RAD CONTRAST
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Questions and Answers

Which substance is non-toxic and relatively cheap?

  • An iodinated contrast media
  • An unspecified absorbent (correct)
  • Water
  • Sodium chloride

    • What is the first structure in the alimentary canal?

  • Esophagus
  • Pharynx
  • Small intestine
  • Oral cavity (correct)

    • Which of the following is NOT an accessory organ of digestion?

  • Gallbladder
  • Spleen (correct)
  • Pancreas
  • Liver

    • What is one function of the digestive system?

    <p>Intake and/or digestion of food</p> Signup and view all the answers

    Which examination focuses on the salivary glands and ducts?

    <p>Sialography</p> Signup and view all the answers

    Which of these could indicate a need for sialography?

    <p>Swelling or pain in the area</p> Signup and view all the answers

    What contrast media is used in sialography to promote salivation?

    <p>Lemon juice</p> Signup and view all the answers

    Which salivary gland is demonstrated for stone formation in imaging?

    <p>Parotid gland</p> Signup and view all the answers

    What is the purpose of cholangiography?

    <p>To demonstrate the hepatic and common bile ducts.</p> Signup and view all the answers

    During which procedure is contrast medium introduced directly to the CBD?

    <p>Operative cholangiography.</p> Signup and view all the answers

    What is the concentration of contrast medium used in post-operative (T-Tube) cholangiography?

    <p>25-30%</p> Signup and view all the answers

    What is the role of kidneys in the body?

    <p>To remove waste materials from the blood and eliminate waste in urine.</p> Signup and view all the answers

    Which special procedure is done to visualize the biliary tract via a needle through the abdominal wall?

    <p>Percutaneous cholangiography.</p> Signup and view all the answers

    What is administered intravenously in intravenous cholecystangiography?

    <p>30 ml of contrast medium.</p> Signup and view all the answers

    Which factor is NOT controlled by kidney function?

    <p>Hair growth.</p> Signup and view all the answers

    What type of contrast medium is used during post-operative cholangiography?

    <p>Water-soluble contrast medium.</p> Signup and view all the answers

    What purpose does the administration of contrast agents serve in special procedures?

    <p>To determine liver function and biliary anatomy</p> Signup and view all the answers

    Which condition is NOT an indication for special procedures using contrast?

    <p>Appendicitis</p> Signup and view all the answers

    Which of the following conditions is a contraindication for the use of contrast agents?

    <p>Active GI disease</p> Signup and view all the answers

    What is the significance of conducting the AP view during a special procedure?

    <p>It demonstrates gallbladder stones and location.</p> Signup and view all the answers

    During which view is the presence of floating gallstones specifically evaluated?

    <p>Erect LAO view</p> Signup and view all the answers

    What does the term 'biliary stenosis' refer to?

    <p>Narrowing of the biliary ducts</p> Signup and view all the answers

    Which contrast agent is specifically associated with the procedure using sodium iodide?

    <p>Biloptin</p> Signup and view all the answers

    What is the expected patient condition regarding food intake before special procedures?

    <p>Food is forbidden, water is encouraged.</p> Signup and view all the answers

    What is the primary purpose of the Wolf Method in special procedures with contrast?

    <p>To demonstrate small lesions and sliding gastroesophageal herniations</p> Signup and view all the answers

    Which part of the small intestine is the longest?

    <p>Ileum</p> Signup and view all the answers

    Which special procedure with contrast is described as a gastrointestinal examination wherein single and double contrast studies are performed on the same day?

    <p>Biphasic Exam</p> Signup and view all the answers

    What is the average length of the small intestine as described in special procedures with contrast?

    <p>22 ft.</p> Signup and view all the answers

    For which condition is a biphasic examination indicated?

    <p>Abdominal mass</p> Signup and view all the answers

    Which of the following is a contraindication for special procedures with contrast?

    <p>Suspected perforation</p> Signup and view all the answers

    Which method is used to evaluate pancreatic mass by demonstrating retrogastric structures?

    <p>Poppel’s Method</p> Signup and view all the answers

    Which position is typically required for the Hamptons procedure?

    <p>Left posterior oblique (LPO)</p> Signup and view all the answers

    What is the primary purpose of compression applied during an AP urogram?

    <p>To slow the drainage of urine</p> Signup and view all the answers

    When should a compression band not be applied during a urogram procedure?

    <p>In patients with renal failure</p> Signup and view all the answers

    What is typically observed at the 10-minute mark during a urogram?

    <p>Renal calyces filling</p> Signup and view all the answers

    Which factor can increase the excretion rate during a Hypertensive IVP?

    <p>Increased blood pressure</p> Signup and view all the answers

    What is the dosage protocol for children aged 2-8 years during contrast procedures?

    <p>40 ml/kg</p> Signup and view all the answers

    What is a common indication for performing a urethrogram?

    <p>Identifying urethral tears</p> Signup and view all the answers

    What does a post-micturition examination assess?

    <p>Urinary bladder emptying efficiency</p> Signup and view all the answers

    What value is commonly checked at the 15-minute mark of a urogram procedure?

    <p>Ureteral visibility</p> Signup and view all the answers

    What is one of the purposes of special procedures with contrast?

    <p>To evaluate the contracting power of the gallbladder</p> Signup and view all the answers

    Which of the following is a condition that indicates the need for special procedures with contrast?

    <p>Cholecystitis</p> Signup and view all the answers

    What is a contraindication for performing special procedures with contrast?

    <p>Renal impairment due to hepatorenal disease</p> Signup and view all the answers

    During which position is the presence of floating gallstones evaluated?

    <p>Erect LAO</p> Signup and view all the answers

    Which of the following substances is used as a contrast medium in special procedures?

    <p>Ioponic</p> Signup and view all the answers

    What is generally discouraged for patients before undergoing special procedures with contrast?

    <p>Consuming fatty meals</p> Signup and view all the answers

    What does biliary stenosis refer to?

    <p>Narrowing of the biliary ducts</p> Signup and view all the answers

    What is a common imaging procedure to confirm the presence of biliary calculi?

    <p>Ultrasound</p> Signup and view all the answers

    Which of the following best describes the primary function of the salivary glands?

    <p>To initiate the digestion of starches</p> Signup and view all the answers

    What is the primary indication for performing a sialography procedure?

    <p>To identify calcified deposits in salivary ducts</p> Signup and view all the answers

    What is the correct sequence in which the alimentary canal begins?

    <p>Oral cavity, Pharynx, Esophagus</p> Signup and view all the answers

    Which salivary gland is associated with Wharton's duct?

    <p>Submandibular gland</p> Signup and view all the answers

    What procedure is necessary to demonstrate any obstructed lesions in the salivary glands?

    <p>Sialography</p> Signup and view all the answers

    Which of the following is classified as an accessory organ of digestion?

    <p>Pancreas</p> Signup and view all the answers

    Which symptom is considered a possible indication for a sialography procedure?

    <p>Dryness of mouth and eyes</p> Signup and view all the answers

    How is the angle typically positioned for an AP view of the parotid gland during imaging?

    <p>Rotated 50 degrees away from the midline</p> Signup and view all the answers

    What position is recommended for Poppel's method to evaluate pancreatic mass?

    <p>Right lateral recumbent</p> Signup and view all the answers

    Which method is used to demonstrate small lesions and sliding gastroesophageal herniations?

    <p>Wolf Method</p> Signup and view all the answers

    Which part of the small intestine is considered the widest?

    <p>Duodenum</p> Signup and view all the answers

    What is a common indication for performing a small intestine follow-through study?

    <p>Diarrhea</p> Signup and view all the answers

    What is the typical length of the small intestine?

    <p>22 feet</p> Signup and view all the answers

    Which method utilizes a biphasic examination in special procedures with contrast?

    <p>Ba.Meal follow-through</p> Signup and view all the answers

    What contraindication involves a condition where no movement of contents occurs within the intestines?

    <p>Ileus</p> Signup and view all the answers

    Which of the following is NOT a method for performing special procedures with contrast?

    <p>Magnetic resonance imaging</p> Signup and view all the answers

    What is the primary purpose of vesiculography?

    <p>To assess abnormalities in the seminal ducts</p> Signup and view all the answers

    What does hysterosalpingography primarily investigate?

    <p>The patency of the uterine tube and abnormalities in the uterus</p> Signup and view all the answers

    What condition does vaginography aim to investigate?

    <p>Congenital vaginal abnormalities and pathologic conditions</p> Signup and view all the answers

    What is the role of fetography in prenatal care?

    <p>To detect suspected developmental abnormalities in the fetus</p> Signup and view all the answers

    What is the main purpose of pelvimetry?

    <p>To analyze the maternal pelvis architecture</p> Signup and view all the answers

    What is injected during discography to visualize lumbar intervertebral disks?

    <p>Contrast medium via lumbar puncture</p> Signup and view all the answers

    Which procedure involves injecting gas or air to demonstrate the brain's ventricular system?

    <p>Encephalography</p> Signup and view all the answers

    What type of imaging does fetal imaging primarily utilize to assess developmental abnormalities?

    <p>Ultrasound imaging</p> Signup and view all the answers

    What is one of the primary purposes of using contrast media in special procedures?

    <p>Opacification</p> Signup and view all the answers

    Which type of reaction is characterized by a sudden drop in blood pressure after the injection of contrast media?

    <p>Hemodynamic reaction</p> Signup and view all the answers

    What is one of the local reactions to contrast media that patients may experience?

    <p>Burning sensation</p> Signup and view all the answers

    Which of the following is a factor to consider when selecting appropriate contrast media?

    <p>Viscosity</p> Signup and view all the answers

    What is a potential major reaction to contrast media that can occur during special procedures?

    <p>Severe bronchial spasms</p> Signup and view all the answers

    Which method is NOT commonly used to introduce contrast media?

    <p>Transdermal application</p> Signup and view all the answers

    What type of contrast media is used to enhance the visibility of internal structures during imaging?

    <p>Positive contrast</p> Signup and view all the answers

    An idiosyncratic reaction to contrast media is influenced by which factor?

    <p>Speed of injection</p> Signup and view all the answers

    Which structure does the alimentary canal begin with?

    <p>Oral cavity</p> Signup and view all the answers

    What is a primary function of the digestive system?

    <p>Intake and digestion of food</p> Signup and view all the answers

    Which procedure involves the radiographic examination of salivary glands and ducts?

    <p>Sialography</p> Signup and view all the answers

    Which of the following is NOT an accessory organ of digestion?

    <p>Stomach</p> Signup and view all the answers

    Which condition is an indication for performing sialography?

    <p>Dryness of mouth and eyes</p> Signup and view all the answers

    Which of the following salivary glands is demonstrated for stone formation?

    <p>Parotid gland</p> Signup and view all the answers

    What is a common method used to promote salivation during sialography?

    <p>Lemon juice</p> Signup and view all the answers

    Which of these is a common indication for performing special procedures with contrast?

    <p>Palpable mass</p> Signup and view all the answers

    What is one of the primary purposes of using contrast media during special procedures?

    <p>To assess liver function and biliary duct patency</p> Signup and view all the answers

    Which procedure is specifically used to evaluate the gallbladder's contracting and emptying power?

    <p>Post motor meal</p> Signup and view all the answers

    What condition involves abnormal calcifications or stones in the gallbladder?

    <p>Cholelithiasis</p> Signup and view all the answers

    Which of the following is a contraindication for using contrast agents during special procedures?

    <p>Pregnancy</p> Signup and view all the answers

    Which view is used to visualize floating gallstones specifically?

    <p>Erect LAO</p> Signup and view all the answers

    What does non-visualization during a procedure typically indicate?

    <p>Complete blockage in the biliary system</p> Signup and view all the answers

    Which imaging technique helps delineate trapped gas in the bowel from radiolucent stones in the gallbladder?

    <p>RAO view</p> Signup and view all the answers

    Which of the following contrasts is used for enhancement during special procedures involving the biliary system?

    <p>Ioponoic</p> Signup and view all the answers

    What is the primary purpose of the esophagography procedure?

    <p>To demonstrate the pharynx and esophagus</p> Signup and view all the answers

    Which esophageal segment is located posterior to the trachea and pharynx?

    <p>Thoracic segment</p> Signup and view all the answers

    What is the filling phase ratio used during esophagography?

    <p>2:1 or 3:1</p> Signup and view all the answers

    Which condition is associated with retrosternal pain and regurgitation?

    <p>Achalasia</p> Signup and view all the answers

    Which of the following is a contraindication for special procedures with contrast?

    <p>Suspected esophageal leakage</p> Signup and view all the answers

    What is the indicator for performing the Modified Valsalva maneuver?

    <p>Testing the elasticity of the hypopharynx</p> Signup and view all the answers

    Which procedure is NOT utilized to detect esophageal reflux?

    <p>Esophagography</p> Signup and view all the answers

    Which of the following indicates a peptic ulcer in the distal esophagus?

    <p>Barrett's syndrome</p> Signup and view all the answers

    What is the main purpose of percutaneous cholangiography?

    <p>To visualize the biliary tract directly</p> Signup and view all the answers

    In which scenario would intravenous cholecystangiography be performed?

    <p>In a patient whose gallbladder has been removed</p> Signup and view all the answers

    What is the recommended concentration of contrast medium used during post-operative (T-Tube) cholangiography?

    <p>25-30%</p> Signup and view all the answers

    Which of the following is NOT a function of the kidneys?

    <p>Production of insulin</p> Signup and view all the answers

    What is the primary contrast medium method used during operative cholangiography?

    <p>Introduced directly to the CBD</p> Signup and view all the answers

    Why might a patient undergo percutaneous cholangiography?

    <p>To visualize bile ducts when jaundice is present</p> Signup and view all the answers

    What does the term 'cholangiography' refer to?

    <p>Imaging of the biliary ducts</p> Signup and view all the answers

    What is introduced during the post-operative (T-Tube) cholangiography procedure?

    <p>Contrast medium through the T-tube</p> Signup and view all the answers

    What should be evaluated at the 5-minute mark during a urogram procedure?

    <p>Filling defects in early calyceal filling</p> Signup and view all the answers

    Why is compression applied during a urogram procedure?

    <p>To slow drainage of urine from the calyceal system</p> Signup and view all the answers

    What time interval is required to see the ureters during a urogram procedure?

    <p>15 minutes</p> Signup and view all the answers

    At what point is the renal parenchyma visible after contrast injection?

    <p>10-14 seconds after injection</p> Signup and view all the answers

    Which of the following is NOT a condition that contraindicates the use of a compression band?

    <p>Obesity</p> Signup and view all the answers

    What is the recommended dosage protocol for children aged 1-2 years during contrast procedures?

    <p>30 ml/kg</p> Signup and view all the answers

    What is primarily assessed during a post-micturition examination?

    <p>The quality of bladder emptying</p> Signup and view all the answers

    What should be done during a delayed urogram procedure for obstructive uropathy?

    <p>Wait for 24 hours</p> Signup and view all the answers

    What are the two phases employed in esophagography?

    <p>Filling phase and Mucosal phase</p> Signup and view all the answers

    Which condition is characterized by retrosternal pain and regurgitation?

    <p>Chalasia</p> Signup and view all the answers

    What is the correct length of the esophagus?

    <p>10 inches / 25-30 cm</p> Signup and view all the answers

    What is NOT an indication for esophagography?

    <p>Dehydration</p> Signup and view all the answers

    Which segment of the esophagus is NOT one of the three main segments?

    <p>Abdominal segment</p> Signup and view all the answers

    What condition involves the protrusion of the stomach through the diaphragm?

    <p>Hiatal hernia</p> Signup and view all the answers

    What is a major contraindication for performing special procedures with contrast?

    <p>Suspected leakage from the esophagus</p> Signup and view all the answers

    Which maneuver requires a patient to exhale and try to inhale against a closed glottis?

    <p>Mueller maneuver</p> Signup and view all the answers

    What is the primary purpose of retrograde pyelography?

    <p>To demonstrate obstructive lesions</p> Signup and view all the answers

    Which of the following is a contraindication for performing Retrograde Urethrography?

    <p>Presence of a urinary tract infection</p> Signup and view all the answers

    What is involved in the cystoscopy procedure?

    <p>Passing a cystoscope through the urethra and bladder</p> Signup and view all the answers

    What is a key indication for performing a voiding cystourethrogram (VCUG)?

    <p>Assessing urethral trauma</p> Signup and view all the answers

    What type of examination does retrograde pyelography provide?

    <p>Non-functional examination of the pelvicalyceal system</p> Signup and view all the answers

    What is the purpose of using double contrast during bladder examinations?

    <p>To enhance visibility of mucosal lesions</p> Signup and view all the answers

    In performing VCUG for female patients, what additional solution is typically used?

    <p>Oily contrast medium</p> Signup and view all the answers

    During which view is the bladder mechanism evaluated in conjunction with micturition?

    <p>AP view</p> Signup and view all the answers

    What is the primary position of the fundus of the stomach when a person is in the supine position during a Barium Meal examination?

    <p>In the lowest part</p> Signup and view all the answers

    How long does it typically take for solids or semisolid food to travel from the mouth to the stomach?

    <p>4 to 8 seconds</p> Signup and view all the answers

    What term describes the semifluid mass that results from the mixing of food with stomach fluids?

    <p>Chyme</p> Signup and view all the answers

    Which condition is a common indicator for performing special procedures with contrast?

    <p>Change in bowel habit</p> Signup and view all the answers

    What is the primary indication for performing a Barium Meal or Upper Gastrointestinal Series (UGIS)?

    <p>To evaluate the function of the GIT</p> Signup and view all the answers

    What is the position that helps relax abdominal muscles to ease the procedure?

