Montana Naturopathic Physician Continuing Education

Hour 1:    Anatomy Review 

• Emphasize the unique anatomy of the cervical spine as related to spinal trauma.
• Point out the importance of the uncinate process joints as related to disc herniation, the nerve root, the vertebral artery, and the spinal cord.
• Explain how cervical spine injury may manifest clinically as low back and leg pain.

Hour 2:    Define Sleep Hygiene

• Explain the role for sleep and sleep’s influence on the ability to safely operate a motor vehicle.
• Summarize the influence of sleep on brain neurochemistry.

Hour 3:    Awareness and Soft Tissue Injury

• Explain the influence of awareness on an impending collision and the muscles ability to protect joints.
• Explain how being “caught by surprise” by a collision is related to a poor prognosis for full recovery.

Hour 4:    Whiplash History

• Summarize the history of whiplash injuries, including mechanical mechanisms, biological mechanisms, pathology, diagnostics and management.
• Define the issues that the early whiplash literature got wrong.
• Emphasize the issues that early whiplash literature got correct.

Hour 5:    Whiplash Today

• Summarize recent advances in the understanding of whiplash injuries, emphasizing anatomy, diagnostics, pain production and pain suppression.
• Integrate whiplash trauma, chronic pain, and chiropractic care.

Hour 6:    Low Speed Collisions and Minor Vehicle Damage

• Point out the mathematics of how a low speed vehicle to vehicle collision can result in passenger injury.
• Explain why vehicle damage should not be used as a proxy for passenger injury.
• Integrate the concepts of awareness, rotation, and pre-accident spondylosis in injury magnitude and prognosis.

Hour 7:    Soft Tissue Injury and Repair

• Define the three phases of soft tissue healing and point out the time sequence for each phase.
• Justify the clinical interventions that have a positive therapeutic influence on each phase of soft tissue injury healing.
• Emphasize the concept of motion in the healing of injured soft tissues, especially spinal adjusting (specific manipulation) motion.
• Quantify acute injury and ultimate recovery(prognosis) by using measurement outcomes.

Hour 8:    Treatment Duration, Frequency, and Prognosis

• Summarize the biology and published data on treatment frequency and duration for whiplash spinal trauma.
• Point out published studies relating to recovery and prognosis.
• Reference the incidence of acceleration of spondylosis in long-term studies following a whiplash injury.

Hour 1:     Low Back and Leg Pain Following Whiplash Injury

• Point out the probable mechanisms for direct injury to the lower back during motor vehicle collisions.
• Distinguish between radiculopathy, neuropathy, and sclerogenic referral of extremity pain.

Hour 2:     Whiplash Injury and the Vertebral Artery

• Review the anatomy of the vertebral-basilar vascular systems.
• Distinguish between the anterior and posterior circulation.
• Summarize the signs and symptoms of a cervical spine vascular injury.
• Solidify the knowledge as to when the suspected vascular injury patient should be referred to diagnostic imaging or emergency services.

Hour 3:     Whiplash Injury and Traumatic Brain Injury

• Explain the differences between a blow brain injury and an inertial brain injury.
• Define the pathoanatomic and patho-biochemistry of traumatic brain injury.
• Justify clinical interventions that have a positive therapeutic influence on traumatic brain injury.

Hour 4:     Cervical Disc Herniation

• Point out the anatomical differences between lumbar and cervical discs.
• Explore the pathoanatomical and therapeutic differences between lumbar and cervical discs lesions.

Hour 5:     Examinations and Evaluations

• Explain the minimum examinations that should be performed.
• Explain the minimum requirements for charting the daily patient contact.

Hour 6:     Informed Consent

• Define the legal requirements for informed consent for chiropractic care.
• Review common entities for an informed consent and the rational for each.

Hour 7:     Reports

• Make recommendations for re-evaluations.
• Make recommendations for interim reports contents.
• Explore common academic terminology and concepts in effective report writing.

Hour 8:     Testimony

• Distinguish between a percipient witness and an expert witness.
• Explain what a subpoena is and what it means to the treating chiropractor.
• Explain what a deposition is for the treating chiropractor. Summarize the basic rules of a treating expert deposition.
• Summarize the mechanics of a personal injury trial from the perspective of the treating chiropractor.

