Myelography, Cardiac Cath, Angiography, Venography for the ARRT

Overview

Special Procedures covers the imaging studies of the central nervous system and the circulatory system. These exams are typically performed in fluoroscopic suites or angiographic labs and involve catheter or needle placement, contrast injection, and dynamic imaging. The ARRT registry expects familiarity with the names, the access sites, and the safety concerns, not the procedural skill itself.

Myelography is contrast-enhanced imaging of the spinal subarachnoid space. Lumbar puncture below L3 (to avoid the spinal cord, which ends at L1–L2 in adults), water-soluble iodinated contrast injection, then fluoroscopic positioning to demonstrate cervical, thoracic, or lumbar pathology. The patient is tilted on the fluoroscopic table to flow contrast cephalad or caudad as needed. Post-procedure: head-of-bed elevated to keep contrast away from the brain.

Cardiac catheterization: percutaneous femoral or radial artery access, catheter advanced retrograde to the coronary ostia, contrast injection during cine imaging. Coronary angiography demonstrates LAD, circumflex, and right coronary artery anatomy. Aortography: thoracic or abdominal aorta evaluation via translumbar or femoral approach. Cerebral angiography: imaging of the carotid and vertebral circulation, performed for aneurysm, AVM, or stroke workup. Peripheral angiography evaluates upper or lower extremity arterial disease. Venography images the venous system, the most common indication is suspected DVT, though Doppler ultrasound has largely supplanted contrast venography for that purpose. Across all special procedures, radiation safety is paramount: the patient is on the table for extended fluoroscopic time, and the radiographer/operator must use lead, distance, and dose-area-product monitoring.