    <p>Sim's position</p> Signup and view all the answers

    In pediatric preparation for an UGI, how long should an infant under 1 year old remain NPO before the procedure?

    <p>4 hours</p> Signup and view all the answers

    Which indication is associated with colitis during special procedures with contrast?

    <p>Stovepipe colon appearance</p> Signup and view all the answers

    What is the significance of the container height during the procedure?

    <p>Prevents undue discomfort to the patient</p> Signup and view all the answers

    What level is the duodenal bulb typically found in relation to the lumbar vertebrae?

    <p>L3 to L4</p> Signup and view all the answers

    What is the average gastric emptying rate after a meal?

    <p>2 to 6 hours</p> Signup and view all the answers

    Which type of lesion commonly presents with an 'apple-core' appearance?

    <p>Neoplasm</p> Signup and view all the answers

    What common complication might arise in patients undergoing special procedures with contrast?

    <p>Toxic megacolon</p> Signup and view all the answers

    What form of bezoar is specifically related to the ingestion of hair?

    <p>Trichobezoar</p> Signup and view all the answers

    Which form of contrast study typically uses a volume range of 75% - 95% WV?

    <p>Double contrast study</p> Signup and view all the answers

    What sign is associated with a twisting of a portion of the intestine, specifically in males aged 20-50?

    <p>Beak sign</p> Signup and view all the answers

    What is the purpose of the Poppel's method in special procedures with contrast?

    <p>To evaluate pancreatic mass</p> Signup and view all the answers

    What body position is primarily used in the Wolf Method?

    <p>Right lateral recumbent</p> Signup and view all the answers

    Which portion of the small intestine is the shortest?

    <p>Duodenum</p> Signup and view all the answers

    Which condition is indicated for performing special procedures with contrast?

    <p>Meckel's diverticulum</p> Signup and view all the answers

    What is the average length of the small intestine described in the special procedures?

    <p>22 ft</p> Signup and view all the answers

    What does the term 'biphasic exam' refer to in gastrointestinal examinations?

    <p>Performing single and double contrast studies at the same time</p> Signup and view all the answers

    What is a defining characteristic of the ileum in the context of the small intestine?

    <p>It is the longest portion</p> Signup and view all the answers

    What is one of the contraindications for performing special procedures with contrast?

    <p>Complete obstruction</p> Signup and view all the answers

    What is the primary function of the pharynx?

    <p>To act as a resonating chamber for sounds.</p> Signup and view all the answers

    Which part of the pharynx lies above the soft palate?

    <p>Nasopharynx</p> Signup and view all the answers

    What is the correct sequence of the parts of the pharynx from top to bottom?

    <p>Nasopharynx, Oropharynx, Laryngopharynx</p> Signup and view all the answers

    Which maneuver tests the elasticity and functional integrity of the glottis?

    <p>Valsalva Maneuver</p> Signup and view all the answers

    Which condition is typically not a reason for performing laryngography?

    <p>Assess vocal cord position</p> Signup and view all the answers

    What does the inspiratory phonation maneuver primarily demonstrate?

    <p>Laryngeal ventricle activity</p> Signup and view all the answers

    Which preparation guideline is typically required before procedures involving contrast media?

    <p>NPO for 5 hours</p> Signup and view all the answers

    Which of the following is NOT an indication for special procedures using contrast?

    <p>Assessment of vocal cord mobility</p> Signup and view all the answers

    What are the three segments of the esophagus?

    <p>Cervical, thoracic, intra-abdominal</p> Signup and view all the answers

    Which phase of esophagography is primarily focused on distending the lumen of the esophagus?

    <p>Filling phase</p> Signup and view all the answers

    What condition is associated with abnormal relaxation of the gastro-esophageal junction?

    <p>Chalasia</p> Signup and view all the answers

    Which indication is commonly associated with performing an esophagography?

    <p>Thyroid gland enlargement</p> Signup and view all the answers

    What is the suggested ratio for the filling phase during esophagography?

    <p>2:1 or 3:1</p> Signup and view all the answers

    Which of the following conditions is NOT a contraindication for special procedures with contrast?

    <p>Presence of esophageal carcinoma</p> Signup and view all the answers

    Which maneuver requires a patient to exhale and then try to inhale against a closed glottis?

    <p>Mueller maneuver</p> Signup and view all the answers

    What is the primary function of esophagography?

    <p>To demonstrate the pharynx and esophagus</p> Signup and view all the answers

    What is the position of the duodenal bulb in a hyposthenic individual?

    <p>At the level of L3 or L4</p> Signup and view all the answers

    What occurs to the air and barium distribution in the stomach in the erect position?

    <p>Air raises to fill the fundus while barium descends</p> Signup and view all the answers

    What is the average time it takes for liquids to pass from the mouth to the stomach?

    <p>1 second</p> Signup and view all the answers

    What is the typical gastric emptying time after an average meal?

    <p>2 to 6 hours</p> Signup and view all the answers

    For pediatric patients under 1 year old, what is the required NPO duration before a UGI procedure?

    <p>4 hours</p> Signup and view all the answers

    What type of mass is a trichobezoar?

    <p>Mass of ingested hair</p> Signup and view all the answers

    What is the primary function of the stomach within the digestive system?

    <p>Mechanical and chemical breakdown of food</p> Signup and view all the answers

    How long does it typically take for chyme to pass through the entire small intestine?

    <p>3 to 4 hours</p> Signup and view all the answers

    What is the primary purpose of vesiculography in male reproductive assessments?

    <p>To evaluate the seminal vesicle and vas deferens</p> Signup and view all the answers

    Which condition is NOT typically investigated using hysterosalpingography?

    <p>Cysts in the ovaries</p> Signup and view all the answers

    What is the main use of fetography during pregnancy?

    <p>To visualize the developing fetus</p> Signup and view all the answers

    What information does pelvimetry provide regarding childbirth?

    <p>Maternal pelvic dimensions</p> Signup and view all the answers

    Which of the following corrects a misconception about vaginography?

    <p>It investigates the female reproductive system</p> Signup and view all the answers

    Encephalography is conducted for which of the following reasons?

    <p>To visualize brain structures via imaging</p> Signup and view all the answers

    What is the main objective of discography during an imaging procedure?

    <p>To evaluate the lumbar intervertebral disks</p> Signup and view all the answers

    Which of the following techniques is used to illustrate conditions in the female reproductive tract?

    <p>Hysterosalpingography</p> Signup and view all the answers

    What is the purpose of glucagon administration during contrast filling procedures?

    <p>To relax the intestines</p> Signup and view all the answers

    What is the significance of the Enteroclysis procedure in gastrointestinal examinations?

    <p>It introduces contrast media directly into the duodenum</p> Signup and view all the answers

    Which of the following best describes the Intubation Method during special procedures?

    <p>It employs a tube inserted through the nose into the stomach</p> Signup and view all the answers

    What is the primary use of the Hypotonic Duodenography procedure?

    <p>To detect pancreatic disease and evaluate duodenal lesions</p> Signup and view all the answers

    What characterizes the Single Contrast Method for examining the large intestine?

    <p>It uses barium sulfate exclusively, without air involvement</p> Signup and view all the answers

    What factor is commonly evaluated during the Double Contrast Method of the colon?

    <p>The presence of polyps or mucosal abnormalities</p> Signup and view all the answers

    Which statement is true regarding the administration of barium during the Enteroclysis procedure?

    <p>30 ml of barium is mixed with 60 ml of water</p> Signup and view all the answers

    What is the effect of post-operative distention addressed by the Intubation Method?

    <p>It decompresses an obstructed small bowel</p> Signup and view all the answers

    What is the primary function of the lateral oblique view in imaging?

    <p>To demonstrate abnormalities in the mandibular ramus</p> Signup and view all the answers

    Which method is used to evaluate abnormalities during swallowing?

    <p>Pharyngography</p> Signup and view all the answers

    What is the purpose of administering atropine before nasopharyngography?

    <p>To minimize salivary and buccal secretions</p> Signup and view all the answers

    During nasopharyngography, what is one method of introducing contrast media?

    <p>Instillation through the nostrils</p> Signup and view all the answers

    What is the significance of the Gunson method in pharyngography?

    <p>Synchronizing exposure during swallowing</p> Signup and view all the answers

    What does the infero-superior view primarily assess?

    <p>Salivary gland and duct structure</p> Signup and view all the answers

    Which of the following salivary glands is least likely affected by sialography?

    <p>Thyroid gland</p> Signup and view all the answers

    What is a common indication for nasopharyngography?

    <p>Investigate nasopharyngeal tumors</p> Signup and view all the answers

    What is the primary aim of operative cholangiography?

    <p>To visualize the biliary ducts during surgery</p> Signup and view all the answers

    What is the primary cause of peptic ulcers?

    <p>Acid gastric juice</p> Signup and view all the answers

    Which procedure is performed to visualize the biliary tract via a needle puncture in the abdominal wall?

    <p>Percutaneous cholangiography</p> Signup and view all the answers

    What characterizes a partial obstruction in the gastrointestinal tract?

    <p>Intermittent blockage that allows some digestion</p> Signup and view all the answers

    What type of contrast medium is used in post-operative (T-Tube) cholangiography?

    <p>Water-soluble contrast medium</p> Signup and view all the answers

    Which type of hernia is characterized by a congenital weakening of muscle?

    <p>Sliding hiatal hernia</p> Signup and view all the answers

    What is a recommended timeframe for post-operative cholangiography to be performed?

    <p>10 days after surgery</p> Signup and view all the answers

    What is a common symptom of gastritis?

    <p>Severe pain/discomfort in the stomach</p> Signup and view all the answers

    Which of the following is NOT a type of ulcer mentioned?

    <p>Esophageal ulcer</p> Signup and view all the answers

    In intravenous cholecystangiography, how much contrast medium is administered if the gallbladder is absent?

    <p>30 ml</p> Signup and view all the answers

    Which of the following is NOT a function of the kidneys?

    <p>Produce bile for digestion</p> Signup and view all the answers

    What is Schatzke’s ring?

    <p>Ringlike constriction at the distal esophagus</p> Signup and view all the answers

    Which condition is indicated by the presence of diverticula?

    <p>Weakening and blind outpouching of the mucosal wall</p> Signup and view all the answers

    Why is intravenous cholecystangiography conducted in patients whose gallbladder has been removed?

    <p>To visualize the biliary duct system</p> Signup and view all the answers

    Which of the following is a contraindication for the use of contrast in special procedures?

    <p>Recent history of bowel perforation</p> Signup and view all the answers

    What is a primary reason for conducting percutaneous cholangiography in a patient?

    <p>To visualize the biliary tract in unknown jaundice</p> Signup and view all the answers

    What is the average capacity of the bladder?

    <p>500 ml</p> Signup and view all the answers

    Which of the following terms describes the urinary tract structures that lie behind the peritoneum?

    <p>Infraperitoneal</p> Signup and view all the answers

    What is a common indication for performing intravenous pyelography (IVP)?

    <p>Suspected urinary pathology</p> Signup and view all the answers

    Which of the following is NOT a contraindication for special procedures with contrast?

    <p>Severe hypertension</p> Signup and view all the answers

    How long should a patient typically be NPO before a special procedure with contrast?

    <p>6-8 hours</p> Signup and view all the answers

    What is the average length of the male urethra?

    <p>18-20 cm</p> Signup and view all the answers

    Which of the following procedures is primarily used to visualize the bladder?

    <p>Cystoscopy</p> Signup and view all the answers

    Which area of the male urethra is NOT included in the three divisions?

    <p>Urethral bulb</p> Signup and view all the answers

    What is a primary indication for performing Retrograde Pyelography?

    <p>Demonstrate the pelvicalyceal system after unsatisfactory excretion urograms</p> Signup and view all the answers

    Which of the following is a contraindication for performing any special procedures with contrast?

    <p>Current urinary tract infection (UTI)</p> Signup and view all the answers

    During which procedure is the urethra and bladder neck primarily demonstrated?

    <p>Voiding cystourethrogram (VCUG)</p> Signup and view all the answers

    What is the primary purpose of a routine examination in special procedures with contrast?

    <p>To detect bladder tumors</p> Signup and view all the answers

    What volume of contrast medium is typically administered during male VCUG?

    <p>150 ml of cm + 20 ml of oily medium</p> Signup and view all the answers

    During Retrograde Urethrography, what is the first step in the procedure?

    <p>Identify the position of a calculus</p> Signup and view all the answers

    What is typically demonstrated during Cystoscopy?

    <p>Urethra and bladder</p> Signup and view all the answers

    Which position is generally utilized during projection for special procedures?

    <p>RPO and LPO</p> Signup and view all the answers

    Which part of the pharynx is located behind the nose and above the soft palate?

    <p>Nasopharynx</p> Signup and view all the answers

    What is the primary purpose of laryngography?

    <p>To demonstrate muscular weakness due to disease</p> Signup and view all the answers

    Which maneuver tests the elasticity and functional integrity of the glottis?

    <p>Valsalva maneuver</p> Signup and view all the answers

    Which part of the pharynx connects the oropharynx to the esophagus?

    <p>Laryngopharynx</p> Signup and view all the answers

    What is typically required in preparation for procedures involving laryngography?

    <p>NPO for 5 hours</p> Signup and view all the answers

    Which vocal cord function is tested during normal phonation?

    <p>Test adduction</p> Signup and view all the answers

    Which indicator is used for demonstrating the presence of an abscess within the pharynx?

    <p>AP view procedure</p> Signup and view all the answers

    Which contrast media is used in laryngography?

    <p>Dionosil 10-15 ml</p> Signup and view all the answers

    What is the range of the position of the stomach in hyposthenic individuals?

    <p>T11 to L5</p> Signup and view all the answers

    In which position does the fundus of the stomach hold the highest position during a barium swallow?

    <p>Prone Position</p> Signup and view all the answers

    What is the typical time frame for the passage of solid food from the mouth to the stomach?

    <p>4 to 8 seconds</p> Signup and view all the answers

    What does chyme refer to in the digestive process?

    <p>Semifluid mass in the stomach</p> Signup and view all the answers

    For how long should infants under 1 year old be NPO before a UGI examination?

    <p>4 hours</p> Signup and view all the answers

    Which of the following conditions is an indication for a barium meal or UGIS?

    <p>Bezoar</p> Signup and view all the answers

    What is the expected time for chyme to pass through the entire small intestine?

    <p>3 to 4 hours</p> Signup and view all the answers

    What is a trichobezoar specifically composed of?

    <p>Ingested hair</p> Signup and view all the answers

    What is the main objective of intravenous cholecystangiography?

    <p>To investigate the biliary duct system after gallbladder removal</p> Signup and view all the answers

    Which procedure involves inserting contrast medium directly through the T-tube?

    <p>Post-operative (T-Tube) Cholangiography</p> Signup and view all the answers

    What is the recommended concentration of contrast medium used in post-operative cholangiography?

    <p>25-30%</p> Signup and view all the answers

    Which of the following is a function of the kidneys?

    <p>Control of blood pressure</p> Signup and view all the answers

    In which scenario is percutaneous cholangiography typically performed?

    <p>When jaundice has an unknown cause</p> Signup and view all the answers

    Which method is used to visualize the biliary tract by introducing contrast medium into the intra-hepatic bile ducts?

    <p>Percutaneous Cholangiography</p> Signup and view all the answers

    What is the initial step in performing post-operative cholangiography?

    <p>Introducing a water-soluble contrast medium</p> Signup and view all the answers

    What anatomical feature are the kidneys primarily responsible for eliminating waste products from?

    <p>Blood</p> Signup and view all the answers

    What is a primary indication for retrograde pyelography?

    <p>Identify the cause of ureter obstruction</p> Signup and view all the answers

    Which of the following is a contraindication for performing retrograde urethrography?

    <p>Current urinary tract infection (UTI)</p> Signup and view all the answers

    What is the purpose of using a double contrast with air or gas insufflation during bladder examinations?

    <p>Detect bladder tumors</p> Signup and view all the answers

    What is the primary role of VCUG in urinary examinations?

    <p>Study the ability to urinate</p> Signup and view all the answers

    What is an indication for performing cystoscopy?

    <p>To evaluate urethra and bladder</p> Signup and view all the answers

    Which statement correctly describes retrograde urethrography?

    <p>It is used to identify the location of urethral obstructions.</p> Signup and view all the answers

    During retrograde pyelography, what is the purpose of introducing a ureteric catheter?

    <p>To direct contrast into the pelvicalyceal system</p> Signup and view all the answers

    What defines the diagnostic approach of a voiding cystourethrogram (VCUG)?

    <p>It evaluates urethral injuries and function during urination.</p> Signup and view all the answers

    What is the main purpose of vesiculography in medical imaging?

    <p>To investigate abnormalities in the seminal ducts</p> Signup and view all the answers

    Which condition is NOT typically investigated through hysterosalpingography?

    <p>Fetal position</p> Signup and view all the answers

    What does vaginography assess in the female reproductive system?

    <p>Congenital abnormalities and vaginal conditions</p> Signup and view all the answers

    What is the significance of fetography in prenatal care?

    <p>To confirm fetal development and position</p> Signup and view all the answers

    Which procedure is specifically designed to examine lumbar intervertebral disks?

    <p>Discography</p> Signup and view all the answers

    What does pelvimetry analyze in obstetrics?

    <p>The architecture of the maternal pelvis</p> Signup and view all the answers

    What type of abnormalities can encephalography detect?

    <p>Ventricular and cisternal issues in the brain</p> Signup and view all the answers

    Hysterosalpingography is notably useful in evaluating which aspect of female reproductive health?

    <p>Infertility and uterine structure</p> Signup and view all the answers

    What is the primary purpose of using contrast media in special procedures?

