Information for patients needing a MRI Arthrogram Information for patients needing a MRI
Arthrogram This information leaflet has been produced to give you general information and hopes to answer most of your questions prior to attending for an Arthrogram. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have concerns or require further explanation, please discuss this with a member of the healthcare team. Please contact the radiology nurses on the number below prior to your procedure if: - You are, or might be, pregnant - You weigh more than 200kg or 31 stone - You suffer from claustrophobia
Why do I need this procedure? Your doctor has referred you for an Arthrogram. This procedure is undertaken for people who are experiencing pain or symptoms in a joint. The Arthrogram will help to get a diagnosis and plan for any further treatment.
What are the benefits of the procedure? An Arthrogram is a specialist radiological procedure for the evaluation of joints. It is a diagnostic test which examines the inside of a joint (e.g. hip, shoulder, and wrist) to assess an injury or a symptom you may be experiencing (e.g. when a joint is painful). Contrast (x-ray dye) is injected into the joint and the doctor will then use x-rays to check the position of the contrast in the joint. The contrast outlines the soft tissue structures in the joint (e.g. ligaments and cartilage). This is then followed by a magnetic resonance scan (MRI). The injection of contrast into the joint before the MRI scan will allow the soft tissue and the internal structure of the joint to be seen in more detail on the MRI scan and may provide more information about what is wrong with the joint. An Arthrogram is usually performed if patients have persistent pain within a joint and damage to the internal structures is suspected.
2 www.qegateshead.nhs.uk What is an MRI scan?
MRI stands for Magnetic Resonance Imaging. It is a type of scan that uses a strong magnetic field and radio waves to produce high quality
pictures of the tissues and organs inside the body. These pictures are examined by a Radiologist (a doctor who specialises in reading MRI images) and will help us to diagnose if there are any problems.
Pictur e of scanner How do I know if this is a suitable procedure for me? Your doctor has suggested this as the most suitable examination to help diagnose the problem with your joint. You will also be asked to give your consent for the procedure to go ahead following a detailed discussion with a radiologist (a doctor who specialises in performing procedures using x-rays and reading the images produced). There will be plenty of time before the procedure to answer any questions you may have.
What preparation is required for an Arthrogram? Please contact the radiology nurses on the telephone number below if: You have or have ever had MRSA as you may require some additional treatment before your arthrogram You are taking any blood thinning medication (such as Warfarin, Aspirin, Clopidogrel, Rivaroxiban) as you may need to stop these before your arthrogram Please complete the MRI Safety questionnaire that is sent with your appointment letter
Please contact the MRI department on the number below before the arthrogram if you answer yes to any questions. Please bring the questionnaire with you.
3 www.qegateshead.nhs.uk What do I need to wear? Please wear clothes that you can easily change out of as you will be asked to change into a hospital gown for your Arthrogram.
What happens during the procedure? In the x-ray department - You will be escorted to the specialist x-ray room where you will be asked to undress and put on a gown in a private changing cubicle. On entering the x-ray room a radiologist, radiographer (person who takes the x-ray pictures) and a nurse will greet you. They will check your personal details and ask a few safety questions, including confirming the answers to the safety questionnaire that was sent with your appointment letter. The Radiologist who will be performing your examination will explain the procedure and ask you to sign a consent form. You will be asked to lie on a couch in the specialist x-ray room within the radiology department. During the Procedure - After cleaning the skin with an antiseptic solution, the radiologist will ask you to keep very still whilst the procedure is performed. You will be awake for the procedure, but a local anaesthetic will be injected into the skin to numb the area above the joint. The local anaesthetic stings but then the area goes numb within 20-30 seconds. Then using x-rays for guidance, you may feel some pressure as the needle is placed into the joint. The doctor will then use x-rays to see the position of the needle and the x-ray dye will be injected into the joint. The injection may be accompanied by a feeling of fullness in the joint but should not be painful. Once enough x-ray dye is injected the needle is removed and a plaster is placed, please try to leave this on for the remainder of the day. You will then be taken to the MRI department for the scan. If the injection has been in your hip you will be asked to sit in a wheelchair to be transferred to the MRI department. Please keep the joint that has been injected as still as possible on your way to the MRI department. When you arrive in the department you will be greeted by the MRI team. A member of the team will take your safety questionnaire and review all the questions with you again. This is a very important part of the examination and the purpose is to ensure your safety in the MRI department. Any loose metal items, jewellery, watches, hair grips and credit cards will be locked away in secure lockers. You will also be weighed prior to your scan. In the scan room the Radiographer (member of the MRI team trained to carry out scans) will explain the MRI examination to you and what to expect. You can ask any questions you may have. You will be asked to lie on your back on the scanning table. Some equipment will then be placed over the area to be scanned. The scanning table will move up and into the scanner. You will need to lie very still while the scan is in progress. The MRI scanner is very noisy and you will be given headphones to protect your hearing during the scan. The headphones will also let you hear the Radiographer speaking to you and allow you to speak back to the Radiographer. You will also be given a safety buzzer to press if you need to speak to the Radiographer during your scan. We will try to keep to your appointment time but occasionally we have to scan patients urgently at short notice. This means your appointment could be delayed. We will let you know if this is the case.
