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Positioning SUMMER 2015 > Special Procedures > Flashcards

Special Procedures Flashcards

1
Q

Arthrography

A

exam of the synovial joints and related soft tissue structures that employs contrast media

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2
Q

what are joints commonly examined

A

hip, knee, ankle, shoulder, elbow, wrist

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3
Q

what are the most common arthrogram procedures

A

shoulder and knee

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4
Q

what are the structures of major interest in knee arthro

A

joint capsule, menisci, collateral, cruciate and other minor ligaments

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5
Q

Knee Arthro

clinical indications

A 
mostly trauma 
tears in joint capsule 
tears or degeneration of menisci 
ligament injury 
bakers cyst
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6
Q

Knee Arthro

contraindications

A

hypersensitivity to iodine based contrast media or local anesthetics

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7
Q

what modality is bakers cyst best seen on?

A

ultrasound

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8
Q

Knee Arthro

patient prep

A

no dietary prep
procedure explained
advise of complications
signed informed consent form

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9
Q

Arthrogram tray

A

prep sponge, drapes, connector, needles, anesthetics, sterile gloves, razor, contrast, bandaid

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10
Q

radiolucent

A

room air

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11
Q

radiopaque

A

iodinated

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12
Q

Knee Arthro

what kind of contrast is used and how much

A

Double contrast study

5mL of positive and 80-100mL of negative (CO2 or air)

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13
Q

Knee Arthro

what type of approaches do physicians use for site of injection

A

retropatellar, lateral, anterior, or medial

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14
Q

Knee Arthro

fluoro imaging

A

20 degree rotation between each exposure

results in 9 spot images of each meniscus

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15
Q

Knee Arthro

overhead projections

A

entire articular capsule outlined

proper AP and Lateral positions

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16
Q

Shoulder Arthro

A

can be single or double contrast study that demonstrates joint capsule, rotator cuff, long tendon of biceps and articular cartilage

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17
Q

Shoulder Arthro

clinical indications

A

chronic pain
general weakness
tears in rotator cuff

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18
Q

rotator cuff

A

a group of four muscles and their tendons that wraps around the front back and top of the shoulder joint

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19
Q

shoulder Arthro

accessory equipment

A

standard arthro tray

spinal needle

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20
Q

shoulder Arthro

contrast media single contrast study

A

10-12mL of positive contrast media

NO negative contrast media

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21
Q

shoulder Arthro

contrast media double contrast study

A

3-4mL of positive contrast media and 10-12mL of negative contrast media

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22
Q

what contrast study for shoulder arthro BEST demonstrates the inferior portion of the rotator cuff

A

double contrast study with pt. in upright position

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23
Q

shoulder Arthro

suggested positioning routine

A

scout AP
internal/external rotation
glenoid fossa AKA grashey
transaxillary or fisk modification (intertubercular groove)