    <p>Opacification of structures</p> Signup and view all the answers

    Which of the following is a type of contrast media?

    <p>Positive and Negative</p> Signup and view all the answers

    What kind of reaction can occur when a patient cannot tolerate contrast media?

    <p>Histamin Imbalance</p> Signup and view all the answers

    What is one effect of a hemodynamic reaction to contrast media?

    <p>Immediate reaction</p> Signup and view all the answers

    Which reaction type can be caused by the speed of injection or the amount of the contrast medium injected?

    <p>Idiosyncratic Reaction</p> Signup and view all the answers

    Which property must contrast media have to be effective?

    <p>Non-toxic when administered</p> Signup and view all the answers

    What method of administering contrast media involves injecting it directly into the bloodstream?

    <p>Parenteral administration</p> Signup and view all the answers

    Which of the following is NOT a local reaction to contrast media?

    <p>Nausea</p> Signup and view all the answers

    Which organ begins the alimentary canal?

    <p>Oral cavity</p> Signup and view all the answers

    What is one of the primary functions of the digestive system?

    <p>Absorb digested food particles</p> Signup and view all the answers

    Which of the following is NOT an accessory organ of digestion?

    <p>Stomach</p> Signup and view all the answers

    What is a common indication for a sialography procedure?

    <p>Dryness of mouth and eyes</p> Signup and view all the answers

    Which salivary gland is primarily evaluated for stone formation during imaging?

    <p>Parotid gland</p> Signup and view all the answers

    Which condition would typically not necessitate a sialography?

    <p>Increased blood pressure</p> Signup and view all the answers

    What is the characteristic of a suitable contrast media used in sialography?

    <p>Water-soluble and stable</p> Signup and view all the answers

    How many pairs of salivary glands are present in the human body?

    <p>Three pairs</p> Signup and view all the answers

    What procedure is used to assess the extent of nasopharyngeal tumors?

    <p>Nasopharyngography</p> Signup and view all the answers

    Which position is typically used for the Lateral Oblique view in imaging the mandibular ramus?

    <p>Semi-prone position</p> Signup and view all the answers

    What is a primary function of the pharynx during swallowing?

    <p>Acting as a passageway for food</p> Signup and view all the answers

    What premedication is commonly given to suppress nasopharyngeal secretions before a nasopharyngography exam?

    <p>Atropine</p> Signup and view all the answers

    Which special procedure focuses on abnormalities during deglutition?

    <p>Pharyngography</p> Signup and view all the answers

    Which method involves synchronizing exposure with the act of swallowing?

    <p>Gunson Method</p> Signup and view all the answers

    What is the purpose of instilling contrast media through the nostrils during nasopharyngography?

    <p>To visualize the nasopharynx</p> Signup and view all the answers

    When performing a Submandibular imaging study, which view is NOT typically utilized?

    <p>Axial view</p> Signup and view all the answers

    What is the primary purpose of glucagon during a special procedure with contrast?

    <p>To relax the intestines during initial filling</p> Signup and view all the answers

    What is administered in an Enteroclysis procedure?

    <p>A small amount of barium mixed with water</p> Signup and view all the answers

    During the Intubation Method, which tube is utilized?

    <p>The Miller-Abbot tube to relieve distension</p> Signup and view all the answers

    The Hypotonic Duodenography procedure is primarily used for evaluating which condition?

    <p>Pancreatic disease detection</p> Signup and view all the answers

    Which is NOT a method used in the examination of the large intestine?

    <p>Enteroclysis method</p> Signup and view all the answers

    In the Single contrast method for large intestine examination, what is primarily used?

    <p>Barium sulfate only</p> Signup and view all the answers

    What is a feature of the Double contrast method in studying the colon?

    <p>It demonstrates the colon and the cecum clearly</p> Signup and view all the answers

    Which condition is commonly indicated for special procedures involving contrast medium?

    <p>Diverticulitis</p> Signup and view all the answers

    What is the primary purpose of using contrast media in special procedures?

    <p>To enhance visualization of organs and structures</p> Signup and view all the answers

    Which of the following conditions is characterized by narrowing of the biliary ducts?

    <p>Biliary stenosis</p> Signup and view all the answers

    Which procedure position is used to demonstrate the presence of floating gallstones?

    <p>Erect LAO</p> Signup and view all the answers

    What is the recommended action regarding food intake prior to special procedures with contrast?

    <p>Patient should not eat but can drink water</p> Signup and view all the answers

    What is one of the indications for performing special procedures with contrast?

    <p>Biliary calculi</p> Signup and view all the answers

    Which of the following is a contraindication for using contrast agents during special procedures?

    <p>Severe Jaundice</p> Signup and view all the answers

    What is the significance of conducting an oblique (RAO) view during a special procedure?

    <p>To delineate gas trapped in the bowel from stones</p> Signup and view all the answers

    Which contrast medium is used to evaluate the functionality of the gallbladder?

    <p>Ioponoic</p> Signup and view all the answers

    What is the primary function of the digestive system?

    <p>Intake and/or digestion of food</p> Signup and view all the answers

    Which pair of salivary glands share a common duct system?

    <p>Submandibular and sublingual</p> Signup and view all the answers

    What is a common indication for performing sialography?

    <p>Obstruction due to calculi</p> Signup and view all the answers

    Which structure begins the alimentary canal?

    <p>Oral cavity</p> Signup and view all the answers

    What is the function of the parotid gland during imaging procedures?

    <p>Demonstrate stone formation</p> Signup and view all the answers

    During which procedure is the water-soluble iodinated contrast media used?

    <p>Sialography</p> Signup and view all the answers

    What role does lemon juice play in the examination of salivary glands?

    <p>Promotes salivation</p> Signup and view all the answers

    Which of the following is NOT an accessory organ of digestion?

    <p>Thyroid gland</p> Signup and view all the answers

    What position causes the fundus of the stomach to be filled with air during a barium swallow procedure?

    <p>Prone Position</p> Signup and view all the answers

    What is the average time for gastric emptying after an average meal?

    <p>2 to 6 hours</p> Signup and view all the answers

    In what way does the anatomy of a hyposthenic individual differ from an asthenic individual?

    <p>Stomach is approximately at T11 to L5 or lower.</p> Signup and view all the answers

    How long should an infant under one year old be NPO before a UGI procedure?

    <p>4 hours</p> Signup and view all the answers

    What happens to the barium and air distribution in the stomach when a person is in an erect position?

    <p>Air fills the fundus while barium fills the pyloric portion.</p> Signup and view all the answers

    What is the term for a mass of undigested material trapped in the stomach?

    <p>Bezoar</p> Signup and view all the answers

    What duration does liquid food take to pass from the mouth to the stomach?

    <p>1 second</p> Signup and view all the answers

    What describes the mixing of food with stomach fluids into a semifluid mass?

    <p>Chyme</p> Signup and view all the answers

    What is the primary anatomical position for performing Poppel's method?

    <p>Lateral recumbent</p> Signup and view all the answers

    Which part of the small intestine has the smallest diameter?

    <p>Ileum</p> Signup and view all the answers

    Which examination method is specifically used to evaluate small lesions in the esophagus?

    <p>Wolf method</p> Signup and view all the answers

    What is the average length of the small intestine?

    <p>22 ft</p> Signup and view all the answers

    Which special procedure involves both single and double contrast studies performed on the same day?

    <p>Biphasic exam</p> Signup and view all the answers

    In which region of the abdomen is the duodenum primarily located?

    <p>Right upper quadrant</p> Signup and view all the answers

    What is a common indication for performing special procedures with contrast?

    <p>Diarrhea</p> Signup and view all the answers

    What is a contraindication for performing special procedures using contrast?

    <p>Complete obstruction</p> Signup and view all the answers

    What is the primary purpose of using double contrast in special procedures?

    <p>To detect small lesions and demonstrate mucosal patterns</p> Signup and view all the answers

    What dosage of BaSO4 preparation is typically administered to a child aged 2 to 4 years?

    <p>4 to 6 oz</p> Signup and view all the answers

    Which specific view is utilized to visualize the pyloric canal and duodenal bulb?

    <p>RAO View</p> Signup and view all the answers

    What should be the patient's status in preparation for special procedures with contrast?

    <p>NPO for 6-8 hours</p> Signup and view all the answers

    In which special procedure is the Gordons Maneuver typically applied?

    <p>To demonstrate the pylorus and bulb</p> Signup and view all the answers

    Which condition would warrant a 24-hour delayed assessment in small intestines?

    <p>Appendicitis</p> Signup and view all the answers

    What is the role of gas-producing tablets during double contrast procedures?

    <p>To create air contrast for better visualization of the stomach lining</p> Signup and view all the answers

    What is being visualized in an LPO view during special procedures?

    <p>Hiatal hernia</p> Signup and view all the answers

    What procedure involves the introduction of a special tube to examine the small bowel?

    <p>Enteroclysis</p> Signup and view all the answers

    Which method is used to relieve post-operative distention in patients?

    <p>Intubation Method</p> Signup and view all the answers

    What is administered to relax the intestines during the complete reflux procedure?

    <p>Glucagon</p> Signup and view all the answers

    Which of the following is NOT an indication for Hypotonic Duodenography?

    <p>Appendicitis</p> Signup and view all the answers

    What type of diet is typically required before enteroclysis?

    <p>Low residue diet</p> Signup and view all the answers

    In what type of study is the colon examined using only barium sulfate?

    <p>Single Contrast Method</p> Signup and view all the answers

    What is the purpose of using a double contrast method in colon studies?

    <p>To enhance visualization of the colon and cecum</p> Signup and view all the answers

    Which contrast medium is typically used in intubation procedures?

    <p>Water-soluble iodinated solution</p> Signup and view all the answers

    What positioning technique is used for the Lateral Oblique view?

    <p>Head rotated 10-15 degrees towards the lateral surface of the mandibular ramus</p> Signup and view all the answers

    Which of the following terms describes a radiographic examination of the nasopharynx with contrast media?

    <p>Nasopharyngography</p> Signup and view all the answers

    What is a primary function of the pharynx as indicated in the content?

    <p>Serve as an air passage from the nasal cavity to the larynx</p> Signup and view all the answers

    What premedication is suggested to suppress secretions before nasopharyngography?

    <p>Atropine</p> Signup and view all the answers

    Which contrast media is specifically mentioned for use in nasopharyngography?

    <p>Dionosil aqueous</p> Signup and view all the answers

    During pharyngography, what method is used to synchronize exposure with swallowing studies?

    <p>Gunson Method</p> Signup and view all the answers

    What type of imaging view helps demonstrate any calcific deposits around the parotid gland?

    <p>Lateral view</p> Signup and view all the answers

    What procedure is indicated to assess the extent of a nasopharyngeal tumor?

    <p>Nasopharyngography</p> Signup and view all the answers

    Which part of the pharynx is located behind the nose and above the soft palate?

    <p>Nasopharynx</p> Signup and view all the answers

    What is a primary indication for performing laryngography?

    <p>To demonstrate muscular weakness due to disease</p> Signup and view all the answers

    What technique is used during the Valsalva maneuver in laryngeal examination?

    <p>Shows complete closure of the glottis</p> Signup and view all the answers

    Which procedure tests the adduction of the vocal cords?

    <p>Normal Phonation</p> Signup and view all the answers

    What structure does the laryngopharynx connect with above and below?

    <p>Oropharynx; esophagus</p> Signup and view all the answers

    What is the purpose of the aspirant maneuver during laryngeal assessment?

    <p>To demonstrate the laryngeal ventricle</p> Signup and view all the answers

    Prior to laryngography, how long should a patient remain NPO?

    <p>5 hours</p> Signup and view all the answers

    Which part of the pharynx is common to both respiratory and alimentary tracts?

    <p>Oropharynx</p> Signup and view all the answers

    What is the primary purpose of retrograde pyelography?

    <p>To demonstrate the kidneys and ureters in cases of doubtful lesions</p> Signup and view all the answers

    Which condition is contraindicated for performing retrograde urethrography?

    <p>Current urinary tract infection</p> Signup and view all the answers

    What indicates the need for a voiding cystourethrogram (VCUG)?

    <p>Evaluation of trauma or involuntary loss of urine</p> Signup and view all the answers

    What material is used during cystoscopy to examine the bladder?

    <p>150 ml of contrast medium</p> Signup and view all the answers

    What is an indication for conducting a routine examination in special procedures with contrast?

    <p>To detect bladder tumors</p> Signup and view all the answers

    In the context of VCUG, what is the primary difference between male and female procedures?

    <p>Female procedures require an oily medium to outline the bladder base</p> Signup and view all the answers

    What is the primary aim of retrograde urethrography?

    <p>To identify obstructions in the urinary tract</p> Signup and view all the answers

    Which special procedure is utilized to evaluate ureteric reflux?

    <p>Voiding cystourethrogram</p> Signup and view all the answers

    What is the recommended preparation time for a patient undergoing special procedures with contrast in cases of suspected pyloric stenosis?

    <p>6 hours</p> Signup and view all the answers

    For which age group is a dosage of 4 to 6 oz. of BaSo4 preparation indicated?

    <p>1 to 3 years</p> Signup and view all the answers

    What is the purpose of administering gas-producing tablets during double contrast studies?

    <p>To coat gastric mucosa</p> Signup and view all the answers

    In which position is the patient typically placed to demonstrate a hiatal hernia during special procedures with contrast?

    <p>Recumbent</p> Signup and view all the answers

    What radiographic view is used to demonstrate the pyloric canal and duodenal bulb?

    <p>RAO View</p> Signup and view all the answers

    What is the main focus of a single contrast study during special procedures?

    <p>Demonstrating gross pathology only</p> Signup and view all the answers

    What is the objective of performing a double contrast study in special procedures?

    <p>To detect small lesions and assess mucosal patterns</p> Signup and view all the answers

    Which procedural modification is used to demonstrate the pylorus and the bulb in a prone position?

    <p>Gordon's Maneuver</p> Signup and view all the answers

    What is the main purpose of the toe-touch maneuver in special procedures?

    <p>To study possible regurgitation into the esophagus</p> Signup and view all the answers

    In which body habitus classification is the stomach positioned at the level of T9 to T12?

    <p>Hypersthenic</p> Signup and view all the answers

    Which imaging position is preferred to clearly visualize the esophagus away from the spine?

    <p>RAO position</p> Signup and view all the answers

    What is the approximate location of the duodenal bulb in a sthenic body habitus?

    <p>L2</p> Signup and view all the answers

    Which type of body habitus is most commonly observed, accounting for about 50% of patients?

    <p>Sthenic</p> Signup and view all the answers

    What is the significance of having a patient exhale fully during procedures to demonstrate esophageal varices?

    <p>To avoid inhaling the contrast medium</p> Signup and view all the answers

    What characteristic defines an asthenic body habitus?

    <p>Slender build with stomach and gallbladder positioned low and vertical</p> Signup and view all the answers

    During which type of procedure is contrast used to visualize the entire esophagus?

    <p>Esophagram</p> Signup and view all the answers

    Study Notes

    Digestive System - Contrast Procedures

    • Absorbent material in the gastrointestinal system should have the following characteristics:
      • Absorbs water
      • High atomic number
      • Insoluble in water and stable
      • Non-toxic
      • Relatively cheap

    Alimentary Canal

    • Starts at the oral cavity
    • Includes the pharynx, esophagus, small intestine, and large intestine
    • Terminates at the anus

    Accessory Organs of Digestion

    • Salivary glands
    • Pancreas
    • Liver
    • Gallbladder

    Functions of Digestive System

    • Intake and digestion of food.
    • Absorption of digested food particles.
    • Elimination of undigested waste products.

    Sialography

    • Radiographic examination of salivary glands and ducts
    • Uses water-soluble iodinated contrast media.
    • Visualizes salivary glands and calculi in their ducts

    Sialography Indications

    • Inflammatory lesions (obstructed or not obstructed)
    • Pain or swelling in the area
    • Palpable mass
    • Calculi
    • Strictures
    • Tumor
    • Infection
    • Dryness of mouth and eyes

    Sialography Procedures

    • Plain films can determine calculi and calcified cervical glands.

    • A 2ml syringe and lemon juice are used to promote salivation and identify the orifice of the duct.

    • 1-2ml of contrast media is injected.

      Salivary Glands

    • Parotid (Stensen's duct)

    • Submandibular/submaxillary (Wharton's duct)

    • Sublingual (Bartholins duct)

    Parotid Gland Radiographic Views

    • AP
    • Lateral
    • Lateral Oblique

    Parotid Gland - AP View

    • Patient supine, head rotated away 50 degrees
    • Central ray level of the lower lip

    Gugliantini Method

    • For infants
    • Patient prone
    • Central ray 20-250 cephalad

    Hamptons Method

    • Demonstrates the leaf-like pattern of the pylorus and bulb
    • LPO position

    Poppel's Method

    • Demonstrates retrogastric space and evaluates for pancreatic mass
    • Right lateral recumbent position

    Wolf Method

    • Applies greater intra-abdominal pressure.
    • Demonstrates small lesions and sliding gastroesophageal herniations.
    • RAO position
    • Rotated body 40-45 degrees
    • Right posterior, T6/T7
    • Central ray 10-200 caudally

    Biphasic Exam

    • Gastrointestinal examination with single and double contrast study performed on the same day.

    Small Intestine (SIS/Ba. Meal Follow Through)

    • Extends from pyloric sphincter to ileocecal valve
    • Averages 22 feet (6 and 1/2 meters) long
    • Proximal 1 and 1/2 inch (4 cm)
    • Distal part 1 inch (2-5 cm)
    • Duodenum is 8-10 inches (20-25 cm)

    Parts of the Small Intestine

    • Duodenum
    • Jejunum
    • Ileum

    Duodenum

    • First part, shortest and widest.
    • 8-10 inches (20-25 cm)
    • Located in the right upper quadrant and left upper quadrant.