Hour 1 

• Point out the probable mechanisms for direct injury to the lower back during motor vehicle collisions.
• Distinguish between radiculopathy, neuropathy, and sclerogenic referral of extremity pain.

Hour 2 

• Define the parameters for cervical and lumber spine central canal stenosis.
• Utilize both the Torg/Pavlov and the ratio radiographic methods for assessing cervical spine central canal stenosis.
• Explain the critical relationship between central canal stenosis and hyperextension spinal injuries.
• Demonstrate a practical method for the clinical assessment of cervical spine central canal stenosis.

Hour 3

• Identify differences seen between a blow brain injury and an inertial brain injury.
• Define the pathoanatomic and patho-biochemistry of injury.
• Explore the relationship between cervical spine injury and TBI

Hour 4

• Discuss the concept of how the systemic inflammatory profile affects local injury.
• List 8 systemic inflammatory factors that should be considered and co-managed on whiplash-injured patients.

Hour 5 

• Discuss the anatomy of the thoracic outlet.
• Demonstrate a management protocol for thoracic outlet syndrome.
• Define cervical angina.
• Demonstrate the single most important test to distinguish cervical angina

Hour 6

• Draw the anatomical basis for cervicogenic headache.
• Integrate cervicogenic headache and the temporomandibular joint (TMJ).
• Define inertial injury and the TMJ articulation.
• Demonstrate a practical assessment and management of TMJ injury.

Hour 7

• Distinguish between a percipient witness and an expert witness.
• Explain what a subpoena is and what it means to the treating chiropractor.
• Explain what a deposition is for the treating chiropractor. Summarize the basic rules of a treating expert deposition.
• Summarize the mechanics of a personal injury trial from the perspective of the treating chiropractor.

Hour 8 

• Demonstrate a typical soft tissue direct examination.
• Show the two most common drawings to support chiropractic care for soft tissue injuries.

• Recite exercise guidelines and recommendations by the ACSPPSE, HHS and ACOG
• Outline and describe 6 benefits of exercise during pregnancy
• Describe 4 maternal physiologic changes that occur during pregnancy
• Describe 3 physiologic changes associated with exercise during pregnancy
• List 5 relative and 5 absolute contraindications to exercise during pregnancy
• Describe 2 fetal outcomes associated with maternal exercise during pregnancy

• Review anatomy and physiology of the female patient
• Perform Physical Examination procedures unique to the female patient
• Identify conditions unique to the female patient that require referral to a Medical Doctor
• Discuss the presentation, evaluation, and management of conditions affecting women’s health within the scope of Chiropractic practice
• Discuss risk factors, screening and prevention recommendations with female patients
• Review nutritional supplementations that can augment conditions affecting women’s health within the scope of Chiropractic practice

Hour 1

• Illustrate the patterns behind disordered eating in female athletes.
• Distinguish differences in the hormonal cycle, and menstrual disturbances in different kinds of female athletes.
• Contrast the differences of evaluation and management of female athletes.
• Compare and contrast the chemically and structural differences between male and female athletes.

.Hour 2:

• List common female athletic injuries.
• Explain how to evaluate knee and lower leg injuries.
• Apply knowledge of muscle strength and hormonal differences to provide suitable training recommendations for a strength athlete.
• Explain nutritional deficiencies in female athletes.

 Hour 3:

• List the detriments in health and/or sports performance from lack of proper nutrition.
• Provide recommendations for appropriate nutritional guidelines for female athletes.
• Consider body composition, increase muscle mass, and improve overall sports performance of female athletes.

• This contains all courses with the educational objectives listed from Xray 103 through Xray 118

• Discuss a common origin of lumbar disc pain
• Describe the orientation of lumbar facet joints
• Identify the effect of lordosis on the position of the nucleus pulposis
• Establish how injuries of the annulus fibrosus can cause nerve root changes
• Identify the dynamic stenosis of the lumbar spine

• Identify anatomical structures of the knee involved with anterior knee pain
• Diagnose fat pad and bursitis syndromes
• Establish pathologies of the patellar tendon in adults and children
• Differentiate different causes of patellofemoral pain
• Match clinical syndromes of knee pain with radiological appearances

• Identify the general anatomy of the knee joint
• Develop an intimate knowledge of the anatomy of the menisci and ligaments of the knee using gross dissection and cross-sectional imaging
• Understand the functional anatomy of the menisci of the knee and define the type and grade of meniscal tears
• Establish the conditions discoid lateral meniscus and meniscal cyst and understand the spectrum of treatment available
• Identify what type treatment is available for meniscal injuries and when it would be prudent to reevaluate a post-op patient with new knee pain

