Arthrography
Arthrography
Definition
Arthrograpy is a procedure involving multiple x rays of a joint using a fluoroscope, or a special piece of x-ray equipment which shows an immediate x-ray image. A contrast medium (in this case, a contrast iodine solution) injected into the joint area helps highlight structures of the joint.
Purpose
Frequently, arthrography is ordered to determine the cause of unexplained joint pain. This fluoroscopic procedure can show the internal workings of specific joints and outline soft tissue structures. The procedure may also be conducted to identify problems with the ligaments, cartilage, tendons, or the joint capsule of the hip, shoulder, knee, ankle or wrist. An arthrography procedure may locate cysts in the joint area, evaluate problems with the joint's arrangement and function, or indicate the need for joint replacement (prostheses). The most commonly studied joints are the knee and shoulder.
Precautions
Patients who are pregnant or may be pregnant should not have this procedure unless the benefits of the findings outweigh the risk of radiation exposure. Patients who are known to be allergic to iodine need to discuss this complication with their physician. Patients who have a known allergy to shellfish are more likely to be allergic to iodine contrast.
Description
Arthrograpy may be referred to as "joint radiography" or "x rays of the joint." The term arthrogram may be used interchangeably with arthrography. The joint area will be cleaned and a local anesthetic will be injected into the tissues around the joint to reduce pain. Next, if fluids are present in the joint, the physician may suction them out (aspirate) with a needle. These fluids may be sent to a laboratory for further study. Contrast agents are then injected into the joint through the same location by attaching the aspirating needle to a syringe containing the contrast medium. The purpose of contrast agents in x-ray procedures is to help highlight details of areas under study by making them opaque. Agents for arthrography are generally air and water-soluble dyes, the most common containing iodine. Air and iodine may be used together or independently. After the contrast agent is administered, the site of injection will be sealed and the patient may be asked to move the joint around to distribute the contrast.
KEY TERMS
Aspirate— Remove fluids by suction, often through a needle.
Contrast (agent, medium)— A substance injected into the body that illuminates certain structures that would otherwise be hard to see on the radiograph (film).
Fluoroscope— A device used in some radiology procedures that provides immediate images and motion on a screen much like those seen at airport baggage security stations.
Radiologist— A medical doctor specially trained in radiology (x ray) interpretation and its use in the diagnosis of diseases and injuries.
X ray— A form of electromagnetic radiation with shorter wavelengths than normal light. X rays can penetrate most structures.
Before the contrast medium can be absorbed by the joint itself, several films will be quickly taken under the guidance of the fluoroscope. The patient will be asked to move the joint into a series of positions, keeping still between positioning. Sometimes, the patient will experience some tingling or discomfort during the procedure, which is normal and due to the contrast. Following fluoroscopic tracking of the contrast, standard x rays of the area may also be taken. The entire procedure will last about one hour.
Preparation
It is important to discuss any known sensitivity to local anesthetics or iodine prior to this procedure. A physician should explain the procedure and the risks associated with contrast agents and ask the patient to sign an informed consent. If iodine contrast will be administered, the patient may be instructed not to eat before the exam. The timeframe of fasting may extend from only 90 minutes prior to the exam up to the night before. There is no other preparation necessary.
Aftercare
The affected joint should be rested for approximately 12 hours following the procedure. The joint may be wrapped in an elastic bandage and the patient should receive instructions on the care and changing of the bandage. Noises in the joint such as cracking or clicking are normal for a few days following arthrography. These noises are the result of liquid in the joints. Swelling may also occur and can be treated with application of ice or cold packs. A mild pain reliever can be used to lessen pain in the first few days. However, if any of these symptoms persist for more than a few days, patients are advised to contact their physician.
Risks
In some patients iodine can cause allergic reactions, ranging from mild nausea to severe cardiovascular or nervous system complications. Since the contrast dye is put into a joint, rather than into a vein, allergic reactions are rare. Facilities licensed to perform contrast exams should meet requirements for equipment, supplies and staff training to handle a possible severe reaction. Infection or joint damage are possible, although not frequent, complications of arthrography.
Normal results
A normal arthrography exam will show proper placement of the dye or contrast medium throughout the joint structures, joint space, cartilage and ligaments.
Abnormal results
The abnormal placement of dye may indicate rheumatoid arthritis, cysts, joint dislocation, rupture of the rotator cuff, tears in the ligament and other conditions. The entire lining of the joint becomes opaque from the technique, which allows the radiologist to see abnormalities in the intricate workings of the joint. In the case of recurrent shoulder dislocations, arthrography results can be used to evaluate damage. Patients with hip prostheses may receive arthrography to evaluate proper placement or function of their prostheses.