    Jejunum

    • Located in left upper quadrant and left lower quadrant.
    • 3-3.5 cm diameter.

    Ileum

    • Right lower quadrant and left lower quadrant.
    • Longest portion of the small intestine.
    • 2.5 cm diameter.

    Small Intestine Procedures

    • Oral administration (by mouth)
    • Complete reflux examination
    • Intubation examination
    • Enteroclysis

    Small Intestine Indications

    • Pain
    • Diarrhea
    • Bleeding
    • Partial obstruction
    • Abdominal mass
    • Failed small bowel enema
    • Enteritis (inflammation of the small intestine)
    • Giardiasis (infection of the small intestine)
    • Ileus
    • Meckel's diverticulum

    Meckel's Diverticulum

    • Saclike outpouching of the intestinal wall.
    • Birth defect.

    Small Intestine Contraindications

    • Complete obstruction
    • Suspected perforation

    Oral Contrast for Small Intestine

    • Telepaque (Ioponoic acid) - 6 tablets
    • Cholebrin (Iocetanic acid) - 6 tablets
    • Biloptin (Sodium iopadate) - 6 tablets
    • Solu-biloptin (Calcium iopadate) - 3 grams/sachet

    Oral Contrast Administration

    • 5-6 tablets given 10-12 hours before exam for normal function

    • No food 10-12 hours before exam

    • Encourage water intake.

      Cholecystography

    • Evaluates the liver and its ability to remove contrast medium from the bloodstream and excrete it into the bile.

    • Determines the patency of the biliary ducts.

    • Evaluates the contracting and emptying power of the gallbladder.

    • Detects biliary calculi.

    Cholecystography Indications

    • Nausea
    • Heartburn
    • Vomiting
    • Cholelithiasis

    Cholelithiasis

    • Abnormal calcifications or stones in the gallbladder.

    Cholecystography Indications (Continued)

    • Milk calcium bile
    • Non-visualization
    • Cholecystitis
    • Acute or chronic inflammation of the gallbladder.
    • Blockage of the cystic duct due to a stone lodge in the neck of the gallbladder.
    • Biliary stenosis
    • Congenital anomalies

    Cholecystography Contraindications

    • Hepatorenal disease with renal impairment
    • Active GI disease (vomiting, severe diarrhea)
    • Pyloric obstruction
    • Severe Jaundice
    • Liver dysfunction
    • Hypersensitivity to iodinated contrast media
    • Pregnancy

    Cholecystography Procedures

    • AP
    • Oblique (RAO)
    • Post motor meal (evaluate contracting power of the gallbladder)
    • Erect LAO
    • Right Lateral Decubitus

    Cholesystography - AP View

    • Demonstrates the presence and location of the gallbladder
    • Demonstrates choleliths.

    Cholecystography - RAO View

    • Delineates trapped gas in the bowel from radiolucent stones in the gallbladder.
    • 15-30 degree body rotation.

    Cholecystography - Fatty Meal Post Motor Meal

    Cholecystography - Erect LAO View

    • Demonstrates floating gallstones
    • 20 degree body rotation.

    Cholecystography - Right Lateral Decubitus View

    • Demonstrates stones heavier than the bile.
    • Stones lighter than the bile can be visualized only by stratification (dropping).

    Cholangiography (Choledochography)

    • Demonstrates the hepatic and common bile ducts during an operation, especially patency and retained calculi.

    Cholangiography Procedures

    • Operative cholangiography
    • Post-operative (T-tube) cholangiography
    • Percutaneous cholangiography
    • Intravenous cholangiography

    Operative Cholangiography

    • Contrast medium is introduced directly into the common bile duct (CBD).

    Post-Operative Cholangiography (T-Tube Method)

    • Contrast medium is introduced through the T-tube.

    • Done 10 days after surgery.

    • RPO position.

    • Water-soluble contrast medium

    • 25-30% concentration

      Percutaneous Cholangiography

    • Visualizes the biliary tract where the contrast medium is injected directly through the lateral abdominal wall, into the intrahepatic bile ducts via a thin flexible needle.

    • Performed in patients with jaundice of unknown cause.

    • Pre-operative radiographic exploration of the biliary tract.

    Intravenous Cholangiography

    • Investigates the biliary duct system, especially in a patient whose gallbladder has been removed.
    • 30 ml contrast medium intravenously.
    • If the gallbladder is present, a fatty meal may be given.

    Urinary System

    • Kidneys are paired, bean-shaped organs.
    • Located in the retroperitoneal space, posteriorly on either side of the vertebral column.
    • Upper portion of the abdomen.
    • Remove waste materials from the blood and eliminate them as urine.

    Kidney Functions

    • Control of water balance.
    • Control of blood pH.
    • Control of electrolyte balance.
    • Excretion of waste products and drugs.
    • Control of blood pressure.

    Intravenous Pyelogram (IVP) Views

    • AP urogram
    • RAO and LAO
    • Prone
    • Postvoiding

    Intravenous Pyelogram (IVP) Procedures

    • Immediate (10-14 seconds after injection) - to show the nephrogram (renal parenchyma, renal tubules).
    • 1 minute - to see nephrogram (enables visualization of filling defects).
    • 5 minutes - to see early calyceal filling or filling defects.
    • 10 minutes -to show the filled calyces
    • 15 minutes - to demonstrate the ureters.
    • 20 minutes - to show drainage of the kidneys, ureters, and bladder filling.
    • 30-45 minutes - to open out the calyces or remove overlying opacities.
    • Post micturation to assess bladder emptying.

    Compression

    • Compression should be applied to the bladder.
      • Slows drainage of urine from the calyceal system.
      • Fills out the calyces for clearer images.
    • Midline, upper margin of the sacrum.

    Compression Contraindications

    • Renal failure
    • Obstruction
    • Children
    • Recent abdominal surgery

    Intravenous Pyelogram (IVP) Additional Views

    • Tomography - to help assess filling defects by removing overlying gas shadows.

    Intravenous Pyelogram (IVP) Dosage Protocol for Children

    • 0-1 year - 3ml/kg
    • 1-2 years - 30 ml/kg
    • 2-8 years - 40 ml/kg
    • 8-18 years - 50 ml/kg

    Hypertensive IVP

    • Increased blood pressure causes an increase in excretion rate.

    Urethrograms

    • Examines the urethra to determine the caliber, or width, of the urethra.

    Urethrogram Indications

    • Strictures
    • Tears
    • Congenital abnormalities
    • Fistulas
    • After surgery
    • Diverticula
    • Urethral valves

    Urethrogram Contraindications

    • Not mentioned in text.

    Contrast Media

    • Purpose: To make structures visible, increase contrast in images
    • Types:
      • Positive: Increase density, appear white on images
      • Negative: Decrease density, appear darker on images

    Reactions to Contrast Media

    • Histamine Imbalance: Occurs immediately after injecting contrast, common in patients with allergies to contrast media
    • Hemodynamic: Can cause systemic shock (sudden blood pressure drop), myocardial infarction, renal shutdown, hypertension, and urticaria
    • Psychosomatic: Transient effect linked to patient anxiety, fatigue, or dehydration
    • Technique: Extravasation (injection outside the vessel) causes burning pain, hematoma, numbness, and vascular constriction
    • Pyrogenic: Reaction without a known cause that leads to a rise in body temperature

    Effects of Hemodynamic Reaction

    • Systemic Shock: Sudden drop in blood pressure after contrast injection
    • Myocardial Infarction: Heart attack
    • Renal Shut-down: Kidney failure

    Effects of Contrast Media on Organs

    • Chemotoxic: Toxic to living organisms causing cell damage
    • Idiosyncratic: Reactions caused by the speed or amount of contrast injected

    Major Reactions

    • Cardiac Arrest: Heart stops beating
    • Severe Bronchial Spasms: Prolonged contraction of the muscle in the wall of the bronchi
    • Severe Hypertension: Extremely high blood pressure

    Local Reactions

    • Pain
    • Burning Sensation
    • Itching
    • Vomiting
    • Rashes
    • Increased Salivation
    • Increase of Tears
    • Choking

    Selecting the Appropriate Contrast Media

    • Non-toxic when administered
    • Produces adequate contrast
    • Suitable viscosity - The quality of a sticky fluid
    • Suitable persistence - It stays visible in the body long enough to obtain images

    Methods of Introducing Contrast Media

    • Ingestion: By mouth
    • Retrograde Administration: Through a natural opening, but backwards
    • Intrathecal: Injection of contrast into a sheath
    • Parenteral: Injection into the bloodstream
      • IV (intravenous): Most common route
      • Intra-arterial: Directly into an artery

    Properties of BaSo4 (Barium Sulfate)

    • Absorbs water
    • High atomic number - This makes it highly radiopaque, meaning it absorbs x-rays well
    • Insoluble in water and stable - It doesn't dissolve in the body liquids
    • Cannot be absorbed in the GIT (Gastrointestinal Tract): It passes through undigested
    • Non-toxic: Generally safe for consumption
    • Relatively cheap

    Upper Gastrointestinal (UGI) System

    • Alimentary Canal: The digestive system
      • Oral cavity
      • Pharynx
      • Esophagus
      • Small intestine
      • Large intestine
      • Anus
    • Accessory Organs of Digestion
      • Salivary Glands
      • Pancreas
      • Liver
      • Gallbladder

    Functions of the Digestive System

    • Intake and/or digestion of food
    • Absorption of digested food particles
    • Elimination of unused material in the form of semi-solid waste

    Sialography

    • Radiographic examination of the salivary glands and ducts using water-soluble iodinated contrast media
    • Purpose:
      • Demonstrate the salivary glands and ducts
      • Show calculi (stones) in the ducts

    Indications for Sialography

    • Inflammatory lesions (obstructed or not obstructed)
    • Pain or swelling
    • Palpable mass
    • Calculi
    • Strictures: Narrowing of a duct
    • Tumor
    • Infection
    • Dryness of mouth & eyes

    Sialography Procedure

    • Plain films: To determine the presence of calculi and calcified cervical glands.
    • 2 ml syringe: Used to inject the contrast
    • Lemon juice: Stimulates salivation for better image quality
    • 1-2 ml contrast media

    Three Pairs of Salivary Glands

    • Parotid gland (Stensen’s duct)
    • Submandibular / submaxillary gland (Wharton’s duct)
    • Sublingual gland (Bartholins duct)

    Parotid Gland Projections:

    • AP (Anteroposterior)
    • Lateral
    • Lateral Oblique

    AP Projection:

    • Position: Supine, head rotated away from the side being examined
    • Central Ray (CR): Level of the lower lip

    UGI Series (Upper Gastrointestinal Series)

    • Biphasic Exam: Combines single and double contrast studies in a single day

    Small Intestine

    • Small bowel (SI) Series / Barium Meal Follow-Through
      • Extends from the pyloric sphincter (stomach outlet) to the ileocecal valve (junction of the small and large intestines)
      • Average Length: 22 feet (6.5 meters)
        • Proximal part: 1.5 inches (4 cm) in diameter
        • Distal part: 1inch (2-5 cm) in diameter
      • Duodenum: 8-10 inches (20-25 cm) long

    Parts of the Small Intestine

    • Duodenum: Shortest and widest part
      • 8-10 inches (20-25 cm) long
      • Lies in the RUQ & LUQ (right and left upper quadrants)
    • Jejunum: 3-3.5 cm in diameter
      • Lies in the LUQ & LLQ ( left upper and left lower quadrants)
    • Ileum : Longest part of the Small Intestine
      • 2.5 cm in diameter
      • RLQ & LLQ (right and left lower quadrants)

    Small Bowel Series Procedures

    • Oral: Ingestion of barium contrast
    • Complete reflux exam: Contrast is passed both ways through the Small Intestine
    • Intubation exam: Using a tube to introduce contrast
    • Enteroclysis: Use of a tube to introduce a large volume of diluted barium into the small bowel

    Small Bowel Series Indications

    • Pain
    • Diarrhea
    • Bleeding
    • Partial obstruction
    • Abdominal Mass
    • Failed small bowel enema
    • Enteritis: Inflammation of small bowel
    • Giardiasis: Infection of the small intestine
    • Ileus: Obstruction of the small intestine
    • Meckel’s diverticulum: Congenital outpouching of the intestinal wall

    Small Bowel Series Contraindications

    • Complete Obstruction: Total blockage
    • Suspected Perforation: Hole in the intestinal wall

    Small Bowel Series Contrast Media

    • Telepaque: Ioponoic acid (6 tablets)
    • Cholebrin: Iocetanic acid (6 tablets)
    • Biloptin: Sodium iopadate (6 tablets)
    • Solu-biloptin: Calcium iopadate (3 grams per sachet)

    Cholecystography (Gallbladder Study)

    • Purpose:
      • Determine the function of the liver's ability to remove contrast media from the bloodstream and excrete it into bile
      • Determine the patency (openness) of the biliary ducts
      • Evaluate the contracting and emptying power of the gallbladder
      • Detect gallstones

    Indications for Cholecystography

    • Nausea
    • Heartburn
    • Vomiting
    • Cholelithiasis: Existence of gallstones
    • Milk Calcium Bile: Presence of gallstones
    • Non-visualization: Inability to visualize the gallbladder
    • Cholecystitis: Inflammation of the gallbladder, can be acute or chronic
    • Biliary stenosis: Narrowing of one of the biliary ducts
    • Congenital anomalies: Abnormalities present at birth

    Cholecystography Contraindications:

    • Hepatorenal disease with renal impairment
    • Active GI disease: Vomitting, severe diarrhea
    • Pyloric obstruction
    • Severe jaundice
    • Liver dysfunction
    • Hypersensitivity to iodinated contrast media
    • Pregnancy

    Cholecystography Procedure:

    • AP (Anteroposterior)
    • Oblique (RAO - Right Anterior Oblique)
    • Post motor meal: To evaluate the contracting power of the gallbladder
    • Erect LAO (Left Anterior Oblique)
    • Right Lateral Decubitus

    AP Projection:

    • Demonstrates the presence and location of the gallbladder and any gallstones

    RAO Projection:

    • Delineates the difference between gas trapped in the bowel and a radiolucent (dark) gallstone
    • 15-30 degrees body rotation is required

    Fatty Meal/ Post Motor Meal:

    • Evaluates the functioning of the gallbladder and the expulsion of bile after a fatty meal

    Erect LAO Projection:

    • Demonstrates floating gallstones
    • 20 degrees body rotation is required

    Right Lateral Decubitus Projection:

    • Demonstrates gallstones in the dependent position

    Male Reproductive System:

    • Vesiculography
      • Demonstrates the seminal ducts (tubes that carry sperm)
      • Investigates abnormalities, such as:
        • Cysts
        • Abscesses
        • Tumors
        • Inflammation
        • Sterility: Inability to have children
      • Demonstrates the vas deferens (tubes that carry sperm from the testes to the seminal vesicles) and seminal vesicles using contrast media

    Female Reproductive System:

    • Hysterosalpingography - Investigates the uterus (womb) and the uterine tubes (fallopian tubes) - Delineates abnormalities of the uterus, such as:
      • Polyps
      • Submucous tumors (tumors in the lining of the uterus)
      • Masses
      • Fistula tracts (abnormal connections between organs)
        - Evaluates the patency (openness) of the uterine tubes - Demonstrates the uterus and fallopian tubes, aiding in infertility investigations

    Other Female Reproductive Imaging

    • Vaginography - Investigates congenital abnormalities, vaginal fistulas (abnormal openings), and other pathological conditions of the vagina
    • Fetography - Demonstrates the fetus in the uterus - Taken 18 weeks after gestation - Detects suspected abnormalities - Confirms suspected fetal death - Determines the presentation and position of the fetus - Determines whether the pregnancy is single or multiple

    Pelvimetry

    • Demonstrates the architecture of the maternal pelvis: Shape and bony structure of the pelvis
    • Compares the size of the fetal head with the size of the maternal bony outlet: To assess if the baby will be able to pass through the birth canal

    Discogram

    • Demonstrates lumbar intervertebral discs by injection of 0.5 ml. of contrast media through a lumbar puncture needle.

    Encephalography

    • Demonstrates the ventricular and cisternal system (fluid-filled spaces) of the brain by injecting gas or air into the lumbar subarachnoid space (the space that surrounds the spinal cord and brain) or directly into the cisterna magna. The contrast media is used to visualize the ventricles(fluid-filled chambers in the brain).

