CNS, Endocrine and reproductive system

Question 1

Myelogram: Purpose and Contrast

Answer 1

Purpose:
To visualize and examine the spinal cord and its nerve root branches

Contrast is injected into the subarachnoid space
(intrathecal); iodinated, water-soluble contrast

Question 2

Myelogram: indications and contraindications

Answer 2

Indications
*Suspected lesion
Herniated disc (most common lesion)
Neoplasm
Arm or leg numbness, weakness, or pain. 
Spinal stenosis
Infection
Inflammation of meninges

Contraindications
Increased intracranial pressure
Bleeding disorders
Contrast allergy
Seizures
Meningitis
Blood in CSF
Recent lumbar puncture (within 2 weeks)

Question 3

Myelogram: procedure

Answer 3

Procedure:
Preliminary films of the spine are done if the patient has not had recent ones.
The radiologist explains the exam to the patient and has the patient sign a consent form for the procedure.
The myelogram tray is prepared

The pt. is prone on the table with pillows under the abdomen

Put a small sponge under the pt’s head (prevents contrast from entering cranium).

The radiologist inserts the needle under fluoro

CSF may be collected and sent to the lab (allowed to drain from connecting tube into vial, never withdrawn)

Contrast is injected, spinal needle removed & images are taken.

Question 4

Myelogram: supplies

Answer 4

SUPPLIES:
Isovue 200- 20 ml (lower osmolality to avoid osmolarity) 
Disposable myelogram tray
Surgical gloves
Steri-stat / betadine
Syringes
Spinal needle 25g 

Consent form
Lab requisitions (if samples taken)
Shoulder braces, foot rest/ankle restraints
Grid/cassettes for HRLs

Question 5

Myelogram: post procedure

Answer 5

The patient is instructed to keep head at least 300 upright for 24-48 hours

Adverse reactions:
Mild reactions which may occur during or shortly after injection are:
Nausea
Vomiting
Feeling of warmth
Metallic taste
Faintness
Sweats
Headache
Dizziness
Fever

May have severe headache lasting up to 48 hours.

Question 6

Lumbar Myelogram

Answer 6

Prone
Puncture at L3-L4

Imaging:
PA
HRL (may be semi-erect)
Also may do AP and/or obliques
Correct markers

Question 7

Cervical Myelogram

Answer 7

Shoulder braces
Pt.’s neck hyper-extended
Puncture: L3-L4 (or at C1-C2 if necessary)

Imaging
HRL/ Swimmer’s HRL
Also may do obliques

Question 8

Post Myelogram CT

Answer 8

Shows the size, shape and position of the spinal cord and nerve roots

Beneficial for compression injuries, dural tears and leaking CSF.

Question 9

Parathyroid Gland

Answer 9

Four glands on the posterior thyroid

Regulates calcium level; causes calcium to be drawn from bones if blood levels require it

Pathology
Hyperparathyroidism
Radiographs to check for calcium loss, KUB to demonstrate any renal stones

radiographic presentation: salt and pepper skull, subperiosteal resorption, or brown tumors?

Question 10

Thymus

Answer 10

Primary organ of lymphatic system
Located in mediastinum between lower border of thyroid and 4th costal cartilage; anterior to trachea and great vessels
Largest at age 2
Atrophies into fat tissue after puberty

Pathology
Abnormal enlargement
Hodgkin’s disease