RADS

321

Final Review 2

5-9-16

Angelas Notes from Tests 1-4

Skull positioning:
Image of PA projection
Image of 15 degree caudal projection
Evaluation criteria for lateral skull:
o The following should be superimposed:
Mandibular rami
Orbital roofs
EAMs
TMJs
AP Axial Towne Method
o If pt unable to tuck chink, IOML perp to plane of film, CR directed 37 degrees caudal.
TMJ, Axiolateral projection is the Schuller Method
Axiolateral TMJs, the CR is 25-30 degrees caudal
Image of axiolateral TMJs
Image -label anatomy of orbit
Facial Bones Positioning:
Lateral Facial Bones
o CR directed perpendicular to midpoint of cassette to enter the lateral surface of the
o Zygomatic bone, way between EAM & outer canthus
o EC:
orbital roofs superimposed
Mandibular rami superimposed
Sella turcica no rotated
All facial bones included with zygoma in the center
Parietoacanthial Projection Waters Method IMAGE
o MML is perpendicular to the plane of the IR
o OML forms an angle of 37 degree angle with the plane of the IR
o EC:
petrous ridge immediately below the maxillae
Modified Parietoacanthial Projection Modified Waters IMAGE
o SS: blow-out fractures of the orbits
Looking at the floor of the orbits
Acanthioparietal Projection-Reverse Waters-TRAUMA
o If pt cannot be moved, place CR parallel to the MML
PA Axial Projection Caldwell Method-IMAGE
o EC: petrous ridges in lower 1/3 of orbits
Lateral Nasal Bones Image
Zygomatic Arches
SMV Schuller Method
o SS: zygomatic arches free of superimposition
o EC: zygomatic arches free of overlying structures
AP Axial Towne Method IMAGE
o CR directed 30 degrees caudal, enters the glabella
Tangential Projection
o Useful if pt has depressed fracture of the cheekbones or flat cheekbones

RADS 321

Final Review 2
5-9-16

Positioning of the Sinuses:
Paranasal sinuses should be imaged with the pt erect
Lateral Projection
o CR directed perpendicular to midpoint of cassette; enters -1 posterior to outer
o canthus farthest from IR
o SS: all 4 sinuses visualized
PA Axial Projection Caldwell
o Pt will rest head on tip of the nose so that the OML forms a 15 degree angle with the horizontal CR
Open Mouth Waters Pirie Method
o The sphenoid sinuses projected through the open mouth
SMV
o Sphenoidal sinuses and ethmoidal air cells are shown
Orbits
Rhese Method Parietoorbital oblique projection
o MSP forms an angle of 53 degrees with plane of IR (because optic foramen is
o 37 degrees medially)

Vertebral Column:
Anatomy of vertebra
Odontoid Image -label anatomy
Image -label anatomy of the sacrum

C-Spine positioning:
Emergency room pts or trauma pts always perform cross-table lateral projection before proceeding with
rest of routine exam
Lateral shows zygopophyseal joints
Obliques show foramina
AP Axial Projection
o CR 15-20 degrees cephalic, enters C-4 at the MSP
o Image What is the projection?
Fuchs image when do you perform this projection?
Lateral projection- what is the kVp range? 85-100
2 lateral images given which is acceptable?
Image of hyperextension

Obliques:
AP Axial Obliques RPO/LPO
o Pt is obliques 45 degrees
o CR 15-20 degrees cephalic, CR enters C4
o Images which foramina do you see?
PA Axial Oblique RAO/LAO
o CR directed 15-20 degrees caudal to C4

Soft tissue neck:

Go down 10 kVp from lateral C-spine

T-Spine:
AP Projection
o Center transversely to the level of T7
o CR perpendicular entering T7
2

RADS 321

Final Review 2

Lateral
o Image how can you improve? Perform a Swimmers
o If the spine is not parallel to the table, the CR is directed:
15 degrees cephalic for males
10 degrees cephalic for females
o Swimmers Image label anatomy and what is the technique/method?
C7 can be identified by locating the elevated clavicle, it crosses over C7
Oblique
o The body is oblique 70 degrees from the plane of the film
o CR is directed perpendicular to T7
o SS: zygopophyseal joints
o Images: what is the position? & what joints do you see?