    Contrast Media Properties

    • Absorbs water
    • High atomic number
    • Insoluble in water and chemically stable
    • Cannot be absorbed in the gastrointestinal tract
    • Non-toxic
    • Relatively cheap

    Alimentary Canal

    • Starts at the oral cavity
    • Continues with the pharynx, esophagus, small intestine, and large intestine
    • Ends at the anus

    Accessory Organs of Digestion

    • Salivary glands
    • Pancreas
    • Liver
    • Gallbladder

    Functions of the Digestive System

    • Intake and digestion of food
    • Absorption of digested food particles
    • Elimination of unused material as semi-solid waste

    Sialography

    • Radiographic examination of the salivary glands and ducts using water-soluble iodinated contrast media
    • Used to visualize salivary glands and calculi in their ducts

    Sialography Indications

    • Inflammatory lesions (obstructed or not obstructed)
    • Pain or swelling in the area
    • Palpable mass
    • Calculi
    • Strictures
    • Tumors
    • Infections
    • Dryness of mouth and eyes

    Sialography Procedure

    • Plain films assess for calculi and calcified cervical glands
    • 2 ml syringe used for contrast administration
    • Lemon juice used to stimulate salivation and identify the orifice of the duct
    • 1-2 ml of contrast media administered

    Salivary Glands

    • Three pairs:
      • Parotid (Stensen's duct)
      • Submandibular/submaxillary (Wharton's duct)
      • Sublingual (Bartholins duct)

    Parotid Gland Projections

    • AP: Patient supine, head rotated away 50 degrees, CR levels with the lower lip
    • Lateral
    • Lateral Oblique

    Modified Valsalva Maneuver

    • Tests the elasticity of the hypopharynx and piriform sinuses

    Esophagography/Barium Swallow

    • Demonstrates the pharynx and esophagus
    • Indirectly investigates suspected lesions of the heart and great vessels

    Esophagus

    • Length: 10 inches / 25-30 cm
    • Located:
      • Posterior to the trachea and pharynx
      • Anterior to the vertebral column
      • Passes through the diaphragm in front of the aorta to enter the stomach

    Esophagus Segments

    • Cervical
    • Thoracic
    • Intra-abdominal

    Esophagography Phases

    • Filling Phase: Distends the lumen of the esophagus using a 2:1 or 3:1 ratio of barium to water
    • Mucosal Phase: Demonstrates the mucosal pattern of the esophagus using a 4:1 ratio of barium to water

    Esophagography Indications

    • Dysphagia
    • Barrett's esophagus/syndrome
    • Thyroid gland enlargement
    • Esophageal carcinoma
    • Mediastinal mass
    • Chalasia
    • Achalasia
    • Hiatal hernia
    • Cardiomegaly
    • Foreign bodies

    Esophagography Contraindications

    • Suspected leakage from the esophagus into the mediastenum, pleural, or peritoneal cavities
    • Aspiration into the bronchial tree

    Esophageal Reflux Tests

    • Breathing exercises:
      • Valsalva maneuver
      • Mueller maneuver
    • Water test: Swallowing a mouthful of water through a straw
    • Telepaque (6-12 tablets)
    • Food forbidden, water encouraged

    Esophagography Contrast Media

    • Telepaque (Ioponoic - 6 tabs)
    • Cholebrin/iocetanic acid (6 tabs)
    • Biloptin/Sodium iopadate (6 tabs)
    • Solu-biloptin/Calcium iopadate (3 g/sachet)

    Cholecystography Purpose

    • To determine the function of the liver and its ability to remove contrast media from the bloodstream and excrete it in the bile
    • To determine patency of the biliary ducts
    • To evaluate the contracting and emptying power of the gallbladder
    • To detect biliary calculi

    Cholecystography Indications

    • Nausea
    • Heartburn
    • Vomiting
    • Cholelithiasis (condition with abnormal calcifications or stones in the gallbladder)
    • Milk calcium bile (biliary stones in the gallbladder)
    • Non-visualization
    • Cholecystitis (acute or chronic inflammation of the gallbladder)
    • Biliary stenosis
    • Congenital anomalies

    Cholecystography Contraindications

    • Hepatorenal disease with renal impairment
    • Active GI disease (vomiting, severe diarrhea)
    • Pyloric obstruction
    • Severe jaundice
    • Liver dysfunction
    • Hypersensitivity to iodinated contrast media
    • Pregnancy

    Cholecystography Procedure

    • AP
    • Oblique (RAO)
    • Post motor meal (to evaluate the contracting power of the gallbladder)
    • Erect LAO
    • Right Lateral Decubitus

    Cholecystography AP Projection

    • Demonstrates the presence and location of the gallbladder
    • Shows the presence of choleliths (gallstones)

    Cholecystography RAO Projection

    • Delineates between gas trapped in the bowel and radiolucent stones in the gallbladder
    • 15-30 degrees body rotation

    Cholecystography Fatty Meal (Post Motor Meal) Projections

    • To evaluate the contracting power of the gallbladder

    Cholecystography Erect LAO Projection

    • Demonstrates floating gallstones
    • Body rotation 20 degrees

    Cholecystography Lateral Decubitus Projection

    • Demonstrates gallstones heavier than bile
    • Stones lighter than bile can be visualized only by stratification or layering

    Cholangiography (Choledocography)

    • Demonstrates the hepatic and common bile ducts during surgery, particularly focusing on patency and retained calculi

    Cholangiography Types

    • Operative Cholangiography: Contrast media is introduced directly into the common bile duct (CBD)
    • Post-operative (T-tube): Contrast media is introduced through the T-tube (done 10 days after surgery)
    • Percutaneous Cholangiography: Contrast media is introduced through the lateral abdominal wall into the intra-hepatic bile ducts (done when the patient has jaundice of unknown cause)
    • Intravenous Cholangiography: Investigates the biliary duct system in patients who have had their gallbladder removed

    Cholangiography Post-operative T-tube Procedure

    • RPO position
    • Water-soluble contrast media
    • 25-30% concentration

    Percutaneous Cholangiography

    • Used to visualize the biliary tract by directing the contrast media through the lateral abdominal wall into the intra-hepatic bile ducts via a thin flexible needle.
    • Performed when the patient has jaundice of unknown cause.
    • Used for pre-operative radiographic exploration of the biliary tract.

    Intravenous Cholangiography

    • Investigates the biliary duct system, particularly in a patient who has had their gallbladder removed.
    • 30 ml of contrast media is administered intravenously.
    • A fatty meal may be given if the gallbladder is present.

    Kidneys

    • Pair of grand-like organs
    • Located in the retroperitoneal space
    • Posteriorly on either side of the vertebral column
    • Upper portion of the abdomen
    • Remove waste materials from the blood and excrete them as urine
    • Bean-shaped organs

    Kidney Functions

    • Control water balance
    • Control blood pH
    • Control electrolyte balance
    • Excretion of waste products and drugs
    • Control of blood pressure

    Intravenous Pyelogram (IVP) Projections

    • AP
    • RAO and LAO
    • Prone
    • Postvoiding

    IVP Procedure

    • Immediate: 10-14 seconds after injection to show the nephrogram (renal parenchyma and renal tubules)
    • 1 minute: Demonstrates the nephrogram (enables visualization of filling defects in the renal parenchyma)
    • 5 minutes: Shows early calyceal filling or filling defects
    • Compression: Slows the drainage of urine from the calyceal system and fills out the calyces for clearer images
    • 10 minutes: Shows the filled calyces
    • 15 minutes: Demonstrates the ureters
    • 20 minutes: Demonstrates the drainage of the kidneys, ureters, and bladder filling
    • 30 and 45 minutes: Used to open out the calyces or remove overlying opacities
    • Post micturation: Assess the quality of bladder emptying, any abdominal bladder shapes, and any reflux
    • Delayed 24 hours: Demonstrates obstructive uropathy

    IVP Compression Contraindications

    • Renal failure
    • Obstruction
    • Children
    • Recent abdominal surgery

    IVP Additional Views

    • Tomography: Used to remove overlying gas shadows or identify the extent of filling defects

    IVP Dosage Protocol for Children

    • 0-1 year: 3 ml/kg
    • 1-2 years: 30 ml/kg
    • 2-8 years: 40 ml/kg
    • 8-18 years: 50 ml/kg

    Hypertensive IVP

    • Increased blood pressure causes an increased excretion rate

    Urethrograms

    • Examination of the urethra to assess the caliber of the urethra

    Urethrogram Indications

    • Strictures
    • Tears
    • Congenital abnormalities
    • Fistulas
    • Post-surgery
    • Diverticulae
    • Urethral valves

    Urethrogram Contraindications

    • Not mentioned in the text

    Special Procedures with Contrast

    • Modified Valsalva tests the elasticity of the hypopharynx and piriform sinuses.

    Esophagography / Ba.Swallow

    • Demonstrates the pharynx and esophagus.
    • Indirectly investigates suspected lesions of the heart and great vessels.

    Esophagus

    • It is approximately 10 inches or 25-30 cm long.
    • Located posterior to the trachea and pharynx.
    • Anterior to the vertebral column.
    • Passes through the diaphragm in front of the aorta to enter the stomach.

    Segments of the Esophagus

    • Cervical segment
    • Thoracic segment
    • Intra-abnormal segment

    Esophagography Phases:

    • Filling Phase
      • Distends the lumen of the esophagus.
      • 2:1 or 3:1 ratio of contrast agent to air.
    • Mucosal Phase
      • Demonstrates the mucosal pattern of the esophagus.
      • 4:1 ratio of contrast agent to air.

    Esophagography Indications:

    • Dysphagia.
    • Barret's esophagus/syndrome:
      • Stricture in the distal esophagus.
      • Developed peptic ulcer in the distal esophagus.
    • Thyroid gland enlargement.
    • Esophageal carcinoma (Ca of the esophagus).
    • Mediastenal mass.
    • Chalasia: Abnormal relaxation of the gastro-esophageal junction.
      • Heartburn, retrosternal pain, regurgitation, and eructation.
    • Achalasia: Abnormal constriction of the gastroesophageal junction.
    • Hiatal hernia: Protrusion of the stomach through the wall of the diaphragm.
    • Cardiomegally.
    • Foreign body (FB).

    Esophagography Contraindications:

    • Suspected leakage from the esophagus into the mediastinum, pleural, or peritoneal cavities.
    • Aspiration into the bronchial tree.

    Esophageal Reflux Procedures:

    • Breathing Exercises
      • Valsalva maneuver: Forced exhalation against a closed glottis.
      • Mueller maneuver: The patient exhales and tries to inhale against a closed glottis.
    • Water Test: Swallow a mouthful of water through a straw.
    • Hyposthenic: Modification of extreme asthenic stature (35% of the population).
      • The stomach is approximately at T11 to L5 or even lower.
      • Duodenal bulb is at the level of L3 or L4.

    Upper Gastrointestinal Series (UGIS) - Air Barium Distribution

    • Supine Position: The fundus of the stomach is in the lowest part, where the heavy barium settles.
    • Prone Position: The fundus is in the highest position, causing the air to fill the fundus of the stomach.
    • Erect Position: Air raises to fill the fundus, whereas barium descends by gravity to fill the pyloric portion of the stomach.

    Peristaltic Activity of the GI Tract

    • The passage of solid or semi-solid food from the mouth to the stomach takes 4 to 8 seconds, liquids pass in about 1 second.
    • Waves of muscular contraction in the esophagus take 1 to 8 seconds.
    • Food is churned or mixed with stomach fluid into a semi-fluid mass called chyme within 2 to 6 hours.
    • Gastric emptying rate after an average meal is 2 to 6 hours.
    • Chyme normally takes 3 to 4 hours to pass through the entire small intestine.

    Pediatric UGI Preparation

    • Infants under 1 year old: NPO for 4 hours.
    • Children older than 1 years old: NPO for 6 hours.

    Barium Meal / UGIS

    • Radiographic examination of the gastrointestinal tract.
    • The stomach is the dilated sac-like portion of the digestive tract extending from the esophagus to the small intestine.
    • From the Greek word "GASTER".
    • Dilated portion of the alimentary canal.
    • Reservoir for swallowed foods and fluids.

    Barium Meal/UGIS Examination

    • Examination of the gastrointestinal tract function:
      • Distal esophagus.
      • Stomach.
      • Duodenum.

    Barium Meal/UGIS Indications

    • Bezoar: A mass of undigested material trapped in the stomach.
      • Trichobezoar: Ingested Hair.
      • Gugliantini: Infant, prone.
        • Demonstrates the stomach, CR 20-250 cephalad.
    • Hamptons: Demonstrates the leaf-like pattern of the pylorus and bulb, LPO position.
    • Poppel's Method: Demonstrates retrogastric space and evaluates pancreatic mass, right lateral recumbent position.
    • Wolf Method: Applies greater intra-abdominal pressure to demonstrate small lesions and sliding gastroesophageal herniations.
      • RAO position, body rotated 40-45 degrees.
      • RPT 6/7, CR 10-200 caudally.

    Biphasic Exam

    • Gastrointestinal examination wherein single and double contrast study performed on the same day.

    Small Intestine Series (SIS) / Ba. Meal Follow Through:

    • Extends from the pyloric sphincter of the stomach to the ileocecal valve.
    • Length averages about 22 feet (6 1/2 meters).
      • Proximal 1 1/2 inches (4 cm) in diameter.
      • Distal part 1 inch (2-5 cm) in diameter.
    • The duodenum is 8-10 inches (20-25 cm) long.

    Parts of the Small Intestine:

    • Duodenum: First, shortest, and widest part, 8-10 inches (20-25 cm) long, located in the RUQ and LUQ.
    • Jejunum: 3-3.5 cm diameter, located in the LUQ and LLQ.
    • Ileum: Longest portion of the small intestine, 2.5 cm diameter, located in the RLQ and LLQ.

    SIS Procedure:

    • Oral: By mouth.
    • Complete reflux exam: Complete examination of the esophagus.
    • Intubation exam: Uses a tube to administer barium.
    • Enteroclysis: Flush with barium mixed with saline.

    SIS Indications:

    • Pain.
    • Diarrhea.
    • Bleeding.
    • Partial obstruction.
    • Abdominal Mass.
    • Failed small bowel enema.
    • Enteritis: Inflammation of the small intestine.
    • Giardiasis: Infection of the lumen of the small intestine.
    • Ileus: Paralysis of the intestinal muscles.
    • Meckel's diverticulum: Sac-like outpouching of the intestinal wall, birth defect.

    SIS Contraindications:

    • Complete obstruction.
    • Suspected perforation.
    • Intraluminal lesions such as polyps.
    • Cleansing enemas shall be prohibited to patients having:
      • Diarrhea
      • Gross bleeding
      • Symptoms of obstruction

    Barium Sulfate

    • 500-1200 ml barium sulfate.
    • Warm: 85-90 degrees Fahrenheit (29-30 degrees Celsius).
    • Cold: 41 degrees Fahrenheit (5 degrees Celsius).
    • 15%-25% WV single contrast.
    • 75%-95% WV double contrast.

    Barium Enema (BE)

    • Performed to evaluate the large intestine (colon).
    • Often used as a diagnostic tool for various conditions of the colon.
    • The patient typically receives a cleansing enema before the procedure.
    • The enema is administered rectally, using a flexible tube.
    • Barium sulfate is a contrast agent, which helps to highlight the colon on X-rays.

    Reasons for using Warm Barium Sulfate:

    • Produces less irritation.
    • Stimulates tonic contraction of the anal sphincter.
    • The container is typically placed 90 cm (36 inches) above the table to avoid undue discomfort to the patient.
    • Barium solution should be 18 to 24 inches (45-60 cm) above the level of the anus.
    • Use 90 cc of air to inflate the rectum for better visualization.

    Sim's Position

    • Used for BE procedures as it relaxes abdominal muscles.
    • Reduces intra-abdominal pressure on the rectum.
    • Promotes relaxation of the anal sphincter.

    BE Indications

    • Changes in bowel habits.
    • Pain in the abdomen.
    • Abdominal mass.
    • Obstruction in the colon.
    • Colitis: Inflammation of the large intestine; saw-tooth or "jagged" appearance.
    • Polyps: Sac-like projections growing inward from the colon's lining.
    • Volvulus: Twisting of a portion of the intestine, most common in males 20-50 years old, "beak" appearance.
    • Intussusception: Telescoping or invagination of one part of the intestine into another, common in infants under 2 years old, "mushroom-shaped" appearance.
    • Ulcerative colitis: Severe form of colitis, cobblestone appearance, can develop "stovepipe colon".
    • Diverticulum: Common in adults over 40 years old.
    • Neoplasm: Benign tumor, "apple-core or napkin ring" appearance.

    BE Contraindications:

    • Toxic megacolon: A rare but serious condition where the colon becomes dangerously enlarged.
    • Pseudomembranous colitis: A serious infection of the colon caused by bacteria.
    • Recent rectal biopsy.
    • Incomplete bowel preparation.
    • Recent barium meal.

    BE Positions:

    • AP/PA.
    • LAO.
    • RAO.
    • Left lateral.
    • UTI (not a BE position, likely a typo).

    Retrograde Urethrography:

    • Examination of the ureters and pelvicalyceal system.

    Retrograde Urethrography Indications:

    • Identify if an opacity is in the ureter.
    • When previous examinations show an obstruction, but the cause cannot be identified.

    Retrograde Urethrography Contraindications:

    • Current urinary tract infection (UTI).
    • Strictures (narrowing of the urethra).

    Retrograde Urethrography Procedure:

    • Control: Locates the position of a calculus to identify the tip of any catheters.
    • 35-degree Oblique (RPO): Full length.
    • A cystoscope is passed per urethra and bladder.

    Retrograde Pyelography

    • Non-functional examination of the urinary system (US).
    • Directly injected into the pelvicalyceal system.
    • Demonstrates the kidneys and ureters in cases of doubtful lesions.

    Retrograde Pyelography Procedure

    • A ureteric catheter is introduced via the urethra and bladder into the ureteric orifice.
    • 35 cc of contrast medium is injected.

    Retrograde Pyelography Indications:

    • Demonstrates the site, length, and lower limit of an obstructive lesion.
    • Demonstrates the pelvicalyceal system after unsatisfactory excretion urograms.

    Retrograde Pyelography Contraindications:

    • Urinary tract infection (UTI),

    Cystoscopy:

    • A non-functional examination of the urinary system (US).
    • Demonstrates the bladder, urethra, and ureteric reflux.
    • Contrast medium of 150 ml.

    Routine Cystography Exams:

    • AP Projection
    • RPO and LPO Projections
    • Lateral Projection
    • Voiding Cystourethrogram (VCUG)
    • PA Projection
    • Chassard-Lapine Projection

    Cystography with Double Contrast:

    • Used to detect bladder tumors.
    • Air or gas insufflation is used to enhance visualization.

