Ch 19 Procedures Flashcards
study for exam
Contrast arthrogram are primarily performed in CT MR and US except for when the patient has:
A. Claustrophobia
B. Multiple tissue injuries
C. Allergies to iodine contrast
D. Adverse reactions to needles
C. Allergies to contrast
(T/F)
we take standard precautions during a T tube cholangiogram.
What precautions?
True
Wear gloves throughout the procedure
Quiz Me:
The presence of ____ is often a contraindication for ERCP
Pseudocyst of pancreas
(t/f)
A hysterosalpingogram (HSG) can serve as a
therapeutic procedure for infertility.
True
(Mayo no longer does these)
Quiz Me:
What was the primary reason for not using an oil-based contrast medium for an HSG?
A. Poor visibility of uterine tubes
B. Increased risk of reaction to contrast medium
C. Poor persistence within uterine tubes
D. Possible pulmonary embolus
D. Possible pulmonary embolus
Quiz Me:
What is the most common pathologic indication for myelography?
A. HNP (herniated nucleus pulposus)
B. Trauma
C. Malignant or benign lesions
D. Spinal cysts
A. HNP
Quiz Me:
The most common injection site for
myelography is:
A. C1-C2
B. L1-L2
C. L3-L4
D. L5
C. L3-L4
Quiz Me:
Iodinated contrast medium used for
myelography is no longer radiographically
detectable after:
A. 1 hr
B. 4 hr
C. 12 hr
D. 24 hr
D. 24 HR
Quiz Me:
What is the name of the special ruler used
during orthoroentgenography?
A. Bell-Thompson
B. Miller
C. Coventry-Miller
D. Miller-Abbott
A. Bell-Thompson
Quiz Me:
An exposure angle of 10° or less is termed:
A. Tomography
B. Zonography
C. Planigraphy
D. Stratigraphy
A. Tomography
Quiz Me:
Which of the following tomographic exposure angles will produce the thinnest sectional thickness?
A. 10°
B. 20°
C. 40°
D. 60°
D. 60 degrees
(more angle=thinner slices!)
Quiz Me:
What is the name of the special endoscopic
device that is used during an ERCP?
A. Duodenoscope
B. Cholangioscope
C. Gastroscope
D. Pancreatic endoscope
A. Duodenoscope
During a cervical myelogram what position do we placed the patient in for the best image?
Prone?
What type of articulation is primarily used for arthrograms?
Synovial but more specifically diarthrodial
What is the most frequent joints for an arthrogram?
shoulder and knee
(shoulder most likely)
What joints can’t be examined during an arthrogram?
Pubis Symphysis
(t/f)
Standard precautions must be followed for a T-Tube Cholangiogram placement
True
(sterile)
What kind of joint is a amphiarthrodial?
distal tibiofibular joint
(limited movement)
What is the insertion point for a myelogram LP?
L3-L4?
subarachnoid space
What are the contraindications for an ERCP?
Mainly: pseudocyst of pancreas
Also Can be:
hypersensitivity to iodine contrast
infection to biliary system
elevated creatinine/BUN levels
*What is the common reason for a myelogram?
to examine the spinal cord/nerve branch and find possible pathologies
What is the name of the scope for a ERCP?
duodenoscope
When it comes to slices what does more angle do?
What does less angle do?
What do small numbers mean?
What do the large numbers mean?
Increasing the angle will make thinner slices?
less angle creates larger slices
How long does it take for contrast not to be radiographically detectable in a myelogram?
24 hours?
Which of the following procedures may be performed during a post operative T tube cholangiogram?
A. remove gallbladder
B. remove a liver cyst
C. remove a biliary stone
D. remove the kidney
C. Biliary stone
(Gall stone)
when it comes to humerus injections, how do we want the arm rotated?
Why?
external rotation
to see the joint space (glenoid cavity)
What is the name for the ruler?
Bell-Thompson?
HSG contraindications:
pregnancy
acute pelvic inflammatory disease
active uterine bleeding
(T/F)
bile is sterile.
False.
Outside of the standard precautions, bile is not sterile.
_______ the slice, the ______ it is.
Why?
Thinner, Blurrier
So we can see past the bone.
Where are we imaging in a long bone study?
Bell-Thompson ruler what joints are we looking at?
For upper?
For lower?