• Outline the physical basis of magnetic resonance imaging
• Identify patients that are candidates for an MRI
• Recognize categories of pathology in the spine that are imaged well with MRI
• Recognize cases that require contrast
• List contraindications for an MRI

• Identify and classify injuries to the anterior cruciate ligament
• Diagnose and develop treatment for injuries to the posterior cruciate ligament
• Diagnose and develop treatment for injuries to the medial collateral ligament
• Diagnose and develop treatment for injuries to the lateral collateral ligament
• Describe and classify ostochondritis dissecans of the knee

• Differentiate ossification from calcification
• Identify the categories of ossification
• Differentiate myositis ossificans progressiva from myositis ossificans traumatica
• Discuss imaging utilization with regards to ossification
• Review common and uncommon entities predisposed to ossification or calcification

• Recognize and identify important key factors for interpreting plain film x-rays of the spine and pelvis
• Recognize important medical/legal issues regarding interpreting plain films of the spine and pelvis and be able to apply appropriate radiographic documentation requirements when charting x-ray findings in the medical record
• Identify, analyze and interpret normal and abnormal anatomical osseous structures, common congenital and acquired pathologies, common normal radiographic variants and soft tissue calcifications/structures of the cervical, thoracic, lumbar, lumbosacral spine and pelvis

• Alert your clinical consciousness to prevent complacency
• Explain ways to identify the most common aneurysms clinically and on x-ray in the abdominal aorta, thoracic aorta, and splenic artery
• Differentiate aneurysm from dissection and pseudoaneurysm

• Identify the source of metastatic lesions
• Determine an advanced imaging protocol once a metastatic lesion is found
• Discuss how to identify on radiographs the two most common primary malignancies of bone - multiple myeloma and osteosarcoma

• Discuss the fundamental role of trauma in musculoskeletal disease and the various diagnostic imaging techniques used to evaluate it
• Identify, describe, and classify fractures by both direct & indirect radiographic signs
• Review fractures of specific etiologies based upon imaging findings
• Evaluate fracture alignment issues, complications, and healing
• Identify non-accidental injury of childhood, as well as normal structures that mimic fractures

• Understand Osteoporosis - (risk factors, incidence, prevalence, morbidity, etc.)
• Understand the fundamentals of DEXA (dual-energy x-ray absorptiometry), the gold standard in bone density testing
• Explain how to interpret the results
• Investigate the advantages and limitations of DEXA
• Investigate the indications and contraindications for utilization of DEXA

• This contains all courses with the educational objectives listed in Xray 119, and, Xray 123 through 127

• Use plain film to identify imaging findings of common diabetic foot fractures
• Discuss foot ulcers and using diagnostic imaging to rule out secondary osteomyelitis
• Identify diagnostic imaging findings of neuropathic osteoarthropathy (Charcot foot)

• Explain the clinical presentation, physical examination findings, orthopedic tests, laboratory findings, and radiographic findings associated with ankylosing spondylitis
• Discuss the extraskeletal manifestations of ankylosing spondylitis
• Explain the similarities and differences between the spondyloarthropathies
• Discuss the surgical and pharmacological management
• Discuss treatment that promotes spine mobility including the chiropractic adjustment

• This contains all courses with the educational objectives listed from Xray 124 through 146

• Explain the origin and pathophysiology of gout
• Understand how to prevent and monitor gout
• Examine gout on plain film
• Determine the clinical presentation of gout
• Describe the differences between the crystal arthritides on plain film

• Describe the patients that are at risk for developing osteoarthritis
• Summarize the pathophysiology behind the disease
• Discuss what osteoarthritis looks like on plain film and which joints are most likely affected
• Discuss the use of advanced imaging in osteoarthritis
• Present the research on many conservative treatment options including: physiotherapy, physical therapy/exercise, diet, and acupuncture

• Describe the anatomy of the disc and what causes the disc herniation
• Discuss the clinical presentation and who is at risk for a disc herniation
• Explain the diagnostic imaging findings for the disc herniation patient
• Evaluate the treatment options for disc herniation patients