    Voiding Cystourethrogram (VCUG):

    • Study of the urethra and evaluates the patient's ability to urinate.

    VCUG Indications:

    • Trauma to the urethra.
    • Involuntary loss of urine (incontinence).

    Male VCUG:

    • Demonstrates the urethra and bladder neck.
    • Requires 150 ml of contrast medium plus 20 ml of oily medium.

    Female VCUG:

    • Requires 150 ml of contrast medium plus 20 ml of a more dense oily medium.
    • Outlines the base of the bladder and urethral catheter in situ.
    • Demonstrates defects in the bladder mechanism.

    AP Projection (VCUG):

    • Performed during urination.
    • Demonstrates defects in the bladder mechanism.

    Urography:

    • Radiographic investigation of the renal drainage or collecting system.

    Pharynx

    • Resonating chamber for sounds produced in the larynx
    • Extends from the base of the skull to the cricoid cartilage
    • Situated behind the nose, mouth and upper part of the throat

    Parts of the Pharynx

    • Nasopharynx: Lies behind the nose & above the soft palate
    • Oropharynx: Lies behind the mouth and extends from the soft palate to the epiglottis
      • Common to both respiratory and alimentary tracts
    • Laryngopharynx: Extends from the upper border of the epiglottis to the lower border of the cricoid cartilage
      • Connects with the oropharynx above and the esophagus below

    Pharynx Imaging Indications

    • Demonstrate tumor, abscess, and presence of foreign bodies
    • Procedures: AP and lateral views

    Laryngography

    • Radiographic examination of the larynx
    • Indications: Demonstrate muscular weakness due to disease, edema or fibrosis, investigation of malignancy
    • Preparation: NPO for 5 hours, contrast media - Dionosil 10-15 ml
    • Quiet inspiration: Test abduction of the vocal cords
    • Normal Phonation: Test adduction of the vocal cords
      • Take a deep breath and exhale slowly, phonate a high or low pitch
    • Inspiratory phonation/reverse phonation/aspirant maneuver: Demonstrate the laryngeal ventricle
      • Exhale completely and then slowly inhale to make a harsh, stridulous sound
    • Valsalva maneuver: Shows complete closure of the glottis
      • Test the elasticity and function integrity of the glottis
    • Modified Valsalva: Test the elasticity of the hypopharynx and piriform

    Esophagography/Ba. Swallow

    • Demonstrate pharynx and esophagus
    • Indirectly investigate suspected lesions of the heart and greater vessels
    • Length: 10” / 25-30 cm
    • Posterior to the trachea and pharynx
    • Anterior to the vertebral column
    • Passes through the diaphragm in front of the aorta to enter the stomach

    Segments of the Esophagus

    • Cervical Segment
    • Thoracic Segment
    • Intra-abnormal Segment

    Esophagography - Two Phases

    • Filling Phase: Distend the lumen of the esophagus - ratio 2:1 or 3:1
    • Mucosal Phase: Demonstrate the mucosal pattern of the esophagus - 4:1 ratio

    Esophagography Indications

    • Dysphagia
    • Barrett's esophagus/syndrome
      • Stricture in the distal esophagus
      • Developed peptic ulcer in the distal
    • Thyroid gland enlargement
    • Esophageal carcinoma - Ca of the esophagus
    • Mediastenal mass
    • Chalasia: Abnormal relaxation of the gastro-esophageal junction
      • Heartburn, retrosternal pain, regurgitation and eructation
    • Achalasia: Abnormal constriction of the gastroesophageal junction
    • Hiatal hernia: Protrusion of the stomach through the wall of the diaphragm
    • Cardiomegally
    • Foreign bodies

    Esophagography Contraindications

    • Suspected leakage from the esophagus into the mediastenum, pleural or peritoneal cavities
    • Aspiration into the bronchial tree

    Esophageal Reflux Procedures

    • Breathing exercises: Valsalva maneuver
    • Mueller maneuver: Exhale and try to inhale against a closed glottis
    • Water test: Swallow a mouthful of water through a straw
    • Hyposthenic: Modification of extreme asthenic (35%)
      • Stomach is approximately T11 to L5 or even lower
      • Duodenal bulb is at the level of L3 or L4

    Air Barium Distribution in the Stomach

    • Supine: The fundus of the stomach is in the lowest part, where the heavy barium settles.
    • Prone Position: The fundus is in the highest position, causing the air to fill this part of the stomach.
    • Erect Position: Air raises to fill the fundus, while barium descends by gravity to fill the pyloric portion of the stomach.

    Peristaltic Activity

    • The passage of solid or semisolid food from the mouth to the stomach takes from 4 to 8 seconds, liquids pass in about 1 second
    • Waves of muscular contraction in the esophagus: 1 to 8 seconds
    • Food is churned or mixed with stomach fluid into a semifluid mass called CHYME in 2 to 6 hours
    • Gastric emptying rate after an average meal is 2 to 6 hours
    • Chyme normally takes 3 to 4 hours to pass through the entire small intestine

    Pediatric UGI Preparation

    • Infants under 1 year old: NPO for 4 hours
    • Children older than 1 year old: NPO for 6 hours

    Barium Meal / UGIS

    • Radiographic examination of the GIT
    • Stomach: Dilated sac-like portion of the digestive tract extending from the esophagus to the small intestine
      • From the Greek word "GASTER"
    • Dilated portion of the alimentary canal - reservoir for swallowed foods and fluids

    Barium Meal / UGIS Examination

    • Distal esophagus
    • Stomach
    • Duodenum

    Barium Meal / UGIS Indications

    • Bezoar - mass of undigested material trapped in the stomach.
      • Trichobezoar: Ingested hair
    • Dehydration

    Barium Meal / UGIS Procedures

    • AP
    • Complete Reflux: Filling of the small bowel about 4500 ml. to fill the colon and small intestines
      • Glucagon may be administered to relax the intestines
      • Diazepam: Diminish discomfort during initial filling

    Enteroclysis

    • Procedure in which contrast media is introduced into the duodenum to examine the small bowel
    • Special polyethylene tube (Bilbao or Sellink tube) is introduced through the esophagus into the stomach
    • 30 ml of barium with 60 ml of water
    • 1200 ml
    • No cleansing enema
    • Low residue diet

    Intubation Method

    • Procedure in which a tube is inserted through the nose and is passed into the stomach
    • To relieve post-operative distention or deflate/decompress an obstructed small bowel
    • Miller-Abbot
    • Water-soluble iodinated or thin BaSo4

    Hypotonic Duodenography

    • Evaluation of post-bulbar duodenal lesions and for the detection of pancreatic disease
    • Indications: Duodenitis, hepatitis, pancreatitis, abdominal mass affecting the C-Loop

    Large Intestine/B-E/Lower GI Tract

    • Study the form and function of the LI
    • Detect any abnormal conditions
    • 5 to 5 1/2 ft. (1 ½ to 3” diameter)

    Large Intestine / B-E / Lower GI Tract Methods

    • Single Contrast Method: Colon is examined with barium sulfate only
      • 40-450F
      • Reduction of intussusception
        • Common in infancy
        • Prolapse of one part of the intestine
    • Double Contrast Method: Demonstrates the colon and the cecum

    Vesiculography

    • Radiographic examination of the seminal ducts
    • Used to investigate abnormalities such as: cysts, abscesses, tumors, inflammation, sterility
    • Demonstrate the vas deferens and seminal vesicle using contrast media

    Hysterosalpingography

    • Determine the uterus and uterine tubes
    • Delineate lesions such as polyps, submucous tumors, masses, and fistula tract
    • Investigate the patency of the uterine tube
    • Demonstrate the uterus and fallopian tube, and investigate infertility

    Vaginography

    • Investigate congenital abnormalities, vaginal fistulas, and other pathologic conditions of the vagina

    Fetography

    • Demonstrate the fetus in the uterus
    • Taken 18 weeks after gestation
    • Detect suspected abnormalities of development
    • Confirm suspected fetal death
    • Determine the presentation and position of the fetus
    • Determine whether the pregnancy is single or multiple

    Pelvimetry

    • Demonstrating the architecture of the maternal pelvis
    • Comparing the size of the fetal head with the size of the maternal bony outlet

    Discography

    • Demonstrate lumbar intervertebral disks by injection of 0.5 ml. / lumbar puncture needle

    Encephalography

    • Demonstrate the ventricular and cisternal system of the brain by injection of a gas or air into the lumbar subarachnoid space or directly into the cisterna magna.

    Lateral Projection

    • Semi-prone position
    • Extends the neck
    • 1 inch (2.5 cm) superior to the mandibular angle
    • Demonstrates bony structures and calcific deposits
    • Highlights the parotid gland

    Special Procedures with Contrast

    • Performed to visualize anatomical structures and identify pathologies

    Submandibular Gland

    • Requires three projections:
      • Lateral
      • Infero-superior
      • Lateral Oblique

    Nasopharyngography

    • Radiographic examination of the nasopharynx
    • Contrast media is used to visualize the area
    • Indications:
      • Assessing the extent of nasopharyngeal tumors
      • Investigating carcinoma

    Nasopharyngography Procedure

    • Two methods for instillation:
      • Continuous breathing modified valsalva
      • Contrast media is introduced through the nostrils
    • Premedication with atropine 30 minutes prior to suppress secretions
    • Contrast media: Dionosil aqueous (8-10 ml)
    • Projections:
      • SMV (OML 40-45° to horizontal)
      • Lateral

    Pharyngography

    • Identifies abnormalities during swallowing
    • Gunson Method:
      • Synchronizes exposure with swallowing studies
      • Uses a shoestring to monitor swallowing

    Pharynx Functions

    • Passageway for food
    • Air passage from nasal cavity or mouth to larynx
    • Identifies phytobezoar (ingested vegetation, fiber, or seeds)

    Pharyngography Radiographic Appearance

    • Light coating of barium sulfate (BaSo4)
    • Visualizes:
      • Diverticula (weakening and blind out pouching of the mucosal wall)
      • Emesis (act of vomiting) to identify the cause
      • Gastritis (inflammation of the stomach lining)
        • Acute (severe pain/discomfort)
        • Chronic (intermittent, often due to diet or stress)
      • Dyspepsia (uncomfortable feeling of fullness, nausea, bloating)
      • Gastrointestinal (GI) Hemorrhage
      • Upper Abdominal Mass
      • Partial Obstruction
      • Hiatal Hernia
        • Congenital
        • Weakening of the muscle
        • Sliding of Hiatal Hernia indicates the degree of herniation, visible radiographically
      • Schatzke’s Ring (ringlike constriction at the distal esophagus)
      • Ulcers
        • Erosions in the stomach or duodenal mucosa
        • Can cause weight loss
      • Types of Ulcers:
        • Peptic (ulceration of the mucous membrane due to acid gastric juice)
        • Duodenal (type of peptic ulcer, common in the second and third aspect of the duodenum)
        • Gastric (ulcer of the gastric mucosa)
        • Perforating Ulcer (ulcer that extends through the entire thickness of the stomach or intestinal wall)
    • Stomach Sections:
      • Cardia
      • Fundus (lies above the horizontal junction of the stomach and esophagus)
      • Body
      • Pyloric Portion

    Stomach Contraindications:

    • Complete large bowel obstruction
    • History of bowel perforation or laceration

    Stomach Functions

    • Two openings:
      • Cardiac Orifice (esophagus and stomach)
      • Pyloric Orifice (stomach and small intestine)

    Stomach Habitus

    • Classified into three types:
      • Eutonic or Normotonic (incisura and pylorus are at the same level)
      • Hypotonic (pylorus is higher than incisura angularis by 1cm)
      • Stone heavier than bile (stones lighter than bile are visible only by stratification)

    Cholangiography (Choledocography)

    • Examines hepatic and common bile ducts during surgery
    • Evaluates patency and retained calculi
    • Two types:
      • Operative (contrast media is introduced directly into the common bile duct during surgery)
      • Postoperative (T-Tube) where contrast media is introduced through the T-tube (10 days after surgery)
        • Performed in RPO projection
        • Uses water-soluble contrast media (25-30% concentration)

    Percutaneous Cholangiography

    • Visualizes the biliary tract by introducing contrast media through the lateral abdominal wall into the bile ducts via a thin, flexible needle.
    • Performed for patients with jaundice of unknown cause.
    • Offers pre-operative exploration of the biliary tract.

    Intravenous Cholecystangiography

    • Investigates the biliary duct system, especially for patients with a removed gallbladder.
    • 30 ml of contrast media is administered intravenously
    • If the gallbladder is present, a fatty meal might be given

    Urinary System

    • Includes: Kidneys, Ureters, Bladder, Urethra

    Kidney Functions

    • Bean-shaped organs lying retroperitoneally
    • Control Water Balance
    • Control Blood pH
    • Control Electrolyte Balance
    • Excretion of Waste Products and Drugs
    • Control of Blood Pressure
    • Activation of Vitamin D

    Ureters

    • Retroperitoneal and run along the psoas muscle, 5 cm from the midline
    • Lie anterior to the kidney

    Bladder

    • Hollow muscular organ located behind the symphysis pubis
    • Acts as a reservoir for urine and contracts to expel it
    • Average capacity is 500 ml

    Urethra

    • Infraperitoneal structure with a length of 18-20 cm for males and 4 cm for females.
    • Divided into three parts:
      • Prostatic Part
      • Membranous Part
      • Spongy Part

    Intravenous Pyelography (IVP) / Intravenous Urography (IVU)

    • Investigates suspected urinary pathologies
    • Demonstrates anatomy and physiology of the urinary tract
    • Visualizes the minor and major calyces, renal pelvis, ureters, and bladder

    Other Urinary System Procedures

    • Percutaneous antegrade Pyelography
    • Retrograde urography
    • Cystoscopy
    • Percutaneous renal puncture
    • Angiographic procedures of the kidney and adrenals

    Urinary System Indications for Special Procedures

    • Calculi
    • Infections
    • Tumors
    • Cysts
    • Malformations of the urinary tract
    • Obstruction
    • Strictures
    • Trauma
    • Non-functioning kidney

    Urinary System Contraindications for Special Procedures

    • Renal Failure
    • Severe Heart Disease
    • Pregnancy
    • Hypersensitivity

    Urinary System Patient Preparation

    • NPO (Nothing by Mouth) for 6-8 hours
    • 50-100 ml of contrast media administered
    • Restrict fluid intake to dehydrate the patient and prevent dilution of the contrast media
    • Exceptions to fluid restriction:
      • Diabetic patient
      • Renal failure
      • Children
    • Recommended doses for children:
      • Neonates: 4.0 ml/kg
      • Babies: 3.0 ml/kg
      • Small Children: 1.5 ml/kg

    Urinary System Scout Film

    • Verifies patient preparation
    • Determines exposure technique
    • Verifies positioning
    • Detects any abnormal calcifications

    Routine Urinary System Examinations

    • UTI (Urinary Tract Infection)

    • AP Projection

    • RPO and LPO Projections

    • Lateral Projection

    • Voiding Cystourethrogram (VCUG)

    • PA Projection

    • Chassard-lapine Projection

    • Double contrast using air or gas insufflation is recommended for detecting bladder tumors.

    Voiding Cystourethrogram (VCUG)

    • Evaluates the urethra and bladder function during urination.
    • Indications:
      • Trauma
      • Involuntary loss of urine

    Male VCUG

    • Demonstrates the urethra and bladder neck
    • 150 ml of contrast media plus 20 ml of oily medium used

    Female VCUG

    • 150 ml of contrast media plus 20 ml of a more dense oily medium is used
    • Outlines the base of the bladder and urethral catheter in place
    • Demonstrates defects in bladder mechanism

    AP Projection

    • Taken during micturation (urination)
    • Demonstrates defects in bladder mechanism
    • Useful for assessing the urethra

    Retrograde Urethrography

    • Examination of the ureters and pelvicalyceal system
    • Indications:
      • Identification of opacity in the ureter
      • Obstruction with unclear cause from previous examinations
    • Contraindications:
      • Current urinary tract infection (UTI)
      • Strictures (narrowing of the ureters)

    Retrograde Urethrography Procedure:

    • Control: To locate the position of a calculus and guide catheter insertion.
    • 35° Oblique (RPO) projection: To capture the full length of the urethra.
    • Cystoscope: Passed through the urethra and into the bladder.

    Retrograde Pyelography

    • Non-functional examination of the urinary system where contrast media is injected directly into the pelvicalyceal system.
    • Indications:
      • Visualization of the site, length, and nature of obstructive lesions.
      • Examination of the pelvicalyceal system when excretion urograms are insufficient.
    • Contraindications:
      • UTI

    Retrograde Pyelography Procedures:

    • Urethral catheter introduced through urethra and bladder to the ureteric orifice
    • 35 cc of contrast media administered

    Cystoscopy

    • Non-functional examination of the urinary system which demonstrates the bladder, urethra, and ureteric reflux.
    • Uses 150 ml of contrast media.

    Pharynx

    • Resonating chamber for sounds generated in the larynx.
    • Extends from the base of the skull to the cricoid cartilage.
    • It is situated behind the nose, mouth, and the upper part of the throat.

    Parts of the Pharynx

    • Nasopharynx: Lies behind the nose and above the soft palate.
    • Oropharynx: Lies behind the mouth, extends from the soft palate to the epiglottis. It is common to both the respiratory and alimentary tracts.
    • Laryngopharynx: Extends from the upper border of the epiglottis to the lower border of the cricoid cartilage, leading to the esophagus. It connects to the oropharynx above and the esophagus below.

