Unit 1 Atrhrography Orthoroentgenography Bone Age and Skeletal Survey Foreign Body Localization

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Unit 1 Atrhrography Orthoroentgenography Bone Age and Skeletal Survey Foreign Body Localization
2015-01-27 20:49:07
Procedures IV
Procedures IV
Unit 1 Atrhrography, Orthoroentgenography, Bone Age and Skeletal Survey, Foreign Body Localization, Eye
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  1. invasive radiographic examination of the soft tissue structures of a diarthrodial joint by the introduction of water soluble contrast media
  2. arthrography is performed in                joints
  3. name seven arthro exams
    • knee
    • wrist
    • hip
    • shoulder
    • TMJ
    • ankle 
    • elbow
  4. arthrography that uses a gaseous medium (air only)
    risk of embolism b/c large amounts of air
  5. arthrography that uses water soluble iodinated contrast
    opaque arthrography
  6. arthrography that uses a combination of gas and acqueous contrast
    double contrast arthrography
  7. indications for arthrography
    • disease or trauma to soft tissue structures
    • tears, rupture of ligaments, tendons, menisci, or articular cartilage of the joint capsule
  8. clear viscous fluid (resembles white of an egg) that reduces friction between joints
    synovial fluid
  9. arthrogram basics
    • scout
    • local anesthetic
    • fluoro
    • sterile tray
    • withdraw fluid
    • inject contrast
    • joint manipulated by dr
    • images under fluoro
    • overhead images
  10. contraindication to arthrogram
    • skin infections
    • anticoagulant therapy (blood thinners)
    • sensitive to dye
    • sensitive to anesthetic
  11. athrography may cause a vasomotor reaction, triggered by freight, pain or trauma, some nervous system responses are:
    • anxiety
    • syncope
    • nausea
    • perspiration
    • pallor
  12. interarticular fibrocartilage of crescent shape located in the knee
  13. attach bone to bone
  14. located on the weight bearing surfaces of bone
    hyaline articular cartilage
  15. padlike sac or cavity found in connective tissue usually in the vicinity of joints. lined with synovial fluid.
    • bursae
    • won't show up on plain film but chronic bursitis will.
  16. fibrous capsule that encloses the synovial joint space. has nerve endings.
    joint capsule
  17. connective tissue that is the inner surface of the fibrous joint capsule. produces synovial fluid.
    synovial membrane
  18. synovial membrane covers everything in the joint except
    • hyaline cartilage
    • menisci
    • intrarticular discs
  19. stress device is needed for
    knee arthrography
  20. injection of water soluble contrast with no greater concentration of 30%
    patient is prone with stress device under femur for distribution of the contrast around the meniscus
    • knee arthrography
    • vertical ray method
  21. projections for vertical ray method knee arthrography
    • AP
    • 20° RPO
    • 20° LPO
    • lateral
    • intercondylar fossa

    *remember to mark M for medial and L for lateral
  22. closely collimate views of each meniscus, rotating       between each exposure with        pictures of each meniscus to demonstrate the meniscus in its entire diameter
    • 20°
    • 9
  23. double contrast study
    better delineation of the knee joint structures
    the excess of the heavy iodinated solution drains into the dependent part of the joint leaving a thin opaque coating on the gas enveloped uppermost part
    Horizontal Ray knee arthrography
  24. patient semi prone
    uses 7x17 cassette
    lead diaphragm 
    low small table or stand to support the knee
    firm pillow
    5 lb bag of sand
    6 images are taken
    horizontal ray knee arthrography
  25. the ligament of the knee that originates on the anterior portion of the femur in the intercondylar notch and inserts on the posterior aspect of the tibial plateau
    cruciate ligament
  26. patient sits with knee flexed 90°
    firm pillow under knee adjusted so that forward pressure can be applied to the leg
    slightly overexposed lateral projection
    ACL imaging
  27. structures of interest in the knee
    • menisci
    • joint capsule
    • collateral, cruciate and other minor ligaments
  28. a baker's cyst is
  29. bursitis can calcify and                   
    tear soft tissue
  30. wrist arthrography projections
    • PA
    • Lateral 
    • Internal oblique
    • External oblique
  31.           ml of contrast is injected in the dorsal surfaceof the wrist where the radius, scaphoid, and lunate join
    1.5 to 4 ml
  32. common puncture site for hip arthrography
    3/4" distal to inguinal crease and 3/4" lateral to the palpated femoral pulse

