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Chap19 Special Pro
Procedures 2 - Special Procedures
| Question | Answer |
|---|---|
| 2 most common arthrograms | shoulder and knee |
| contraindication of knee arthrography | allergic to an iodine based contrast or local anesthetics |
| _____ contrast study is most common for knee arthrography | double. (radiolucent and radiopaque iodinated water soluable) |
| When the contrast is injected, why is the knee gently flexed? | produces a thin and even coating of the soft tissue |
| ___ mL of positive and ____ mL of negative for knee arthrography. (_____ contrast is injected first) | 5, 80-100. Positive- water soluable iodinated |
| (Knee) during fluoro, closely collimated veiws of each meniscus are taken rotating the leg about ___ degrees between exposures. Result is ____ spot images of each meniscus | 20 degrees, 9 |
| Arthrography of shoulder demonstrates what 4 things | joint capsule, rotator cuff, long tendon of the biceps muscle, articular cartilage |
| A double-contrast study is often preferred to demonstrate specific areas better (shoulder arthro) such as the ______ portion of the _____. | inferior portion of the rotator cuff |
| what is the rotator cuff? | conjoined tendons of four major shoulder muscles |
| ____-__ mL of positive contrast for single shoulder arthros, __-___ mL of positive and ___-___ negative for double studies | 10-12. 3-4 positive and 10-12 negative |
| The injection site, directly over the shoulder joint, is preped and a spinal needle __-___ inches must be used | 2 3/4ths to 3 1/2 inches |
| Typically, _______ contrast agent is used for CT and ____ for MRI | iodinated water soluble, gadolinium |
| When is T-Tube cholangiography performed? Why? | after a cholecystectomy, check for residual stones in the biliary ducts |
| Other than checking for residual stones, what else is a clinical indication for T-Tube cholangiography? | region of biliary ducts may bave been narrowed called a stricture |
| 3 contraindications for T-tube cholangiography? | hypersensitivity to iodinated contrast, acute infection of the biliary system, elevated creatinine or BUN (same as ERCP except this doesnt have issue with pseudocysts) |
| T-tube choleangiography, Pt should be in gown and be NPO for ____ hours before procedure. | 8 |
| T-tube shaped catheter inserted into the ___ duct during the cholecystectomy. | common bile |
| ERCP stands for | endoscopic retrograde cholangiographic pancreatography |
| Deuodenoscope is commonly used for ERCP, its first inserted into the duodenum through the mouth, its useful for locating and inserting a catheter/cannula into the ________ sphincter, leading from the duodenum into the common bile and main pancreatic ducts | hepatopancreatic |
| ERCP is performed frequently for examination of the | biliary and main pancreatic ducts |
| ERCP can be a diagnostic or ____ procedure | theraputic |
| Therapeutically, ERCP relieves pathological conditions by | removal of choleliths or small lesions, repair a stenosis (narrowing or blockage of duct) of the hepatopancreatic sphincter or other ducts |
| Diagnostically, ERCP includes endoscopic and catheterization into common bile or pancreatic duct, followed by ______ injection. Usually is performed by a ________. | retrograde, gastroenterologist |
| Contraindications for ERCP. 4 | Iodine sensitivity, acute infection of biliary system, possible pseudocyst of pancreas, elevated creatinine or BUN. (same as T-tube except added pseudocysts) |
| Why dont you perform an ERCP if patient has possible pseudocyst? | injecting contrast into a pseudocyst may lead to repture, producing infection. |
| ERCP. Pt should be NPO for how many hours before procedure? How many after? | 8, 1 |
| Hysterosalpingiogram primarily demonstrates what | uterus and uterine tubes |
| Female reproductive organs are within the ___ pelvis | true |
| Uterus central in female pelvis, bordered posteriorly by ______ and anteriorly by ______ | rectosigmoid colon, bladder |
| Uterus is subdivided into 4 | fundus, Corpus (body), isthmus, cervix (neck) |
| the narrow constricted segment that joins the cervix at the internal os, is the | isthmus |
| ___ is the distal portion that projects into the vagina, ending as the _____ | cervix, external os |
| Inner middle and outer layer of uterus | endometrium, myometrium, serosa |
| Uterine/fallopian tubes communicate with the uterine cavity from a superior lateral aspect between the body and ____. This region is termed | fundus, cornu |
| Uterine tube length | 10-12 cm (1-4mm in diameter) |
| Uterine tubes subdivided into 4 segments | interstitial, isthmus, infundibulum, ovarian fimbria |
| _______ division of uterine tube contains finger like projections called _____, one of which are attached to each ovary | infundibulum, fimbriae |
| Hysterosalpingiogram (HSG) best demonstrates the uterine cavity and the ____ of the uterine tubes | patency. (openness) |
| Clinical indications for for HSG for infertility assesment? | Performed to dx functional or structural defects. Can be therapeutic (injection of contrast may dilate, straighten, or unblock a uterine tube) |
| Clinical indications for HSG for demonstration of pathology? | abnormal bleeding, pelvic pain/fullness, lesions, polyps, masses, spontaneous abortions. Also eval of uterine tube after tubal ligation or reconstruction |
| Contraindications for an HSG? | pregnancy, acute pelvic inflammatory disease, active uterine bleeding |
