0:00

So when it comes to suspected off in myelitis.

0:04

It's important to know that there are appropriateness criteria.

0:07

Generated by the American College of radiology. And so

0:10

let's look into that a bit further.

0:13

So when it comes to suspected Optimus infection

0:16

within the bone, we need to determine whether it's infection

0:19

suspected within the spine or outside of

0:22

the spine. If it's not in the spine a

0:25

plane radiograph would be appropriate.

0:27

We may see areas that may

0:30

constitute lucencies.

0:32

We may see loss of the trabecula pattern in this

0:35

particular area. We may even see sort of Suspicion for

0:38

thickening of the cortex in the

0:41

case of spinal regions.

0:44

We want to get an MRI with and without contrast that's going

0:47

to help us to identify areas where there's bone

0:50

marrow edema that's going to help us identify if there's

0:53

any sub periosteal or sort of intraosseous abscesses

0:56

and if there is any extra

0:59

obvious extension of the infection,

1:03

So when it comes to suspected bone tumors in

1:06

similar fashion, the ACR has criteria

1:09

that helps us to understand. What do we do in this

1:12

particular setting if there's a suspected primary tumor?

1:16

A plane radiograph is appropriate now in that

1:19

setting we can essentially move from

1:22

a plane radiograph to a

1:25

CT without Ivy contrast in the case of an osteoid

1:28

us, you know, we can see that introosseous Midas we

1:31

can see that surrounding reactive sclerosis

1:34

and or cortical thickening

1:37

in that region or if it's not an Australia,

1:40

which can be a nice slam dunk. We may

1:43

say you know what actually let's go ahead and get an MRI

1:46

with and without contrast so we can understand exactly

1:49

what primary tumor this is.

1:52

Now if there's suspected metastasis or

1:55

there's a history of metastasis in

1:58

the setting of new symptoms a technician 99 bones

2:01

scan may be particularly appropriate and what

2:04

we're looking at here is we're looking for hot lesions. These

2:07

hot lesions will let us know where there

2:10

is increased bone turnover increase metabolism.

2:13

And so that will show us very

2:16

readily where there's increased radio Tracer uptake

2:19

in the setting of this increased bone

2:22

turnover and increase metabolism of the

2:25

radio Tracer. So when we have Imaging work

2:28

up for bone pathology, there are some exceptions

2:31

from the acr's appropriateness criteria

2:34

that will sort of call to mine when we think about prostate cancer.

2:37

The technician 99 bones scan is a whole body scan

2:40

that's particularly indicated. If we have a

2:43

sample in a patient perhaps from a prostate

2:46

cancer biopsy performed by the urologist

2:49

or even Radiologists where we have poorly differentiated.

2:52

Ideology or in a setting where the PSA

2:55

in the prostate for specific antigen is greater than or equal

2:58

to 20 nanograms per milliliter. Now, there are other

3:01

settings where we're performing staging in the setting of non-small cell

3:04

lung cancer. We have the fdg pet is actually

3:07

the first line for staging an assessment of

3:10

Aussies involving

3:11

Now finally, we have individuals that may

3:14

have suspected spinal metastasis. The MRI

3:17

has improved sensitivity and specificity over

3:20

other modalities. And so when we're dealing with spinal

3:23

metastases other than the appendicular and

3:26

axial metastases, in other parts of

3:29

the body that were particularly appropriate in the setting of the technician 99

3:32

scan. The spinal metastases are very

3:35

much. Well worked up by the MRI.