Quiz 4 Flashcards
What is lymphography?
the radiologic exam of the lymph vessels and nodes after they have been opacified by an injected oil based contrast media
What is a lymphadenography?
a radiographic study of the lymph nodes performed 24 hours after the injection
What is a lymphangiography?
a lymphatic radiographic study of the lymph vessels carried out within one hour after the injection of the contrast media
What is an indication?
the reason why we are doing the test
What are the indications for lymphography?
1) assess the clinical extent of lymphoma
2) staging of radiation treatment
3) obstruction or other impairment of the lymphatic system
4) locating nodes for biopsy or surgical removal
What is a contraindication?
reason why you’re not doing an exam
What are contraindications of lymphography?
1) sensitivity to the vital dye, contrast media or local anesthetic
2) respiratory insufficiency
3) concurrent radiation therapy to the lungs
Who gets the informed consent signed?
the radiologist only
How long does the patient need to be NPO of solid foods prior to the procedure, although clear liquids are permitted.
8 hours
What kind of scout is taken prior to the procedure?
chest to assess the lungs
Due to the injection do vital dye, the patient may void what color tinted urine and may see some discoloration of the skin on the foot and along the course of the lymphatic vessels?
Blue
What are the four colors of vital dye?
-Patent Blue V
-Evans Blue
-Brilliant Blue GFF
-Direct Sky Blue
What are the four colors of vital dye?
-Patent Blue V
-Evans Blue
-Brilliant Blue GFF
-Direct Sky Blue
How much blue dye is injected between the toes?
.25 to .50 mL
How much blue dye is injected between the toes?
.25 to .50 mL
How long should it take for the dye to visualize the lymphatic vessels?
15 minutes
How is incision made on the dorsum of the foot to locate the dye filled lymphatic?
longitudinal
How many sutures are placed around the vessel?
2
The lymphography needle is advanced what side up into the lumen?
bevel
Why is normal saline injected slowly into the vessel?
it dilates it
How long is oil contrast media slowly injected into the vessel?
30 to 45 minute period
What radiographs are taken after about one minutes of the injection time to ensure that the contrast media is a lymphatic vessel?
Foot and Ankle area
What kind of contrast media is used in lympoangiogram?
oil-based contrast
If the contrast is too thick, what might you have to do to it?
warm it up
How long does ethiodol remain in the lymph vessels for after injection?
up to three to four hours
How long does ethiodol remain in the nodes after injection?
for periods of three to four weeks
How long may abnormal nodes retain the contrast media?
several months
After how long are the lymph nodes best demonstrated post contrast media?
24 hours
What is the recommended dose per lower extremity for an adult?
6 to 8 mL
What is the recommended setting at a rate of?
0.1 to 0.2 mL/minutes
How long is the total injection time approximately?
30 to 45 minutes
What are routine radiographs?
-Lower extremities
-AP Pelvis
-AP Abdomen
-RPO/LPO Abdomen
What are optional radiographs?
-Lateral view of the Abdomen
-AP Chest
What is post procedural care?
The needle is removed, the cut sutured and antibiotic ointment applied
How long after are the sutures removed?
5 to 7 days
What are complications?
1) Contrast media reactions
2) Pain and possible vessel rupture
3) pulmonary cerebral or hepatic emboli
4) infection at the injection site may occur if sterile technique is not maintained
When are vascular obstructions best visualized?
On the initial set of films (Day 1)
What kind of syringe is used?
Tuberculin Syringe
What is arthography?
a contrast media study of synovial joints and related soft tissue structures
What joints are studied in arthrography?
hip, knee, ankle, shoulder, elbow, wrist, and TMJ
What is the purpose of knee arthrograms?
performed to demonstrated and assess the knee joint and associated soft tissue structures for pathology
What are knee arthrography indications?
-tears of the joint capsule
-menisci or ligaments maybe caused by trauma
What are knee arthrography contraindications?
known to be allergic to iodine based contrast medium or local anesthetics
What is patient prep for knee arthrography?
-procedure explained thoroughly to patient
-Informed consent signed
-Patient advised of any complications that may occur
How much positive contrast medium is drawn up for injection?
5mL with 10 mL syringe and an 18 gauge needle
The physician injects the skin, underlying tissues and joint capsule with local anesthetic using what kind of syringe and needle?
a 10 mL syringe and a 21 or 25 gauge needle
Where is the injection usually injected?
in the medial aspect of the knee
What color is normal knee joint fluid?
clear and tinged yellow
What color is abnormal knee joint fluid?
cloudy and should be sent to the lab for assessment
What is injected after the knee joint fluid is aspirated?
the positive contrast injected through the 20 gauge needle
If the knee arthrography is dual contrast what do you need?
50mL syringe is used to inject negative contrast
Why is an ace bandage wrapped around the distal femur?
Collapse/dissolve the area of the area of the suprapatellar bursae
What kind of contrast media is used for knee arthrography?
radiolucent medium or radiopaque water soluble medium or combo of both
What kind of contrast study is the method of choice?
Dual
What are three kinds of negative medium can be used?
Carbon dioxide, oxygen, room air
Why after the medium injected is the knee flexed?
produces a thin even coating of the soft tissue structures with the positive medium
What technologist images are taken for knee arthrography?
AP and Lateral to demonstrate the entire articular capsule by the combination of negative and positive contrast media
Why is shoulder arthrography done?
to demonstrate the joint capsule, rotator cuff, the long tendon of the biceps muscle and the articular cartilage
How much contrast is used for a single contrast study for shoulder arthrography?
10-12 mL of positive contrast
How much contrast is used for a double contrast study for shoulder arthrography?
3 to 4 mL of positive and 10/12 mL of negative contrast
What are the routine radiographs are suggested images?
AP projections with internal and external rotations; and a glenoid fossa, transaxillary or intertubcular groove projection
