Arthrography

Question 1

What is Arthrography

Answer 1

Method of radiographically visualizing the inside of a synovial joint and related soft tissue structures using contrast medium

Question 2

What contrast is used for Arthrography

Answer 2

Radiopaque, radiolucent (CO2/air), or both types of contrast may be used

Question 3

Joints commonly examined with Arthrography

Answer 3

Shoulder - most common
Knee 
Hip
Elbow 
Wrist

Question 4

General Procedure Guidelines of Arthrograms

Answer 4

Local anesthetic used in area of contrast injection
Procedure performed under careful aseptic conditions
Contrast administered under Fluoro
Radiographs or spot films may also be taken
If Joint effusion is present is aspirated after local anesthesia but before contrast administration
After contrast is injected the rad manipulates the joint to distribute contrast

Question 5

Patient prep for Arthrograms

Answer 5

No food restrictions
History of allergies is taken (iodine, contrast, anesthesia)
Patient gowned based on type of Arthrogram
Thorough explanation of procedure is given to the patient including possible complications
Informed consent must be signed

Question 6

Equipment needed for Arthrogram

Answer 6

Arthrogram tray

• prep sponge
• fenestrated drape
• syringes
• flexible conductor
• needle
• gauze

Question 7

Knee Arthrography clinical indications and contraindications

Answer 7

Indications
- tears in joint capsule 
- tears or degeneration of menisci 
- ligament injury 
Contraindications 
- hypersensitivity to iodine based contrast media or local Anesthetics

Question 8

General Procedure for Knee Arthrography

Answer 8

Prepare site
Retropetellar, lateral, anterior, or medial approach
Skin anesthetized
Fluid aspirated if any is present
Contrast media is instilled (5ml of positive and 80-100 ml of negative CO2 or air)
Needle removed and knee wrapped
Knee exercised

Question 9

Hip Arthrography is performed to

Answer 9

Evaluate congenital hip dislocation in children
Detect loose hip prosthesis in adults
Confirm infection in adults, aspirate is sent for fluid analysis
Inject steroid, pain relief or artificial synovial fluid (synvisc) in patient awaiting replacement surgery

Question 10

Common puncture site for hip Arthrography

Answer 10

3/4 inch (1.9cm) distal to inguinal crease and 3/4 inch lateral to palpated femoral pulse

Question 11

Shoulder Arthrography is performed to evaluate

Answer 11

Partial or complete tears in rotator cuff or glenoid labrum
Persistent pain or weakness
Frozen shoulder
Often done in conjunction with MRI afterwards, gadolinium also injected as MRI contrast at the same time

Question 12

Shoulder Arthrography contrast techniques

Answer 12

Single uses 0 to 12 ml of positive agent

Double uses 2 to 4 ml of positive agent and 10 to 12 ml of air

Question 13

Wrist Arthrography indications

Answer 13

Trauma
Persistent pain
Limitation of motion

Question 14

Wrist Arthrography procedure

Answer 14

1.5 to 4ml of contrast injected into dorsal wrist at the articulation of radius, scaphoid, and lunate
Wrist manipulated to disperse contrast

Question 15

Wrist Arthrography common projections

Answer 15

PA, lateral, obliques

Fluoro is recommended during ration to detect leaks

Question 16

Pre-procedure for Arthrograms

Answer 16

Patient completes consent form
Tech sets up applicable tray for procedure
Tech sets up Fluoro equipment
Tech completes all pertinent documentation

Question 17

What is the pertinent documentation

Answer 17

Consent form
Records Fluoro time, images taken
Lists contrast meds used (and how much)
Records injection time
Records any reaction to contrast 
Fills out lab requisition is aspirate is being sent to lab