rad211: long bones

Orthoroentgenography

Used to identify discrepancies in limb length
(one leg shorter than other)

Why are do regular images of long bones have magnification and elongation?

because of divergence of beam

What are some indications for a Orthoroentgenogram?

1. Leg length differences
2. Post surgery to check to see if difference have been corrected; pt will have several years of x-rays

What are the separate projections taken of each joint is taken? (Orthoroentgenogram)

UPPER: shoulder, elbow, & wrist
LOWER: Hip, knee, & ankle

Arthrography

Study looking at a joint (synovial joints)
• Looks at the soft tissue structures of joints
• Menisci, ligaments, cartilage, rotator cuff tears

Other than conventional radiography of synovial joints (e.g., arthrography), which imaging procedure is preferred by physicians for studying synovial joints?

MRI or CT

What are the most common Arthrogram exams?

Knee & shoulder

Contrast media study of synovial joints & related soft tissue structures

arthrography

Arthrogram injections are made under...

aseptic conditions

**Sterile items required vary according to part being examined

What are some indications for a Arthrogram?

1. Trauma- tears in joint capsule, menisci or ligaments
2. Pathology- like a cyst

List the three common forms of knee injury that may require an arthrogram:

1. Tears of the joint capsule
2. Tears of ligaments
3. Tears of menisci

What are three clinical indications for a shoulder Arthrogram?

1. Chronic Pain
2. General Weakness
3. Suspected Tear in Rotator cuff

Give a example of a nontraumatic pathology of the knee joint indicating a arthrogram:

Baker Cyst

What type of needle is commonly used for a shoulder arthogram?

2.75 - 3.5 Spinal needle.

What is general name for the conjoined tendons for the four major shoulder muscles?

Rotator Cuff

What are the two primary contraindications to a Arthrography of any joint?

Allergic to iodine based contrast or local anesthetics

After contrast medium is introduced into the knee joint, why must the knee be flexed or exercised?

Knee must be flexed/exercised in order to distribute the contrast around the joint.

What is the normal appearance of synovial fluid?

Clear and tinged yellow

List two types of contrast media used for a knee arthrogram:

1. Positive or radiopaque media such as iodinated, water-soluble contrast agent
2. Negative or radiolucent contrast agents, such as room air, oxygen, or carbon dioxide

What type of needle is used during a knee arthrogram?

Usually a 20 gauge needle

How much contrast is injected during an Arthrogram of the knee?

5 cc of contrast

How much air is injected during a double contrast Arthrogram of the knee?

80 - 100 cc

What will an Arthrogram of the shoulder demonstrate?

1. Partial or complete tears in the rotator cuff
2. Persistent pain or weakness
3. Frozen shoulder

What four aspects of shoulder of shoulder anatomy are demonstrated with shoulder arthrography?

1. Joint Capsule
2. Rotator Cuff
3. Articular Cartilage
4. Long tendon of biceps muscle

How much contrast is injected during an Arthrogram of the shoulder?

10-12 cc of positive

How much air & contrast is injected during a double contrast Arthrogram of the shoulder?

3-4 cc of positive & 10-12 cc of negative (air)

What are some indications for a Arthrogram of the wrist?

1. Trauma
2. Persistent pain
3. Limitation of motion

How much contrast is injected during an Arthrogram of the wrist & where is the contrast injected?

1.5 - 4 cc's at the articulation of the radius, scaphoid and lunate

What are some indications for an Arthrogram of the hip?

1.) In children- most often done to evaluate congenital hip dislocation before and after treatment

2.) In adults-used to detect loose hip prosthesis confirm presence of infection

Sialography

radiologic examination of the salivary glands and ducts

What are the 3 main pairs of salivary glands?

parotid, sublingual, and submandibular

How much saliva do the glands produce each day?

1 liter

What are some indications for a Sialography?

1. Looking for a stone or tumor
2. Evaluate salivary fistulae
3. Evaluate for strictures/stenosis
4. Evaluation for sialectasia (dilation of duct)
5. Foreign body

What is a contraindication to a Sialography?

1. Severe inflammation
2. Infection

How much contrast is used during a Sialography?

Water soluble contrast media 1-2 cc

Hysterosalpingography

a radiographic examination of the uterus and fallopian tubes

What are some indications for a Hysterosalpingogram?

1. Demonstrate pathology- like fibroids, pelvic masses, endometrial polyps, and could also visualize ectopic pregnancy

2. To determine size, shape and position of the uterus and uterine tubes (fallopian tubes)

3. To assess fertility-to look for defects like blockages of 1 or both tubes

What is a contraindication to a Hysterosalpingogram?

1. Pregnancy
2. Pt has pelvic inflammatory disease
3. Active uterine bleeding

What position is the pt. in during a Hysterosalpingogram and why?

