x-ray

Lichtman's radiographic classification of aseptic necrosis of lunate bone Kienbock's disease

Kienbock's disease is an eponym for avascular necrosis of the lunate bone. It usually affects man working manually with tools like pneumatic hammer that cause repetitive trauma.

Stage Description
Stage I normal x-ray
Stage II sclerosis of lunate with possible decrease of lunate height on radial side only
Stage IIIa lunate collapse, no scaphoid rotation
Stage IIIb

van der Heijde modification of Sharp score of joint involvement by rheumatoid arthritis on plain radiographs

A) Erosion score

The van der Heijde modification of the Sharp erosion score includes 16 areas from each hand and wrist, 10 metatarsophalangeal joints on both sides and two interphalageal joints of the big joints. The maximum erosion score is 160 for hands:

  • 5 metacarpophalangeal joints (MCP)
  • 4 proximal interphalangeal joints (PIP)
  • interphalangeal joint of the thumb (IP)
  • radius
  • ulna
  • trapezium and trapezoideum as one unit (multangular)
  • scaphoid
  • lunate

and 120 for feet:

Sharp score of joint involvement by rheumatoid arthritis on plain radiographs

The original Sharp score included erosion score and joint space narrowing score for each evaluated joint. The number of evaluated joints was later decreased to reflect more accurately the extent of abnormalities and to shorten the amount of time required to read the films.
This modification considers 17 areas for erosion for each hand:

  • five proximal interphalageal joints (PIP)
  • five metacarpophalangeal (MCP)
  • base of the first metacarpal bone (MCB)
  • multangular bone
  • navicular bone
  • lunate bone

Larsen score of joint involvement by rheumatoid arthritis on plain radiographs

Larsen's scoring system atributes 0 to 5 points to each synovial joint evaluated on a radiograph. As each synovial joint can be included in the score, description of scored joints and maximum attainable score should be reported.

The original method from 1977 included hands, wrists, and feet with a maximum possible score of 250 (10 joints per hand or foot + 2 x 5 x wrist) x 5. The wrist is considered as one unit and the score is multiplied by five:

  • 5 distal interphalangeal joints (DIP)
  • 4 proximal interphalangeal joints (PIP)

Grades of osteoarthritis by Ahlbäck

Ahlbäck Grade Description
Grade I Joint space narrowing (joint space < 3 mm)
Grade II Joint space obliteration
Grade III Minor bone attrition (0–5 mm)
Grade IV Moderate bone attrition (5–10 mm)
Grade V Severe bone attrition (>10 mm)

References:

Grades of osteoarthritis by Kellgren and Lawrence

Grading of joint osteoarthritis by Kellgren and Lawrence uses plain radiograph to assess the extent of degenerative disease. Originally, the authors assessed degenerative joint disease on a single x-ray view: AP for hips, knees, and feet, lateral view for cervical and lumbar spine, and PA view for hands. In the following studies, several mutations of this classification were used.

Grade - Changes Description
Grade 0 - None no changes

ARDS on chest x-ray: phases

ACUTE EXUDATIVE PHASE

  • First week
  • First findings > 12 hours after insult
  • Patchy alveolar infiltrates
    • bilateral
    • gravity dependent, both central and peripheral
    • costophrenic angles are spared
    • air-bronchograms
    • Kerley lines are uncommon
  • Infiltrates coalesce to large dense air-space bilateral shadows

 

FIBROTIC PHASE

  • Begins as early as in the second week
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