the evolving role of the radiologist assistant
DESCRIPTION
The Evolving Role of the Radiologist Assistant. Richard Danieli. Outline. Introduction Radiology journey R.R.T. to R.A. Education as a Radiologist Assistant student Registered Radiologist Assistant (R.R.A.) Handbook ARRT RA education requirements Procedure List - PowerPoint PPT PresentationTRANSCRIPT
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The Evolving Role of the Radiologist Assistant
Richard Danieli
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Outline• Introduction• Radiology journey R.R.T. to R.A.• Education as a Radiologist Assistant student• Registered Radiologist Assistant (R.R.A.) Handbook ARRT• RA education requirements• Procedure List• Mandatory procedures• Elective procedures• Competency requirements• CR1 Forms• CR2 Forms• Summative Evaluations• Board license eligibility • Exam outline• Career outlook• Current legislation• HR 3032 Medicare Access to Radiology Care Act• Society of Radiology Physician Extenders• Interesting Case studies• Fibrin sheath port injection study• Hiatal Hernia on UGI• Loopogram obstruction• TFC tear wrist arthrogram• Questions and Answers
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Introduction
• Clark F. Miller School of Radiologic Technology at Central Maine Medical Center
• Central Maine Community College• Florida Hospital College of Health Science• Currently at Quinnipiac University Masters in Health
Science Radiologist Assistant– 24 Month Full time: first year classroom, second year
clinicals. Clinical placement:• Yale New Haven Hospital, CT.• Fallon Clinic Worcester, MA.• Baystate Medical Center Springfield , MA.• Cooper Univerisity Hospital Camden, NJ. • Uconn Medical Center Farmington, CT
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R.R.T. to R.A.• R.R.T. license in every state for clinicals• Advance Cardiac Life Support (ACLS)
– Moderate/Conscious sedation– Response to a code/anaphylaxis/allergic reaction– Cardiac rhythyms
• Educational structure differences and the importance of good educators• The bridge between Radiologist and Technologist
– Technician difficulties and interpretation difficulties – logistics (PACS,RIS, proper orders etc…)
• Responsibilities- need to recognize pathology– RT’s have Merrills. RA’s have….. Pathology, experience, Radiologist preferences.– IR-Coagulation factors
• If you don’t know about it, you don’t look for it– Radiologist-4 years undergrad, 4 years medical school, 1 year surgery/ internal medicine internship, 4
years residency, 1 year fellowship= 14 years education– RA’s- 4 years undergrad, 2 years graduate school= 6 years education
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Q.U. Education Courses•Clinical Pharmacology I•Human Anatomy•Human Anatomy Lab•Imaging Pathophysiology•Radiation Safety and Health Physics•Image Critique & Pathologic Pattern Recognition I•Image Critique & Pathologic Pattern Recognition II•Interventional Procedures I•Interventional Procedures II
•Patient Assessment, Management and Education•Research Methods and Design•Clinical Seminar I•Clinical Seminar II•Clinical Seminar III•Radiologist Assistant Clinical I•Radiologist Assistant Clinical II•Radiologist Assistant Clinical III•Radiologist Assistant Clinical IV•Thesis I•Thesis II
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• GastroIntestinal and Chest• Esophageal study must fluoro and image the
esophagus, may be with UGI• Swallow Function Study (participate in procedure
and provide initial observations to radiologist• Upper GI Study• Small Bowel study- direct the study and spot TI• Small bowel study via enteroclysis tube• Enema with barium, air, or water soluble contrast• Nasogastric/enteric and orogastric/enteric tube
placement-may not require image guidance• T-tube cholangiogram• Defecography• Perform chest fluoroscopy for diaphragmatic
motion• Genitourinary• Antegrade urography through existing tube (e.g.