Pt in lithotomy position & slight trendelenburg in order to help facilitate the flow of contrast media into the uterine cavity.

Where is fertilization of the ovum occur?

In the Uterine Tube

What is the term used to describe the "degree of openness" of the uterine tube?

Patency

List three common types of lesions that can be demonstrated during an HSG:

1. Endometrial polyps
2. Uterine Fibroids
3. Intrauterine adhesions

The contrast medium preferred by most RADs for an HSG is:

Water-soluble, iodinated

What device might be needed to aid the insertion and fixation of the cannula or catheter during the HSG?

Tenaculum

The distal portion of the uterine tube opens into the......

Peritoneal cavity

Myelogram

Radiographic study of the spinal cord & nerve root branches.

List clinical indications demonstrated during a myelography:

1. Herniated Nucleus Pulpous (HNP - herniated discs)
2. Possible bone fragments (Trauma)
3. Cancerous or Benign Tumors
4. Spinal cord swelling resulting from traumatic injury
5. Cysts

Into which spinal space is the contrast medium introduced during myelography?

subarachnoid space

List the two common puncture sites for contrast media injection during a myelogram:

Lumbar: L3-L4
Cervical: C1-C2

List four common contraindications for myelography:

1. Arachnoiditis
2. Recent Lumbar puncture (within 2 wks.)
3. Blood in cerebrospinal fluid - blood means irritation & contrast can aggravate the irritation
4. Increased intracranial pressure

What is Arachnoiditis?

Inflammation of arachnoid membrane. Contrast may increase inflammation

Intrathecal =

Intraspinal injections

What is the pt's general body position for each of the following punctures?

Lumbar: Prone or L. Lateral
Cervical: Erect or Prone

Why is a large positioning block placed under the abdomen for a lumbar puncture in the prone position?

For spinal flexion to widen the interspinous spaces to facilitate needle placement

What supplies are needed for a myelogram?

Myleogram tray, 20-22 gauge spinal needle & contrast

What type of radiographic table must be used for a myelography?

90/45-degree or 90/90-degree tilting table

Which type of contrast medium is most commonly used for a myelography?

Nonionic, water soluble
(Provides good radiopacity up to 1 hr after injection)

What dosage range of contrast medium is usually injected for a myelography?

9-15 mL/cc

What is the conus view used for?

To see bottom of spinal cord
AP @ xiphoid
May do trendelenburg to move contrast to that area or can lift legs

True or False: Myelography has been largerly replaced by MRI & CT

TRUE

How is contrast removed from the body after a myelography?

excreted by the kidneys

Bone Survey indications:

1. Abuse cases
2. Metastatic bone disease - to evaluate if cancer has spread; can be used alone with bone scan (NM)

What is a skeletal survey?

Radiographic images that encompass entire skeletal or those regions appropriate for indications

What are some indications for a skeletal survey?

Fractures, bone lesions, metabolic bone diseases, skeletal dysplasia, developmental changes, or anatomic variants.

Bone age

To determine the skeletal maturity in children or lack thereof

A bone age study measures/evaluates:

1. appearance
2. size
3. differentiation of various ossification centers

For soft tissue exams how should you adjust technique:

Decrease density by 50% by decreasing mAs

List some clinical indications for soft tissue exams:

1. Croup - caused by a viral infection (by flu or cold)
2. Epiglottitis
3. Foreign Body- eval blockage

Epiglottitis

bacteria infection
It is an emergency situation—very serious
Usually in children 2-5 yrs old
Blockage of airway due to swelling
Need to keep them calm because they can't breathe

Croup (laryngotracheobronchitis)

infection of the upper airways in children characterized by a barking cough
Primarily in children ages 1 to 3
Pt. has harsh barking sound

DEXA (Bone Densitometry)

Measuring bone density in order to diagnose osteoporosis

(DEXA) measurement values are used to asses:

1. Bone strength
2. Low bone density diseases
3. Monitor effects of therapy
4. Predict risk of future fractures

Venography

Evaluating veins with use of contrast

How much contrast is used during a Venography?

50 to 150 cc of water-soluble iodinated contrast is used

DVT (deep vein thrombosis)

preventable condition with a potentially fatal complication

How does DVT occur?

Occurs when a thrombus (blood clot) forms in one of the large veins leading to either partially or completely blocked circulation

What happens if a DVT is left untreated?

If left untreated clot can move to lungs causing a PE pulmonary embolism

Contributing factors to DVT (deep vein thrombosis):

Smoking, obesity, air travel w/ prolonged sitting, cancer, pregnancy, oral contraceptives, infection, inflammation diseases, inherited clot

What is the major reason hip-to-ankle long bone measurement studies are conducted?

To determine limb length discrepancies and lower limb extremity alignment

If surgery is indicated, how might long bone measurement imaging help with planning?

To determine hardware needs & prothesis or appliance placement