5-9-16

L-Spine
AP Projection
o 11x14 cassette center to L3
Lateral Projection
o 85-100 kVp
o CR directed perpendicular to: 11x14 1 above the crest (L3)
o If no support under the lower thorax, CR is angled caudally 5 degrees for males and
8 degrees for females
Lumbosacral Junction
o When the spine is parallel, CR is perpendicular to IR enters 1 inferior to the iliac
Crest and 2 posterior to the ASIS
o When the spine is not parallel to the IR, CR is 5 degrees caudal for males and
8 degrees caudal for females
PA Oblique Projections
o Images what position, what joints? for AP & PA
o Oblique 45 degrees
Sacrum/coccyx
Sacrum
o AP Axial Projection
CR-15 degrees cephalic
Enters 2 superior to symphysis
o Lateral
3 posterior to the ASIS and at the level of the ASIS
Coccyx
o AP Axial Projection
10 degrees caudal
2 superior to pubic symphysis
o Lateral
3 1/2 posterior to and 2 inferior to the ASIS
Bony Thorax
The bony thorax consists of: sternum, 12 pairs of ribs, 12 thoracic vertebrae
Manubrial notch lies at the T2-T3 interspace

RADS 321

Final Review 2

Ribs:
Anatomy
o Spaces between the ribs are called intercostal spaces
o Head expanded posterior end; articulates with the vertebral bodies
o Tubercle articulates with the transverse process of the thoracic vertebra
Axillary portion of the ribs are best shown in the oblique position
Ribs above the diaphragm should be done erect
Erect PA CXR may be part of routine at some hospitals to rule out hemothorax or pneumothorax
o
o

5-9-16

Ribs below the diaphragm:

Exposure made at end of expiration to elevate the diaphragm
Bottom of IR @ the iliac crest
Obliques:
Pt oblique 45 degrees
AP hurt side down
PA hurt side up

Sternum:
o Image RAO position
o For RAO oblique pt 15-20 degrees
Lateral
o 72 SID
o Roll shoulders posteriorly, lock hands
o Respiration: suspend on deep inspiration

SC Joints:
Bilateral rest head on chin
CR perpendicular to T3

Scoliosis:
Scoliosis is abnormal lateral curvature of the spine.
Use of compensating filters to provide a uniform exposure (radiographic density)
PA protects gonads and breast tissue in young girls

Pediatrics:
Radiation protection:
use high kVp & low mAs
Pedi Conversions: (on test was a 6 year old pt)
o 0-1: .25
o 1-3: .5
o 3-7: .7
o 7-13: .9
o Reduce kVp by 2 for every cm difference from the adult and reduce mAs
(adult mAs x conversion factor)
o Pigg-o-stat most commonly used device for upright radiography for ages up to 2 yrs
?? on test, how to take a CXR of a 10 year old?
Concerns about child abuse should be directed to radiologist or attending physician

Geriatrics:
o Skin tears & fall risk

RADS 321

Final Review 2

Long bone measurement:
Lower extremity most commonly performed
Pt is supine for all exams
There will be 3 exposures of each limb:
o Upper: wrists, elbows, shoulders
o Lower: ankles, knees, hips
Computed tomography is considered to be more consistently reproduced

Bone Age:
Bone age can be determined by studying the epiphyses
Most common radiograph is a PA projection of the wrist and hand

Dialysis Survey:
Purpose to evaluate the demineralization of bones
Hyperparathyroidism:
o Causes an increase in serum calcium due to overproduction of parathyroid
o Hormones, which causes bone resorption. This results in bone resorption
o Or osteoporosis

Bone Metastatic Bone Survey:

May also be called skeletal survey
Surveys are carried out when metastases are suspected but not know

