Understand the examination, the imaging workflow, the team, and what deserves confirmation.
General clinical-team orientation. Current orders, qualified-clinician direction, facility policy, and approved product labeling remain controlling.
Begin with its purpose and basic imaging process.
A qualified clinician places a spinal needle into the subarachnoid space and administers approved intrathecal iodinated contrast. Fluoroscopy shows the contrast within the subarachnoid space as it outlines the nerve roots, thecal sac, and related structures.
It may help assess nerve-root or spinal-canal abnormalities, postoperative anatomy, or cases in which MRI is limited, contraindicated, or does not answer the clinical question.
A CT scan is often part of the examination while intrathecal contrast remains present. Confirm whether CT is ordered and follow the selected contrast product’s current labeling and the facility protocol for imaging timing.
Know the common setting, equipment, and positioning needs.
The room commonly includes a fluoroscopy-capable table, X-ray tube and detector or C-arm, image monitor, and positioning supports. CT access is expected when CT myelography is ordered.
The patient may be positioned prone or lateral for the puncture, then repositioned or the table tilted for contrast movement and imaging. Supports and safety measures depend on the table, patient, and planned views.
IV access, physiologic monitoring, sedation support, observation time, transportation, and discharge requirements vary. Confirm the local pathway before the patient arrives.
Use current approved sources for selections that can change.
A radiologist or other appropriately qualified clinician performs the puncture and contrast administration. Radiologic technologist, nurse, CT technologist, sedation, and recovery support depend on the order and facility.
Confirm the spinal needle, sterile skin preparation, drapes, gloves, syringes, local-anesthetic supplies, connector items, dressing, labels, and specimen tubes if cerebrospinal fluid collection is ordered.
Use only contrast specifically approved and selected for intrathecal administration. Verify the order, current product label, concentration, volume, expiration, allergies, local anesthetic, and any sedation or rescue medications. Confirm required hydration, product inspection and handling, trained personnel, and emergency equipment.
Conceptual views for familiarization. They do not establish exact anatomy, a required room setup, or procedural technique.
Original AI-generated VSEEE educational illustrations. Reviewed as conceptual orientation; verify anatomy, positioning, equipment, and workflow against current approved clinical sources.
Descriptive orientation—not a protocol, checklist, or set of clinical instructions.
Confirm the region, clinical question, prior imaging, consent pathway, medication plan, allergies and prior contrast reaction, pregnancy screening when applicable, required laboratory results, and post-procedure arrangements.
After positioning, sterile preparation, and local anesthesia, the qualified clinician obtains lumbar subarachnoid access. Approved intrathecal contrast is administered, images are acquired, and the patient or table may be repositioned.
When CT myelography is ordered, its timing follows the selected contrast product’s current labeling and the facility protocol. Observation, positioning, hydration guidance, activity limits, neurologic checks, discharge criteria, and symptom instructions follow the responsible clinician’s and facility’s requirements.
These prompts do not replace the facility checklist, consent, product labeling, or responsible-clinician direction.
Use the current source and approved local documents for decisions; this page is a concise orientation.
ACR–ASNR–SPR Practice Parameter for the Performance of Myelography and Cisternography, revised 2024.
Overview developed by the American College of Radiology and Radiological Society of North America.
Current product labeling controls selection, concentration, route, handling, imaging timing, warnings, and dosing. This January 2026 ISOVUE-M label is an example, not a VSEEE product recommendation.