    spinal needle is used b/c the joint is deep
  33. in children, hip arthrography is most commonly done for
    congenital hip dislocation
  34.                  can be used to distinguish between two positive contrast agents
    photographic subtraction
  35. can use cement with barium to fasten in place
    or to check for infection
    loose hip prosthesis
  36. in the shoulder, the soft tissue structure of interest is the
    rotator cuff
  37. 4 muscles join to form the rotator cuff
    • teres minor
    • supraspinous
    • infraspinous
    • subscapularis
  38. indications for should arthrography
    • partial or complete tears in the rotator cuff of glenoid labrum
    • persistent pain
    • frozen shoulder
  39. in shoulder arthrography, single contrast uses            ml and double contrast uses             ml positive and              ml of negative
    • 10-12 ml
    • 3-4 ml
    • 10-12 ml
  40. injection site for shoulder athrography
    • 1/2" inferior and lateral to the coracoid process
    • use a spinal needle
    • erect position
  41. Shoulder arthrography projections
    • AP internal rotation
    • AP external rotation
    • 30° Oblique (Grashey)
    • tangential-axillary
    • after contrast study, CT may be done
  42. on an open mouth lateral of TMJ abnormalities of                  can be visualized
    articular disk

    can be the result of trauma or a stretches or loose posterior ligament
  43. How much contrast and where is the injection site for TMJ arthrography
    • .5-1 ml
    • 1/2" anterior to tragus of ear
  44. used to evaluate the length or differences in length between long bones
  45. fairly common in children
    most often in lower limbs
    caused from various disorders (congenital or growth deficiencies)
    requires annual xrays
    length differences in long bones
  46. centering points for lower limbs for orthoroentgenography
    • hip, 1-1 1/4" lateroditally at a right angle to the midpoint of an imaginary line from ASIS to symphysis
    • knee, below apex of patella at the level of the depression between the femoral and tibial condyles
    • tibiotalar joint, midway between malleoli

    mark centering point with skin marking pencil
  47. magnification can be decreased by
    • decreased OID 
    • increased SID
  48. centering points for upper limbs for orthoroentgenography
    • shoulder, superior margin of the head of the humerus
    • elbow, 1/2- 3/4" below the plane of the epicondyles
    • wrist, midway between styloid process of radius and ulna
  49. CT for long bone measure has                    exposure
    • 50-200 times less
    • can be more consistently reprodruced
  50. premature fusion of epiphysis to shorten a bone
  51. epiphysial fusion at the distal femur or proximal tibia
  52. treatment methods for long bone growth problems
    • control the growth of the normal side
    • increase the growth of the shorter limb
  53. describe methods to increase the growth of the shorter limb
    • surgically cutting the femur and/or tibia-fibula
    • frame is placed around the cut ends
    • pressure seperates the bone, extends the leg, and promotes healing
  54. the formation of bone substance. the conversion of other tissue into bone.
  55. primary centers of bone formation that appear before birth 
    shaft or body
  56. secondary centers of ossification involve the ends of long bones
  57. the space between the diaphysis and epiphysis that is made up of cartilage
    present until skeleton growth maturity around 25 years old
    epiphyseal plate
  58. the bone age of an individual can be determined by studying                       
    the development of the epiphyses
  59. the most common radiograph taken to calculate bone age is
    AP projections of the left hand and wrist
  60. the degree of maturation of bone is determined by the size, appearence and differentiation of the
    ossification centers
  61. variations from the chart for bone growth can occur from
    • genetic diversity
    • nutritional status
    • race
  62. bone age protocols for ages 1-2 often include              and             
    • knee and foot
    • most commonly left knee
    • because the knee and foot develop more rapidly during this time

    so all the images taken for an infant are hand, knee and foot)
  63. the epiphyses of the                   is the last bony structure to ossify
    • iliac crest 
    • important to include in estimating whether there will be any future changes to spinal development
  64. taken to demonstrate closure of the fontanels
    AP and lateral skull
  65. a lateral view of the sella turcica is sometimes requested in                 to estimate developmental age
  66. indications for skeletal survey
    • fractures 
    • metastasis
    • osteomyellitis
    • degenerative conditions
    • suspected child abuse
  67. projections for skeletal survey (25)
    • AP & Lateral Skull
    • AP & Lateral complete spine
    • AP both Humeri
    • AP both forearms
    • PA both hands
    • PA both wrists
    • AP pelvis
    • AP both femora
    • AP both Tibia fibula
    • AP both feet
    • AP & Lateral chest for ribs (on table with low kvp)
  68. any object that enters the body that is not part of the body
    foreign body
  69. images should be taken                     
    in two planes
  70. if glass contains             or                   it may show on film
    • lime 
    • metallic oxide
  71. the purpose of the initial exam is to
    • verify suspected foreign body
    • determine what it may be
    • the size, shape, location
    • extent of any bony or soft tissue trauma
  72. projections for smaller parts with foreign body close to sight of injury
    • direct central ray through the foreign body
    • two images at right angles to one another
  73. examples of frequent foreign body traumas in adults
    • fragments of fish or chicken bones
    •  bolus of solid food
    • dental appliances
  74. if aspirated into the air passages, the foreign body will be located                      in the neck or chest
    above the diaphragm
  75. when there is any doubt of location or if the object has been passed, image from                          to                         
    • level of the highest external body orifice to the lowest
    • (ears to anal canal)
    • include the neck, chest, abdomen, and pelvis.
  76. radiolucent foreign bodies require                        to coat the object or localize the site of obstruction and determine the condition of soft tissues at the point where the object has lodged
    contrast medium
  77. because an aspirated object can be drawn into the distal branch of the airway. the initial radiographs of infants and young children should be
    large enough to include the entire respiratory system
  78. projections for an aspirated object
    • AP head and chest (extending below diaphragm)
    • lateral neck
    • top border of film at the level of the EAM to include the entire nasopharynx