5-9-16

RADS 321

Final Review 2

5-9-16

Final New Information:

Mobiles and Surgery:
Principles of Mobile Radiography
Performed in:
Patients rooms
ER
ICU
Surgery
Recovery
Nursery/Neonatal Units
Some machines are designed for transport by:
Van
Automobile
To nursing homes, extended care facilities, or other off-site locations requiring radiographic imaging
services
Mobile X-Ray Equipment
When patients cant come to the department for imaging, we must go to them. It is then a portable or mobile
procedure
These 2 terms are not interchangeable:
1. Mobile Equipment:
Equipment that is capable of being moved
Mounted on wheels
Can be pushed by human or mechanical power
2. Portable Equipment:
Equipment that is capable of being carried with the implication that it does not need (in theory
anyway) more than one able bodied person to do the carrying at any given time
Instead of Portable we should call it- Mobile
Portable means it can be packed up and setup somewhere else, like a field unit
Mobiles & Surgical Radiography
Mobiles is an area of diagnostic radiology without standard routines
Most common mobile procedures are:
Chest
C-spine
Abdomen
Extremities in traction
Typical mobile machine has kVp & mAs settings
kVp Range- 40 - 130
mAs Range- 0.04 320
Total Power of the Unit Range- 15 25 kilowatts
Some mobile units have preset anatomic programs
Mobile X-Ray Machines are Classified as:
Battery Operated
Capacitor Discharge

AEC is available on some mobile units:

The paddle containing the ionization chamber is behind the IR
The paddle is used to determine exposure time
6

RADS 321

Final Review 2

Direct Digital Capability:
Image is acquired immediately on the unit
Uses a flat panel detector similar to those found in a DR table bucky
The detector is usually connected by:
Tethered cord
Communicates through wireless technology

5-9-16

Mobile X-Ray Machines

Battery Powered Mobile Unit:
GE machines are a primary example of this type of equipment
Contain (up to as many as ten) 12-volt lead acid battery packs connected in series which operates a drive
motor and the x-ray tube
The batteries are usually maintenance free
Batteries should last up to 2 years
Maintenance should include:
Plugging in only when battery is low
Usually when the batteries are fully charged, charging stops and a neon light will indicate a full
charge
Normally plug in every night and on weekends
Check acid levels every 2 weeks
Driving Mechanism
Forward/Reverse
A strong deadman type of brake is standard, which means the machine stops instantly when
the push handle is released
Advantage of this type of mobile unit:
Cordless
Provides constant kVp & mAs
Circuitry differs from the stationary unit
Have an inverter, which changes the battery DC voltage to 1 kHertz (1000 Hz) AC
Then it has rectifiers which change AC back to DC for the tube
Includes full wave rectification provided by means of selenium rectifiers
Full wave rectification allows greater efficiency
Technical Considerations
Grids:
General Rules:
Keep IR and part as parallel as possible
Grid use is critical in mobile imaging
Grid must be level to prevent cut-off
Grids most often used: 6:1 or 8:1 focal range 36-44
Be familiar with the type of grid that is being used:
Focused- specific SID is critical
Linear
Also, know the grid ratio for technique considerations
Keep CR perpendicular to the part
Anode Heel Effect:
Causes a decrease in density under the anode side of the tube
More pronounced with:
Short SID
Larger field sizes
Small anode angles
Know the anode/cathode orientation of the tube to best utilize this effect

RADS 321

SID:

Final Review 2

5-9-16

SID should be 40 for most mobile exams

Longer distances of 40-48 require increased mAs to compensate for increased distance
The mA limitations of a mobile unit necessitate longer exposure times when SID exceeds 40
Therefore, the result could be motion artifacts especially when imaging children/infants or the
critically ill adult patients

