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Hannah RAD III > Specialty Imaging PPT > Flashcards

Flashcards in Specialty Imaging PPT Deck (51):
1

What is the name of the procedure that examines the CNS structures situated within the vertebral canal?

Myelogram

2

Spinal cord and its _______ structures with the
use of contrast

Nerve

3

Spinal Cord Review

Slender, elongated structure
Adult – 18” to 20” long

4

***Spinal Cord Extends from

brain (connects to medullaoblongata @ level of
foramen magnum) to space between _1st & 2nd_vertebra

5

Spinal Cord ends @

L1-L2
Cornus Medullaris

6

Spinal Cord connects to

31 pairs of spinal nerves

7

***Spinal Cord Most pathology and trauma occur in the

Cervical & lumbar areas of the spine

8

Myelograms are used to identify

– Extent
– Size
– Level of pathological process

9

***Pia mater

Inner sheath; adhere closely to spinal cord

10

***Subarachnoid space

Wide space separating arachnoid from pia mater
– Continuous with ventricular system of brain
– Ventricles & subarachnoid space contains cerebrospinal fluid
» CSF produced in ventricles

11

***Arachnoid

Delicate, central sheath

12

***Dura mater

Outermost sheath
– Strong fibrous covering of brain and spinal cord

13

***Subdural space

Separates dura from arachnoid space
– Does not communicate with ventricular system

14

***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

15

***What are some of the contraindications for a myelogram?


-Blood within CSF
-Arachnoiditis (inflammation)
-Increased intracranial pressure
-Recent lumbar puncture (w/t 2 weeks)

16

***What contrast agent introduced in late 1970s for myelogram?

Water‐soluble
Nonionic Iodinated

17

***Nonionic & water‐soluble contrast

– Provide visualization of nerve roots
– Readily absorbed by body
• _4-5_hours hazy effect; undetectable after 24 hours

18

Nonionic & water‐soluble contrast good enhancement for

CT of spine (follow‐up)

19

***What type of injection is used for a myelogram?

Intrathecal injection
Store intrathecal injection separate from other contrast

20

***Where is the contrast for a myelogram commonly injected?

L2-L3 or L3-L4 interspace
Also @ cisterna magna between C1 & occipital bone

21

Most commonly used contrast agents for myelogram are

– Isovue
– Omnipaque

22

Using ionic contrast may
cause

Severe & fatal neurotoxic reactions

23

***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

24

What are some common complications of a myelogram?

Headache
Nausea/vomiting
Seizure
Allergic reaction
Bleeding
Infection

25

Myelogram Demonstrates

– Deformity in subarchnoid space
• Obstruction of passage of contrast within space

26

Myelogram Conus projection

– Demonstrates conus medullaris
– AP position with CR @ T12‐L1

27

***What is the name of the procedure for radiography of a joint or joints?

Arthrogram

28

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)

29

***MRI

has reduced number of arthrograms

30

***What are the most frequent sites for an arthrogram to be performed?

Knee & shoulder

Hip, wrist & TMJ

31

***Images are taken for arthrogram

Fluoroscopy and conventional images

32

What are some common indications for a knee arthrogram?

*Tears of the joint capsule, menisci or ligatments (trauma)
*Baker’s cyst (nontrauma)

33

Purpose of knee arthrogram

Demonstrate and assess knee joint &
associated soft tissue

34

***What are indications for a shoulder arthrogram?

*Evaluation of partial or complete tear in rotator cuff or glenoidal labrum
*Persistent pain or weakness
*Frozen shoulder

35

***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

36

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

37

Shoulder Arthrogram Projections

– AP (internal/external)
– 30‐degree AP oblique
– Axillary
– Tangenital

38

Shoulder Arthrogram Increasingly performed with

MRI
– Injection of gadolinium contrast into joint capsule

39

CT follows double contrast arthrogram

Images obtained @ 5‐mm intervals

40

Wrist Arthrogram Indications

•– Trauma
– Persistent pain
– Limitation of motion

41

Wrist Arthrogram Contrast is injected

– Dorsal wrist @ articulation of radius, scaphoid &
lunate
– 1.5 to 4 mL

42

***Hip Arthrogram

Performed most often on children
– Evaluate congenital hip dislocation before &
after treatment

43

***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

44

Injection site of Hip Arthrogram

¾” distal to inguinal crease & ¾” lateral to palpated femoral pulse
• Spinal needle

45

***What is the name of the radiologic procedure that examines the nonpregnant uterus, accessory organs and vagina?

HSG

46

***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

47

***What are some contraindications for an HSG?

-Pregnancy
-Acute pelvic inflammatory disease
-Active uterine bleeding

48

***The HSG examination should be scheduled approximately

7 to 10 days after the onset of menstruation.

49

***What position will be the patient be placed in to facilitate the flow of contrast during an HSG?

Trendenlenburg
(LITHOTOMY position)

50

Where should the contrast spill out into when performing an HSG?

Peritoneal cavity

51

How much contrast is used to fill the uterine cavity and how much is needed to fill the uterine tubes?

4 to 5 ml
Additional 4 to 5 ml for uterine tube patency