pyelostography, nephrostography)• Cystography or voiding cystourethrography, with
minimum of 10 bladder catheterizations• Retrograde urethrography or urethrocystography• Loopography through existing tube• Hysterosalpinography- imaging only• Hysterosalpinography- procedure and image
(physian participation required)
• Invasive Nonvascular• Arthrogram (radiography, CT, MR joint injection
and aspirations)• Lumbar Puncture• Cervical, thoracic, or lumbar myelography-
imaging only• Lumbar Puncture with contrast• Thoracentesis with or without catheter• Placement of catheter for pneumothorax• Paracentesis• Abscess, fistula, sinus tract study• Injection sentinel node localization• Breast needle localization• Change of percutaneous tube or drainage
catheter• Thyroid biopsy• Liver biopsy• Invasive Vascular• Peripheral insertions of central venous catheter
placement• Insertion of non-tunneled central venous
catheter• Insertion of tunneled central venous catheter• Port injection• Extremity Venography• Post processing• Perform CT post processing• Perform MR post processing
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Clinical Portfolio
• The Clinical Portfolio consists of the following components: – (1) Clinical Experience Documentation and Clinical
Competence Assessments – (2) Professional Activities and Accomplishments
Record– (3) Case Studies – (4) Summative Evaluation Rating Scales.
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Form CR-1: Summary of Clinical Experience and Competence Assessments
• 1. This form is completed by the student as he or she: (a) completes the requisite number of cases for the mandatory and elective procedures; and (b) is evaluated by a radiologist on the mandatory and elective procedures.
• 2. The student records the number of cases completed for each mandatory and elective procedure he or she performs.
• 3. The student records only the date that the competency assessment was completed. Note that the actual competence assessments are completed by a radiologist using Form CR-2
• 4. The preceptor and program director must verify and sign the bottom of Form CR-1. This form is submitted to ARRT at the time of application.
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Form CR-2: Clinical Competence Assessments (Forms CR-2A through CR-2E)
• 1. These forms are completed by the radiologist at the time he or she evaluates the student. There are separate evaluation forms for each class of radiologic procedures:– Form CR-2A: GI/Chest Form CR-2C: invasive nonvascular– Form CR-2B: GU Form CR-2D: invasive vascular– Form CR-2E: post-processing activities
• 2. The radiologist and student are required to sign the bottom of Form CR-2 for each assessment, which is subsequently reviewed and signed by the program director.
• 3. The student must submit a minimum total of 15 assessment forms to ARRT (12 mandatory and 3 elective procedures).
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Summative Evaluation
• The Summative Evaluation Rating Scales address five skill areas: – (1) evaluation of medical information – (2) patient communication– (3) radiation safety– (4) professionalism– (5) specific procedural skills
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R.R.A. Exam Board Eligibility
• 1. ARRT Certified and Registered in Radiography
• 2. One year of Acceptable Clinical Experience• 3. Educational Program Completion• 4. Didactic Competence Requirement
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R.R.A. Licensing Exam Board Eligibility
• 5. Clinical Education Requirements– 5A. Component 1: Clinical Experience
Documentation and Competence Assessments– 5B. Component 2: Professional Activities
and Accomplishments Record– 5C. Component 3: Case Studies– 5D. Component 4: Summative Evaluation Rating
Scales
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R.R.A. Licensing Exam Board Eligibility
• 6. Baccalaureate Degree• 7. ARRT Ethics Requirements• 8. Application for Certification
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Registered Radiologist Assistant Examination Content Categories
• Multiple Choice:– A.Patient Communication, Assessment, and Management- 45 points– B. Drugs and Contrast Materials -30 points– C. Anatomy, Physiology, and Pathophysiology- 55 points– D. Radiologic Procedures- 40 points– E. Radiation Safety, Radiation Biology, and Fluoroscopic Operation- 15
points– F. Medical-Legal, Professional, and Governmental Standards -15 points– Total Number- 200 points– Testing Time Allowed 3.5 hours
• 2 Case Studies – Each case is followed by four to six essay questions worth 3 or 6 points
each.– Testing Time Allowed 2.5 hours
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Career Outlook
• Momentarily Difficult– New Profession, Myths, and Fears (lack of support)– Reimbursement issues (CMS Guidelines and supervision
requirements)• R.R.A. roles beyond ARRT
– Image interpretation ( think radiology residence)– Radiology Procedures not listed (bone marrow biopsy, IVC filter
placement, drainage tube insertion, port removal, radiologist comfort etc…)
– Liability• United kingdom
– Advanced radiographer Practitioner• Quality of service provided
– Clinical training of RA vs resident, PA, NP
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HR 1148 Medicare Access to Radiology Care Act of 2013
• To amend title XVIII of the Social Security Act to provide for payment for services of qualified radiologist assistants under the Medicare program.