Radiation Safety
Mobile radiography produces some of the highest occupational radiation exposures for radiographers
Radiation safety for radiographers, other is immediate area, and patient is extremely important
Radiographer must:
Wear a lead apron
Stand as far away from the patient, tube, and use beam as the room and exposure allow
Recommended minimal distance: 6 (2m)
Most effective means of radiation protection is distance
The radiographer should inform all persons in the immediate area that an x-ray exposure is about to occur
Lead protection should be provided:
For any individuals who are unable to leave the room
For individuals who may have to hold a patient or IR
Shield patients gonads
Source-to-skin distance cannot be less than 12 in accordance with federal safety regulations

Gonadal Shielding
For the following situations:
X-ray exams performed on children
X-ray exams performed on patients of reproductive age
Any exams for which the patient requests protection
Exams in which the gonads lie in or near the useful beam
Exams in which shielding would interfere with imaging of the anatomy that must be shown
Isolation Considerations:
Two types of patients to consider:
1. Patients who have infectious microorganisms
2. Patients who need protection from potentially lethal microorganisms
Make sure the mobile unit is properly cleaned and disinfected to prevent transmission of infectious
microorganisms
Preliminary Steps before Performing Exam:
Announce your presence to nursing staff, etc.; ask for assistance if needed
Determine that the correct patient is in the room
Introduce yourself to the patient and family
Observe equipment in the room, IV poles, etc.
Ask family members/visitors to leave

Mobile X-ray Equipment

C-Arm- implies mobile Fluoroscopy
X-ray tube head and image intensifier are mounted so that they are at opposite ends of a C-arm
X-ray tube at lower end and image intensifier at upper end with its input phosphor facing towards the x-ray tube
Tube can be on top when positioning
Not recommended because it increases the OID
This also increases the exposure to the head and necks of the operator and surgery team
At the back of the image intensifier is a TV pickup tube, either a 675-line vidicon (more common) or 875-line
plumbicon

8

RADS 321

Final Review 2

C-Arm Mounted on a Cross-Arm
Tube head, stationary anode, dual focal spot (0.3-1.0 mm) has a 5:1 grid
Input phosphor: Cesium Iodide
Field Sizes: 5, 6, & 9
Control console mounted on wheels
TV Monitor & Control Cart:
2 Monitors Needed:
One for the active image
One for Image Hold (still image)
Generally active on left and hold on right

5-9-16

Operation Mode:
Mag Mode- magnify image- so surgeon can better visualize structures that are frequently viewed from
distance
Pulse Mode- to create a pulsating x-ray beam at timed increments to reduce exposure
Snapshot or Digital Spot Mode- activates digital spot; results in a higher quality computer enhanced
image as compared to a fluoro image
Film Mode- for exposing standard cassette; cassette holder attached to image intensifier tower
Converts machine to conventional mobile radiography unit

Additional Operational Modes:

Subtraction (digital subtraction)- self-explanatory
Road Mapping- method of image display
A specific fluoro image is held on screen in combination with continuous fluoro
Especially useful for placement of catheters and guide wires
Foot Pedal- fully equipped, has multiple pedals
Scout Fluoro- unprocessed fluoro
Digital Process Fluoro- activates computer enhanced processing
Image Save- saving of last image displayed
Snapshot or Boost Digital Spot

Mobile Radiography
3 Key Accessories for Mobiles Are:
1. Grid cassettes
2. IR holders
3. Slip-on Grids
Common Accessories:
Sponges
Tape
Rolled sheets
Sand bags
Lead aprons
Mobile Chest
Most commonly performed mobile procedure
Remember CR perpendicular to cassette; Part parallel to cassette
Make sure to not produce a lordotic image