Resources
ORGANIZATIONS
American College of Radiology. 1891 Preston White Drive, Reston, VA 22091. (800) 227-5463. 〈http://www.acr.org〉.
Arthritis Foundation. 1300 W. Peachtree St., Atlanta, GA 30309. (800) 283-7800. 〈http://www.arthritis.org〉.
Arthrography
Arthrography
Definition
Arthrography is the radiologic examination of soft tissue structures in the joints following an injection of a contrast agent with or without air. The structures demonstrated are the menisci, ligaments, tendons, articular cartilage, and bursae.
Purpose
The most commonly studied joints are the knee and shoulder, but this procedure may also be done on the hip, wrist, elbow, ankle and temporomandibular joints. Arthrography of the knee or a knee arthrogram is the most frequently performed arthrographic procedure; it is requested for patients with persistent pain, decrease in range of motion, or locking of the knee. Arthrography of the shoulder may be used to demonstrate partial or complete tears of the rotator cuff. A hip arthrogram is often used to detect a loose hip prosthesis or a congenital abnormality. Arthrography of the temporomandibular joints is ordered to detect abnormalities of the articular disk due to trauma or loosening of the ligaments. In many cases, however, an MRI may be obtained instead of an arthrogram.
Precautions
Patients who are or may be pregnant should not have this procedure unless the benefits of the findings outweigh the risk of radiation exposure. Patients who are known to be allergic to iodine should discuss this complication with their physician. Routine x rays of the affected joint must be taken before starting an arthrogram to ensure that there is no fracture or dislocation.
Description
The patient is asked to change into a hospital gown for a hip, knee, or shoulder arthrogram. Since arthrography is done in a sterile field to prevent infection, the x-ray technologist must be trained to work with the radiologist under sterile conditions. All needles, syringes, contrast material, local anesthetic, extension tubing, and cleansing solutions are prepared in advance by the x-ray technologist depending on the part to be examined.
Routine x rays of the affected joint are done by the x-ray technologist if no recent x-rays have been taken. The films are reviewed by the radiologist to ensure that there is no fracture or dislocation in the joint.
The radiologist begins the procedure by cleansing the skin of the affected joint and applying a sterile drape. The x-ray technologist places all the required needles and syringes onto the sterile tray using proper sterile technique and assists the radiologist by drawing up the anesthetic and contrast material into the various syringes.
Once the area of skin over the joint has been numbed with a local anesthetic, the radiologist will place the needle into the joint, using x-ray images to guide placement. Additional fluid in the joint may be aspirated and sent for analysis, particularly if a joint infection is suspected. A small test injection of the contrast medium is done to confirm accurate needle placement. The contrast medium is then injected either with or without air depending on the area under investigation. The needle is removed and a small self-adhesive dressing is applied. The joint is then manipulated to properly distribute the contrast medium over the entire joint space.
Before the contrast medium can be absorbed by the joint itself, several films will be taken by the radiologist. The patient will be asked to move the joint into a series of positions, keeping still between positioning. During a knee arthrogram, the knee is manually stressed by the radiologist to open the joint space. Patients may experience some tingling or discomfort during the procedure. These are normal reactions, caused by the contrast material and air inside the joint as well as the manual positioning of the painful joint.
Following fluoroscopic tracking of the contrast medium, standard x rays of the area are taken by the x-ray technologist. An overexposed lateral x ray of the knee flexed at 90 degrees is usually done in addition to the routine AP (anteroposterior) internal and external oblique x rays in order to visualize the cruciate ligaments. An axillary view of the shoulder is usually requested as well as an AP (anteroposterior) view of the shoulder with the arm rotated internally and externally. The procedure is usually completed within 30 minutes.
Preparation
It is important to alert the physician to any known sensitivity to local anesthetics or iodine prior to an arthrogram. Routine x rays of the affected joint should be taken before starting the arthrogram to make sure there is no fracture or dislocation, and to verify the diameter of the joint space before the needle is inserted. A small section of the knee may be shaved before starting the arthrogram.
Aftercare
The affected joint should be rested for approximately 12 hours following the procedure. Swelling may occur and can be treated with an application of ice or cold packs. A mild pain reliever may also be necessary to lessen discomfort for the first 12 hours. Noises in the joint such as cracking or clicking are normal for a few hours following an arthrogram. These noises are the result of the extra liquid (contrast) and air in the joint.