• Assess the clinical presentation and diagnostic imaging procedure for vertebral compression fractures
• Discuss the use of plain film, CT, MRI, and DEXA
• Discuss treatments for vertebral compression fractures
• Identify other causes of vertebral fractures
• Identify other fractures besides vertebral fractures

• This contains all courses with the educational objectives listed from Xray 129 to Xray 134

• Summarize the current literature on fracture prevention
• Discuss diagnostic imaging and treatment of hip fractures
• Evaluate common lower extremity fractures, including stress fractures
• Discuss common upper extremity fractures, including the Colle's fracture and stress fractures
• Demonstrate knowledge of fractures in special populations, including adolescents and the developmentally disabled

• Evaluate the plain film images of upper and lower extremity dislocations
• Determine the mechanism of action and clinical presentation for upper and lower extremity dislocations
• Summarize the treatment options for the different upper and lower extremity dislocation
• Use assessment tools to determine treatment outcomes for extremity dislocations

• Determine the risk of MRI procedures and gadolinium contrast agents with respect to children
• Discuss the consequences of ionizing radiation in plain film, computed tomography, nuclear medicine, and fluoroscopy
• Demonstrate procedures to lessen the consequences of diagnostic imaging and discuss alternatives to the riskier modalities

• Determine the risks of ionizing radiation on the fetus
• Demonstrate the usefulness and limitations of ultrasound with regards to the pregnant woman
• Analyze the appropriate usage of magnetic resonance imaging in fetal diagnoses

• This contains all courses with the educational objectives listed from Xray 133 through Xray 144

• Demonstrating the differences between pediatric fractures and adult fractures
• Looking at the red flags for reporting non-accidental trauma (child abuse)
• Identifying fractures in children with osteopenia
• Discussing common upper extremity and lower extremity fractures
• Assessing proper protocol in imaging pediatric fractures, namely the use of plain film, ultrasound, MRI and CT

• Identifying bone and joint uses for PET
• Discussing neurological uses of PET, focusing on Parkinson’s disease and Alzheimer’s disease diagnosis
• Demonstrating the oncology use of PET
• Comparing PET with other diagnostic imaging modalities

• Determine the skeletal manifestations of neurofibromatosis and Paget’s disease
• Assess the diagnostic features of someone with neurofibromatosis or Paget’s disease
• Identify benign and malignant tumors commonly associated with neurofibromatosis and Paget’s disease
• Discuss the pathophysiology of neurofibromatosis and Paget’s disease

• Order proper diagnostic imaging for the lumbar spine
• Determine appropriate imaging for various pediatric musculoskeletal complaints
• Use plain film imaging for extremity complaints
• Determine what advanced imaging is appropriate for different extremity pathology

• Identify common causes of back pain
• Assess pro and con of different imaging modalities related to back pain
• Identify imaging features that may relate to back pain
• Develop imaging strategy for back pain

• Recognize normal bony and soft tissue anatomy of the upper cervical spine.
• Describe the direct and indirect signs of cervical trauma.
• Identify the more common mimics to cervical spine trauma.
• Summarize specific traumatic conditions affecting the upper cervical spine and their imaging findings.
• Assess which traumatic conditions of the upper cervical spine are stable, which are unstable, and how to manage each.

• Determine the diagnostic imaging findings consistent with a diagnosis of emphysema
• Discuss the plain film findings of congestive heart failure and conservative treatment options for these patients
• Determine the stage of sarcoidosis on plain film
• Identify the most common mediastinal masses of the chest
• Analyze different diagnostic imaging manifestations of pneumonia

• Point out the anatomy of the upper cervical spine and associated regional anatomy as seen on the APOM
• Identify variants of anatomy on APOM, noting if they are clinically relevant in providing Chiropractic care
• Differentially Diagnosis pathology noted in the region
• Discuss the advantages and disadvantages of imaging modalities for the upper cervical spine and maxillofacial region

• Recognize the signs and symptoms of patients entering the chiropractic with flu and sinusitis that may mimic musculoskeletal conditions
• Identify radiographic features of sinusitis on standard chiropractic projections and differentially diagnose from other musculoskeletal conditions
• Identify radiographic features of flu on standard chiropractic projections  and differentially diagnose from other musculoskeletal conditions
• Examine basic treatment options within chiropractic scope of practice and when to refer

• Analyze the debate between ALARA and AHARS with respect to the allowable amount of artificial radiation
• Express the cost vs. benefit of using CT, the imaging modality with the highest radiation risk
• Understand the added risk of radiation consequences in children
• Identify the different types of ionizing radiation

• Assess cervical radiographs to identify the radiographic signs of lower cervical spine trauma, recognizing which views are most diagnostic.
• Recognize, differentiate, and classify cervical hyperflexion and hyperextension injuries with respect to spinal stability.
• Identify and describe the imaging findings of neural arch trauma in the lower cervical spine.
• Discuss and categorize the complications of lower cervical spine trauma.
• Summarize the gravity as well as the evolving imaging and management protocols of penetrating neck injury.

