RTR.4 Diagnostic and Therapeutic Procedures

Aspirations (Fine Needle Aspiration)

• Withdrawing fluid or tissue for diagnostic purposes, but can also provide temporary relief

• Fine Needle Aspiration = 25g needle collects tissue sample by breaking up the tissue, for pathologies more solid in nature and with limited fluid, eg. tumors

Biopsies

Core Needle Biopsies: a cylindrical column of tissue is collected

UGI Prep and Procedure

• ES&D

• NPO night before

• Barium and gas pills

• Pt positioned LPO → roll 360 

SBFT Prep and Procedure

• NPO after evening meal

• AXR → thin barium, record time → pt is supine

Barium Enema

• barium prep, laxatives, NPO

• barium and possibly air

Voiding Cystourethrograms Pt Position and Procedure

• Male: 30 RPO

• Female: AP or slight OBL

• Foley catheter to inject contrast, then pts voids after removal of the foley 

Retrograde Cystography Procedure

Foley to inject contrast, and pt voids via foley 

Percutaneous Nephrolithotomy 

• Removal of medium-to-large kidney stones in the urinary tract by inserting a scope through the patient's back

• Higher success

• Effective for larger stones

Extracorporeal Shockwave Lithotripsy

• small kidney stone removal

• currently used more often than PCNL

• lower sucess, and only for small stones <3cm

Cryoblation

Cycle of freezing (Ar) and thawing (He) to destroy cancerous cells

Mircrowave Ablation

High-frequency microwave heat to destroy cancerous cells

Radiofrequency Ablation

Radio wave heat to destroy cancerous cells

CT Enterography Prep and CM

• NPO 3hrs prior

• IV and oral (1-2L Breeza or PEGlyte)

Colongraphy

• Prep

• CM

• Post-processing

• Purpose

• colon prep

• PEGlyte and CO2

• 3D remodelling of the colon on a 3D station

• for pts who had an unsucessful optical colonscopy

Required contrast enhancement level

250-300 HU

RA Bolus Arrival Time @3-3.5ml/s

6-12s

Pulmonary Artery Bolus Arrival Time @3-3.5ml/s

9-15s

Aortic Arch Bolus Arrival Time @3-3.5ml/s

15-22s

Carotids Bolus Arrival Time @3-3.5ml/s

16-24s

Bolus Triggering/ Monitoring/ Tracking

Scan auto-triggered or manually started once bolus is seen in the ROI

Test Bolus Method

• Test bolus used to pre-determine TTP

• Produces higher contrast enhancement but additional time and contrast are used, thus used for PE studies

18g Flowrate

4-6mls

20g Flowrate

3-4ml/s

22g Flowrate

1.5-3mls

24g Flowrate

1-2ml/s

Transient Interruption of Contrast (TIC)

Temporary halt of CM flow in the arms, due to large breath holds

Head Perfusion Scan vs. Venogram

• Perfusion = assess blood flow and brain tissue damage

• Venogram = assess venous structures eg. cerebral veins and venous sinuses

Cardiac CT Pharmaceuticals

• nitroglycerin to dilate vessels

• betablocker if pt has >60BPM

T score higher than -1

normal

T-score between -1 to -2.5

osteopenia

Less than -2.5

osteoporosis

Double J Stent

• Curled ends (which prevent stent migration) reside in the renal pelvis and bladder to allow urinary flow

• Generally require changing every 3-6 months

Dynamic Hip Screws

Hip Screw

IM Nail

Cannulated Hip Screws

Vertebroplasty vs. Kyphoplasty

• vertebroplasty: to stabilize fracture fragments and further prevent VB collapse

• kyphoplasty: the use of a balloon catheter to expand a compressed vertebra

Vertebroplasty/Kyphoplasty Cement Mixture

• PMMA (polymethyl-methacrylate) and barium powder

• sets after 5mins

Percutaneous Transluminal Angioplasty (PTA)

therapeutic procedure utilizing specialized catheters to dilate a stenotic vessel

IVC Filiters

specialized devices that are placed in a patient’s IVC to trap and prevent blood clots from traveling into the pulmonary arteries

IVC Filter Indications

• diagnosed with deep vein thrombosis (DVT) that:

  • (1) have a contraindication to anticoagulant therapy due to their increased risk of hemorrhaging, or 

  • (2) still have progressive DVT or embolisms despite the use of anticoagulants

• that are suffering from multiple trauma injuries