Shoulder, hip, and knee arthrography needle placement using fluoroscopic guidance: practice patterns of musculoskeletal radiologists in North America

• Published in: Skeletal radiology 2009-04, Vol.38 (4), p.377-385
• Main Authors: Shortt, Conor P., Morrison, William B., Roberts, Catherine C., Deely, Diane M., Gopez, Angela G., Zoga, Adam C.
• Format: Article
• Language: English
• Subjects: Arthrography - statistics & numerical data; Biological and medical sciences; Fluoroscopy - statistics & numerical data; Gadolinium - administration & dosage; Imaging; Injections - statistics & numerical data; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging - statistics & numerical data; Medical sciences; Medicine; Medicine & Public Health; Needles - statistics & numerical data; North America; Nuclear Medicine; Orthopedics; Osteoarticular system. Muscles; Pathology; Practice Patterns, Physicians' - statistics & numerical data; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiology; Radiology - statistics & numerical data; Scientific Article
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-009-0648-3

Objective The aim of this study was to evaluate the range of techniques used by radiologists performing shoulder, hip, and knee arthrography using fluoroscopic guidance. Materials and methods Questionnaires on shoulder, hip, and knee arthrography were distributed to radiologists at a national radiology meeting. We enquired regarding years of experience, preferred approaches, needle gauge, gadolinium dilution, and volume injected. For each approach, the radiologist was asked their starting and end needle position based on a numbered and lettered grid superimposed on a radiograph. Results Sixty-eight questionnaires were returned. Sixty-eight radiologists performed shoulder and hip arthrography, and 65 performed knee arthrograms. Mean experience was 13.5 and 12.8 years, respectively. For magnetic resonance arthrography, a gadolinium dilution of 1/200 was used by 69–71%. For shoulder arthrography, an anterior approach was preferred by 65/68 (96%). The most common site of needle end position, for anterior and posterior approaches, was immediately lateral to the humeral cortex. A 22-gauge needle was used by 46/66 (70%). Mean injected volume was 12.7 ml (5–30). For hip arthrography, an anterior approach was preferred by 51/68 (75%). The most common site of needle end position, for anterior and lateral approaches, was along the lateral femoral head/neck junction. A 22-gauge needle was used by 53/68 (78%). Mean injected volume was 11.5 ml (5–20). For knee arthrography, a lateral approach was preferred by 41/64 (64%). The most common site of needle end position, for lateral and medial approaches, was mid-patellofemoral joint level. A 22-gauge needle was used by 36/65 (56%). Mean injected volume was 28.2 ml (5–60). Conclusion Arthrographic approaches for the shoulder, hip, and knee vary among radiologists over a wide range of experience levels.