• More senator Co-sponsorship needed.
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Society of Radiology Physician Extenders
• “The Society of Radiology Physician Extenders (SRPE) is a non-profit organization for the RPA and RRA sharing a common bond within the global mid-level radiology profession and medical community in general. The society holds an annual conference conducting seminars and presentations. The SRPE is an active participant with other health care professionals and organizations to educate and promote the role of the mid-level radiology extender. Our organization is committed to fostering the highest values and promoting superior lifelong success both personally and professionally.” – Conferences with Continuing Education Credits– Legislative involvement
• http://www.srpeweb.org/DesktopDefault.aspx
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References
• A.R.R.T (2013). Registered Radiologist Assistant (R.R.A.) | ARRT - The American Registry of Radiologic Technologists. Retrieved January 12, 2013, from https://www.arrt.org/Certification/Registered-Radiologist-Assistant
• S.R.P.E. (2013). Society of Radiology Physician Extenders Inc. Society of Radiology Physician Extenders Inc. Retrieved January 12, 2013, from http://www.srpeweb.org/DesktopDefault.aspx
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PORT INJECTIONRichard Danieli
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Patient Information
55 year old female Right breast grade 3 infiltrating ductal carcinoma
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Breast Cancer
Mammogram of Right Breast
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Breast Cancer
Ultrasound of Right Breast
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Patient History
Left sided portacatheter placed 5/23/12 in good location and functional
Portacatheter needed for chemothereapy treatment for cancer of the right breast
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Initial post port chest x-ray on 5/23/12
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Reason for the Examination
No blood return from port when accessed two days ago
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Relevant Information
Left sided portacatheter placed to keep right side open for surgical and radiation options
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Radiographic Procedure
• Portacatheter was accessed using sterile technique
• Patient was positioned supine on fluoroscopy table
• Scout spot x-ray obtained• Patient was positioned in right anterior
oblique• 10 cc non ionic iodinated contrast was
injected in the port• Live fluoroscopy and rapid sequence
imaging was obtained
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Note: Loop in catheter
Note: Distal location of catheter
Scout fluoroscopy image 1 month post port placement
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Examination Results
Malposition of the distal end of the portacatheter
Loop in middle portion of portacatheter Fibrin sheath formation of distal
portacatheter lumen
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Note: contrast jetting superiorly and laterally from catheter.
Port Injection Image
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Differential Diagnosis
Extravasation of contrast through fracture or hole of catheter
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Discussion
Migration of the catheter tip superiorly with a mid-portion loop is known complication especially with left sided ports due to the vessel pathway
Fibrin sheath formation of the distal catheter lumen another known complication of portacatheters allowed a limited forward flush, but no blood aspiration
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Suggestions
Removal of current portacatheter Replace with a new portacatheter
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Discussion Questions
John: 1. What are the indications for a central venous port? 2. What are the indications for a left chest port placement?
Stacy: 1. If a large symptomatic venous air embolism is caused, in
what position do you place your patient? 2. What is the treatment for a large symptomatic venous
air embolism? Tina:
1. What are the post op port placement instructions for patients?
2. Describe the details involved with using tissue plasminogen activator to treat fibrin sheaths or clots at the catheter tip.
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References
Kandarpa, K., & Machan, L. (2011). Handbook of interventional radiologic procedures (4th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health.
Kessel, D., Robertson, I., & Sabharwal, T. (2011). Interventional radiology: A survival guide (3rd ed.). Edinburgh: Churchill Libingstone/Elsevier.