RADS 321

Surgical Radiography

Final Review 2

5-9-16

Operating Room Attire

Masks
Shoe covers
Caps
Gloves
Dosimeter
Proper ID
Personal Hygiene
Persons with infection not permitted to enter OR suite:
Cold
Open cold sore
Sore throat
Known to be carrier of transmittable conditions
Daily body & hair cleanliness to prevent transportation of microbial fallout which could cause open wound
infections
Surgical Radiography
Requires a good knowledge of aseptic technique
Aseptic Technique- means free from germs or without infection
Extremity Examinations
Choose appropriate size of IR to include all anatomy and hardware
Working in a Sterile Field
Patient is draped with sterile sheets to provide an antibacterial barrier between the patient and the sterile attired
team
Sterile attire in surgery reduces the air-borne contamination because sterile attired persons touch sterile items
Sterile attire is from waist up and only the front
Sterile attired persons should pass front to front or back to back
When in doubt if an object is sterile, consider it non-sterile
When contamination occurs, it is called a Strike Through
Radiographic Equipment for the Operating Room
Three important hazards to consider when using mobile radiographic equipment in OR:
1. Risk of Infection- a mobile unit is used throughout hospital and if not properly cleaned, could bring
infection into OR
Manufacturers have designed features on the mobile units to help in the cleaning process of the units
2. Risk of Explosion
Because anesthetic gases are used in OR:
Using electrical equipment that may produce a spark (static electricity- friction) could be
explosive
This risk is decreasing because anesthetic gases which readily ignite or promote ignition are
now less often used
Mobile units have wheels with special conducting rubber to prevent static

10

RADS 321

Final Review 2
5-9-16

3. Radiation Risk to Everyone in OR
Most ORs have their own supply of lead aprons
It is the responsibility of the RT to remind everyone in OR that x-rays will be used and assist them in
getting lead aprons
The greatest amount of scatter occurs on the tube side of the machine. Best to have fluoroscopic tube
under the patient (ex. C-arm in surgery)
Also, if tube is under the patient, the shielding should also be under the patient
The source-to-skin distance should not be less than 12
Time Saving
Another important factor in OR
The OR team has to subject the patient to anesthesia and open surgery for the shortest possible time
Therefore, rapid radiographic results are necessary
Mobile fluoro units with an image intensifier are one way to save time
The radiographer must remember that if they are operating fluoro in the absence of a radiologist
The responsibility of radiation safety is carried by the radiographer
This gives the radiographer an authoritative voice should not hesitate to speak even to the most senior surgeons if
radiation dose to patient and staff appears unreasonably high
It is the radiographers ultimate responsibility to communicate with the anesthetist or anesthesiologist to assure
that breathing has been stopped before the exposure
Radiation Safety
Highest occupational exposure
Wear lead apron
Distance- 6 recommended
Shield patient gonads
Source-to-skin distance cannot be less than 12- federal safety regulations

Reading Assignment: Merrills Volume III p.1-18

Anatomy of the Spinal Cord

Conus Medullaris- most inferior portion of the spinal cord at the lower border of L-1
Filum Termiale- a fibrous strand that extends from the terminal tip of the cord
Attaches the cord to the upper coccygeal segment
Cauda Equina- spinal nerves that extend below the termination of the spinal cord
Resembles a horses tail

11

RADS 321

Final Review 2

Nervous System
Any traumatized patient with possible CNS involvement
Begins with a cross-table lateral C-spine
Rules out fractures & misalignment of C-spine
Approximately 2/3rds of significant spine pathology can be detected on this image

5-9-16

Spinal Cord Injuries

Level of injury is helpful in predicting what parts of the body might be affected by paralysis/loss of function

Cross-table C-spine would be followed by CT before going into a true nervous system examination
Routine spine images will assess:
Narrowed disk space
Degeneration of the disk
Osteoarthritis
Post-op changes

Radiographic Examinations of the Nervous System

Cerebral Pneumography- is outdated, historically, need to know it was an exam of the brain; involved injecting
contrast into the ventricular system
2 Types of Cerebral Pneumography:
1. Pneumoventriculography- inject contrast directly into the ventricular system; Burr holes are
associated with this exam
2. Pneumoencephalography- inject contrast into subarachnoid space via a spinal puncture
Myelography
It is a general term used for radiographic exam of the CNS structures located within the spinal cord
(Myelos- marrow; spinal cord)
Performed by introducing a contrast agent into the subarachnoid space via a spinal puncture (intrathecal injection)
Purpose is to Demonstrate:
Extrinsic spinal cord compression caused by a herniated disk
Bone fragments
Tumors
Swelling resulting from traumatic injury
Contrast agents may be opaque or gaseous:
Opaque Agents:
Oil Based (Pantopaque): 1942
Used for many years
Must be removed following exam
Did not coat thin areas such as nerve roots in lumbar region

