UNIT 4: Arthrography Flashcards
ANATOMY OF THE SYNOVIAL JOINT includes
Articular Capsule, Meniscus, Bursae
Articular Capsule
-Surrounds the joint
-Fibrous capsule: outer layer of fibrous tissue
-Synovial membrane: inner layer that produces the synovial fluid
Meniscus
pad of fibrocartilage located in some synovial joints that act as a shock absorber
Bursae
fluid-filled sacs located outside some synovial joints to reduce friction
ANATOMY OF THE KNEE
• Femur, tibia, fibula, and patella
• Held together by network of ligaments
-Posterior cruciate ligament
-Anterior cruciate ligament
-Tibial collateral ligament
-Fibular collateral ligament
• Lateral and medial menisci
What is ARTHROGRAPHY
Radiography of synovial joints utilizing an injection of contrast media into the joint capsule
ARTHROGRAPHY exam commonly performed in conjunction with MRI or CT
• Pneumoarthrography: injection of a negative contrast agent (air)
• Opaque arthrography: injection of a positive contrast agent (water-soluble iodinated solution)
• Double-contrast arthrography: injection of both negative and positive agents
- Demonstrates soft tissue structures within the joint capsule (ie: meniscus, ligaments, articular cartilage, and bursae)
Joints commonly examined:
• Shoulder (most common)
• Hip
• Wrist
• Knee
Arthrography Procedure: Supplies needed
Procedure performed under aseptic conditions in a standard R/F room
• Sterile tray
• Cleaning agent for skin
• Sterile syringes
• Needles for fluid draw
• Contrast media
• Lidocaine
• Needle for joint access
• Sterile gloves
• Sterile draping
• Sterile marker to mark the skin
• Sterile tubing
• Speciman vials
Arthrography Procedure: Radiographers role
• Room prepared prior to patient entering fluoroscopy suite
• Sterile tray and supplies set out
• Contrast media drawn up
• Console set to fluoro
• Protective curtain NOT USED for this exam due to interference with sterile field
• Bucky tray at the foot of the bed
• Footboard on the table if applicable
• Immobilization devices available
• CR Cassettes available if not DR digital
• Shielding available
• Prior imaging studies available
• Radiographer takes a complete history and explains procedure to the patient
• Patient puts on a gown and removes all foreign bodies from area of interest
• MRI/CT technologist may come in at this time and ask additional questions and explain their portion of the exam
• Informed consent obtained from the technologist and signed by the patient
• Patient positioned for procedure
• Radiologist enters the room and performs introduction and time out procedure
Time Out
Arthrography Procedure: Radiologists role
• Radiologist utilizes fluoroscopy to locate injection site and marks skin with a skin marker or sharpie pen
• Patient skin is prepped and draped in a sterile fashion
• Radiologist injects a numbing agent into the skin and muscle layer
• Fluoroscopy is used to guide a needle into the joint capsule of interest
• Confirmation of placement made with aspiration of clear joint fluid
• If infection is present, aspiration of the joint can be done at this time and specimens sent to the lab for diagnosis
• Contrast agent administered under fluoroscopy and digital spot films obtained
• Example cocktail: 5 mL lidocaine, 5 mL iodinated contrast agent, 4 mL saline, 1/10 mL Gadolinium (MRI contrast agent)
• If contrast leaks into tissue surrounding the joint, it is evidence of a tear in the bursae or joint supporting ligaments
• Needle removed and additional images obtained as the radiologist manipulates the limb and repositions the joint
• Patient escorted to MRI or CT for further imaging of the joint.
Knee Arthrogram Images
- Uses a stress device
SHOULDER ARTHROGRAM
-10 to 12 mL contrast injected
-Common Shoulder Projections:
-AP internal and external rotation
-30 degree oblique
-Axillary
-Tangential
Hip Arthrogram
Wrist Arthrogram
MRI Arthrogram