    Laryngography

    • Radiographic examination of the larynx.
    • Indications:
      • Demonstrates muscular weakness due to disease.
      • Demonstrates edema or fibrosis.
      • Investigates malignancy.
    • Preparation:
      • NPO for 5 hours.
      • Contrast Media: Dionosil (10-15 ml).

    Laryngography Procedures

    • Quiet Inspiration: Tests abduction of the vocal cords.
    • Normal Phonation: Tests adduction of the vocal cords. Patient takes a deep breath, then exhales slowly phonating a high or low pitch.
    • Inspiratory Phonation/Reverse Phonation/Aspirant Maneuver: Demonstrates the laryngeal ventricle. Patient exhales completely, then inhales slowly creating a harsh, stridulous sound.
    • Valsalva Maneuver: Shows complete closure of the glottis. Tests the elasticity and functional integrity of the glottis.

    Hyposthenic

    • Modification of extreme asthenic body type (35%).
    • Stomach is at the level of T11 to L5 or even lower.
    • Duodenal bulb is at the level of L3 or L4.

    Air Barium Distribution

    • In the supine position, the fundus of the stomach is in the lowest part where the heavy barium settles.
    • In the prone position, the fundus is in the highest position, causing the air to fill this part of the stomach.
    • In the erect position, air raises to fill the fundus, whereas barium descends by gravity to fill the pyloric portion of the stomach.

    Peristaltic Activity

    • Solid or semisolid food takes 4 to 8 seconds to pass from the mouth to the stomach, while liquids pass in about 1 second.
    • Waves of muscular contraction in the esophagus take 1 to 8 seconds.
    • Food is churned or mixed with stomach fluid into semifluid mass termed CHYME in 2 to 6 hours.
    • Gastric emptying rate after an average meal is 2 to 6 hours.
    • Chyme normally takes 3 to 4 hours to pass through the entire small intestine.

    Pediatric UGI Preparation

    • Infants under 1 year old: NPO for 4 hours
    • Children older than 1 year old: NPO for 6 hours

    Barium Meal / UGIS

    • Radiographic Examination of the GIT.
    • Examines the distal esophagus, stomach, and duodenum.
    • Indications:
      • Bezoar (mass of undigested material trapped in the stomach):
        • Trichobezoar: Ingested hair.
        • Stone: Stones heavier than bile are visible. Stones lighter than bile may only be visible through layering/dropping.

    Cholangiography (Choledocography)

    • Demonstrates the hepatic and common bile ducts during operation, specifically patency and retained calculi.
    • Types:
      • Operative Cholangiography: Contrast media is introduced directly into the CBD.
      • Post-operative (T-Tube): Contrast media is introduced through the T-tube, done 10 days after surgery in RPO position using water-soluble contrast media (25-30% concentration).

    Percutaneous Cholangiography

    • Visualizes the biliary tract when contrast media is directly injected through the lateral abdominal wall into the intra-hepatic bile ducts using a thin flexible needle.
    • Done in patients with jaundice of unknown cause. Also used for pre-operative radiographic exploration of the biliary tract/duct.

    Intravenous Cholecystangiography

    • Investigates the biliary duct system, particularly in patients who have had their gallbladder removed.
    • 30 ml of contrast media is administered intravenously.
    • A fatty meal may be given if the gallbladder is present.

    Kidney

    • A pair of bean-shaped organs, lying retroperitoneally in the upper abdomen on either side of the vertebral column.
    • Remove waste materials from the blood and eliminate waste in the urine.

    Kidney Functions

    • Control water balance.
    • Control blood pH.
    • Control electrolyte balance.
    • Excretion of waste products and drugs.
    • Control of blood pressure.
    • Prevention of UTI.

    Retrograde Urethrography

    • Examination of the ureters and pelvicalyceal system.
    • Indications:
      • Identify if an opacity is in the ureter.
      • To identify the cause of an obstruction seen in a previous examination.
    • Contraindications:
      • Current UTI.
      • Strictures.
    • Procedure:
      • Control: Identify the position of a calculus to identify the tip of any catheters.
      • 350 Oblique (RPO): Full length.
      • Cystoscope passed per urethra and bladder.

    Retrograde Pyelography

    • Non-functional examination of the urinary system directly into the pelvicalyceal system.
    • Demonstrates the kidneys and ureters in cases of doubtful lesions by introducing a ureteric catheter via the urethra, bladder into the ureteric orifice.
    • 35 cc of contrast media used.

    Retrograde Pyelography Indications

    • Demonstrate the site, length and nature of an obstructive lesion.
    • Demonstrate the pelvicalyceal system after unsatisfactory excretion urograms.

    Retrograde Pyelography Contraindications

    • UTI.

    Cystoscopy

    • Non-functional examination of the urinary system.
    • Demonstrates the bladder, urethra and ureteric reflux.
    • 150 ml of contrast media used.

    Routine Examination

    • AP projection.
    • RPO and LPO.
    • Lateral projection.
    • Voiding cystourethrogram.
    • PA projection.
    • Chassard-lapine.

    Cystoscopy Notes

    • Double contrast using air or gas insufflation is used to detect bladder tumors.

    VCUG (Voiding Cystourethrogram)

    • Studies the urethra and the patient's ability to urinate.

    VCUG Indications

    • Trauma or involuntary loss of urine.

    VCUG for Male

    • Demonstrates the urethra and bladder neck.
    • 150 ml of contrast media plus 20 ml of oily medium is used.

    VCUG for Female

    • 150 ml of contrast media plus 20 ml of more dense oily medium is used to outline the base of the bladder and the urethral catheter in situ.
    • Demonstrates defects in the bladder mechanism.

    AP Projection During Micturation

    • Demonstrates defects in the bladder mechanism.

    Urography

    • Radiographic investigation of the renal drainage or collecting system.

    Vesiculography

    • Radiographic examination of the seminal ducts.
    • Used to investigate abnormalities such as:
      • Cysts.
      • Abscesses.
      • Tumors.
      • Inflammation.
      • Sterility.
    • Demonstrates the vas deferens and seminal vesicle using contrast media .

    Hysterosalpingography

    • Determines the uterus and uterine tubes.
    • Delineates lesions like polyps, submucous tumours, masses and fistula tract.
    • Investigates the patency of the uterine tube.
    • Demonstrates the uterus and fallopian tube and used to investigate infertility.

    Vaginography

    • Investigates congenital abnormalities, vaginal fistulas and other pathologic conditions of the vagina.

    Fetography

    • Demonstrates the fetus in the uterus starting from 18 weeks of gestation.
    • Detects suspected abnormalities of development.
    • Confirms suspected fetal death.
    • Determines the presentation and position of the fetus.
    • Determines if the pregnancy is single or multiple.

    Pelvimetry

    • Demonstrating the architecture of the maternal pelvis.
    • Comparing the size of the fetal head with the size of the maternal bony outlet.

    Discography

    • Demonstrates lumbar intervertebral disks by injection of 0.5 ml of contrast media through a lumbar puncture needle.

    Encephalography

    • Demonstrates the ventricular and cisternal system of the brain by injecting gas or air into the lumbar subarachnoid space or directly into the cisterna magna.

    Contrast Media

    • Used for opacification, visualization, and contrast studies.

    Types of Contrast Media

    • Positive: Used to increase the radiographic density of structures.
    • Negative: Used to decrease the radiographic density of structures.

    Contrast Media Reactions

    • Histamine Imbalance: Occurs when the patient cannot tolerate the contrast media, leading to reactions such as hives, itching, and swelling.
    • Hemodynamic: Reaction occurs upon injection, causing sudden drops in blood pressure, as well as potential myocardial infarction, renal shutdown, and immediate reactions like hypertension and urticaria.
    • Psychosomatic: Mild transient effect associated with patient anxiety, fatigue, and dehydration.
    • Technique: Complications include extravasation with burning pain, hematoma numbness, and vascular constriction.
    • Pyrogenic: A reaction without apparent cause that tends to cause a rise in body temperature.

    Major Reactions to Contrast Media

    • Cardiac arrest.
    • Severe bronchial spasms (prolonged contraction of muscles in the wall of the bronchi).
    • Severe hypertension.

    Local Reactions to Contrast Media

    • Pain.
    • Burning sensation.
    • Itching.
    • Vomiting.
    • Rashes.
    • Increased salivation.
    • Increase of tears.
    • Chocking.

    Factors in Selecting the Right Contrast Media

    • Must be non-toxic when administered.
    • Must produce adequate contrast.
    • Must have suitable viscosity (quality of a sticky fluid).
    • Must have suitable persistence.

    Methods of Introducing Contrast Media

    • Ingestion: Taken orally.
    • Retrograde Administration: Inserted into a body cavity through a natural opening.
    • Intrathecal: Introduced into a sheath (e.g., the spinal canal).
    • Parenteral: Injecting into the bloodstream, the most common method, which can be done intravenously or intra-arterially.

    Properties of Barium Sulfate (BaSo4)

    • Absorbs water.
    • High atomic number, meaning it absorbs x-rays more effectively.
    • Insoluble in water and stable.
    • Cannot be absorbed in the gastrointestinal tract (GIT).
    • Non-toxic.
    • Relatively inexpensive.

    Upper Gastrointestinal System

    • Alimentary canal begins at the oral cavity, followed by the pharynx, esophagus, small intestine, large intestine, and terminates at the anus.

    Accessory Organs of Digestion

    • Salivary glands.
    • Pancreas.
    • Liver.
    • Gallbladder.

    Functions of the Digestive System

    • Intake and/or digestion of food.
    • Absorb digested food particles.
    • Eliminate any unused material in the form of semi-solid waste products.

    Sialography

    • Radiographic examination of the salivary glands and ducts using water-soluble iodinated contrast media.
    • Used to demonstrate salivary glands and calculi in their ducts.

    Indications for Sialography

    • Inflammatory lesions, obstructed or not.
    • Pain or swelling in the area.
    • Palpable mass.
    • Calculi.
    • Strictures.
    • Tumor.
    • Infection.
    • Dryness of mouth and eyes.

    Sialography Procedure

    • Plain Films: Used to determine the presence of calculi and calcified cervical glands.
    • 2 mL syringe: Used during the procedure.
    • Lemon juice: Used to promote salivation and identify the orifice of the duct.
    • 1-2 mL contrast media: Administered to the duct.

    Three Pairs of Salivary Glands

    • Parotid (Stensen's duct): Located near the ear, emptying into the mouth opposite the upper second molar.
    • Submandibular/Submaxillary (Wharton's duct): Located under the jaw, emptying into the mouth under the tongue.
    • Sublingual (Bartholin's duct): Located under the tongue, emptying into the floor of the mouth.

    Parotid Gland Projections for Sialography

    • AP: Patient supine, head rotated away 50 degrees, CR level of the lower lip. Demonstrates stone formation.
    • Lateral: Patient semi-prone, extending the neck, RP 1” (2.5 cm) superior to the mandibular angle. Demonstrates bony structure, calcific deposits, swelling, and the three pairs of salivary glands.
    • Lateral Oblique (PA Tangential): Patient PA, head rotated 10-15 degrees towards the lateral surface of the mandibular ramus.

    Submandibular Gland Projections for Sialography

    • Lateral
    • Infero-superior
    • Lateral Oblique

    Nasopharyngography

    • Radiographic examination of the nasopharynx following instillation of contrast media.
    • Used to assess the extent of nasopharyngeal tumors and investigate carcinoma.

    Methods for Nasopharyngography

    • Continuous breathing modified valsalva: The patient breathes continuously while performing a modified valsalva maneuver (holding the breath while gently pushing out with the mouth closed).
    • Contrast media is introduced/instilled through the nostrils: The contrast media is introduced through the patient's nostrils.

    Premedication for Nasopharyngography

    • Atropine (30 mins before exam): Used to suppress nasopharyngeal and buccal secretions.

    Contrast Media Used for Nasopharyngography

    • Dionosil aqueous, 8-10 mL.

    Projections for Nasopharyngography

    • SMV: OML 40-45 degrees to horizontal.
    • Lateral

    Pharyngography

    • Used to identify abnormalities during the active progress of deglutition (swallowing).

    Gunson Method for Pharyngography

    • Synchronizes the exposure with the height of the swallowing studies of the pharynx and superior esophagus.
    • A dark colored shoestring is tied snugly around the patient's throat above the thyroid cartilage to serve as a visual marker.

    Functions of the Pharynx

    • Acts as a passageway of food.
    • Air passage from the nasal cavity or mouth to the larynx.
    • Dehydration.

    Procedures for Pharyngography

    • AP
    • Complete Reflux: Filling of the small bowel with approximately 4500 mL to fill the colon and small intestines. Glucagon may be administered to relax the intestines. Diazepam may be administered to diminish discomfort during initial filling.

    Enteroclysis

    • Procedure in which contrast media is introduced into the duodenum to examine the small bowel.
    • A special polyethylene tube (Bilbao or Sellink tube) is introduced into the esophagus and into the stomach.
    • 30 mL of barium is mixed with 60 mL of water, followed by 1200 mL of contrast media.
    • No cleansing enema is required, and the patient is given a low residue diet.

    Intubation Method

    • A procedure in which a tube is inserted through the nose and passed into the stomach.
    • Used to relieve post-operative distention or deflate or decompress an obstructed small bowel.

    Miller-Abbott Tube

    • Frequently used for intubation.

    Contrast Media for Intubation Method

    • Water-soluble iodinated contrast media or thin Barium sulfate.

    Hypotonic Duodenography

    • Evaluation of post-bulbar duodenal (the area of the duodenum after the bulb) lesions and for the detection of pancreatic disease.

    Indications for Hypotonic Duodenography

    • Duodenitis
    • Hepatitis
    • Pancreatitis
    • Abdominal mass affecting the C-loop (the second curve of the duodenum).

    Large Intestine/B-e/Lower GI Tract

    • Study the form and function of the large intestine.
    • Detect any abnormal conditions.
    • The large intestine is approximately 5 to 5 1/2 feet long and between 1 ½ to 3 inches in diameter.

    Methods for Barium Enema (BE)

    • Single Contrast Method: The colon is examined with barium sulfate only.
    • Double Contrast Method: Barium sulfate and air are used together to highlight the colon and cecum.

    Contrast Media for Double Contrast Barium Enema

    • Telepaque (Ioponoic acid): 6 or 12 tablets.
    • Cholebrin (Iocetanic acid): 6 tablets.
    • Biloptin (Sodium Iopadate): 6 tablets.
    • Solu-biloptin (Calcium Iopadate): 3 g/sachet.

    Purpose of Cholecystography (GB)

    • Determine the liver's function and its ability to remove contrast media from the bloodstream and excrete it through the bile.
    • Determine the patency (openness) of the biliary ducts.
    • Evaluate the contracting and emptying power of the gallbladder.
    • Detect biliary calculi (gallstones).

    Indications for Cholecystography (GB)

    • Nausea.
    • Heartburn.
    • Vomiting.
    • Cholelithiasis.
    • Milk calcium bile, which indicates biliary stones in the gallbladder.
    • Non-visualization of the gallbladder.
    • Cholecystitis.
    • Biliary stenosis (narrowing of one of the biliary ducts).
    • Congenital anomalies.

    Contraindications for Cholecystography (GB)

    • Hepatorenal disease with renal impairment.
    • Active GI disease (vomiting, severe diarrhea).
    • Pyloric obstruction.
    • Severe jaundice.
    • Liver dysfunction.
    • Hypersensitivity to iodinated contrast media.
    • Pregnancy.

    Procedure for Cholecystography (GB)

    • AP
    • Oblique (RAO)
    • Post motor meal: Used to evaluate the contracting power of the gallbladder.
    • Erect LAO: Demonstrate floating gallstones.
    • Right Lateral Decubitus: Demonstrate gallstones.

    AP Projection for Cholecystography (GB)

    • Demonstrates the presence and location of the gallbladder.
    • Demonstrates the presence of choleliths (gallstones).

    RAO Projection for Cholecystography (GB)

    • Delineates between gas trapped in the bowel and radiolucent stones in the gallbladder.
    • Patient is rotated 15-30 degrees.

    Erect LAO Projection for Cholecystography (GB)

    • Demonstrates floating gallstones.
    • Patient is rotated 20 degrees.

    Right Lateral Decubitus Projection for Cholecystography (GB)

    • Demonstrates gallstones.

    Fatty Meal for Post Motor Meal

    • A high-fat meal is given to the patient to stimulate the release of bile.

    BaSO4 Properties

    • Barium Sulfate (BaSO4) is used as a contrast media in many special procedures
    • BaSO4 absorbs water
    • BaSO4 has a high atomic number
    • BaSO4 is insoluble in water
    • BaSO4 is stable
    • BaSO4 cannot be absorbed in the gastrointestinal tract (GIT)
    • BaSO4 is non-toxic
    • BaSO4 is relatively cheap

    Alimentary Canal

    • The alimentary canal begins at the oral cavity
    • The alimentary canal moves through the pharynx
    • The alimentary canal moves through the esophagus
    • The alimentary canal moves through the small intestine
    • The alimentary canal moves through the large intestine
    • The alimentary canal terminates at the anus

    Accessory Organs of Digestion

    • The salivary glands are an accessory organ of digestion
    • The pancreas an accessory organ of digestion
    • The liver an accessory organ of digestion
    • The gallbladder is an accessory organ of digestion

    Functions of the Digestive System

    • The digestive system is responsible for the intake and digestion of food.
    • The digestive system is responsible for absorbing digested food particles.
    • The digestive system is responsible for eliminating any unused material in the form of semi-solid waste product.

    Sialography

    • Sialography is a radiographic examination of the salivary glands and ducts using a water-soluble iodinated contrast media.
    • Sialography is used to demonstrate the salivary glands and calculi in their ducts.