Kim, F. M., Burrows, P. E., Hoffer, F. A., & Chung, T. (1996). Interpreting the results of pediatric central venous catheter studies. Radiographics, 16, 747-754. Retrieved from http://radiographics.rsna.org/content/16/4/747.full.pdf+html.
Mauro, M. (1998). Delayed complications of venous access. Techniques in Vascular and Interventional Radiology, 1(3), 158-167. doi:10.1016/S1089-2516(98)80145-5 .
Slaby, J., & Navuluri, R. (2011). Chest Port Fracture Caused by Power Injection. Seminars in Interventional Radiology, 28(3), 357-358. doi:10.1055/s-0031-1284463.
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ESOPHAGRAM PATHOLOGY
Richard Danieli
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Patient Information
77 year old female No known surgery to gastrointestinal
tract No weight loss
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Patient History
Dysphagia Pharyngeal perforation, aspiration, and
fistula were not clinically indicated therefore thick and thin barium contrast was used and not water soluble contrast.
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Reason for the Examination
The patient stated “food gets stuck in my throat”
Other clinical reasons for performing an esophagram include: Dysphagia (difficulty swallowing) Odynophagia (painful swallowing) Globus (sensation of a lump in the throat) Suspected aspiration Postoperative assessment of laryngectomy Penetrating Trauma
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Relevant Information
Endoscopy showed antral deformity follow up with GI study recommended
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Radiographic Procedure
Esophagram performed Thick and thin barium used in vertical and
horizontal positions Patient positioned upright in right lateral,
AP, and LPO Patient positioned supine in RAO, AP and
RPO Images obtained of esophagus collapsed
and dilated with barium Modifications of routine exam to image
visualized pathology
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HH on CXR
The chest x-ray shows the Hiatal Hernia. Notice the circumscribed lucency behind the heart.
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Zenckers Diverliculem
Notice the small Zenker’s diverticulm.
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Diverticulum
Notice the distal esophageal diverticulum with barium distending distal esophagus
Image obtained in upright position
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Distal Esophageal diverticulum
Notice distal esophageal diverticulum has barium pooling. In comparison to previous image there are tertiary contractions of the distal tortuous esophagus
Image obtained in upright positionstomach
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Distal Esophageal diverticulum
Notice the location of the diaphragm, clearly showing a Type IV complex paraesophageal hiatal hernia.
Image obtained supine notice difference in appearance from prior images done upright showing or movement of the hernia
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Examination Results of Radiology Report
Results:Multiple tertiary contractions of the esophagus are seen associated with prominence of the cricopharyngeus sphincter. 5mm in diameter Zenkers diverticulum is noted. No aspiration or penetration is seen. Large Hiatal hernia is seen with the majority of the stomach herniated into the chest cavity. There is considerable gastroesophageal reflux. A 2cm diameter outpouching is noted of the distal aspect of the esophagus compatible with distal esophageal diverticulum.
Impression: Prominence of the cricopharyngeal sphincter associated with small Zenkers diverticulum. Significant motility dysfunction of the esophagus. Diverticulum of the distal esophagus as described. Large hiatal hernia. See above
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Differential Diagnosis
The differentials for the hiatal hernia on the frontal chest x-ray are: retrocardiac lung abscess retrocardiac empyema epiphrenic esophageal diverticulum
There are no differentials for the esophagram images. They could potentially be wrongly diagnosed. The stomach could be wrongly diagnosed as a volvulus or
malrotation if the interpreter did not notice the level of the diaphragm, but these diagnosis should be done on an UGI where the duodenum is visualized
The zenckers diverticulum could be wrongly diagnosed as an ulcer
The distal esophageal diverticulum could be wrongly diagnosed as a large ulcer
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Discussion
Zenker’s diverticulum correlates with the sensation of food getting stuck in the upper esophagus
Motility dysfunction which contributes to the patient’s dysphagia.
