Arthrography

Question 1

What pathology is this showing?

Answer 1

A torn vs. healthy meniscus

Question 2

What is this showing here?

Answer 2

Infected arthroplasty

Question 3

What is this showing here?

Answer 3

Antibiotic leads

Question 4

What process is this showing here?

Answer 4

Joint injection

Question 5

What is this showing?

Answer 5

MR Shoulder with Contrast

Question 6

What is arthrography?

Answer 6

Radiography of a joint, joint capsule, soft tissues or cartilage

Question 7

T/F

Arthrography requires contrast to see structures

Answer 7

True

Question 8

What modality is used for arthrography?

Answer 8

Requires fluoroscopy and potentially an overhead tube

Question 9

T/F

Arthrography requires a sterile tray and set-up

Answer 9

True

Question 10

What are the 3 contrast agents that were used in the past for arthrography?

Answer 10

1.Negative-air
2.Positive-iodinated compound
3.Double contrast-Both positive and negative

Question 11

What are the cons to using Negative - Air contrast for an arthrogram?

Answer 11

-Large amounts needed (150 ml)
-Very painful (distention)
-Least accurate diagnosis

Question 12

What are the benefits to using positive contrast for arthrography?

Answer 12

-Readily absorbed, greater accuracy
-Smaller amounts, less painful

Question 13

What is the best of methods at producing an accurate diagnosis in arthrography?

Answer 13

A combination of positive and negative contrast

Question 14

T/F

When using positive and negative contrast together, you need to increase the amount of contrast of each

Answer 14

False; Smaller amounts of both contrast agents used

Question 15

What are the joints that arthrography evaluates?

Answer 15

Hip, Knee, Ankle, Shoulder. Elbow, Wrist

Question 16

T/F

In Double Contrast Studies, joints are exercised and manipulated

Answer 16

True

Question 17

What views are done in double contrast studies in arthrography?

Answer 17

-Cross-table images
-Stress views

Question 18

What are the Pathologic indications for arthrography?

Answer 18

–Tears in joint capsule
–Tears or degeneration of menisci
–Ligament injury
–Loose bodies

Question 19

What is the radiographic criteria for arthrography?

Answer 19

-Entire articular capsule outlined
-Proper AP and lateral positions
-Markers

Question 20

Where is double Contrast injected for a meniscal injury?

Answer 20

Into the lateral aspect of the suprapatellar recess

Question 21

What views are done for meniscal imaging of the knee with arthrography?

Answer 21

-Images taken from prone to lateral to supine, rotating the knee 30 degrees each exposure
-Cross-table imaging required

Question 22

How many views can be done on a single image receptor in arthrography?

Answer 22

Six views per image receptor

Question 23

What modalities are used now in replacement for arthrography? Why??

Answer 23

-MRI and US
-Are non-invasive
-Less risk and better diagnosis

Question 24

T/F

MRI demonstrates MOST pathologies involving ligaments and tendons and joint capsule without needing an injection

Answer 24

True

Question 25

T/F

Current arthrograms use negative contrast only

Answer 25

False; Positive

Question 26

T/F

Arthrograms can use conventional X-ray

Answer 26

True

Question 27

What equipment is needed on an Arthrogram Tray?

Answer 27

–Prep sponge
–Fenestrated drape
–Syringes
–Flexible connector
–Needles

Question 28

What position is the patient placed in for an arthrogram; supine or prone?

Answer 28

Supine

Question 29

Read over the procedure for an arthrogram:

Answer 29

1.EXPLAIN procedure to patient
2.Consent form signed
3.Patient supine
4.Preliminary image (for localization)
5.Aseptic procedure
6.Local anesthetic
7.May aspirate some fluid
8.Injection of contrast(s) into joint capsule under fluoroscopy

Question 30

What are the current applications of arthrography?

Answer 30

1.Joint aspiration – sample sent to the lab to rule out infection
2.Joint injection – therapeutic to try and reduce pain in joint.
-Like an oil change
3.Arthrogram Pre-MRI

Question 31

What is an example of a pathology that requires MRI contrast?

Answer 31

A Labral tear in the shoulder

Question 32

What contrast must be given for pathologies that cannot be seen on MRI without it?

Answer 32

Iodinated contrast and gadolinium mixed

Question 33

T/F

Fluoro can be used to ensure that gadolinium has been injected into the joint

Answer 33

True