Mark Hecksel
October 20, 2012
Radi 211
Contrast Agent Study 2
(2o points each)

1. Name of procedure/exam (one only) (1 point)
Shoulder Arthrography

2. Exam Indications (2 points) * Assessment of the integrity of the rotator cuff * Assessment of shoulder instability * For diagnosis of glenoid labrum tear * For diagnosis of adhesive capsulitis

3. Patient instructions according to textbook (before, during or after the exam) (2 points)
E.g. preparation, diet, pre-medications, diabetes patients, etc. * Patient Identification (3 C's- correct patient, correct side, correct procedure) * Is the patient pregnant? * Does the patient have a history of contrast/iodine allergy? * Is the patient intending to drive home after the procedure? * Change patient into hospital gown if required * Check departmental policy re signed consent by the patient to the procedure * Ensure old imaging is on-hand/available * Advise the CT scanning suite when you are about to start the procedure if CT arthrography is required after the fluoroscopy examination
Clinical Symptoms * Pain * Swelling * Limited range of motion * Recurrent instability (such as ankle)

It is an invasive procedure therefore there are certain risks to the patient: * Reaction to contrast media * Vasovagal reaction * Nausea, perspiration and pallor * Allergy to anesthetic agent * Inflammatory synovitis
If a patient claims that previous to this specific exam they had an allergic reaction to the specific contrast media being administered for this new exam address the situation with questions about these allergic reactions. If the patient claims they were "Allergic Reactions" they could in fact be normal "Side Affects" that are associated with the administration of contrast media such as that of a metallic taste, a hot flash, or an involuntary sense to urinate. This would be the most likely phase of what the patient claims to be an allergic reaction and it is important to assure them that these are normal side effects to the contrast media and that these sensations are in fact common. If in fact the patient claims to have experienced such effects of nausea, vomiting or other more less common and severe side effects address the situation by confronting the radiologist for further instructions. 4. Contrast utilized (4 points) * Proprietary (trade/brand name) * Generic name (if any) * Type of contrast media * E.g. Nonionic, water-soluble iodine-based media, positive or negative, etc * Contraindications

Water soluble iodinated contrast * Ionic or non-ionic * 30-100ml can be used * Contrast is readily absorbed, tolerated and excreted * Produces greater diagnostic accuracy * Concentration should be no more than 30% * Single or double contrast can be used * Single 10-12 ml * Double 3-4 positive contrast and 10-12 of air

* Verify it is the correct contrast * Ionic or Non-ionic iodinated contrast * Omnipaque or Isovue (non-ionic) * Correct concentration * Check expiration date * Keep contrast vial in room until procedure is complete * Contraindications: * Hypersensitivity to iodine

5. Method of Administration (1 point)
The patient is positioned supine on the fluoroscopic table with the shoulder of interest closest to the radiologist. It may be necessary to use the invert/flip image controls to achieve the correct fluoroscopic anatomy orientation. The needle can be inserted with the patient supine or with the patient rotated 45 degrees onto the affected shoulder and supported with a 45 degree positioning sponge under the contralateral shoulder. The 45 degree oblique position profiles the gleno-humeral joint. This position places the glenoid labrum in the path of the advancing needle. The patient's arm of interest is