    *short exposure time
  79. aspirated objects usually get stuck in which bronchus? Why?
    • Right
    • shortest, widest and most vertical
  80. exact location of aspirated objects in small bronchial branches may require
  81. thoracic cavity projections utilized two PA projections, and inspiration and expiration, why?
    the interference with air flow will be demonstrated by no change in the radiolucency of the lung in the affected area.
  82. smooth surfaced foreign bodies such as coins and marbles are usually followed with
    24 hour interval films to verify that they have cleared the pylorus and iliocecal valve until final radiograph confirms that the object is no longer in the body
  83. if an object perforates tissue it may cause
    free air in image
  84. projections for lateral retrosternal exam
    • lateral on expiration
    • lateral as patient swallows
  85. if a swallowed object is not found in the pharynx a           and             should be taken
    • RAO
    • AP abdomen
  86. water soluble contrast medium loacalizes a non opaque foreign body by
    • giving it an opaque coating, revealing the site of obstruction and permits better evaluation of any soft tissue trauma
    • water soluble wont adhere to foreign body
  87. what procedures should be followed to examine a child who swallowed a smooth foreign object?
    entire alimentary canal with follow up images every 24 hours until the object has passed
  88. what should be done in the preliminary exam if a young child is brought into the examining room and its not certain whether the foreign object has been inhaled into the respiratory system or swallowed?
    • images from the level of the uppermost external orifice to the lowest
    • EAM to anal canal
  89. how much of the optic bulb is in the anterior orbital cavity and projects beyond the base
  90. how much of the optic bulb is in the posterior segments of the orbital cavity
  91. major parts of the eye
    • optic bulb
    • optic nerve
    • blood vessels
  92. accessory parts of the eye
    • extrensic muscles (6)
    • lacrimal apparatus
    • eyelids
  93. thin mucous membrane that covers the exposed part of the eye and the eyelids
  94. secretes tears that keep the conjuctival membrane moist. prevents drying and friction between the eyeball and eyelids
    lacrimal gland
  95. components of inner eye
  96. components of middle eye
    • choroid
    • ciliary bodies
    • iris
  97. components of outer eye
    • sclera 
    • cornea
  98. the white of the eye
    the posterior segment of outer coat
  99. anterior segment of outer coat
    transparent membrane for passage of light
    located in front of the iris and pupil with its center point corresponding to the pupil
  100. delicate membrane that is continuous with the optic nerve
    contains rods (dim light) and cones (color)
  101. refractive media components of the eye
    • crystalline lens 
    • aqueous humor (water like)
    • vitreous body (jelly like, bulb of eye)
  102. how light enters the eye and is focused toward the retina
    refractive media
  103. order in which light enters the eye to receive message
    • cornea
    • acqueous humor
    • pupil
    • lens
    • retina
    • optic nerve
  104. how many extrensic muscles are in the eye
    • 6
    • (4 rectus, 2 oblique)
  105. two modalities frequently used to localize foreign bodies within orbit or eye
    • ultrasound
    • CT
  106. film quality requirements for orbital imaging
    • ultrafine recorded detail
    • short OID
    • small focal spot
    • Long SID
    • close collimation
    • clean cassette
  107. preliminary exam for orbit
    • lateral (outer canthus of eye)
    • PA
    • Bone free studies
    • modified waters

    *all done tabletop with reduced technique
  108. Centering point and angle for PA axial orbit
    • 30° caudal to exit orbits
    • 3/4" distal to the nasion

    moves pyramids below orbits
  109. Modified waters for orbits requires what angle of the OML to the plane of the film