Pseudosubluxation" of C2 2 2 2 6 -
"V"-shaped atlanto-dental interspace 2 2 2 6 -
Cervical posterior arch anomalies and variants 0 - - 6 -
Cervical ribs 2 - - 6 -
Hyperplastic C7 transverse processes 0 - - 6 -
Klippel-Feil syndrome 2 - - 6 -
Sprengel's deformity 2 - - 6 -
Omovertebral bone 2 - - 6 -
Nuchal bones 1 - - 6 -
Stylohyoid ligament ossification & Eagle syndrome 2 - - 1,6 -
Laryngeal and tracheal anomalies and variants 0 - - 6 -
Spinal segmentation anomalies (eg hemivertebrae, butterfly vertebrae) 1 - - 6 -
Normal vascular channels 0 - - 6 -
Schmorl's nodes & limbus bones 2 2 - 6 -
Rib anomalies and variants 0 - - 6 -
Srb's anomaly 2 - - 6 -
Transtional thoracolumbar and lumbosacral segments 0 - - 6 -
Clavicle anomalies 0 - - 6 -
Companion shadows 0 - - 6 -
Vertebral body morphology - variants and anomalies 0 - - 6 -
Facet joint asymmetry (tropism) 0 - 2 6 -
Lumbar styloid process 0 - - 6 -
Oppenheimer's ossicle 2 - - 6 -
Agenesis/hypoplasia of a pedicle, articular process or other portion of posterior arch 0 - - 6 -
Bertolotti's syndrome 2 - - 6 -
Iliolumbar ligament ossification 2 - - 6 -
Knife-clasp deformity 0 - 2 6 -
Paraglenoid fossa 2 - - 6 -
Os acetabulum 0 - - 6 -
Ischiopubic synchondrosis 0 - 2 6 -
Phleboliths 2 - - 6 -
Growth resumption lines 2 2 2 6 -
Bone bars 2 - - 6 -
"Tug lesions" 2 - - 6 -
Physiologic vacuum phenomenon 0 - - 6 -
Acetabular notch 0 - - 6 -
Foreshortening of the femoral neck 0 - - 6 -
Synovial herniation pit 2 2 2 6 -
"Pseudo-slipped" femoral capital epiphysis 0 - - 6 -
Os fabella 0 - - 6 -
Bipartite patella 2 - - 6 -
Ludloff's spot 0 - - 6 -
Posterior femoral defect 2 2 2 6 -
Dorsal defect of the patella 0 - - 6 -
Patellar teeth 2 - - 6 -
Accessory ossicles of the ankle and foot 2 - - 6 -
Tarsal coalition 2 - - 1,6 -
Talar beak 2 - - 1,6 -
"Sever's disease" 2 - - 6 -
Bipartite sesamoid 0 - - 6 -
Sesamoid bones of the foot 0 - - 6 -
Metatarsus primus varus and metatarsus adductus 2 - 2 1,6 6
Morton's toe 2 - - 6 -
Olecranon foramen 0 - - 6 -
Coronoid bone 0 - - 6 -
Supracondylar process 2 - 2 6 -
Patella cubiti 0 - - 6 -
Carpal coalition 2 - - 6 -
Benign carpal cysts 0 - - 6 -
Negative and positive ulnar variance 2 - - 6 -
Os styloideum 2 - - 6 -
Metacarpal sign 2 - - 6 -
Phalangeal ridges & flanges 0 - - 6 -
Sesamoid bones of the hands 0 - - 6 -
Polydactyly 0 - - 6 -
Syndactyly 0 - - 6 -
Clinodactyly 2 - - 6 -

Elaboration of Coding Definitions Regarding the Conditions

The following codes refer to the depth of coverage for Etiology and Epidemiology, Pathophysiology, and Natural History and Course:

0 No coverage or content

1 Introduction, without test items

2 Moderate class discussion and/or handout material, with test items

3 Extensive discussion and/or handout material, with test items


For Exam and Diagnosis, the following numbers indicate which aspects of exam and diagnosis of each condition are taught in this course:

  1. Presenting symptoms: Presenting symptoms related to conditions are discussed.

  2. History findings: Relevant personal and family history are discussed.

  3. Exam findings: General physical exam findings are discussed.

  4. Chiro. findings: Posture, subluxation, muscle tone and length, trigger points.

  5. Lab findings: Blood, urine, CSF...

  6. Imaging findings: Plain films, CT, MRI...

  7. Special test findings: eg. sweat test for cystic fibrosis, spirometry for asthma.

For Treatment/ Management, the following numbers indicate which aspects of treatment and management of each condition are taught in this course:

  1. Chiropractic: Adjustments, soft tissue techniques

  2. PT: Physical therapy modalities of all types

  3. Nutrition/ Suppl: Diet and supplement recommendations

  4. Exercise: Stretching, strengthening, aerobic exercise recommendations

  5. Lifesyle Mgmt: Stress reduction, smoking cessation, allergen avoidance ...

  6. Medical: Drugs, antibiotics, surgical procedures, radiotherapy ...

  7. Other: Acupressure/puncture, massage, homeopathic or herbal treatments ...

  8. Guidelines: If published, do you refer to them regarding this condition?


PSYCHOMOTOR DOMAIN


Students will be able to handle and arrange x-rays on a view box in a manner most conducive to interpretation.

a. In addition, students will observe and analyze images as a first step in processing information. This involves detection and discernment of findings prior to discrimination of normal, versus abnormal findings and differential diagnosis.

AFFECTIVE DOMAIN


Students will demonstrate integrity, sensitivity, respect, courtesy, compassion and professionalism at all times, both in lectures and labs.
Weekly Calendar of Learning Objectives
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Week Dates Topics/Learning objectives
Week 1 5-1-07 Lecture: Review syllabus. Introduction to plain film radiography - Utilization, economics and other considerations
Lab: Assigned articles
Week 2 5-7-07 Lecture: Finish introduction. Imaging overview in chiropractic practice. Advanced imaging
Lab: Advanced imaging case studies.
Week 3 5-14-07 Lecture: Begin cervical spine mensuration.
Lab: Cervical spine mensuration, with critical analysis of technical factors.
Week 4 5-21-07 Lecture: Finish cervical spine & begin lumbar spine mensuration.
Lab: Cervical & lumbar spine mensuration, with critical analysis of technical factors.
Week 5 5-28--07 Lecture: Finish lumbar spine and pelvic mensuration.
Lab: Lumbar spine mensuration, with critical analysis of technical factors.
Week 6 6-4-07 Lecture: Scoliosis
Lab: Scoliosis
Week 7 6-11-07

Midterm Exams -

Week 8 6-18-07

Lecture: Skull & cervical spine variants & anomalies

Lab: Review cases of skull & cervical spine variants & anomalies

Week 9 6-25-07 Lecture: Finish cervical spine variants & anomalies - Begin thoracic spine
Lab: Review cases of cervical spine variants & anomalies
Week 10 7-2-07 Lecture: Finish thoracic spine variants & anomalies- Begin lumbar spine
Lab: Review cases of thoracic spine variants & anomalies
Week 11 7-9-07 Lecture: Finish lumbar spine variants & anomalies, Begin pelvis & hip
Lab: Review cases of lumbar spine variants & anomalies
Week 12 7-16-07 Lecture: Finish pelvis & hip variants & anomalies - Lower extremity
Lab: Review cases of pelvic and hip variants and anomolies
Week 13 7-23-07

Lecture: Upper extremity variants & anomalies
Lab: Review cases of extremity variants & anomalies

Week 14 7-30-07 FINAL EXAMS
Week 15 8-6-07 FINAL EXAMS
Please Note
This schedule of lecture and lab topics and quizzes and exams may be changed during the course of the trimester as circumstances require. Whenever possible, such changes will be announced in class before the date and time in question. You are responsible for anything that transpires during lectures and labs, even when you are unable to attend. In the event that you miss a class session, make sure you check with a classmate about any announcements or schedule changes which may have been made. Makeup exams are allowed only according to the policies described in the current student handbook, which is available in the Student Affairs office.
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Northwestern College of Chiropractic
Last updated: 26 April, 2007
 

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