Washington Chiropractic Assistant Education and Continuing Education

• 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

• 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

• 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

• 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

• 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.

• 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

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

• Understand how x-rays are produced
• Prepare a patient to have an x-ray examination
• Recognize basic x-ray terminology
• Recall patient positioning and x-ray projection terms
• Recognize new advances in the radiology field
• Visualize the basic positioning of the views discussed
• Identify x-ray machine components
• Describe particular views that make up an x-ray series
• Recall general anatomy that will be seen on a certain view
• Discuss the x-ray technique of the views described

• Demonstrate the basics of a radiographic shoulder series
• Understand the positioning of the elbow joint
• Recognize possible wrist injuries based on patient history
• Recall positioning of hand, fingers and thumb radiographs
• Summarize chest x-ray basics
• Identify the views in a hip series
• Demonstrate the positioning of the knee joint in a radiographic series
• Understand the basics of ankle x-rays and injuries
• Recall the positioning for x-rays of the foot and toes
• Summarize the general anatomy of the lower extremities

• Discuss safety measurements when taking x-rays
• Review mistakes to Avoid when Taking Radiographs
• Outline tips for Taking Optimal Radiographs
• Discuss proper darkroom technique
• Address safety measurements