Flashcards in Specialty Imaging PPT Deck (51)
What is the name of the procedure that examines the CNS structures situated within the vertebral canal?
Spinal cord and its _______ structures with the
use of contrast
Spinal Cord Review
Slender, elongated structure
Adult – 18” to 20” long
***Spinal Cord Extends from
brain (connects to medullaoblongata @ level of
foramen magnum) to space between _1st & 2nd_vertebra
Spinal Cord ends @
Spinal Cord connects to
31 pairs of spinal nerves
***Spinal Cord Most pathology and trauma occur in the
Cervical & lumbar areas of the spine
Myelograms are used to identify
– Level of pathological process
Inner sheath; adhere closely to spinal cord
Wide space separating arachnoid from pia mater
– Continuous with ventricular system of brain
– Ventricles & subarachnoid space contains cerebrospinal fluid
» CSF produced in ventricles
Delicate, central sheath
– Strong fibrous covering of brain and spinal cord
Separates dura from arachnoid space
– Does not communicate with ventricular system
***What are some of the indications for a myelogram?
-Extrinsic spinal cord compression caused by a herniated disk, bone fragment, cyst or tumor (Most common-HNP)
-Spinal cord swelling resulting from traumatic injury
-Identifies narrowing of subarachnoid space
***What are some of the contraindications for a myelogram?
-Blood within CSF
-Increased intracranial pressure
-Recent lumbar puncture (w/t 2 weeks)
***What contrast agent introduced in late 1970s for myelogram?
***Nonionic & water‐soluble contrast
– Provide visualization of nerve roots
– Readily absorbed by body
• _4-5_hours hazy effect; undetectable after 24 hours
Nonionic & water‐soluble contrast good enhancement for
CT of spine (follow‐up)
***What type of injection is used for a myelogram?
Store intrathecal injection separate from other contrast
***Where is the contrast for a myelogram commonly injected?
L2-L3 or L3-L4 interspace
Also @ cisterna magna between C1 & occipital bone
Most commonly used contrast agents for myelogram are
Using ionic contrast may
Severe & fatal neurotoxic reactions
***Lumbar Myelogram Procedure
Contrast (_9-12 mL) slowly injected
• Angulation of table for distributing contrast
– Erect to Trendelenburg
– Head fully extended
-Patient is monitored for 4 to 6 hours
• Patient’s head and shoulders elevated 30 to 45 degrees
• Bed rest for several hours
– Avoid strenuous activity for 72 hours
What are some common complications of a myelogram?
– Deformity in subarchnoid space
• Obstruction of passage of contrast within space
Myelogram Conus projection
– Demonstrates conus medullaris
– AP position with CR @ T12‐L1
***What is the name of the procedure for radiography of a joint or joints?
Radiologic examination of soft tissue structures of joints after injection of 1 or 2 contrast agents into capsular space
– Pneumoarthrography (gaseous)
– Opaque arthrography (water‐soluble iodinated)
– Double‐contrast arthrography (combination)
has reduced number of arthrograms
***What are the most frequent sites for an arthrogram to be performed?
Knee & shoulder
Hip, wrist & TMJ
***Images are taken for arthrogram
Fluoroscopy and conventional images
What are some common indications for a knee arthrogram?
*Tears of the joint capsule, menisci or ligatments (trauma)
*Baker’s cyst (nontrauma)
Purpose of knee arthrogram
Demonstrate and assess knee joint &
associated soft tissue
***What are indications for a shoulder arthrogram?
*Evaluation of partial or complete tear in rotator cuff or glenoidal labrum
*Persistent pain or weakness
***Where is the injection site for a shoulder arthrogram?
* ½ inch inferior and lateral to the coracoid process
* Spinal needle is used due to deep location of capsule
Shoulder Arthrogram Procedure
• Single contrast: 10 to 12 mL of contrast
• Double contrast: 3 to 4 mL of contrast along with 10 to 12 mL of air
Shoulder Arthrogram Projections
– AP (internal/external)
– 30‐degree AP oblique
Shoulder Arthrogram Increasingly performed with
– Injection of gadolinium contrast into joint capsule
CT follows double contrast arthrogram
Images obtained @ 5‐mm intervals
Wrist Arthrogram Indications
– Persistent pain
– Limitation of motion
Wrist Arthrogram Contrast is injected
– Dorsal wrist @ articulation of radius, scaphoid &
– 1.5 to 4 mL
Performed most often on children
– Evaluate congenital hip dislocation before &
***If performed on adults
– Detect loose hip prosthesis
– Confirm presence of infection
Cement used to fasten hip prosthesis components
– Barium sulfate added to cement (radiographically visible)
***Use SUBTRACTION technique
Injection site of Hip Arthrogram
¾” distal to inguinal crease & ¾” lateral to palpated femoral pulse
• Spinal needle
***What is the name of the radiologic procedure that examines the nonpregnant uterus, accessory organs and vagina?
***What are some indications for an HSG?
* Assessment of female infertility
* Size, shape and position of uterus & uterine tubes
* Delinate lesions (polyps, tumor masses or fistulous tracts)
* Patency of uterine tubes
***What are some contraindications for an HSG?
-Acute pelvic inflammatory disease
-Active uterine bleeding
***The HSG examination should be scheduled approximately
7 to 10 days after the onset of menstruation.
***What position will be the patient be placed in to facilitate the flow of contrast during an HSG?
Where should the contrast spill out into when performing an HSG?