Complications
Some patients may have allergic reactions to iodine, ranging from mild nausea or a rash to severe cardiac and resiratory problems. Since the contrast material is injected directly into a joint, however, rather than the venous circulation, allergic reactions are rare. Facilities licensed to perform contrast examinations should meet requirements for emergency equipment, supplies and staff training in order to handle a possible severe reaction. Nonionic contrast material is also available in most radiology departments.
Arthrographic studies should not be done on patients with a known joint infection, bleeding problems, or severe active arthritis.
Results
A normal arthrogram demonstrates a normal joint space with no damage to the articular cartilage, tendons, ligaments or bursae. Partial or incomplete tears of the rotator cuff are better demonstrated using MRI imaging.
Abnormal results of an arthrogram may indicate partial or complete tears of the rotator cuff, demonstrated as a leakage of contrast material out of the joint and into the bursa. In a knee arthrogram, meniscal tears are demonstrated as well as problems with the ligaments or evidence of a popliteal cyst, commonly referred to as a Baker's cyst. A Baker's cyst is demonstrated on the radiographs as an extension of fluid into the popliteal fossa located behind the knee. Dislocations of the hip are visible as well as a loose hip prosthesis. Joint space narrowing and arthritis are also visualized on an arthrogram.
Health care team roles
Since a reaction to an iodine-based contrast medium is always a risk in arthrography, the x-ray technologist must be familiar with emergency procedures in place to deal with a cardiac arrest. The x-ray technologist works closely with the radiologist during this procedure and must be familiar with sterile techniques in order to prevent infection.
Patient education
The radiography technologist explains the procedure to the patient and inquires about any known allergies and the possibility of pregnancy. Since many patients are nervous about an injection directly into the joint, the x-ray technologist must assure the patient that the area will be numbed in advance with a local anesthetic. During a knee arthrogram the radiologist manually positions the patient, so the patient must be encouraged to relax the knee completely. All radiography technologists must be certified and registered with the A.S.R.T. and are required to obtain continued education credits to maintain their credentials.
KEY TERMS
Aspirate— To remove fluids by suction, often through a needle.
Bursa— A closed space between two moving surfaces containing a small amount of lubricating fluid to reduce friction in the joint.
Contrast (agent, medium)— A substance injected into the body that outlines certain structures that would otherwise be hard to see on the radiograph (film).
Fluoroscope— An under-table x-ray tube used to visualize structures in real time on a television screen.
Fossa— An anatomical cavity or hollow.
Meniscus— A wedge of cartilage that separates the articulating bones in certain joints.
Popliteal— Pertaining to the area at the back of the knee.
Rotator cuff— A group of muscles lying outside the shoulder joint that allow the joint to move in many directions.
X ray— A form of electromagnetic radiation with shorter wavelengths than normal light. X-rays can penetrate most structures.
Following the arthrogram, the patient is also instructed to put ice on the affected joint and to take a mild pain reliever if necessary.
Resources
BOOKS
Ballinger, Phillip. Merill's Atlas of Radiographic Positioning, 6th ed. St. Louis, MO: CV Mosby Publishing.
Eisenberg, Ronald. Clinical Imaging: Atlas of Differential Diagnosis, 3rd ed. New York: Thieme Publishing, 1997.
ORGANIZATIONS
American College of Radiology. 1891 Preston White Drive. Reston, VA 22091. (800) ACR-LINE. 〈http://www.acr.org〉.
The Arthritis Foundation. 1330 West Peachtree Street. Atlanta, GA 30309. (800) 283-7800. 〈http://www.arthritis.org〉.
Arthrography
Arthrography
Definition
Purpose
Description
Preparation
Aftercare
Risks
Normal results
Definition
Arthrograpy is a procedure involving multiple x rays of a joint using a fluoroscope, a special piece of x-ray equipment that shows an immediate x-ray image. A contrast medium (in this case, a contrastiodine solution) injected into the joint area helps highlight structures of the joint.
Purpose
Frequently, arthrography is ordered to determine the cause of unexplained joint pain. This fluoroscopic procedure can show the internal workings of specific joints and outline soft tissue structures. The procedure may also be conducted to identify problems with the ligaments, cartilage, tendons, or the joint capsule of the hip, shoulder, knee, ankle, wrist, or other joints. An arthrography procedure may locate cysts in the joint area, evaluate problems with the joint’s arrangement and function, indicate the need for joint replacement, or show problems with existing joint replacement (prostheses). The most commonly studied joints are the knee and shoulder.
