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Positioning SUMMER 2015 > Special Procedures > Flashcards

Special Procedures Flashcards

1
Q

Arthrography

A

exam of the synovial joints and related soft tissue structures that employs contrast media

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2
Q

what are joints commonly examined

A

hip, knee, ankle, shoulder, elbow, wrist

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3
Q

what are the most common arthrogram procedures

A

shoulder and knee

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4
Q

what are the structures of major interest in knee arthro

A

joint capsule, menisci, collateral, cruciate and other minor ligaments

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5
Q

Knee Arthro

clinical indications

A 
mostly trauma 
tears in joint capsule 
tears or degeneration of menisci 
ligament injury 
bakers cyst
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6
Q

Knee Arthro

contraindications

A

hypersensitivity to iodine based contrast media or local anesthetics

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7
Q

what modality is bakers cyst best seen on?

A

ultrasound

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8
Q

Knee Arthro

patient prep

A

no dietary prep
procedure explained
advise of complications
signed informed consent form

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9
Q

Arthrogram tray

A

prep sponge, drapes, connector, needles, anesthetics, sterile gloves, razor, contrast, bandaid

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10
Q

radiolucent

A

room air

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11
Q

radiopaque

A

iodinated

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12
Q

Knee Arthro

what kind of contrast is used and how much

A

Double contrast study

5mL of positive and 80-100mL of negative (CO2 or air)

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13
Q

Knee Arthro

what type of approaches do physicians use for site of injection

A

retropatellar, lateral, anterior, or medial

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14
Q

Knee Arthro

fluoro imaging

A

20 degree rotation between each exposure

results in 9 spot images of each meniscus

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15
Q

Knee Arthro

overhead projections

A

entire articular capsule outlined

proper AP and Lateral positions

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16
Q

Shoulder Arthro

A

can be single or double contrast study that demonstrates joint capsule, rotator cuff, long tendon of biceps and articular cartilage

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17
Q

Shoulder Arthro

clinical indications

A

chronic pain
general weakness
tears in rotator cuff

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18
Q

rotator cuff

A

a group of four muscles and their tendons that wraps around the front back and top of the shoulder joint

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19
Q

shoulder Arthro

accessory equipment

A

standard arthro tray

spinal needle

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20
Q

shoulder Arthro

contrast media single contrast study

A

10-12mL of positive contrast media

NO negative contrast media

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21
Q

shoulder Arthro

contrast media double contrast study

A

3-4mL of positive contrast media and 10-12mL of negative contrast media

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22
Q

what contrast study for shoulder arthro BEST demonstrates the inferior portion of the rotator cuff

A

double contrast study with pt. in upright position

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23
Q

shoulder Arthro

suggested positioning routine

A

scout AP
internal/external rotation
glenoid fossa AKA grashey
transaxillary or fisk modification (intertubercular groove)

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24
Q

what contrast media is used for CT to follow

A

iodinated water soluble

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25
Q

what contrast media is use for MRI to follow

A

Gadolinium

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26
Q

Biliary duct procedures

A

T-tube or dleayed, cholangiography

endoscopic retrograde cholangiopancreatography ERCP

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27
Q

T-tube/delayed purpose

A

performed if surgeon has concerns about residual stones in biliary ducts that went unsuspected during cholecystectomy

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28
Q

T-tube/delayed procedure

A

T-tube shaped catheter is placed in common bile duct during cholecystectomy.
the catheter extends to the outside of the body
T-tube is unclamped and drains excess bile into emesis basin
syringe with adapter is attatched to t-tube
iodinated contrast is injected under fluoro
spot images taken and residual stones if detected may be removed

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29
Q

T-tube/delayed clinical indications

A

residual calculi

strictures (narrowing of biliary duct)

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30
Q

T-tube/delayed contraindications

A

hypersensitivity to iodinated contrast media
acute infection of biliary system
elevated creatinine or BUN levels

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31
Q

T-tube/delayed patient prep

A

NPO for at least 8 hrs prior to exam
exam explained
careful clinical history

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32
Q

why is the t-tube clamped off the day prior to the t-tube cholangiogram?

A

done as a preventative measure against air bubbles entering ducts where it might simulate stones.

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33
Q

what contrast media is used for t-tube/delayed

A

water soluble iodinated contrast media

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34
Q

what endoscope is commonly used for ERCP’s

A

duodenoscope

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35
Q

ERCP procedure

A

endoscopic inspection, cannulation and injection of the biliary ducts with the use of a duodenoscope

36
Q

ERCP purpose

A

to examine biliary and main pancreatic ducts

can be diagnostic or therapeutic

37
Q

ERCP therapeutic procedure

A

removal of choleliths or small lesions

repair stenosis of spincter of oddi or associated ducts

38
Q

ERCP diagnostic procedure

A

retrograde injection of contrast into biliary ducts usually performed by gastroenterologist

39
Q

ERCP pathologic indications

A

residual calculi

strictures

40
Q

ERCP contraindications

A

hypersensitivity to iodinated contrast media
acute infection of biliary system
possible pseudocysts of pancreas
elevated creatinine and/or BUN levels

41
Q

ERCP patient prep

A

NPO 8 hrs prior to exam
NPO at least 1 hr after exam to prevent aspiration
explain procedure

42
Q

ERCP contrast media

A

iodinated water soluble contrast

43
Q

ERCP injection process

A

endoscope introduced through mouth until it reaches hepatopancreatic ampulla
catheter inserted into CBD and contrast injected

