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Arthrography Week 2

Arthrography Week 2 RT 72

What is Arthrography? A radiographic image of a joint space and its surrounding structures
What are indications for arthrography? What are the traumatic ones and pathologic? A patient has symptoms that cannot be diagnosed with x-ray's. Tears of joint capsule, menisci, or ligaments are traumatic. Bakers Cyst is pathologic.
What are some of the joint structures that show up on arthrography? Menisci, Ligaments, Articular Cartilage, Bursae.
What is Pneumoarthrography? Arthrography performed with negative contrast in the joint space (usually air or gas)
What is Opaque Arthrography? What type of contrast is used? Arthrography performed with positive contrast. With water soluble contrast, either ionic, or non ionic.
What is dual contrast arthrography? What type is injected first. Why is this? A combination of positive & negative contrast. Positive contrast is injected first, then negative contrast. The negative contrast pushes the positive contrast to the outside of the joint capsule.
What are possible reactions to the contrast for arthrography? Vasovagal reactions, allergic reactions, infection.
Why is the scout film taken for knee arthrography? To verify patient position, for openness of joint to verify tube angle. Baseline to verify technique based on pathology & to verify there's no fracture.
Why is the small amount of contrast injected under fluoroscopy? To verify the needle is in the correct place, make sure the contrast is going in the joint space.
If there's swelling at the joint what must be done and why? Synovial fluid must be removed to avoid dilution of contrast media.
For knee arthrography what technique is used for spot films. Why is this? low kVp with a small focal spot. Are checking for tears, not bone, so want long scale contrast.
For knee arthrography where is the ace bandage wrapped and why? Where should the contrast concentrate> The ace bandage is wrapped around the knee & slightly above it. It keeps the contrast in the joint & the contrast collects in between the Tibia & Femur.
Why is the knee exercised for 30 seconds after contrast injection for knee arthrography? To disperse the contrast around the joint structures.
For knee arthrography, which method uses the stretch device? Where is the stretch device placed for medial delineation? For later delineation? Vertical/Overhead Method. Stress device is placed lateral just above the knee for medial delineation & medial just above the knee for lateral delineation.
For knee arthrography, how many exposures are taken for the Vertical/Overhead method & how many degrees is the knee rotated? For the Horizontal method? Generally 9 exposures with 20-30 degree rotation between exposures for the vertical/overhead method. Generally 6 exposures & 30 degrees rotation between exposures, for the horizontal method.
For vertical/overhead method why is the leg placed in a stress device for knee arthrography? It permits better distribution of the contrast material around the knee.
What are the scout films taken for knee arthrography? AP, Lateral (possibly obliques & tunnel)
What type of contrast will be used for double contrast horizontal method for knee arthrography? Why is this? Double contrast. Improves delineation of joint structures.
How much contrast, what size syringe, what size needle is used for knee arthrography for positive contrast? What size syringe is used for double contrast? 10 ml syringe, 20 gauge needle, 5 ml contrast. For double contrast a 50 ml syringe.
Why is hip arthorgraphy commonly performed in adults? To detect loose hip prosthesis, or confirm presence of infection.
Why is Barium Sulfate used as cement additive to fasten hip prosthesis? To make the cement bone interface visible.
Why is subtraction used on the films of hip arthrography? Contrast medium is readily distinguished by subtraction.
Why is hip arthrography commonly performed on children? Evaluation prior to and after treatment of congenital hip dislocations.
Where is the common puncture site for hip arthrography? 3/4" distal to inguinal crease & 3/4" lateral to palpated femoral pulse.
What type of needle is used for the injection on hip arthrography? Why this size? The spinal needle. Need a pretty long needle to get in to the hip joint.
What are the 4 aspects of the shoulder anatomy demonstrated on shoulder arthrography? Joint capsule, long tendons of the Biceps Musle, Rotator Cuff, Articular Cartilage.
What is the name for the 4 major conjoined tendons in the shoulder? Rotator cuff
What are the overheads for the shoulder arthrography. AP scout, AP internal & external rotation, 30 degree oblique, Axillary (Inferosuperior), Bicipital Groove, Glenoid Fossa
What are the clinical indications for shoulder arthrography? Rotator cuff or Glenoid Labrum abnormalities, Persistent pain or weakness, Frozen shoulder.
Where is the injection site for shoulder arthrography? What size needle is used? How much contrast is used for single contrast & double contrast? about 1/2" inferior & lateral to coracoid process. a 2 1/2" to 3 1/2" spinal needle. 10-12 ml positive contrast for single contrast. 3-4 ml positive contrast & 10-12 ml negative contrast for double contrast.
What may result in abnormalities of TMJ? Trauma. Stretched or loose posterior ligament.
Where is the injection site for TMJ arthrogram? How much contrast is used? 1/2" anterior to tragus of ear. About 0.5 ml to 1.0 ml of positive contrast.
What are the preliminary tomograms for TMJ arthrography? open & closed mouth.
Created by: jamestkelley