Description
Arthrograpy may be referred to as “joint radiography” or “x rays of the joint.” The term arthrogram may be used interchangeably with arthrography. The joint area will be cleaned and a local anesthetic will be injected into the tissues around the joint to reduce pain. Next, if fluids are present in the joint, the physician may suction them out (aspirate) with a needle. These fluids may be sent to a laboratory for further study. Contrast agents are then injected into the joint through the same location by attaching the aspirating needle to a syringe containing the contrast medium. The purpose of contrast agents in x-ray procedures is to help highlight details of areas under study by making them opaque. Agents for arthrography are generally air- and water-soluble dyes, the most common containing iodine. Air and iodine may be used together or independently. After the contrast agent is administered, the site of injection will be sealed, and the patient may be asked to bend and flex the joint to distribute the contrast.
Before the contrast medium can be absorbed by the joint itself, several films will be quickly taken under the guidance of the fluoroscope. The patient will be asked to move the joint into a series of positions, keeping still between positioning. Sometimes, the patient will experience some tingling or discomfort during the
KEY TERMS
Aspirate— Remove fluids by suction, often through a needle.
Contrast (agent, medium)— A substance injected into the body that outlines certain structures that would otherwise be hard to see on the radiograph (film).
Fluoroscope— A device used in some radiology procedures that provides immediate images and motion on a screen much like those seen at airport baggage security stations.
Radiologist— A medical doctor specially trained in radiology (x ray) interpretation and its use in the diagnosis of diseases and injuries.
X ray— A form of electromagnetic radiation with shorter wavelengths than normal light. X rays can penetrate most structures.
procedure, which is normal and due to the contrast. Following fluoroscopic tracking of the contrast, standard x rays of the area may also be taken. The entire procedure will last about one hour.
Generally, a joint is evaluated first by MRI (magnetic resonance imaging) instead of an arthrogram, or by MRI combined with the arthrogram. Gadolinium, an MRI contrast agent, is injected if the arthrogram is performed as part of an MRI procedure. If the arthrogram is performed as part of a MRI arthrogram, the MRI scan will then be obtained immediately afterward.
Preparation
It is important to discuss any known sensitivity to local anesthetics or iodine prior to this procedure. A physician should explain the procedure and the risks associated with contrast agents and ask the patient to sign an informed consent. If iodine contrast will be administered, the patient may be instructed not to eat or drink anything for a period of hours before the exam. The timeframe of fasting may range from only 90 minutes prior to the exam up to the night before. There is no other preparation necessary.
Aftercare
The affected joint should be rested for approximately 12 hours following the procedure. The joint may be wrapped in an elastic bandage, and the patient should receive instructions on the care and changing of the bandage. Noises in the joint such as cracking or clicking are normal for a few days following arthrography. These noises are the result of liquid in the joints. Swelling may also occur and can be treated with application of ice or cold packs. A mild pain reliever can be used to lessen pain in the first few days. However, if any of these symptoms persist for more than a few days, patients are advised to contact their physician.
Risks
In some patients iodine can cause allergic reactions, ranging from mild nausea to severe cardiovascular or nervous system complications. Since the contrast dye is put into a joint, rather than into a vein, allergic reactions are rare. Facilities licensed to perform contrast exams should meet requirements for equipment, supplies, and staff training to handle a possible severe reaction. Infection or joint damage are possible, although not frequent, complications of arthrography.
Normal results
A normal arthrography exam will show proper placement of the dye or contrast medium throughout the joint structures, joint space, cartilage, and ligaments.
The abnormal placement of dye may indicate rheumatoid arthritis, cysts, joint dislocation, tear of the rotator cuff, tears in the ligament, and other conditions. The entire lining of the joint becomes opaque from the technique, which allows the radiologist to see abnormalities in the intricate workings of the joint. In the case of recurrent shoulder dislocations, arthrography results can be used to evaluate damage. Patients with hip prostheses may receive arthrography to evaluate proper placement or function of their prostheses.
Resources
BOOKS
Juhl, John H., and Andrew B. Crummy. Paul and Juhl’s Essentials of Radiologic Imaging, 7th edition. Philadelphia: Lippincott Williams & Wilkins, 1998.
ORGANIZATIONS
American College of Radiology. 1891 Preston White Drive, Reston, VA 22091. (800) 227-5463. http://www.acr.org.
Arthritis Foundation. 1300 W. Peachtree St., Atlanta, GA 30309. (800) 283-7800. http://www.arthritis.org.
Teresa Norris, RN
Lee A. Shratter, M. D.
Tish Davidson, A. M.
Arthrography
Arthrography
Definition
Arthrograpy is a procedure involving multiple x rays of a joint using a fluoroscope, a special piece of x-ray equipment that shows an immediate x-ray image. A contrast medium (in this case, a contrast iodine solution) injected into the joint area helps highlight structures of the joint.
