Arthrograms Presentation

ARTHROGRAMSARTHROGRAMSSTUDYSTUDY

SUPPORTSUPPORTSTATISTICSSTATISTICS

Eileen Dixon

Radiologic Technologist

The Cleveland Clinic Imaging Institute

THE CLEVELAND CLINIC FOUNDATIONTHE CLEVELAND CLINIC FOUNDATION



• During the 2008 presidential primaries, The Cleveland Clinic received accolades from President Obama for providing “the highest quality of care at costs well below the national norms.”

• That spirit of efficiency, effectively using resources, is at work in our radiology departments.

• At the Cleveland Clinic Imaging Institute, we are raising the level of expectation, information, consciousness, awareness, and participation of the radiology technical staff.

• Seminars in MRI, CAT scan and Ultrasound , offering 7-8 category A continuing education credits, have been or soon will be offered to technologist at the institute.



• During a 2008 radiology town-hall meeting, Dr. Michael Recht, a former radiologist at the Institute, now chairman of the Department of Radiology at New York University’s Langone Medical Center, discussed the need for technologists and physicians to work together in order to produce the best possible patient exam.

• This presentation illustrates how that heightened spirit of awareness works during the arthrogram process.

ARTHROGRAMSARTHROGRAMSSTUDYSTUDY SUPPORTSUPPORT STATISTICSSTATISTICS

•

•What we do in the arthrogram suite.•How technologist support the physicians.•A little bit about our numbers.


•Infusing a joint with contrast or air, followed by a succession of images, using conventional x-ray or fluoroscopy, best describes a basic arthrogram.


After injection of iodinated contrast, it was evident that this patient had a fibrocartilage ligament tear.

An arthrogram was performed before the patient went to MR.

PA, deviation and supination spots were obtained.

ARTHROGRAMSARTHROGRAMSMRIMRI

MR Arthrography:• Most accurate method

of depicting intra-articular anatomy and pathology.

• Unparalleled evaluation of labro-ligamentous structures.

• Commonly used for young competitive athletes.

Figure – www.ajronlins.org - Labral Tear. HH – Humeral head. G - Glenoid.

http://www.ajronlins.org/


Why is MR so useful?• Excellent soft tissue

contrast.• High resolution of

bone and cartilage.• Injected contrast

distends the joint capsule and seeps into abnormal defects.

• Top – Impingement syndrome.• Bottom – Rotator Cuff.

ARTHROGRAMSARTHROGRAMSMRI MRI

• Because the dilute Gadolinium seeps into the distended labro-ligamentous structures, it is excellent for labral tears.

• Top - Biceps tendon rupture.• Bottom - Labral Tear

ARTHROGRAMSARTHROGRAMSMRI - TECHNIQUEMRI - TECHNIQUE

• Patient is supine with the affected arm externally rotated.

• Local anesthetic is given directly over the medial and lower third of the glenoid.

• Needle is advanced until it contacts the humeral head.

• Position is confirmed with a small amount of iodinated contrast.

• 10–12 mls of dilute Gad is injected into the patient’s joint capsule. Patient is taken to MR.



• MR arthrography is excellent for the acetabular labrum.

• After the confirming intra-articular injection, and distention of this woman’s left hip, contrast leaked into the superolateral acetabular labrum, indicating a tear.

JOINT INJECTIONSJOINT INJECTIONSand and

ASPIRATIONSASPIRATIONS• After needle placement

is confirmed with iodinated contrast, medicines are injected for joint therapy.

• This fluoro guided process is also used for aspirations. After removal of the aspirate, a confirmation spot may or may not be taken.

ILIOPSOAS TENDON ILIOPSOAS TENDON INJECTION THERAPYINJECTION THERAPY

• Patient is supine with the affected leg slightly externally rotated.

• Skin is marked.• Position is confirmed

with a small amount of contrast.

• Generally, 2cc of steroid and 6-8cc of bupivacaine or lidocaine is given for pain relief.

TECH SUPPORTTECH SUPPORT


TECH SUPPORTSUPPORT• Name Bracelets• Allergy bands• Previous X-ray exams• Exams in the hospital• Scheduling problems• Incomplete orders

from outside facility• Insurance problems• Coordinate exam with

MR

TECH TECH SUPPORTSUPPORT• Meet and greet the

patient.• Put patient information

in the C-Arm.• Set the tray up: - medications needed for joint therapy. - labels and culture tubes for aspirations. - contrast needed for

MR and CT.

TECH TECH SUPPORTSUPPORTPatient Interview• Check the name band.• Confirm birth date.• Make sure the patient

understands the procedure.• Ask about allergies.• Blood thinners.• MRI – claustrophobia• Confirm the correct body

part and side (R or L).• Ask if they have any

questions.


TECH TECH SUPPORTSUPPORT• Position Patient and take a

scout fluoro spot.• Clean the injection site.• Assist the physician with tray

prep.• Save a confirmation injection

spot.• Transport the patient to MR.• Make sure aspirate samples

are properly taken care of.• Get the tray ready for

sterilization.

ARTHROGRAMSARTHROGRAMS

ARTHROGRAMSARTHROGRAMS

• Arthrogram technologists at the institute try to be pro-active, assertive and look for ways to stretch themselves.

• We attend the seminars, try to meet the needs of our patients and support our radiologist the best way we know how.

• My job is challenging, sometimes difficult, and sometimes I ask myself, “Why am I here?” But I love my job and enjoy coming to work.

Documents

Arthrograms Presentation