Puerto Rico Chiropractic Continuing Education

Hour One:

• Identify normal/abnormal anatomical structures i.e.: osseous anatomy of the cervical spine
• Identify, analyze and interpret the importance of an increase ADI
• Identify normal/abnormal anatomical soft tissue structures (i.e.: calcifications of carotid/vertebral arteries and thyroid cartilage) of the cervical spine
• Recognize the importance of specific laboratory and diagnostic studies to aid in the differential diagnosis of common radiographic findings to rule out most often seen musculoskeletal disorders of the cervical spine

Hour Two:

• Identify normal/abnormal anatomical structures i.e.: osseous anatomy of the thoracic spine
• Identify normal/abnormal anatomical soft tissue structures (costal cartilage calcifications, trachea and bronchial air shadows, heart, diaphragm, hilar region, aortic knob etc.)
• Recognize the importance of specific diagnostic studies to aid in the differential diagnosis of common radiographic findings to rule out most often seen musculoskeletal disorders of the thoracic spine

Hour Three

• Identify normal/abnormal anatomical structures i.e.: osseous anatomy of the lumbar spine and pelvis
• Identify normal/abnormal anatomical soft tissue structures i.e.: vascular calcifications like abdominal aortic aneurysm, mesenteric lymph nodes etc
• Recognize the importance of specific laboratory and diagnostic studies to aid in the differential diagnosis of common radiographic findings to rule out most often seen musculoskeletal disorders of the lumbar, lumbosacral spine and sacroiliac joints

• Analyze the risk factors and causes of the distal radius fracture in teenagers.
• Utilize diagnostic imaging to assess the adolescent idiopathic scoliosis (AIS).
• Describe the risk factors leading to a poor outcome for patients with osteosarcoma.
• Evaluate the various ways Ewing sarcoma presents on x-ray.
• Differentiate ganglioneuroma from other neurogenic tumors.

• Develop and consistently use a complete search pattern for chest radiographs. 
• Recognize and describe the radiological features of a normal lung. 
• Recognize and describe the radiological features of pathology on chest radiographs 
• Link the history and physical examination findings with the radiological abnormalities to arrive at a reasonable diagnosis or differential diagnosis. 
• Discuss the indications for referral based on abnormal chest radiographic findings. 
• Select appropriate imaging or other diagnostic procedures based on the history and physical examination

• Develop and consistently use a complete search pattern for chest radiographs. 
• Recognize and describe the radiological features of a normal lung. 
• Recognize and describe the radiological features of pathology on chest radiographs 
• Compare, contrast and describe the radiographic signs of Atelectasis and Consolidation of the lungs.
• Recognize and describe the radiological features of Interstitial disease (Infiltrative disease) of the lungs.
• Identify the various diseases that can result in Atelectasis, Consolidation, Interstitial patterns
• Link the history and physical examination findings with the radiological abnormalities to arrive at a reasonable diagnosis or differential diagnosis. 
• Discuss the indications for referral based on abnormal chest radiographic findings. 
• Select appropriate imaging or other diagnostic procedures based on the history and physical examination

• Develop and consistently use a complete search pattern for chest radiographs.
• Recognize and describe the radiological features of Interstitial disease (Infiltrative disease) of the lungs.
• Identify the various diseases that can result in Atelectasis, Consolidation, Interstitial patterns.
• Link the history and physical examination findings with the radiological abnormalities to arrive at a reasonable diagnosis or differential diagnosis.
• Discuss the indications for referral based on abnormal chest  radiographic findings.Select appropriate imaging or other diagnostic procedures based on the history and physical examination.

• Develop and consistently use a complete search pattern for chest radiographs.
• Link the history and physical examination findings with the radiological abnormalities to arrive at a reasonable diagnosis or differential diagnosis.
• Recognize the presence of hilar enlargement.
• Know the conditions that can lead to hilar enlargement.
• Recognize the presence of mediastinal masses and know the disease that can cause mediastinal mass.
• Be able to identify diaphragmatic hernias on chest radiographs Know the indications for referral based on abnormal chest radiographic findings.
• Select appropriate imaging or other diagnostic procedures based on the history and physical examination.

• Develop and consistently use a complete search pattern for chest radiographs.
• Recognize and describe the radiological features of pleural fluid.
• Recognize and describe the radiological features of pleural calcification.
• Recognize and describe the radiological features of pleural-based tumors.
• Identify the various diseases that can result in Atelectasis, Consolidation, Interstitial patterns and pleural fluid.
• Link the history and physical examination findings with the radiological abnormalities to arrive at a reasonable diagnosis or differential diagnosis.
• Know the indications for referral based on abnormal chest radiographic findings.
• Select appropriate imaging or other diagnostic procedures based on the history and physical examination.

• Execute a complete search pattern for chest radiographs.
• Recognize and identify the different patterns of chest pathology.
• Recognize the radiological features of primary lung tumors.
• Recognize various radiological features of secondary tumors of the lungs.
• Link the patient’s clinical presentation with the chest radiograph to arrive at a reasonable diagnosis or differential diagnosis.
• Make a referral based on abnormal chest radiographic findings.
• Select appropriate imaging or other diagnostic procedures based on the history and physical examination

• Identify pathology on chest radiographs 
• Recognize the radiographic signs of different chest pathologies such as Atelectasis, Consolidation, infiltrative disease, and plural disease. 
• Recognize radiological features of Pneumoconiosis and Chronic Obstructive Pulmonary diseases. 
• Differentially diagnose based on the patient clinical presentation and chest radiographic findings. 
• Make referral based on abnormal chest radiographic findings. 
• Select appropriate imaging or other diagnostic procedures based on the history and physical examination.