• Identify plain film features of abdominal pathology that may present in the Chiropractic office, with an emphasis on calcifications
• Differentiate cystic from solid mass lesions
• Classify vascular calcifications
• Recognize when calcifications need immediate medical referral

• Summarize the radiographic findings of simple compression fractures and discuss how spinal biomechanics predispose to their occurrence.
• Describe the radiographic signs and sequelae of burst fractures and differentiate them from simple compression fractures.
• Identify the imaging findings of Chance type fractures and discuss their most common complications.
• Recognize the common radiographic manifestations of posterior arch trauma.
• Categorize the different types of intervertebral disc lesions and summarize their imaging findings.

• Identify imaging modalities used in sports and musculoskeletal imaging
• List indications for advanced imaging in the athlete
• Explain why imaging of the weekend “athlete” could save your practice
• Integrate imaging into treatment plans
• Assess progress of care with imaging

• Examine common orthopedic hardware on plain film and what needs to be reported
• Explain Xray findings which require Orthopedic referral and the various options
• Determine when advanced imaging is appropriate and what modality to use
• Discuss possible complications when finding orthopedic hardware

Hour 1

• Examine common orthopedic hardware on plain film and what needs to be reported
• Explain Xray findings which require Orthopedic referral and the various options
• Determine when advanced imaging is appropriate and what modality to use
• Discuss possible complications when finding orthopedic hardware

Hour 2

• Discuss congestive heart failure: diagnosis, imaging, and treatment
• Understand the imaging and treatment of multiple myeloma
• Understand the nature of chronic obstructive pulmonary disease, specifically emphysema
• Evaluate the use of DXA in the diagnosis of osteoporosis
• Determining appropriate care for patients with osteoarthritis

Hour 3

• Determining common geriatric conditions that need special consideration in a patient assessment
• Identifying diabetic foot complications, specifically Charcot's foot
• Analyzing bone metastasis in the elderly, specifically carcinomas
• Understanding thoracic and abdominal aorta aneurysms and aorta dissections
• Explaining pneumonia, specifically community acquired pneumonia, from a clinical perspective

Hour 4

• Determining the risk factors, diagnostic imaging and pathophysiology of atherosclerosis
• Assessing patient risk for developing hip fractures
• Understanding prevention and diagnosis of lung cancer
• Identifying normal anatomy of the disc and what goes wrong in degenerative disc disease
• Reviewing common orthopedic hardware found in elderly patients

• Discuss congestive heart failure: diagnosis, imaging, and treatment
• Understand the imaging and treatment of multiple myeloma
• Understand the nature of chronic obstructive pulmonary disease, specifically emphysema
• Evaluate the use of DXA in the diagnosis of osteoporosis
• Determining appropriate care for patients with osteoarthritis

• Determining common geriatric conditions that need special consideration in a patient assessment
• Identifying diabetic foot complications, specifically Charcot's foot
• Analyzing bone metastasis in the elderly, specifically carcinomas
• Understanding thoracic and abdominal aorta aneurysms and aorta dissections
• Explaining pneumonia, specifically community acquired pneumonia, from a clinical perspective

• Determining the risk factors, diagnostic imaging and pathophysiology of atherosclerosis
• Assessing patient risk for developing hip fractures
• Understanding prevention and diagnosis of lung cancer
• Identifying normal anatomy of the disc and what goes wrong in degenerative disc disease
• Reviewing common orthopedic hardware found in elderly patients

• Explaining in layman’s terms the basics of cancer
• Determining prognosis when skeletal metastasis is found on plain film
• Identifying osteolytic versus osteoblastic metastasis on plain film and specifying what advanced imaging is appropriate based on the cancer’s radiographic appearance
• Exploring current literature on emerging treatment options
• Discussing pathophysiology of bone metastasis