12

RADS 321

Final Review 2

5-9-16

Water-Soluble Iodinated (Isovue, Omnipaque)

Most commonly used today
Coats nerve roots better than pantopaque
Does not have to be removed
Less irritating to spinal cord
Absorbed quickly, causing more post myelographic headaches
Inject slowly or it will dilute
When using omnipaque, patient is to be well-hydrated
Will provide good contrast for at least 30 minutes
Gaseous Medium
Is absorbed quickly
Does not mix with CSF well
Procedure Preparation:
Must be performed under aseptic technique
Clean table & overhead equipment before patients arrival
Attach footboard and shoulder supports
Have sterile tray & non-sterile items required for injection & spinal puncture
Patient Preparation:
Discontinuance of neuroleptic drugs for at least 48 hours (drugs for psychotic behavior)
Maintain normal diet up to 2 hours prior
Ensure hydration fluids up to procedure
Examination Procedure:
Explanation to patient
Maneuvers
Why head is placed in full-extension (to compress the cisterna magna to prevent contrast from
entering the ventricles)
Assure patient of safety during procedure
Optional: Scout film of the area of interest
Lumbar
Cervical
Placement for Spinal Puncture:
Prone on cushion or lateral with flexion
Puncture done under aseptic technique
Lumbar region usual site for spinal puncture: usually L2-L3 or L3-L4
Cervical Puncture: at the cisterna magna between C-1 & occipital bone
Physician will withdraw small amount of spinal fluid & replaced with contrast agent
Rate of injection is slow or over 1-2 min.
Amount is 9-12cc (same amount for single or complete)
Then view contrast travel fluoroscopically
Spot filming along the way
Must keep patient head elevated above spine to prevent CM from going superiorly past the
clivus & entering into the ventricles
Do not lower head of table more than 15
Ventral Decubitus: marking the IR at the posterior surface of the body (side UP) or cross-table lateral
(Center where band-aid is)

13

RADS 321

Final Review 2

Lumbar Myelogram
14x17 LW for PA or Cross-table Lateral
40 SID
70-80 kVp
Large focal spot
Cross-Table Lateral:
CR Perpendicular to IR center
Entering at needle or puncture site
Must include from Conus Medullaris to Filum Terminale
PA:
CR Perpendicular to IR center
Enter over puncture site

5-9-16

Cervical Myelogram
10x12 for PA, Cross-table Lateral, or Swimmers
40 SID
70-80 kVp
Large focal spot
Cross-Table Lateral:
CR Perpendicular to IR center
Enters C-4
Top of IR at TEA
PA:
CR Perpendicular to IR
Enters level of C-4
Swimmers:
40 SID
CR Perpendicular to IR center
Enters C-4
Top of IR at TEA

14

RADS 321

Final Review 2

5-9-16

(Left) Prone, Cross-table lateral projection showing CM passing through foramen magnum & lying against lower clivus
(arrows)
(Right) Cervical Myelogram: AP projection showing symmetric nerve roots (arrows) & axillary pouches (a) on both sides
& spinal cord
Complete Myelogram
Perform both Lumbar & Cervical Myelograms
Thoracic area only by request
Post Procedure Care (Omnipaque)
Most Physicians Recommend:
Elevate head at least 30-45 during recovery
Slow movement
Close observation for at least 12 hours
Encourage oral fluids
Follow department protocols
Computed Tomography Myelography (CTM)
Involves CT examination of the vertebral column after the intrathecal injection of a water-soluble contrast agent
CTM demonstrates the size, shape, & position of the spinal cord & nerve roots
Useful in Patients With:
Compressive injuries
Extensive dural tears resulting in extravasation of CSF
MRI