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24
Q

what contrast media is used for CT to follow

A

iodinated water soluble

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25
what contrast media is use for MRI to follow
Gadolinium
26
Biliary duct procedures
T-tube or dleayed, cholangiography | endoscopic retrograde cholangiopancreatography ERCP
27
T-tube/delayed purpose
performed if surgeon has concerns about residual stones in biliary ducts that went unsuspected during cholecystectomy
28
T-tube/delayed procedure
T-tube shaped catheter is placed in common bile duct during cholecystectomy. the catheter extends to the outside of the body T-tube is unclamped and drains excess bile into emesis basin syringe with adapter is attatched to t-tube iodinated contrast is injected under fluoro spot images taken and residual stones if detected may be removed
29
T-tube/delayed clinical indications
residual calculi | strictures (narrowing of biliary duct)
30
T-tube/delayed contraindications
hypersensitivity to iodinated contrast media acute infection of biliary system elevated creatinine or BUN levels
31
T-tube/delayed patient prep
NPO for at least 8 hrs prior to exam exam explained careful clinical history
32
why is the t-tube clamped off the day prior to the t-tube cholangiogram?
done as a preventative measure against air bubbles entering ducts where it might simulate stones.
33
what contrast media is used for t-tube/delayed
water soluble iodinated contrast media
34
what endoscope is commonly used for ERCP's
duodenoscope
35
ERCP procedure
endoscopic inspection, cannulation and injection of the biliary ducts with the use of a duodenoscope
36
ERCP purpose
to examine biliary and main pancreatic ducts | can be diagnostic or therapeutic
37
ERCP therapeutic procedure
removal of choleliths or small lesions | repair stenosis of spincter of oddi or associated ducts
38
ERCP diagnostic procedure
retrograde injection of contrast into biliary ducts usually performed by gastroenterologist
39
ERCP pathologic indications
residual calculi | strictures
40
ERCP contraindications
hypersensitivity to iodinated contrast media acute infection of biliary system possible pseudocysts of pancreas elevated creatinine and/or BUN levels
41
ERCP patient prep
NPO 8 hrs prior to exam NPO at least 1 hr after exam to prevent aspiration explain procedure
42
ERCP contrast media
iodinated water soluble contrast
43
ERCP injection process
endoscope introduced through mouth until it reaches hepatopancreatic ampulla catheter inserted into CBD and contrast injected
44
HSG
exam of the uterus and fallopian tubes after the injection of contrast
45
4 parts of uterus
1. fundus 2. body 3. isthmus (where uterus joins the cervix) 4. cervix
46
3 layers of the uterus
1. endometrium (inner) 2. myometrium (middle) 3. serosa (outer)
47
cornu
the region of the uterus where the uterine tubes communicate with the uterus
48
uterine tube divided into 4 parts
1. interstitial segment 2. isthmus 3. ampulla 4. infundibulum
49
purpose of and HSG
detects lesions such as polyps, fistulas and neoplasms shows patency of uterine tubes
50
HSG | clinical indications
infertility assessment demonstration of intrauterine pathology pelvic masses, fistulas, congenital defects, spontaneous abortions evaluation of uterine tubes after tubal ligation or reconstructive surgery
51
HSG | contraindications
pregnancy pelvic inflammatory disese active uterine bleeding
52
HSG | patient prep
``` proper bowel prep mild pain reliever empty bladder explain procedure consent form signed ```
53
HSG | contrast media
``` water soluble iodinated absorbed easily no residue in reproductive tract will cause pain *used to use oil based contrast media ```
54
HSG | scout image positioning
2 inches above pubic symphysis | additional images may be RPO/LPO
55
myelography
study of spinal cord and its nerve root branches that uses a contrast medium
56
a common lumbar puncture site for removal of CSF and injection of contrast is often performed between
L3 and L4 | some people do L2/L3 but is risky because Spinal cord ends at lower level of L1
57
3 layers of meninges
1. dura mater (tough mother) 2. arachnoid (middle menix) 3. pia mater (innermost)
58
epidural space
potential space between the dura mater and the inner table of the skull
59
trauma to the head can cause an
epidural hematoma
60
what is an epidural hematoma
an accumulation of blood between the skull and the dura mater
61
subdural space
thin space between the dura mater and arachnoid which contains interstitial fluid and various blood vessels can have a subdural hematoma
62
subarachnoid space
between the arachnoid and pia mater. | contains CSF
63
what areas of the spine are most common sites for myelography
lumbar and cervical
64
myelography | clinical indications
presence of a lesion that may be protruding into canal
65
myelography | pathology demonstrated
HNP (MRI used) cancerous or benign tumors (MRI used) cysts (MRI used) trauma (CT used)
66
what is the most common clinical indication for myleography
herniated nucleus pulposus
67
myelography | contraindications
blood in CSF arachnoiditis (inflammation of arachnoid menix) increased cranial pressure recent lumbar puncture (within 2 weeks of procedure)
68
myelography | patient prep
pt. may be pre medicated with a sedative 1 hour prior exam and possible complications explained informed consent signed
69
myelography | contrast media
best type is one that is miscible with CSF easily absorbed, non toxic and inert and has good radiopacity non ionic water soluble iodine based media is the best due to low osmalality approved for intrathecal injections
70
myelography | contrast media dosage
varies with concentration of medium | range of about 9-15mL
71
myelography | needle placement
lumbar L3-L4 | cervical C1-C2
72
what is the reason the cervical site would be used over the lumbar site during myelography
only if the lumbar site is contraindicated or a pathologic condition indicates complete blockage of vertebral area above lumbar area
73
2 body positions used for lumbar puncture
1. prone | 2. left lateral
74
cisternal puncture
erect C1-C2 level | prone with head flexed
75
cervical myelogram positioning
horizontal beam lateral swimmer's lateral horizontal beam additional : anterior obliques
76
thoracic myelogram positioning
right lateral decubitus left lateral decubitus right or left lateral vertical beam
77
lumbar myelogram positioning
semierect horizontal lateral horizontal CR to L3 additional: anterior obliques, or PA/AP
78
orthoroentgenogram
obtain accurate and comparative long bone measurements
79
orthoroentgenogram | what to do
immobilize extremity tape ruler to table no movement of extremity or ruler between exposures
80
orthoroentgenogram | clinical indications
back pain resulting from leg length difference developmental anomalies bone lengthening survey
81
is it more precise to do orthoroentgenograms bilaterally or unilaterally
unilaterally
82
orthoroentgenogram | procedure
3 exposures per IR CR centered to joint ruler next to limb
83
what is the ruler called that is used foe orthoroentgenograms
bell thompson ruler
84
orthoroentgenogram | lower limb measurement includes
AP hip CR centered to head of femur AP knee CR centered to knee joint AP ankle CR centered to ankle joint
85
orthoroentgenogram | upper limb measurement includes
AP shoulder CR centered to shoulder joint hand supinated AP elbow CR centered to mid elbow joint AP wrist CR centered to mid wrist
86
CT long bone measurement
hip to ankle knees true AP demonstrates bilateral lower extremity to include iliac crest and calcaneus

Positioning SUMMER 2015 (5 decks)

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