CHAPTER 1: Introduction to Diagnostic Imaging

1. THE STARTING POINT

❑ Sort Out the Wherefore and Why of Imaging

Modern diagnostic imaging in the 21st century presents a plethora of imaging choices. A patient's hospital chart may be liberally littered with reports of imaging-related examinations, treatments, and procedures. Imaging can seem almost exponential in its capacity to help manage the patient's medical course. And it can be overwhelmingly confusing to the novice clinician.

The purpose of this handbook is to simplify and clarify the musculoskeletal diagnostic imaging field for any clinician. Whether you are the clinician writing the imaging orders, the clinician evaluating the patient, or the clinician rehabilitating the patient, an ability to understand and collaborate regarding the patient's imaging studies will assist you in making better clinical decisions.

Let's proceed in organized steps.

1. The first step to sorting out the wherefore and why of imaging studies is to categorize the radiologic practice areas to understand how imaging is being utilized.

2. The second step is to categorize the imaging studies themselves.

3. The third step is to understand the capacity of each imaging study to define different pathologies.

4. The final step is to access the evidence-based research to discover which imaging study is the best for which patient. This tremendous amount of information is condensed in the remaining nine chapters of this book, which are divided by anatomic joints or spinal regions.

❑ First: Recognize Three Radiologic Practice Areas

Radiologists practice in three areas, and thus imaging is utilized for the following three distinct purposes:

• Interventional radiology diagnoses and treats conditions nonsurgically. Radiologists use imaging guidance to place stents, catheters, guidewires, needles, balloons, and other devices noninvasively in any system of the body.

• Radiation oncology uses targeted radiation to treat patients with cancer. Radiation may be used alone or in combination with surgery or chemotherapy. Radiation is also used to relieve symptoms in patients with incurable cancers. Originally part of general radiology training, radiation oncology is now a separate specialty.

• Diagnostic imaging evaluates every system of the body. This includes breast imaging, cardiac imaging, gastrointestinal imaging, musculoskeletal imaging, pediatric imaging, neurological (head/neck) imaging, nuclear isotope imaging, thoracic imaging, urologic imaging, vascular imaging, and women's imaging. Radiologists often subspecialize in one of these areas through fellowship training after their general residency program.

  • ◗ This handbook is all about diagnostic imaging of the musculoskeletal system.

❑ Second: Categorize the Modalities of Imaging

The second step to sorting out diagnostic imaging is to recognize two categories of imaging studies:

• Conventional Radiography: includes any image made by the century-old technology of x-ray production. Images are captured on film or digitized image receptors.

• Advanced Imaging: includes whole body or sectional imaging studies that require sophisticated computer postprocessing.

❑ Third: Understand ...