• This contains all courses with the educational objectives listed from Xray 154 to Anatomy 158

Hour 1

• Describing common conditions affecting the middle aged adult, including the following: osteoarthritis, rheumatoid arthritis, disc herniations, Type 2 diabetes mellitus, and abdominal aortic aneurysms
• Observing diagnostic imaging related to each of the above conditions and determining the best imaging modality to use for the various conditions
• Determining appropriate prevention and ancillary treatments for the discussed conditions

Hour 2

• Analyzing obesity through assessment and intervention
• Discussing breast cancer diagnostic imaging and disease management
• Diagnosing and treating congestive heart failure
• Evaluating diagnosis and treatment options for the osteoporosis patient

• This contains all courses with the educational objectives listed from Xray 155 through Xray 165

• Outline the utility of bone scintigraphy in the pediatric population
• Summarize basic bone physiology & radiopharmaceutical dosing
• Discuss image acquisition and analyze scans for signs of pathology
• Identify common clinical indications for pediatric bone scintigraphy
• Recognize the various imaging phases of bone scintigraphy and their clinical utility

• Review the pathophysiology of spondylolisthesis
• Evaluate the two classifications of spondylolisthesis
• Classify transitional segments
• Determine necessity and efficacy of imaging of spondylolisthesis and transitional segments

• Differential diagnosis osteopenia and its relevance towards Chiropractic practice
• Identify imaging features of osteopenia
• Recognize ominous features of osteopenia
• Select appropriate chiropractic treatments for the osteoporotic patient

• Identify the risk factors for breast cancer – preventable and non-preventable.
• Determine appropriate diagnostic imaging for screening and breast cancer assessment.
• Investigate different CAM approaches to breast cancer prevention and symptom management.

• In plain film radiographs, identify the orthopedic hardware used to treat femur, humerus, tibia, and radius fractures.
• Discuss special situations for fracture repair, such as osteoporosis, metastasis, pediatrics, and obesity.
• Review various fracture risk assessment tools that can be used in clinical practice.
• Evaluate when various hardware such as screws, nails, and plates are utilized.

• Identifying vertebral characteristic features on plain film for the following diagnoses: Adolescent Idiopathic Scoliosis, Neurofibromatosis-1, Multiple myeloma, Paget's disease of bone, and vertebral compression fractures.
• Determining what advanced imaging might be warranted for each of the vertebral conditions.
• Describing general features of each condition such as incidence, clinical presentation and treatment options.

• Determine the incidence and the characteristics of different spine pathology.
• Demonstrate, with plain film radiographs and magnetic resonance imaging, characteristics of central nervous system tumors and metastasis, syringomyelia, disc herniation, and trauma.
• Identify clinical features and treatment for various spine pathologies.

• Understand the general features of the inflammatory arthritides
• Discuss the clinical presentation, radiographic features, and chiropractic treatments for Rheumatoid Arthritis
• Discuss the clinical presentation, radiographic features, and chiropractic treatments for Ankylosing Spondylitis
• Compare the two most common inflammatory arthritides – Rheumatoid Arthritis and Ankylosing Spondylitis – to the other diseases in this category
• Compare the inflammatory arthritides to the most common arthritide – osteoarthritis

• Differentiate Rheumatoid Arthritis from Ankylosing Spondylitis, the two most common inflammatory arthritides.
• Differentiate Rheumatoid Arthritis from Erosive Osteoarthritis, both hand arthritides.
• Differentiate Degenerative from Inflammatory arthritis.
• Differentiate Osteoarthritis from Gout, the most common arthritide and the most common metabolic arthritide respectively.

• Learn a systematic approach to feature identification of arthritis
• Identify radiographic features of arthritis
• Develop a differential diagnosis of arthritis
• Apply knowledge to classify unknown cases

• Determine the safety of surgical clips with magnetic resonance imaging
• Examine the safety and usage of computed tomography and magnetic resonance imaging for patients with embedded bullets or shrapnel
• Assess the major types of hip arthroplasty and the usefulness of computed tomography and plain film x-ray
• Utilize different diagnostic imaging modalities for analysis of spinal fusion
• Identify external fixators on plain film and advanced imaging

• Assess the signs of non-accidental trauma in infants.
• Identify the unique childhood fracture known as the greenstick fracture.
• Evaluate a young adult for potential cervical spine fracture after trauma.
• Determine the work-up of a middle-aged patient with a Colles’ fracture.
• Examine the osteoporosis vertebral compression fracture, and consider diagnosis, treatment, and prevention.