To examine the joint spaces
Ruler is for synovial diarthrodial joints
upper: shoulder, wrist, elbow
Lower: Hips, Knee, ankle
For examining the kidney, we want _____ slices.
We want it to be ______.
Why?
Thinner slices
Blurry (for the bones)
We want to see the kidney and thin slices make the bones blurrier
What is the desired outcome for tomography?
Blurriness
(T/F)
We can flex the knee when putting in contrast into the knee joint.
True.
the doctor manipulates the knee to see how the fluid flows in the capsule
(T/F)
Arthrogram should be a sterile procedure.
True
We need to prep the skin for the needle
Myelogram is for?
abnormality in spinal cord
spinal stenosis
map out for spinal chemo
What is a necessity during a cervical myleogram?
patient either prone/fowler with chin hyperextended to prevent contrast going to the brain
After explaining, signing, prepping, and poking patient we then:
collect CSF
inject the contrast
live Fluro pictures
take “finals” one last picture
Workbook:
An indication of Baker’s Cyst suggests the need for an arthrogram procedure for the:
Knee
Order for events for a myelogram:
(1-4)
- explain procedure
- sign the consent form (bc of needle)
- prep the patient (sterilize)
- insert the needle
8 Steps to a LP/Myelogram
- explain procedure
- Sign consent form
- Prep the patient (sterilize)
- Insert the needle
- Collect the CSF
- Inject the contrast
- Use live fluro for the contrast
- Take “finals”
General:
What does ERCP stand for?
What is it for?
endoscopic Retrograde Cholangiography pancreatography
examine the biliary and pancreatic ducts
General:
(registry)
What is a hysterosalpingogram?
demonstrartes uterus/follopian tubes
General:
What is hysterosalpingography (HSG)?
x-ray (fluro) of female reproductive system WITH contrast
General:
What organs do HSG look at?
Vagina
uterus
uterine tubes
ovaries
(Mayo doesn’t do these)
General:
What is Arthrography?
What are some spots we examine?
study of synovial joints and surrounding soft tissue structures w/ contrast
hip, ankle, shoulder, elbow, wrist, and TMJ joints
General:
What is a T tube?
When is it most common?
special shaped catheter into the common bile duct
most common after Cholecystectomy (gallbladder removal) to prevent residual stones
General:
How long should a patient be NPO prior to ERCP?
After procedure?
8 hours
1 hour post op
General:
Patient positions for Lumbar punctures? (2)
prone
left lateral position
General:
CR for Cervical:
Horizontal beam lateral:
Swimmers lateral horizontal beam:
C4-C5
Swimmers: C7
General:
CR for thoracic right lateral decubitis:
T7
General:
What is the position/insertion site for a Cisternal puncture?
Erect or Prone
C1 & C2
General:
What is a Myelogram?
radiographic study of spinal cord and nerves
General:
How are Myelograms diagnosed?
shape & contour of the contrast in lumbar/cervical areas
General:
What is the Fulcrum?
Pivot point between IR and X-ray tube
(center point)
Workbook:
How many exposures are made, and how much is the leg rotated during each exposure for horizontal beam knee arthrograms?
9 exposures per meniscus
20 degree rotation
Workbook:
What length needle is most often used to introduce contrast media during a shoulder arthrogram?
2 3/4 - 3 1/2 spinal needle
Workbook:
Oil-based or water-soluble contrast is preferred for the majority of HSG?
Water-Soluble
Workbook:
The absorption of the water-soluble contrast media into the vascular system of the body begins approximately ______ after injection and is totally undetectable radiographically after _____
30 minutes
24 hours
Workbook:
Which position will move the contrast media column from lumbar to the cervical region during a myelogram?
Trendelenburg
Workbook:
The formal term for a radiographic long bone measurement study is:
Orthoroentgenography
Workbook:
Object plane:
the plane in which the target anatomy is clear
Workbook:
Exposure angle:
The factor that determines slice thickness
Workbook:
Tomogram:
radiography produced by a tomographic unit
Workbook:
Blur
distortion of objects outside the objective plane
Workbook:
Fulcrum:
The pivot point between the tube and the image receptor
Workbook:
Sectional Thickness
thickness of the focal plane
Orthoroentgenogram means:
Straight right angled radiograph
Usual long bone x-ray produces magnification and elongation bc of divergent beam
Orthoroentgenogram is most common on:
Why?
Children, lower extremities
To evaluate different limb lengths