4 www.qegateshead.nhs.uk After the MRI Scan - You will be shown to a changing cubicle to change and should be able to go home after the scan has been completed. You will not be able to drive after the arthrogram, therefore please make arrangements for someone to take you home.
What happens after the procedure? Most patients feel some mild to moderate increase in soreness in the joint for 24-48 hours following the injection. The joint will then return to feeling the way it was before the examination.
How long does the Arthrogram take? The arthrogram usually takes approximately 30 minutes. You may then have to wait a short time before having the MRI scan performed, the MRI may take 20-30 minutes depending on the joint and the number of scans that have to be done. You should allow approximately 2 hours from arrival at the radiology department.
What are the risks of an Arthrogram? An Arthrogram is a very safe procedure and complications are unusual. Any possible side effects will be fully explained to you. However, the most serious complication is an infection of the joint. This is usually caused by organisms from the patient’s skin being transferred into the joint and for this reason the procedure should not be carried out if there is broken or infected skin overlying the joint. Occasionally people may be allergic to the x-ray contrast medium that is injected, and this most commonly results in a rash but may be more serious, however complications of gadolinium contrast medium used in an MRI have not been reported in the very small amounts used for MRI Arthrogram. You may get a little bleeding from the puncture site; a small dressing is all that should be necessary to stop this. A small number of people feel faint during the procedure, this usually settles quickly without the need for any treatment. MRI is one of the safest diagnostic tests available.
However you MUST NOT have a scan if you have:
A cardiac pacemaker or internal cardiac defibrillator Aneurysm clips in the brain A cochlear implant (in your ear) A neurostimulator (a spinal, nerve or sacral stimulator).
Please contact the MRI department on the number below if you have any of the above implants.
5 www.qegateshead.nhs.uk What should I do if I have any worries or concerns about my Arthrogram? If you have any worries or concerns about your Arthrogram please ring the radiology nurses on the number below. The MRI team will also be happy to discuss your concerns and provide reassurance before you come for your scan and can be contacted on the MRI number below. If you are claustrophobic the Radiographers can provide additional information and support to enable you to have your scan.
Can I take my medication as normal? Most medication can be taken as normal. If you are taking Metformin or any blood thinning medication such as aspirin, warfarin, clopidogrel or rivaroxiban, it is important that you let the radiology nurse know as soon as possible on the number below as the medication may need to be stopped before the procedure.
What should I do if I am or may be pregnant? For all x-rays you should let the Radiographer know if you are pregnant or if there is a chance that you might be pregnant. X-rays aren’t usually recommended for pregnant women unless it is an emergency. You may be asked information regarding your menstrual cycle and be offered a pregnancy test if there is a possibility that you are pregnant.
How do I find out the results of my scan? The results of your scan will go back to your referrer (the doctor or person who referred you for the scan). Although this takes 2-3 weeks, your results will not usually be discussed with you until your follow up appointment. The Radiographer undertaking your scan cannot comment on your pictures as all results are produced by Radiologists (doctors who specialize in examining MRI images).
How soon will I be back to normal? You will be allowed to go home straight after the test. You must not drive on the day of your arthrogram but there are no restrictions for driving once you have recovered. If you have any concerns do not hesitate to contact your GP or the radiology nurse on the number below.
What happens if I decide not to have the procedure? You will be referred back to the doctor who recommended the arthrogram to discuss this further.
6 www.qegateshead.nhs.uk What if I have any special requirements? If you have any special needs or requirements please contact the staff on the number below.
Where can I get more information? Radiology nurses can be contacted on: 0191 445 3260 Monday to Friday 9am to 5pm MRI Team can be contacted on: 0191 445 3782 Monday to Friday 9am to 5pm
Data Protection Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible. In order to assist us to improve the services available, your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews and Statistics. Further information is available via Gateshead Health NHS Foundation Trust website or by contacting the Data Protection Officer by telephone on 0191 445 8418 or by email [email protected].
This leaflet can be made available in other languages and formats upon request
NoIL635 Version: 1 First Published:05/2018 Review Date: 05/2020 Author: Interventional Radiography Team
7 www.qegateshead.nhs.uk