Considerable gastroesophageal reflux (suspected treatment or forgot to mention symptoms)
Asymptomatic distal esophageal diverticulum Asymptomatic type IV complex
paraesophageal hiatal hernia
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Suggestions
Treatment for the reflux would be recommended such as Prilosec (an antacid).
Surgery of hiatal hernia only necessary if hernia causes strangulation which cuts off the blood supply or causes an obstruction
No treatment for asymptomatic type IV complex paraesophageal hiatal hernia
No treatment for 77 year old asymptomatic distal esophageal diverticulum
No treatment for the Zencker’s diverticulum No treatment for dysmotility
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Suggestions
Upper gastrointestinal barium study to visualize the stomach and duodenum could be done for further evaluation
Small bowel follow through with barium could also be done to further evaluate potential areas of obstruction.
CT with oral contrast of the abdomen and pelvis could be performed to further evaluate the anatomy
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Discussion Questions
John: What are the four types of Hiatal Hernias? What are two properly named diapragmatic
hernias? Stacy:
Discuss the indications and contraindications of using a barium tablet during an esophagram
Discuss the indications and contraindication of administering effervescent granules
Tina: Define a Zenker’s diverticulum Discuss another type of esophageal diverticulum
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References Herring M.D., W. (2007). Recognizing Tumors, Tics, and Ulcers:
Radiology of the Gastrointestinal Tract. In Learning Radiology Recognizing the Basics. (1st ed.). (pp. 181-196). Philadelphia, Pennsylvania: Mosby Elsevier.
Houston M.D., J. D., & Davis M.D., M. D. (2001). Pharyngeal and Esophageal Examinations. In Fundamentals of Fluoroscopy. (1st ed.). (pp. 15-47). Philadelphia, Pennsylvania: W.B. Saunders Company.
Mettler,JR., M.D., F. A. (2005). Gastrointestinal System. In Essentials of Radiology. (2nd ed.). (pp. 170-188). Philadelphia, Pennsylvania: Elsevier Saunders.
Pretorius,M.D., E. S., Solomon,M.D., J. A., & Rubesin,M.D., S. E. (2011). Upper Gastrointestinal Tract. In Radiology Secrets Plus. (3rd ed.). (pp. 101-118). Philadelphia, Pennsylvania: Mosby Elsevier.
Sandstrom,M.D., C. K., & Stern, M.D., E. J. (2011). Diaphragmatic Hernias: A Spectrum of Radiographic Appearances. Current Problems in Diagnostic Radiology, 40(3), 95-115. doi:http://dx.doi.org/10.1067/j.cpradiol.2009.11.001,
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LOOPOGRAMRichard Danieli
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Patient Information
A 68 year old male with history of muscle invading bladder cancer.
Post operative robotic assisted radical cystoprostatectomy
Post operative ileal conduit urinary diversion performed
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Patient History
History of bladder cancer Prior CT
Filling defects in the dilated left renal pelvis Absence of contrast opacification of the left
ureter, Recommend direct inspection of the left
collecting system with cystoscopy and ureteroscopy.
Interval worsening of the left hydroureteronephrosis.
Anastomotic stricture at the junction between the ureter and ileal conduit cannot be excluded
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Reason for the Examination
Recommendation from prior CT Evaluate Ileal Conduit Evaluate left ureter by retrograde
contrast administration
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Relevant Information
History of bladder cancer Obstructed proximal left ureter seen on
prior CT
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Radiographic Procedure
24-gauge Foley catheter inserted into stoma with 30 cc balloon inflated
Conray-60 introduced into ileal conduit by gravity infusion
Reflux into right ureter No contrast entered the left ureter despite
various positional changes and delayed imaging.