Purpose
Frequently, arthrography is ordered to determine the cause of unexplained joint pain. This fluoroscopic procedure can show the internal workings of specific joints and outline soft tissue structures. The procedure may also be conducted to identify problems with the ligaments, cartilage, tendons, or the joint capsule of the hip, shoulder, knee, ankle, wrist, or other joints. An arthrography procedure may locate cysts in the joint area, evaluate problems with the joint's arrangement and function, indicate the need for joint replacement, or show problems with existing joint replacement (prostheses). The most commonly studied joints are the knee and shoulder.
Description
Arthrograpy may be referred to as "joint radiography" or "x rays of the joint." The term arthrogram may be used interchangeably with arthrography. The joint area will be cleaned and a local anesthetic will be injected into the tissues around the joint to reduce pain. Next, if fluids are present in the joint, the physician may suction them out (aspirate) with a needle. These fluids may be sent to a laboratory for further study. Contrast agents are then injected into the joint through the same location by attaching the aspirating needle to a syringe containing the contrast medium. The purpose of contrast agents in x-ray procedures is to help highlight details of areas under study by making them opaque. Agents for arthrography are generally air- and water-soluble dyes, the most common containing iodine. Air and iodine may be used together or independently. After the contrast agent is administered, the site of injection will be sealed, and the patient may be asked to bend and flex the joint to distribute the contrast.
Before the contrast medium can be absorbed by the joint itself, several films will be quickly taken under the guidance of the fluoroscope. The patient will be asked to move the joint into a series of positions, keeping still between positioning. Sometimes, the patient will experience some tingling or discomfort during the procedure, which is normal and due to the contrast. Following fluoroscopic tracking of the contrast, standard x rays of the area may also be taken. The entire procedure will last about one hour.
Generally, a joint is evaluated first by MRI (magnetic resonance imaging ) instead of an arthrogram, or by MRI combined with the arthrogram. Gadolinium, an MRI contrast agent, is injected if the arthrogram is performed as part of an MRI procedure. If the arthrogram is performed as part of a MRI arthrogram, the MRI scan will then be obtained immediately afterward.
Preparation
It is important to discuss any known sensitivity to local anesthetics or iodine prior to this procedure. A physician should explain the procedure and the risks associated with contrast agents and ask the patient to sign an informed consent . If iodine contrast will be administered, the patient may be instructed not to eat before the exam. The timeframe of fasting may range from only 90 minutes prior to the exam up to the night before. There is no other preparation necessary.
Aftercare
The affected joint should be rested for approximately 12 hours following the procedure. The joint may be wrapped in an elastic bandage, and the patient should receive instructions on the care and changing of the bandage. Noises in the joint such as cracking or clicking are normal for a few days following arthrography. These noises are the result of liquid in the joints. Swelling may also occur and can be treated with application of ice or cold packs. A mild pain reliever can be used to lessen pain in the first few days. However, if any of these symptoms persist for more than a few days, patients are advised to contact their physician.
Risks
In some patients iodine can cause allergic reactions, ranging from mild nausea to severe cardiovascular or nervous system complications. Since the contrast dye is put into a joint, rather than into a vein, allergic reactions are rare. Facilities licensed to perform contrast exams should meet requirements for equipment, supplies, and staff training to handle a possible severe reaction. Infection or joint damage are possible, although not frequent, complications of arthrography.
Normal results
A normal arthrography exam will show proper placement of the dye or contrast medium throughout the joint structures, joint space, cartilage, and ligaments.
Abnormal results
The abnormal placement of dye may indicate rheumatoid arthritis, cysts, joint dislocation, tear of the rotator cuff, tears in the ligament, and other conditions. The entire lining of the joint becomes opaque from the technique, which allows the radiologist to see abnormalities in the intricate workings of the joint. In the case of recurrent shoulder dislocations, arthrography results can be used to evaluate damage. Patients with hip prostheses may receive arthrography to evaluate proper placement or function of their prostheses.
Resources
books
Juhl, John H., and Andrew B. Crummy. Paul and Juhl's Essentials of Radiologic Imaging. Philadelphia: J. B. Lippincott Co., 1993.
organizations
American College of Radiology. 1891 Preston White Drive, Reston, VA 22091. (800) 227-5463. <http://www.acr.org>.
Arthritis Foundation. 1300 W. Peachtree St., Atlanta, GA 30309. (800) 283-7800. <http://www.arthritis.org>.
Teresa Norris, RN
Lee A. Shratter, MD