44
Q

HSG

A

exam of the uterus and fallopian tubes after the injection of contrast

45
Q

4 parts of uterus

A
  1. fundus
  2. body
  3. isthmus (where uterus joins the cervix)
  4. cervix
46
Q

3 layers of the uterus

A
  1. endometrium (inner)
  2. myometrium (middle)
  3. serosa (outer)
47
Q

cornu

A

the region of the uterus where the uterine tubes communicate with the uterus

48
Q

uterine tube divided into 4 parts

A
  1. interstitial segment
  2. isthmus
  3. ampulla
  4. infundibulum
49
Q

purpose of and HSG

A

detects lesions such as polyps, fistulas and neoplasms shows patency of uterine tubes

50
Q

HSG

clinical indications

A

infertility assessment
demonstration of intrauterine pathology
pelvic masses, fistulas, congenital defects, spontaneous abortions
evaluation of uterine tubes after tubal ligation or reconstructive surgery

51
Q

HSG

contraindications

A

pregnancy
pelvic inflammatory disese
active uterine bleeding

52
Q

HSG

patient prep

A 
proper bowel prep 
mild pain reliever
empty bladder 
explain procedure 
consent form signed
53
Q

HSG

contrast media

A 
water soluble iodinated 
absorbed easily
no residue in reproductive tract 
will cause pain 
*used to use oil based contrast media
54
Q

HSG

scout image positioning

A

2 inches above pubic symphysis

additional images may be RPO/LPO

55
Q

myelography

A

study of spinal cord and its nerve root branches that uses a contrast medium

56
Q

a common lumbar puncture site for removal of CSF and injection of contrast is often performed between

A

L3 and L4

some people do L2/L3 but is risky because Spinal cord ends at lower level of L1

57
Q

3 layers of meninges

A
  1. dura mater (tough mother)
  2. arachnoid (middle menix)
  3. pia mater (innermost)
58
Q

epidural space

A

potential space between the dura mater and the inner table of the skull

59
Q

trauma to the head can cause an

A

epidural hematoma

60
Q

what is an epidural hematoma

A

an accumulation of blood between the skull and the dura mater

61
Q

subdural space

A

thin space between the dura mater and arachnoid which contains interstitial fluid and various blood vessels
can have a subdural hematoma

62
Q

subarachnoid space

A

between the arachnoid and pia mater.

contains CSF

63
Q

what areas of the spine are most common sites for myelography

A

lumbar and cervical

64
Q

myelography

clinical indications

A

presence of a lesion that may be protruding into canal

65
Q

myelography

pathology demonstrated

A

HNP (MRI used)
cancerous or benign tumors (MRI used)
cysts (MRI used)
trauma (CT used)

66
Q

what is the most common clinical indication for myleography

A

herniated nucleus pulposus

67
Q

myelography

contraindications

A

blood in CSF
arachnoiditis (inflammation of arachnoid menix)
increased cranial pressure
recent lumbar puncture (within 2 weeks of procedure)

68
Q

myelography

patient prep

A

pt. may be pre medicated with a sedative 1 hour prior
exam and possible complications explained
informed consent signed

69
Q

myelography

contrast media

A

best type is one that is miscible with CSF
easily absorbed, non toxic and inert and has good radiopacity
non ionic water soluble iodine based media is the best
due to low osmalality
approved for intrathecal injections

70
Q

myelography

contrast media dosage

A

varies with concentration of medium

range of about 9-15mL

71
Q

myelography

needle placement

A

lumbar L3-L4

cervical C1-C2

72
Q

what is the reason the cervical site would be used over the lumbar site during myelography

A

only if the lumbar site is contraindicated or a pathologic condition indicates complete blockage of vertebral area above lumbar area

73
Q

2 body positions used for lumbar puncture

A
  1. prone

2. left lateral

74
Q

cisternal puncture

A

erect C1-C2 level

prone with head flexed

75
Q

cervical myelogram positioning

A

horizontal beam lateral
swimmer’s lateral horizontal beam
additional : anterior obliques

76
Q

thoracic myelogram positioning

A

right lateral decubitus
left lateral decubitus
right or left lateral vertical beam

77
Q

lumbar myelogram positioning

A

semierect horizontal lateral
horizontal CR to L3
additional: anterior obliques, or PA/AP

78
Q

orthoroentgenogram

A

obtain accurate and comparative long bone measurements

79
Q

orthoroentgenogram

what to do

A

immobilize extremity
tape ruler to table
no movement of extremity or ruler between exposures

80
Q

orthoroentgenogram

clinical indications

A

back pain resulting from leg length difference
developmental anomalies
bone lengthening survey

81
Q

is it more precise to do orthoroentgenograms bilaterally or unilaterally

A

unilaterally

82
Q

orthoroentgenogram

procedure

A

3 exposures per IR
CR centered to joint
ruler next to limb

83
Q

what is the ruler called that is used foe orthoroentgenograms

A

bell thompson ruler

84
Q

orthoroentgenogram

lower limb measurement includes

A

AP hip CR centered to head of femur
AP knee CR centered to knee joint
AP ankle CR centered to ankle joint

85
Q

orthoroentgenogram

upper limb measurement includes

A

AP shoulder CR centered to shoulder joint hand supinated
AP elbow CR centered to mid elbow joint
AP wrist CR centered to mid wrist

86
Q

CT long bone measurement

A

hip to ankle
knees true AP
demonstrates bilateral lower extremity to include iliac crest and calcaneus

Positioning SUMMER 2015 (5 decks)

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