Allows clear visualization of areas of the CNS normally obscured by bone

Preferred modality for evaluating the middle cranial fossa & posterior fossa of the brain & spinal cord
Spinal Cord: (Direct Visualization)
Cord
Nerve roots
Surrounding CSF
Paramagnetic IV Contrast: Gadolinium
Helpful in Assessing:
Demyelinating diseases such as Multiple Sclerosis
Spinal cord compression
Post-radiation therapy changes in spinal cord tumors
Metastatic disease
Herniated disks
Congenital anomalies of the vertebral column

15

RADS 321

Final Review 2

5-9-16

(Left) CT myelogram of lumbar spine demonstrating subarachnoid space narrowing (arrows)

(Right) Sagittal MRI of lumbar spine demonstrating distal spinal cord & cauda equine (arrows)
Diskography or Nucleography
General term used in examinations of individual intervertebral disks
Purpose:
Investigation of internal disk lesions, such as rupture of nucleus pulposus (HNP- Herniated Nucleus
Pulposus), which is not demonstrated on myelography
A small quantity of water-soluble iodinated CM injected into the center of the disk using a double needle entry

The nucleus pulposus has ruptured & is leaking

Facet Injection
This examination is diagnostic & therapeutic
Diagnostic- finds level of pain
Therapeutic- temporarily relieves pain
This procedure indicates to the physician where the pain is originating
Uses a number of spinal needles, usually 22g if doing 3 levels; bilaterally, need 6 needles
Depomedrol- 80mg/mL (steroid)
Know drugs, not dosages!
Marcaine 50% (nerve block)
Xylocaine 1% (numbing agent)
3cc syringe for each level that is done containing 1cc of each of the following:
Depomedrol, Xylocaine, & Marcaine
& a 10cc syringe of Xylocaine

16

RADS 321

Final Review 2

Procedure:
Place patient in oblique position, if left side is affected- RAO; elevated side is side of interest
Make injection under fluoro
First 10cc of Xylocaine, then 3cc syringe
3cc syringe goes directly into facet
After examination, patient gets dressed & walks around to see if it helps

5-9-16

Vertebroplasty & Kyphoplasty

Used for treating compression fractures or other pathologies of the spine
Procedure:
Minimally invasive procedure
Uses fluoroscopic guidance to place a large needle into the vertebral body
Injection of iodinated contrast to confirm location
Serious Complications:
Most Common Complication: leakage of cement before it hardens
Pulmonary embolism & death is rare, but have been reported
Techs need to educate patient & ensure that informed consent has been documented
Percutaneous Vertebroplasty
Injection of radiopaque bone cement into a painful compression fracture under fluoroscopic guidance
Injection hardens in 10-20 minutes
Advantages:
Stabilizes fractures, relieves pain, & increases mobility within 48 hours
Eliminates pain in over 90% of patients
Continues to provide pain relief for years
No open surgery
No hospitalization

Bone cement injected during Vertebroplasty under image guidance

17

RADS 321

Final Review 2
5-9-16

Percutaneous Kyphoplasty
Percutaneous Kyphoplasty sometimes referred to as Balloon-Assisted Vertebroplasty
Procedure:
Differs from vertebroplasty in that a balloon catheter is used to expand the compressed vertebral body to
near its original height before injection of the bone cement
After the balloon is deflated, a cement-like substance is injected in the bone (very similar to Vertebroplasty)
Lumbar Epidural Steroid Injections (LESI)
Considered C-arm procedure (Non-Ortho) for program comp
Epidural steroid injections used to treat low back pain
Procedure:
Patient receives medication intravenously for relaxation (mild sedation)
Then a numbing medication is injected into the skin area where injection will take place
Using fluoro, the needle is inserted into the epidural space of the affected area
Following injection, patient is moved to recovery area and monitored for approximately 1 hour

18