Overview

In the field of physical therapy, understanding imaging interpretations is crucial for accurate diagnosis and treatment planning. This module aims to equip physical therapists with the knowledge and skills necessary to interpret X-ray images effectively, focusing on common themes PTs will encounter in the field, such as juvenile hip conditions, cervical spinal pathology, common anatomic variants as well as discussion topics on atypical foot/ankle presentation(s). Additionally, the module will explore the Pittsburgh and Ottawa rules, providing a comparative analysis to aid in clinical decision-making.

• Lectures with visual aids (radiographs, diagrams, etc.)
• Case studies and clinical scenarios
• Group discussions and peer learning
• Online resources for further reading and self-assessment

This module has two assignments. One will be a discussion forum where you can make a recommendation based on the radiograph of a patient complaining of foot pain and then collaborate with your classmates. The second will involve assessing and evaluating different radiograph images and delving deeper into the Pittsburgh and Ottawa rules. For each assignment, you will research other resources and support your responses in both the discussion forum and your assignment with at least one additional reference.

By mastering the interpretation of X-ray images, such as identifying juvenile hip conditions and cervical spine abnormalities, and understanding the application of Pittsburgh and Ottawa rules, physical therapists can enhance their clinical skills and contribute to more accurate diagnoses and effective treatment plans. This module provides a comprehensive foundation for integrating imaging interpretation into physical therapy practice, ultimately improving patient outcomes and healthcare delivery.

Module objectives

By the end of this module, students will be able to:

1. Identify radiograph views of different parts of the body.
2. Describe the implications for physical therapy treatment for radiographs.
3. Compare and contrast the Pittsburgh and Ottawa rules for ordering radiographs.
4. Assess fractures and other abnormal pathologies on radiographs and describe the rehab implications.
5. Perform an ABCS & D evaluation on a radiograph.

Readings

Assignments

Assignment 1

Foot case discussion board

The radiograph above is a lateral view of a 58-year-old female with a history of long-standing diabetes. She has a history of several foot surgeries and is now complaining of general foot pain and difficulty walking. Clinical Decision Rules (CDR) are tools for helping clinicians make diagnostic and therapeutic decisions during initial patient evaluations. They provide a universal language and set of principles to avoid imaging overuse. The Ottawa Ankle Rules are one example of a CDR.

Discuss the following points in your original post. Read your classmate’s viewpoints on the case and share your thoughts about their recommendations. As you work on this assignment, reflect on your experience as a clinician and how your new knowledge can benefit your practice.

• Was it appropriate for the physician to order X-rays on this patient based on the Ottawa Ankle Rules? Please discuss and support your answer.
• Review the radiograph and discuss a pathological finding that might be present.
• Discuss what type of gait deficiencies this patient may have and what could contribute to her complaints.
• What other ankle view might be necessary to assess this patient’s foot properly? Support your answer.

Assignment 2

Part 1: Cervical spine images evaluation

1. X-ray 1-3: Identify the three views depicted in cervical spine images. Which cervical view is not depicted in this series?
2. X-ray 1: Perform an ABCs & D evaluation. Provide a thorough discussion about the whole image. Use X-ray images #2 and #3 to support and identify any abnormalities in X-ray image #1. Discuss some of the clinical presentations this patient may exhibit.
3. X-rays 4-5: Identify the structure at the arrow.

X-ray 1: Cervical spine-lateral view

X-ray 2: Cervical spine-oblique view

X-ray 3: Cervical spine

X-ray 4: Cervical spine

X-ray 5: Cervical spine

Part 2: Clinical decision rules

Several medical professionals use set criteria when ordering radiographs. Compare and contrast the Pittsburgh and Ottawa rules for ordering radiographs. Which do you think is best? What populations are not covered by these rules? How could the physical therapy profession benefit from a standard set of rules?

Knowledge check

Each module will include a knowledge check section. This quiz is to check your knowledge on the topic from this week and it will also give you some idea of the types of questions asked on the graded quizzes. Click below to complete the knowledge check.