Patient vomited possibly due to relative over distention of the ileal bladder in attempts to induce left ureteral reflux
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Examination Results
Normal right upper urinary tract Normal ileal conduit contour No reflux into left ureter due to
obstruction at the ureteroileal junction
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Loopogram Spot Film AP
Catheter
Catheter balloon Ileal conduit
Right ureter
Note: No contrast in left ureter
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Loopogram Spot Film Slight LPO
Right ureter
Catheter
Catheter balloon
Ileal conduit
Note: No contrast in left ureter
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Loopogram Spot Film Steep LPO
Right ureter
Catheter
Catheter balloon
Ileal conduit
Note: No contrast in left ureter
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Abdomen/Pelvis CT with IV Contrast Coronal Image
IV contrast in right ureter
IV contrast remained in left renal pelvis
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Abdomen/Pelvis CT with IV Contrast Axial Image
IV contrast in right ureter
IV contrast remained in left renal pelvis
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Differential Diagnosis
No contrast extravasated therefore obstructed Ureteral obstruction post ileal conduit
Improperly fashioned anastomosis Ischemia of the ureter with subsequent fibrosis and
stricture Recurrent tumor in the ureter (rare) Infection or abscess formation with reaction Edema Calculus Sloughed papilla Adhesions or scarring. Torsion or compression at the sigmoid
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Discussion
No extravasation of contrast outside of the ileal conduit or the right ureter
Normal contour of ileal conduit and right ureter
No contrast filling into the left ureter during the loopogram.
Left ureter not evaluated from retrograde contrast administration via loopogram or antegrade contrast administration via CT
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Suggestions
Renal ultrasound Renal radionuclide studies, Percutaneous nephrogram/ureterogram Intravenous pyelogram (IVP) Abdomen/pelvis CT (with oral contrast,
with and without IV contrast)
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Discussion Questions
John: 1. Where are post operative ileal conduit obstructions
most common? 2. Besides obstruction, what is the other most common
abnormality post operative ileal conduit surgery. Stacy:
1. Describe pseudoobstruction (conduit malfunction) and the cause.
2. What is a mucus plug in reference to a loopogram? Tina:
1. Describe two renal complications of an ileal conduit. 2. What risks are associated with an excessive length
of an ileal conduit?
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References
Appleby, S., & Atala, A. (2010, September 2). Urostomy and Continent Urinary Diversion. National Kidney and Urologic Diseases Information Clearinghouse. Retrieved July 7, 2012, from http://kidney.niddk.nih.gov/kudiseases/pubs/urostomy/index.aspx
Banner, M. P., Pollack, H. M., Bonavita, J. A., & Ellis, P. S. (1984). The radiology of urinary diversions. Radiographics, 4, 885-913. Retrieved from http://radiographics.rsna.org/content/4/6/885.full.pdf+html?sid=b58c27e0-59a3-40e3-bba6-39316da2f87d
Fernbach, S., & Holland, E. (1988). Undiversion of the urinary tract: The pre-and postoperatie evaluation. Radiographics, 8, 213-233. Retrieved from http://radiographics.rsna.org/content/8/2/213.full.pdf+html?sid=b58c27e0-59a3-40e3-bba6-39316da2f87d
Noble, J., Amin, Z., Kessel, D., & Rickards, D. (1994). Recurrent upper tract urothelial tumours: the use of loopography following cystectomy for bladder cancer. British Journal of Radiology, 67(803), 1057-1061. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7820396
Thiruchelvam, N., Harrison, M., & Page, A. C. (2007). The double wire technique: an improved method for treating challending ureteroileal anastomotic strictures and occlusions. British Journal of Radiology, 80, 103-106. Retrieved from http://bjr.birjournals.org/content/80/950/103.long
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RIGHT WRIST ARTHROGRAM WITH
GADOLINIUM INJECTIONRich Danieli
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Clinical
19 year old female continued right wrist discomfort for four months status post surgery for fracture of 5th metacarpal due to traumatic fall
Patient continues to have pain with movement and therefore range of motion is slightly limited.
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History
An evaluation of patient and patients chart shows no contraindication for arthrogram or MRI (not pregnant, not claustrophobic, non-ferrous orthopedic hardware, no other metallic hardware, normal coagulations, no infection, and no known allergies.
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Risks
BleedingInfection Contrast Reaction Joint Capsule Rupture.
