Fluoroscopy- Arthrography & Hysterosalpingiography

Fall 2025

What is Arthrography?

Arthrography is an imaging technique involving the injection of contrast material into a joint space to visualize soft tissue arount joints such as cartilage, ligaments, and tendons using X-rays, MRI, or CT scans.

What are the 3 contrast medias used in arthrography?

Radiopaque, radiolucent, or both

What other modalities have reduced the need for radiographic contrast arthrography?

CT, MRI, US

What entity ranks radiographic arthrography from very low to not at all appropriate as a diagnostic tool>

ACR- american college of radiology

When is Radiographic Contrast Arthrography an appropriate diagnostic tool?

-Contraindications for Gadolinium with MRI

-lack of US expertise

-Aspiration in suspected septic or inflammatory arthropathies (fluid build up in joint)

-following knee arthroplasty as a routine follow up for complications

• to rule out the hip as referred pain source after other negative imaging

T/F any joint may be evaluated if needed

True

List the general procedural guidelines

1. Local anesthetic for contrast injection site

2. Aseptic technique (sterile technique during contrast injection)

3. Contrast under fluoroscopy

4. Radiographs or spot films

5. Joint is manipulated after contrast is injected to ensure proper distribution of the contrast agent

What do radiologists do if joint effusion exists?

Fluid is aspirated after local anesthesia, but before contrast is administered.

What is the most common joint examined using contrast arthrography?

Shoulder joint

List 3 Reasons why shoulder arthrography is done?

1. To evaluate tears in the rotator cuff or glenoid labrium

2. persistent pain or weakness

3. frozen shoulder

What type of contrast is used in shoulder arthrography?

single contrast- 10-12 ml of POSITIVE agent (omnipaque/ visipaque)

Double contrast- 2-4 ml of positive agent and 10-20 ml of air

What projections are used in shoulder arthrography?

AP- internal/ external rotation

AP oblique- 30*

Axillary

tangential

What other modality is commonly used in conjunction with shoulder Arthrogram?

CT

What 2 methods are used in knee arthrography?

Vertical ray method

Horizontal ray method

Which method typically uses double contrast in knee arthrography?

horizontal ray method

The 1st exposure is on the medial meniscus

The joint is widened manually

5 exposures are taken. The knee is rotated 30* toward the spine after ea. exposure

Which knee arthrography method used a stress device after contrast is injected?

vertical ray method to widen the side of the joint space '

AP/ AP oblique 20* right and left

Why is hip arthrography done?

1. congenital hip dislocation

2. detect loose hip prosthesis

3. confirms infection

What is a common puncture site for hip arthrography?

¾ in (1.9 cm) distal to inguinal crease & ¾ lateral to palpated femoral pulse

When is the wrist evaluated using arthrography?

1. trauma

2. persistent pain

3. limited motion

   1.5 to 4 ml of contrast is injected in dorsal wrist at radius, scaphoid, lunate

   contrast is dispersed

what projections are used for wrist arthrography?

PA/ Lateral/ Both Obliques

fluoro is recommended during rotation to detect leaks

What is a Hysterosalpingography?

uterine contrast study

Why are Hysterosalpingorams done?

1. to determine size, shape & position of uterus and uterine tubes

2. ID polyps, lesions, tumors or fistulous tract

3. To ID patency of the fallopian tubes in patients who cannot conceive.

   ***always shield upper body, restrict fluoro, imaging, repeats

What type of contrast is used for uterine studies?

water-soluble radiopaque- injected int o uterus via cannula

What is the patient prep for hysterosalpingogram?

1. intestinal tract cleaned with:

Laxatives

enemas

meals withheld

2. no sex for 10 days at start of menstruation: this is when the endometrium is least congested and least risk of irradiating fertilized egg

3. empty bladder

4. irrigate vagina and clean perineal area using sterile technique

List the steps for Hysterosalpingogram

1. 10×12 scout supine

2. Pt place in lithotomy position

3. DR. places speculum

4. uterine cannula placed in cervix

5. contrast injected to fill uterus (contrast will flow to peritoneal cavity if tubes are patent)

What is seen on TYPICAL hysterosalpingogram?

pelvic region (centered 2” Above pubic symphysis) contrast in spill areas

short scale contrast

What is Hydosalpinx?

Fluid blockage in the fallopian tubes

What are uterine fibroids?

common growths of the uterus

What is an essure device?

A permanent contraceptive implant placed in the fallopian tubes to prevent pregnancy.