Preface

A Letter to the Reader, a Nonradiologist

This book was initially conceived 25 years ago as a primer for the brand-new inclusion of diagnostic imaging into physical therapy curricula. Since that time, this book has been present for some of the most significant transformations in the field of physical therapy. These landmarks include the advancement of physical therapy from a bachelor’s degree program to a doctoral degree program, and the progression from treating patients under direct physician guidance to practicing in direct access roles. Concurrent with these changes has been the improved accessibility of the patient’s diagnostic images. Not only has imaging become more physically available via the electronic patient health record, it has become academically valuable as another tool the physical therapist can use to help unravel the complexity of musculoskeletal dysfunction.

The goal of this book has always been to serve as the key to the fundamentals of imaging, sufficient for any physical therapist to optimize their interactions with imaging. Despite similar educational preparation, wide variability exists in a physical therapist’s dealings with imaging. A physical therapist of today may be part of a healthcare system that permits the physical therapists themselves to order imaging, similar to military models in the United States. Or a home-care therapist may never view an image but reads imaging reports in the patient chart. Or an outpatient clinician performing an initial evaluation may recognize that imaging is needed before initiating treatment and obtains it through a consulting physician. Any of these instances require a foundational understanding of imaging.

Whatever setting you practice in, this book will serve as a primer, a reference, or a decipher of diagnostic imaging to enable you to provide the best care for the patient. Remember—you are not the radiologist, you are a member of the healthcare team who has to learn enough about imaging to function competently and collaboratively. Collaboration requires an understanding of what the other parties have to offer.

This text introduces you to imaging in logical steps. I want all students to feel as though they are learning to swim in the shallow end of the pool instead of being thrown into the deep end! So, wade through these chapters in the order intended. Read the first three chapters to gain a foundation in radiologic science, search patterns, and common pathological and fracture characteristics on radiograph. Read the next three chapters to understand advanced imaging modalities. After that, you can paddle around the next 11 anatomy chapters at your leisure.

Each anatomy chapter has a similar organization. First, a brief anatomy review is presented to refamiliarize the landscape. Next, the routine radiologic evaluation is explained in detail. Radiologic observations are taught for each projection with illustrations to point out anatomic relationships. The tracings of the radiographs are most valuable for teaching you to “see” radiographic anatomy. Ideally you will make your own tracings of the radiograph with a transparency sheet and marker, and then compare results with the printed tracing. Drawing is an invaluable intellectual exercise for teaching anatomy and will enhance your perception of radiographic anatomy in a dimension not afforded by point-and-click exercises.

After radiographs, the advanced imaging protocols for CT and MRI are presented. The order of this content is significant: The value of learning the routine radiographic examination before advanced imaging is that radiographs serve as anatomical “road maps” to help you understand the orthogonal planes of sectional imaging.

Finally, the remainder of each anatomy chapter covers the trauma and pathological conditions most often seen at that body region. Brief descriptions, etiologies treatments, and prognoses are accompanied by images that encompass that condition. Each chapter concludes with a Summary of Key Points to help reinforce main ideas and Self-Tests using unknown images to challenge the reader’s visual interpretation skills.

The book wraps up appropriately with the final chapter, “Integration of Imaging into Physical Therapy Practice.” This content is important in understanding the increasing responsibilities of nonphysician clinicians as first-contact providers and referral sources. It also explores evolving issues regarding practice environments and how they relate to ordering imaging in the military, in civilian roles, and outside the United States.

The access code that comes with this book opens the door to online resources specific to the book’s content:

• Interactive Imaging Practice Application houses radiographic exercises designed to teach you to identify normal anatomy on every routine radiographic projection of each joint. Also, another set of exercises requires the viewer to identify different pathologies on radiographs.

• An Imaging Atlas of MRI lets you scroll through all three orthogonal planes, slice by slice, of each joint. Pertinent anatomy is labeled and also color coded to make it as easy as possible to learn sectional anatomy.

• Glossaries for each chapter are available with an active search feature.

• Focus On research topics, related to each chapter, are in-depth articles written on specific pathological conditions and related imaging.

• A direct link to the American College of Radiology (ACR) Appropriateness Criteria is provided. These evidence-based guidelines assist clinicians in making the most appropriate imaging or treatment decision for a specific clinical condition.

To conclude, this fifth edition preserves the vision of the original edition: to provide an organized introduction to the fundamentals of musculoskeletal imaging. By the time you get to the end of this book, my hope is that you have (1) an awareness of the capabilities and limitations of the different imaging modalities, (2) an understanding of the information given on the radiologist’s report, and (3) the ability to look at images yourself and appreciate what you can see. Viewing the image independently can be a critical skill, especially if you are seeking information not provided on the radiologist’s report, which is written from and to a medical physician’s perspective. The information the rehabilitation clinician seeks can be of a different nature.

So it is the wish of this author that you gain a new vision with which to see anatomy and the potential to develop the skill of correlating imaging findings with clinical findings. It is hoped that this skill will become a valuable tool that contributes to the rehabilitation of patients, helps you collaborate with the other professionals, and furthers your individual growth.