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Benefits
It assists and increases the ability to diagnose pathology within the wrist on the MRI.
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Alternatives
Do nothing MRI without gadolinium Arthogram without gadolinium and MRI Wrist arthroscopy.
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Important Components
20ml syringe Gadolinium mixture 15ml saline 5ml isovue iodinated contrast 0.2ml of gadolinium.
Injection site of the wrist radioscaphoid joint
Small patient and small jointonly 2.5ml of Gad mixture was injected.
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End of Procedure
Exercise wristFinal images obtained and recorded Send patient to MRI
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Differential
Artifact Gadolinium injected in the wrong area Delayed gadolinium injection time from MRI
scan time
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Triangular Fibrocartilage Complex
homogenous structure composed of articular disc, the dorsal and volar radioulnar ligaments, the meniscus homologue, the ulnar collateral ligament, and the sheath of the extensor carpi ulnaris
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Results
Partial sprain triangular fibrocartilage complex ligament at its attachment to the ulnar styloid
Internal sprain triangular fibro cartilage.
Arthrogram right wrist with contrast and gadolinium injection
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Results
Partial sprain TFC ligament at its attachment to the ulnar styloid
Internal sprain triangular fibro cartilage.
MRI right wrist with gadolinium
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Results
Partial sprain TFC ligament at its attachment to the ulnar styloid
Internal sprain Triangular fibro cartilage.
MRI right wrist with gadolinium
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Radiology Report MRI
No prior MRI available for comparison, intra-articular injection performed prior to patient’s arrival to the MRI center.. There is normal marrow signal in the distal radius and ulna, carpal bones and the base of the metacarpal bones. There is no eveidence of fracture or bone contusion. There is a partial tear of the triangular fibrocartilage ligament at it attachment to the ulnar styloid. There is a sprain of the scapholunate ligament. There is no evidence of vascular necrosis of the scaphoid. Surrounding soft tissue structures are unremarkable. There is no joint effusion. The median nerve has a proper signal characteristic in the caudal tunnel. There is no abnormal fluid collection. There is metal artifacts along the diaphysis of the fifth metacarpal. Posterior rotation of the distal ulna and a shallow ulnar notch of the distal radius suggesting distal radial ulnar instability.
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Questions
John What is the specific components of the
patient’s orthopeadic hardware made of that make it compatible with MRI?
What are the typical sequences used for an MRI of the wrist with Gadolinium?
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Questions
Tina What are the pros and cons of patient
positioning when performing an MRI of the wrist between having the wrist above the head (superman position) or having the wrist by the patient’s side?
If the patient was pregnant, what would have been the best diagnostic test to perform?
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Questions
Stacy What is a patient assessment test to check for
triangular fibrocartilage complex injury and how is it performed?
Was an MRI with Gadolinium necessary for this patient to determine her diagnosis?
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References
David W. Stoller, The wrist, Seminars in Roentgenology, Volume 30,
Issue 3, July 1995, Pages 265-276, ISSN 0037-198X, 10.1016/S0037-198X(05)80015-X.
Houston,MD, J., & Davis, MD, M. (2001). Musculoskeletal Examinations. In Fundamentals of Flouroscopy. (1st ed.). (pp. 135-138). Philadelphia, PA: W.B. Saunders Company.
Luis Cerezal, Faustino Abascal, Roberto García-Valtuille, Francisco del Piñal, Wrist MR Arthrography: How, Why, When, Radiologic Clinics of North America, Volume 43, Issue 4, July 2005, Pages 709-731, ISSN 0033-8389, 10.1016/j.rcl.2005.02.004.
Robinson, P. (2005). MR imaging of the wrist. Current Orthopaedics, 19(3), 196-208.
Usha Chundru, Geoffrey M. Riley, Lynne S. Steinbach, Magnetic Resonance Arthrography, Radiologic Clinics of North America, Volume 47, Issue 3, May 2009, Pages 471-494, ISSN 0033-8389, 10.1016/j.rcl.2009.02.001.
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Questions