• Apply a complete search pattern for chest radiographs.
• Identify the various diseases that can result in Consolidation, and Interstitial/Infiltrative disease.
• Link the history and physical examination findings with the radiological abnormalities to arrive at a reasonable diagnosis or differential diagnosis.
• Recognize and describe the radiographic signs of granulomatous disease on chest radiographs.
• Recognize and describe the abnormal radiographic signs of the common Cardiovascular diseases.
• Refer based on abnormal chest radiographic findings.

• Differentiate the presenting features of Ewing’s sarcoma, chondrosarcoma, osteosarcoma and metastasis in the extremities.
• Determine the appropriate diagnostic imaging and identify the characteristic features of Ewing’s sarcoma, chondrosarcoma, osteosarcoma, and metastasis on diagnostic imaging.
• Identify the treatment options and prognosis for patients with Ewing’s sarcoma, chondrosarcoma, osteosarcoma or metastasis in the extremities.

• Determine how a torus fracture looks on plain film radiographs and how to manage the fracture
• Utilize the scoring criteria in the diagnosis and denoting the disease progression in the gout foot on plain film radiographs
• Describe the most common primary tumors that result in foot metastasis
• Explain the typical appearance of the rheumatoid foot on radiographs and how to assess and manage the condition
• Evaluate how to diagnose and appropriate treatment methods for the Lisfranc fracture-dislocation.

• Evaluate hand chondrosarcoma by identifying the following: diagnostic imaging features and treatment options.
• Differentiate erosive osteoarthritis from other hand osteoarthritis cases and determine how to assess and treat them.
• Identify the appearance on radiographs and treatment of the various finger dislocations.
• Discuss how diagnostic imaging can help identify disease progression and symptoms in patients suffering from rheumatoid arthritis in the hand.
• Explain the most likely hand injuries in the child and athlete and the treatment options for each.

• Examine the appearance and use of plain film, computed tomography (CT), and magnetic resonance imaging (MRI) in the evaluation of bullets to the head.
• Identify Arnold-Chiari Type I malformation with magnetic resonance imaging.
• Review CT, positron emission tomography (PET), and MRI findings for cerebral bleeds.
• Evaluate stroke using different types of CT and MRI imaging.
• Discuss what to look for clinically and radiographically in cases of child abuse induced head trauma.

• Conduct and evidence-based assessment of the diagnostic, therapeutic and clinical utility of routine and repeat radiographs (without red flags) for the structural and functional assessment of the spine by chiropractors
• Summarize the current evidence for the use of spinal x-rays within chiropractic practice, with consideration to the related risks and benefits
• Determine if diagnostic imaging influences clinical outcomes in patients with low back pain presenting for chiropractic care
• Analyze whether an association between vertebral endplate structural defects and back pain exists
• Assess the relationship between movement-related pain in the shoulder and the number or severity of rotator cuff MRI findings

Hour 1

• Select the appropriate imaging modality for suspected foreign bodies
• Identify foreign bodies on radiographs
• Identify foreign bodies CT
• Identify foreign bodies MRI
• Identify foreign bodies Ultrasound

Hour 2

• List various indications for radiographic evaluation in relationship to specific clinical scenarios
• List various limitations for radiographic evaluation in relationship to specific clinical scenarios
• Identify fracture patterns on radiographic imaging
• Identify radiographic abnormalities within the soft tissues

 Hour 3

• List various indications for MRI and CT imaging evaluation in relationship to specific clinical scenarios
• List various limitations for MRI and CT imaging evaluation in relationship to specific clinical scenarios
• Identify osseous landmarks on MRI and CT imaging
• Identify abnormalities within the bones and soft tissues on MRI and CT imaging

 Hour 4

• List various indications for ultrasound imaging evaluation in relationship to specific clinical scenarios
• List various limitations for ultrasound imaging evaluation in relationship to specific clinical scenarios
• Identify osseous landmarks on ultrasound imaging
• Identify abnormalities within the bones and soft tissues on ultrasound imaging

Hour 1

• Identify the radiographic features which aid in lesion recognition, to distinguish between benign or aggressive skeletal neoplasia.
• Expand overall radiographic interpretation skills with respect to diagnosis of benign skeletal neoplasia.
• Assess a variety of benign skeletal neoplasia for clinical significance, by reviewing which ones are merely incidental findings.
• Recognizing those benign conditions which possess malignant potential, by gaining familiarity with the clinical and radiographic changes that suggest malignant degeneration.
• Apply improved patient management when patients present with these conditions.

• Review the radiographic features which aid in lesion recognition, to distinguish between benign or aggressive skeletal neoplasia.
• Expand overall radiographic interpretation skills with respect to diagnosis of primary versus secondary (metastatic) malignant skeletal neoplasia.
• Assess a variety of primary malignant skeletal neoplasia for radiographic identification and clinical significance.
• Study metastatic disease as it relates to the skeleton, including lytic and blastic varieties, common sites of involvement, methods of spread, and the various primary carcinomas which tend to metastasize to bone.
• Employ improved patient management when patients present with these conditions.

• Define common fracture types and describe their radiographic characteristics.
• Describe fracture orientation and spatial relationships used in radiographic interpretation and documentation of skeletal trauma.
• Explain mechanisms and radiographic features associated with common joint dislocations.
• Outline stages of fracture repair and factors that influence the rate of bone healing.
• Analyze potential complications of fractures and their clinical implications.
• Compare mechanisms and radiographic presentations of traumatic injuries affecting the axial and appendicular skeleton, with an emphasis on anatomical regions.