• Discuss the anatomy of the shoulder region
• Correlate imaging findings with physical findings
• Determine necessity and efficacy of imaging for shoulder pathologies
• Apply simple and effective treatments for shoulder pathologies

Hour one:

• Discuss overall picture of degenerative conditions of the spine
• Develop a differential diagnosis for arthritic conditions of the spine
• Discuss in detail the structural components of the disc
• Learn how the components are involved in the degenerative processes.

Hour two:

• Understand the standard nomenclature
• Classify disc lesions (herniations, etc.)
• Demonstrate types of disc lesions on imaging modalities (x-ray, MRI, CT and Myelogram).

Hour three:

• Demonstrate degenerative conditions on imaging modalities (x-ray, MRI, CT and myelogram)
• Discuss in detail degenerative conditions of the neural arch components
• Describe long term effects of degeneration (stenosis, spondylolithesis)
• Discuss marrow changes associated with degenerative conditions.

• Define QC and QA
• List parameters necessary for great x-rays
• Identify tests the doctor can do tomorrow
• Describe the QC darkroom procedures
• How to comply with state and federal regulations

• Identify common causes of non-traumatic compression fracture
• Identify some uncommon causes of non-traumatic compression fracture
• Describe types of compression fracture
• Differentiate benign and malignant compression
• Integrate radiologic findings into clinical care

• Identify imaging modalities used for head and neck imaging
• List imaging modalities available for neuro imaging
• Contrast and compare CT and MRI in brain imaging
• Indicate conditions suitable for advanced imaging
• Use advanced imaging to justify treatment and referral

• Develop and consistently use a complete search pattern for abdominal radiographs.
• Link the history and physical examination findings with the radiological abnormalities to arrive at a reasonable diagnosis or differential diagnosis.
• Identify the various soft tissue calcifications within the abdomen and state their clinical relevance.
• Know the indications for referral based on abnormal abdominal radiographic findings.
• Select appropriate imaging or other diagnostic procedures based on the history and physical examination.

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

• Systematically identify features of degenerative conditions of the spine.
• Identify and correlate x-ray findings with gross anatomy
• Distinguish types of degenerative changes of the spine
• Review gross anatomy of the spine

• 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.

• Discuss the essential anatomy of the foot and ankle
• List the potential mechanisms for ankle injuries
• Identify possible fractures sites for each mechanism of injury
• Outline examples of actual clinical cases

• Discuss the pertinent anatomy of the fore, mid and rear foot
• Differentially diagnose disorders of the fore, mid and rear foot pain
• Assess examples of representative imaging cases
• Quantify and assess different imaging modalities and gauge their use in evaluating foot pain

• Discuss the pertinent anatomy of foot and ankle of adult and pediatric patient
• Take alignment measurements of the foot and ankle
• Discuss the relevance of alignment measurements to practice
• Assess imaging examples of representative cases

• 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.

• Discuss the pertinent anatomy of the forearm, wrist and hand
• Differentially diagnose disorders of each location of the wrist
• Assess imaging findings of representative cases in the list of differential diagnosis
• Quantify and access different imaging modalities and gauge their use in evaluating wrist pain

• Discuss the pertinent anatomy of the forearm, wrist and hand
• Differentially diagnose disorders of each location of the wrist
• Assess imaging findings of representative cases in the list of differential diagnosis
• Quantify and access different imaging modalities and gauge their use in evaluating wrist pain

• 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

• Discuss meniscus anatomy with emphasis on collagen network.
• Identify how collagen network can predict the type of tear and imaging manifestations.
• State how root ligaments are involved in injury, pain and OA.
• Correlate certain types of meniscal dysfunction to clinical presentation

• Discuss the anatomy of hip and anterior pelvis.
• Diagnose dysfunction and pathologies of the hip and anterior pelvic structures.
• Order appropriate imaging and clinically correlate findings with conditions affecting the hip and anterior pelvis conditions.

• Recite statistics relative to bone lesions.
• Utilize the global approach to recognizing bone lesions.
• Recognize parameters of classifying bone lesions.
• Discuss examples of different classes of bone lesions.