Intervencionismo en musculoesquelético. Ecografía y tac

[Sterile puncture of large joints]

OBJECTIVE

Puncture of large joints is performed for diagnostic purposes on the one hand and for the treatment of joint pathologies on the other. Puncture can be used for rapid pain relief by relieving effusions or intra-articular hematomas. The obtained puncture specimen allows immediate visual assessment and subsequent microscopic-cytological and microbiological evaluation in the laboratory.

INDICATIONS

The indication for puncture of a large joint is for diagnosis and/or therapy of inflammatory, traumatic or postoperative joint problems. Diagnostic punctures are used to obtain punctate, to differentiate the location of pain or (rarely) to apply contrast medium for magnetic resonance arthrography. Therapeutic punctures allow the injection of drugs or platelet-rich plasma (PRP) as well as the relief or drainage of effusions.

CONTRAINDICATIONS

If there are inflammatory skin alterations-especially purulent inflammation-joint punctures through these lesions are absolutely contraindicated. Special attention is necessary if the patients are on anticoagulants.

SURGICAL TECHNIQUE

Absolute sterile handling is mandatory. Unnecessary pain can be avoided by a sterile skin wheal of local anesthesia, safe puncture points, and careful handling of the cannulas.

POSTOPERATIVE MANAGEMENT

Joint aspiration material has to be handled according to the local, intrahospital rules in a timely manner. Puncture sites are covered with sterile dressings, and if intra-articular medication is administered, the joints have to be passively moved through the range of motion to distribute the medication. Thereafter, compression therapy from distally to proximally while also covering the puncture site avoids recurrence of swelling or hematoma.

FACTS

If sterile conditions are guaranteed, infections rarely occur (0.04-0.08%, 4-8/10,000 cases). The risk of false-positive detection of microorganisms is extremely low.

Procedure-specific CT Dose and Utilization Factors for CT-guided Interventional Procedures

Purpose To present procedure-specific radiation dose metric distributions and define quantitative CT utilization factors for CT-guided interventional procedures. Materials and Methods This single-center, retrospective study collected dictation reports and radiation dose data from 9143 consecutive CT-guided interventional procedures in adult patients from 2012 to 2017. Procedures were sorted into four major interventional categories: ablation, aspiration, biopsy, and drainage, each of which was further divided into subcategories. After exclusion, a total of 8213 procedures (4391 in men and 3822 in women) were divided into 21 subcategories. The mean patient age at examination for men was 62 years ± 15 (standard deviation; age range, 19-114 years), and for women it was 61 years ± 15 (age range, 19-113 years). Distributions of dose metrics and CT usage-related parameters were analyzed by category with descriptive statistic outcomes. Quantitative CT utilization factors (which measure average CT usage) for each interventional subcategory were derived by using total scan length, acquisition count, and number of images. Results Interventional CT scans have distinctly different dose metric characteristics from diagnostic CT scans. Wide variations of dose metrics were observed among subcategories, even within the same major category. For the most frequently performed CT-guided interventional procedures within each major category, liver ablation, chest aspiration, liver biopsy, and single abdominal drainage, the median dose-length product was 2351, 657, 1175, and 1125 mGy ∙ cm, respectively. Procedure-specific CT utilization factors ranged between 0.6 and 3.6. Conclusion This study provides procedure-specific CT dose metric distributions and quantitative CT utilization factors on the basis of a large number of procedures and categorization of CT-guided interventional procedures. © RSNA, 2018.