| Pt prep for HSG | possibly bowel prep (laxatives, enema...), pain reliever before because it causes cramping, empty bladder immediately before. |
| Why should pt empty bladder before HSG? | prevent displacement of uterus and uterine tubes |
| What is a tenaculum and what exam is it sometimes used for | instrument with hooked clamp for gathering and holding tissues in place, for HSG |
| two categories of radiopaque iodinated contrast that could be used in HSG | water soluble iodinated (preferred) but this causes pain when injected into uterus, may last several hours. Oil-based used to be used. (has a slow absorption rate and risks an embolus that could reach lungs) |
| Beginning or HSG, pt lies supine on the table in the ______ position. Pt is draped with sterile towels, the vaginal walls/cervix are cleansed. A cath w/ balloon is inserted preventing ..... | lithotomy. preventing contrast from flowing out of cavity once injected |
| When cath is inserted for HSG, physician may remove the speculum and place the pt in a slight ________ position to help fill the uterine cavity | trendelenburg |
| IF the uterine tubes are open, contrast flows from the distal ends of the tubes into the | peritoneal cavity |
| Typically, for an HSG, scout images are obtained, then during injections, and maybe more after injection. Pt often remains supine, but images be obtained in ____ or _____ | LPO or RPO |
| A myelogram is | study of the spinal cord and its nerve root branches that employs a contrast |
| 2 most common areas a myelogram is done of | lumbar and cervical |
| clinical indications of a myelogram.. 4/5 | lesions (impingement on cord.. pain/numbness in upper/lower limbs). Lesions commonly demonstrated are herniated nucleus pulposus, tumors, cysts, bone fragments |
| 4 contraindications of a myelogram | blood in CSF, arachnoiditis, intracranial pressure, recent lumbar puncture (within 2 weeks) |
| to reduce anxiety for a myelogram, pt may be given a sedative or relaxant injection ____ before exam | 1 hr |
| Contrast used for myelogram? | nonionic water soluble iodine based. |
| myelogram: absorption of contrast begins about ____ after injection. Good radiopacity evident up to about ____ hr(s) after injection. After _____ hr(s) contrast has a hazy effect. Radiographically undetectable after ____ hrs | 30 mins, 1 hr, 4-5 hrs, 24 hrs |
| Generally, a range of __-___ mL of contrast is used in a myelogram | 9-15mL |
| During exam of cervical area with the pt prone or trendelenburg, how should the pts head be positioned? | chin extended to prevent contrast from flowing into the cranial region of the subarachnoid space |
| 2 locations of myelogram puncture sites | lumbar L3-4, cervical C1-2 |
| When would you use the C1-2 site for a myelogram? | If lumbar area is contraindicated, or if a pathologic condition indicates complete blockage of the vertebral canal above the lumbar area that would prevent contrast flow to upper part |
| two body positions generally used for lumbar puncture | prone, with pillow under abdomen to flex spin, or left lateral with spine flexed. |
| Why do you want the spine flexed for a myelogram | widens the interspinous space, where the spinal needle is introduced |
| Cervical region myelogram: 2 positions? Thoracic? Lumbar? | C- horizontal beam lateral & swimmers lateral horizontal beam. T- Right and left lat decub (AP or PA) & Right OR left lateral vertical beam. L- semierect lateral horizontal beam |
| Horizontal beam lateral for cervical myelogram: pt position and CR | prone, arms extended down sides, chin is extended (on sponge or linen), CR at C4-5 |
| Swimmers for a myelogram: pt position and CR | prone, chin extended. For a right lateral, right arm is extended alongside body, left arm is flexed up toward head. CR @ c7 |
| Thoracic right lateral decub position and CR | true right lat, right arm flexed above head, left arm extended along body. CR @ T7. |
| Why use a water soluble media for myelogram? | absorbs by vascular system and is excreted by kidneys |
| Why use decub positions for T spine myelogram radiographs? | contrast is known to pool if pt is supine.. best visualizion if they are in decub |
| Lumbar region semierect lateral: pt position and CR | prone, arms flexed above head (like superman), table is semierect? angle helps concentrate contrast in lumbar region, CR @ L3 |
| myelogram may be used in conjuction with | CT |
| Orthoroentgenogram literally means "_____" | "straight or right-angle radiograph" |
| Orthoroentgenogram is performed with a straight or right angle CR to radiograph... | the long bones without magnification to obtain accurate and comparative long bone measurements |
| Orthoroentgenogram is performed on adults and more commonly children for | leg length discrepancies |
| epiphysiodesis is | Limb shortening operation |
| Orthoroentgenogram of a limb usually has ___ exposures on one radiograph, CR centered to ____, ruler placed beside limb | 3, joints |
| Lower limbs are commonly performed on each limb separately so the CR is more centrally located. Some references suggest that if the limb discrepancy is greater than ___, limbs should be done separate. | 1 inch |
| * type of ruler used for Orthoroentgenogram | bell-thompson type with radiopaque markings |
| T or F. For Orthoroentgenograms it is important that neither the limb or ruler be moved between exposures | true |
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Zoest35
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