    Sialography Indications

    • Sialography is used for inflammatory lesions, obstructed or non-obstructed
    • Sialography is used for pain or swelling in the area
    • Sialography is used for palpable mass
    • Sialography is used for calculi
    • Sialography is used for strictures
    • Sialography is used for tumour
    • Sialography is used for infection
    • Sialography is used for dryness of the mouth and eyes

    Sialography Plain Films

    • Plain Films are used to determine if there are calculi or calcified cervical glands
    • Plain Films use a 2 ml syringe
    • Lemon juice is used to promote salivation and to identify the orifice of the duct
    • 1 to 2 ml of contrast media is used

    Pairs of Salivary Glands

    • The Parotid (Stensen’s duct) is a pair of salivary glands
    • The Submandibular/submaxillary (Wharton’s duct) are a pair of salivary glands
    • The Sublingual (Bartholins duct) are a pair of salivary glands

    Parotid Gland

    • The parotid gland can be used to demonstrate stone formation
    • The parotid gland is demonstrated by 1. AP, 2. Lateral, and 3. Lateral Oblique views

    Parotid Gland AP View

    • The patient should be in the supine position, head rotated away 50 degrees
    • The CR (central ray) should be at the level of the lower lip

    Body Types

    • Asthenic body type has a long and slender body
    • Hyposthenic body type - a modification of the asthenic type - 35%
    • Sthenic body type - a modification of the asthenic type - 50%
    • Hypersthenic body type - a modification of the asthenic type - 75%
    • Extreme Asthenic body type - a modification of the asthenic type - 100%

    UGI (Upper Gastrointestinal System)

    • The UGI system is a system that examines the digestive system from the esophagus to the duodenum.
    • An UGI is usually performed via a "barium meal"
    • In an UGI, barium absorbs fluid and moves through the body, filling the digestive system
    • The position of the body determines the distribution of barium and air in the stomach during an UGI

    Air Barium Distribution in the Stomach

    • Supine position - the fundus of the stomach is in the lowest part, where the heavy barium settles.
    • Prone position - the fundus is in the highest position, causing the air to fill this part of the stomach.
    • Erect position - air raises to fill the fundus, whereas barium descends by gravity to fill the pyloric portion of the stomach.

    Peristaltic Activity

    • The passage of solid or semisolid food from the mouth to the stomach takes from 4 to 8 seconds, whereas liquids pass in about 1 second.
    • Waves of muscular contraction in the esophagus take 1 to 8 seconds.
    • Churned or mixed with stomach fluid into a semifluid mass termed CHYME in 2 to 6 hours.
    • Gastric emptying rate after an average meal is 2 to 6 hours.
    • Chyme normally takes 3 to 4 hours to pass through the entire small intestine

    Pediatric UGI Preparation

    • For infants under 1 year old: NPO (nothing by mouth) for 4 hours
    • For children older than 1 year old: NPO (nothing by mouth) for 6 hours

    Barium Meal / UGIS

    • Upper Gastrointestinal Series (UGIS) is a radiographic examination of the GIT (gastrointestinal tract).
    • The stomach is a dilated sac-like portion of the digestive tract extending from the esophagus to the small intestine.
    • Stomach is from the Greek word GASTER.
    • The stomach is the dilated portion of the alimentary canal
    • The stomach is a reservoir for swallowed foods and fluids.

    Barium Meal / UGIS

    • Barium Meal is the examination of the GIT and its function including the distal esophagus, stomach, and duodenum.

    Bezoar

    • Bezoar is a mass of undigested material trapped in the stomach.
    • Trichobezoar is ingested hair that forms a bezoar.
    • Steerhorn bezoar - the incisura is higher by 1 cm than the pylorus.

    Barium Meal / UGIS - Indications

    • Barium Meal / UGIS - NPO 6-8 hours before the procedure

    • 6 hours delayed*

    • Barium Meal / UGIS - to assess gastric emptying rate

    • 24 hours delayed*

    • Barium Meal / UGIS - to assess suspected pathologies in the small intestine, appendix or colon

    BaSO4 Preparation

    • 1 yr.= 2 to 4 oz.
    • 1- 3 yrs.= 4 to 6 oz.
    • 3 – 10 yrs.= 6 t0 12 oz.
    • Older than 10 yrs.= 12 to 16 oz.
    • 30 – 50% Weight Volume.
    • 50-80 ml. - esophagus.& mocusal pattern of the stomach.
    • 300 ml – stomach & duodenum.
    • 100 g/ 8 oz of water.

    Single Contrast

    • Single Contrast is used to demonsrate gross pathology only
    • Single Contrast is used for children
    • Single Contrast is used for very ill patients

    Double Contrast

    • Double Contrast is used to demonstrate mucosal pattern of the stomach and to detect small lesions.
    • Gas-producing tablets are given
    • The patient is rotated 360 degrees
    • This helps coat gastric mucosa

    Barium Meal / UGIS - Views

    • PA View - demonstrates the relationship of the stomach and retrogastric space
    • AP View - demonstrates the antrum/body of the stomach
    • RAO (Right Anterior Oblique) - demonstrates the pyloric canal and duodenal bulb
    • RLR (Right Lateral Recumbent) - demonstrates the duodenal loop and duodenojejunal junction
    • LPO (Left Posterior Oblique) - demonstrates hiatal hernia

    Barium Meal / UGIS - Modifications

    • Gordon's Manuever - to demonstrate the pylorus and the bulb - prone - CR (central ray) 35 – 450 cephalad.
    • Gugliantini - for infants - prone - CR (central ray) 20 – 250 cephalad.
    • Hamptons – to demonstrate the leaf-like pattern of the pylorus and the bulb - LPO.
    • Poppel’s method- to demonstrate the retrogastric space and evaluate pancreatic masses - right lateral recumbent.
    • Wolf Method- to demonstrate small lesions, or sliding gastroesophageal herniations - RAO - rotated body 40-450 - R.P.T6 / T7 - CR (central ray) 10- 200 caudally

    Bipasic Exam

    • A Gastrointestinal examination where single & double contrast studies are performed on the same day.

    SIS/ Ba.Meal Follow Through

    • The small intestine (SI) extends from the pyloric sphincter of the stomach to the ileocecal valve.
    • The SI averages about 22 ft. (61/2) meters
    • The proximal portion of the SI is 1 ½ “ (4 cm.).
    • The distal portion of the SI is 1” (2-5 cm.).
    • The duodenum is 8-10 (20-25 cm.).

    Small Intestine Parts

    • Duodenum - The first part, shortest, widest
    • Duodenum - located right upper quadrant (RUQ) & left upper quadrant (LUQ)
    • Duodenum - 8-10” (20-25 cm.)
    • Ileum - located right lower quadrant (RLQ) & left lower quadrant (LLQ)
    • Ileum - the longest portion of SI
    • Ileum - 2.5 cm diameter
    • Jejunum - located LUQ & LLQ
    • Jejunum - 3-3.5 cm diameter

    SIS/ Ba.Meal Follow Through - Procedures

    • Oral/by the mouth
    • Complete reflux exam
    • Intubation exam
    • Enteroclysis

    SIS/ Ba.Meal Follow Through - Indications

    • Pain
    • Diarrhea
    • Bleeding
    • Partial obstruction
    • Abdominal mass
    • Failed small bowel enema
    • Enteritis - inflammation of the small intestine
    • Giardiasis - infection of the lumen of the small intestine
    • Ileus
    • Meckel’s diverticulum - a saclike outpouching of the intestinal wall - a birth defect

    SIS/ Ba.Meal Follow Through - Contraindications

    • Complete obstruction
    • Suspected perforation
    • Dehydration

    SIS/ Ba.Meal Follow Through - Procedures

    • AP view
    • Complete Reflux - filling of the small bowel about 4500 ml to fill the colon and small intestines - glucagon may be administered to relax the intestines - Diazepam may be administered to diminish discomfort during initial filling
    • Enteroclysis - a procedure where the contrast media is introduced into the duodenum to examine the small bowel. A special polythene tube (Bilbao or sellink tube) is intro. to the esophagus into the stomach. 30 ml of barium with 60 ml of water is used, as well as 1200 ml in total. No cleansing enema is required and the patient should be on a low-residue diet.
    • Intubation Method - A procedure where a tube is inserted through the nose and passed into the stomach. Used to relieve post-operative distention or deflate, or to decompress an obstructed small bowel. Miller-Abbott tubes are used. Water-soluble iodinated or thin BaSO4 is used.

    Hypotonic Duodenography

    • Evaluation of post bulbar duodenal lesions & for the detection of pancreatic disease.

    Hypotonic Duodenography - Indications

    • Duodenitis
    • Hepatitis
    • Pancreatitis
    • Abdominal mass affecting the C-Loop

    Large Intestine / B-E / Lower GI Tract

    • The large intestine is also called the Lower GI Tract (LGI)
    • The large intestine is about 5 to 5 1/2 ft. (1 ½ to 3” diameter)
    • The purpose of B-E / Lower GI Tract is to study the form and function of the LGI and to detect any abnormal conditions.
    • An LGI study is a procedure that uses barium to assess the large intestine

    Large Intestine / B-E / Lower GI Tract - Methods

    • There are two methods of performing an LGI study
    • Single Contrast Method - This procedure examines the colon only and uses barium sulfate as a contrast media
    • Single Contrast Method - The tube used for contrast is a 40-450F, with a reduction to make it easier to perform in infants (commonly used in cases of intussusception, which is a prolapse of one part of the intestine.)
    • Double Contrast Method - This procedure demonstrates both the colon and the cecum.
    • Double Contrast Method- This procedure also helps to demonstrate small lesions.

    Intussusception

    • Intussusception is a prolapse of one part of the intestine.
    • Intussusception is common in infancy.

    Lateral Projection

    • Semi-prone position, extending the neck
    • Radiographic position: 1 inch (2.5 cm) superior to the mandibular angle
    • Demonstrates the bony structure and potential calcifications or swelling in the parotid gland area
    • Demonstrates the three pairs of salivary glands

    Submandibular

    • Lateral projection
    • Infero-superior projection
    • Lateral oblique projection

    Nasopharyngography

    • Radiographic examination of the nasopharynx following contrast media instillation
    • Indicates need to assess the extent of nasopharyngeal tumors and investigate carcinoma
    • Two approaches:
    • Continuous breathing modified Valsalva
    • Contrast media introduced via nostrils
    • Premedication with atropine 30 minutes before the exam to suppress nasopharyngeal and buccal secretions
    • Contrast media used: Dionosil aqueous, 8-10ml
    • Procedure Positions:
    • SMV: OML 40-45 degrees to horizontal
    • Lateral projection

    Pharyngography

    • Identifies abnormalities during the active progress of deglutition
    • Gunson Method: Synchronize exposure with the height of the swallowing studies of the pharynx and superior esophagus
    • Used to tie a dark-colored shoestring snugly around the patient’s throat above the thyroid cartilage
    • Function of the Pharynx:
    • Passageway for food
    • Air passage from the nasal cavity or mouth to the larynx
    • Resonating chamber for sounds produced in the larynx
    • Extends from the base of the skull to the cricoid cartilage and is situated behind the nose, mouth, and upper part of the throat

    Parts of The Pharynx

    • Nasopharynx: Lies behind the nose and above the soft palate
    • Oropharynx: Lies behind the mouth and extends from the soft palate to the epiglottis. Common to both the respiratory and alimentary tracts
    • Laryngopharynx: Extends from the upper border of the epiglottis to the lower border of the cricoid cartilage, where it continues to the esophagus. Connects with the oropharynx above and the esophagus below.

    Indications for Pharyngography

    • Demonstration of tumors
    • Demonstration of abscesses
    • Demonstration of foreign bodies

    Procedure Positions for Pharyngography

    • AP (anteroposterior projection)
    • Lateral (side view)

    Laryngography

    • Radiographic examination of the larynx
    • Indicates the need to demonstrate muscular weakness due to disease
    • Indicates the need to demonstrate edema or fibrosis and investigate malignancy

    Preparation for Laryngography

    • NPO for 5 hours
    • Contrast media - Dionosil 10-15 ml.
    • Procedures:
    • Quiet inspiration: Test abduction of the vocal cords
    • Normal Phonation: Test adduction of vocal cords. Instruct the patient to take a deep breath and then exhale slowly, phonating a high or low pitch.
    • Inspiratory phonation/reverse phonation/aspirant maneuver: Demonstrate of the laryngeal ventricle. Exhale completely and then slowly inhale to make a harsh, stridulous sound
    • Valsalva maneuver: Shows complete closure of the glottis, test the elasticity and functional integrity of the glottis.
    • Compression technique: Use a compression paddle in prone to provide pressure
    • Toe-touch maneuver: Study possible regurgitation into the esophagus from the stomach. Used for esophageal reflux and hiatal hernias

    Esophagography

    • Procedure Positions:
    • AP or PA
    • RPO: 35-40 degrees
    • LPO
    • RAO: To throw the esophagus clear of the spine

    Indications for Esophagography

    • Demonstrate esophageal varices. Instruct the patient to exhale fully and then follow the barium flow - avoid inhaling until exposure is made.
    • Demonstrate entire esophagus

    Body Habitus (Classification)

    • Hypersthenic
    • Sthenic
    • Hyposthenic
    • Asthenic

    Hypersthenic

    • Massive build
    • Stomach level: T9 to T12
    • Duodenal bulb level: T11 to T12
    • Stomach & GB occupy high, almost horizontal position, less than 5% of the population fits into this category.

    Sthenic

    • Modification of Hypersthenic. Predominant type
    • 50% of patients fit into this category.
    • Stomach level: T10 to T11 to L2
    • Duodenal bulb: L2

    Asthenic

    • Extremely slender build
    • Stomach & GB are low, vertical, and near the midline
    • Lower extreme, about 10% of the population.
    • Stomach Level: T11 to L4
    • Duodenal bulb level: L3

    Steershorn

    • Incisura is higher by 1 cm. than the pylorus.

    Preparation for Upper Gastrointestinal Series

    • NPO for 6-8 hours
    • 6 hours delayed: Used in cases of suspected pyloric stenosis to assess the gastric emptying rate.
    • 24 hours delayed: Used if there is suspicion in the small intestine, appendix or colon.
    • Barium Sulfate (BaSO4) Preparation:
    • 1 year: 2-4 oz.
    • 1-3 years: 4-6 oz.
    • 3-10 years: 6-12 oz.
    • Older than 10 years: 12-16 oz.
    • 30-50% weight volume - 50-80 ml for esophagus and mucosa pattern of the stomach
    • 300 ml for stomach and duodenum
    • 100 g per 8 oz of water

    Single Contrast

    • Used for gross pathology only
    • Applicable for children and very ill patients.

    Double Contrast

    • Demonstrate mucosal pattern of the stomach and to detect small lesions
    • Gas-producing tablets are given
    • Rotate the patient 360 degrees to coat the gastric mucosa

    Procedure Positions for a Upper Gastrointestinal Series

    • PA: Demonstrate the relationship of the stomach and the retrogastric space (AP - Antrum/Body)
    • RAO: Demonstrate the pyloric canal and duodenal bulb. (Antrum/Greater curve/peristalsis of the stomach)
    • RLR: Demonstrate the duodenal loop, duodenojejunal junction, and the right retrogastric space

    Variations for Upper Gastrointestinal Series

    • LPO: Demonstrate a hiatal hernia. Head down by 25-30 degrees with 10-15 degrees of body rotation.

    Modifications for Upper Gastrointestinal Series

    • Gordons Maneuver: Demonstrate the pylorus and bulb. Patient is prone with CR 35-45 degrees cephalad. Demonstrate the greater and lesser curvatures and the antral portion of the stomach.
    • UTI: Upper tract investigations

    Retrograde Urethrography

    • Examination of the urethra and pelvicalyceal system.
    • Indications:
    • Identify if an opacity is in the ureter.
    • Previous examinations show obstruction, but the cause is unidentifiable.
    • Contraindications: Current UTI or strictures.

    Procedure for Retrograde Urethrography

    • Control: Identify the position of a calculus to identify the tip of any catheters.
    • 35 degrees Oblique (RPO): Full length.
    • Cystoscope is passed per urethra and bladder.
    • Positioning: AP
    • Positioning: 35 degrees Oblique (RPO)

    Retrograde Pyelography

    • Non-functional examination of the urinary system, injecting contrast media directly into the pelvicalyceal system.
    • Demonstrates the kidneys and ureters in cases of doubtful lesions.
    • Urethral catheter is introduced via the urethra and bladder into the ureteric orifice. 35 cc of contrast media are injected
    • Indications:
    • Demonstrate the site, length, and nature of obstruction lesions
    • Demonstrate the pelvicalyceal system after unsatisfactory excretion urograms.
    • Contraindications: UTI

    Cystoscopy

    • Non-functional examination of the urinary system.
    • Demonstrates the bladder, urethra, and ureteric reflux
    • 150 ml of contrast media.

    Routine Examination – Upper Urinary Tract

    • AP projection
    • *RPO and LPO (right posterior oblique and left posterior oblique)
    • Lateral projection
    • Voiding cystourethrogram
    • PA projection
    • Chassard-lapine

    Indications for a Double Contrast Cystogram

    • To detect bladder tumors.
    • Air or gas insufflation is used.

    Voiding Cystourethrogram (VCUG) - Indications

    • Study of the urethra and evaluate the patient's ability to urinate.
    • Evaluate trauma or involuntary loss of urine.

    VCUG - Male

    • Demonstrate the urethra and bladder neck.
    • 150 ml + 20 ml of oily medium.

    VCUG - Female

    • 150 ml of contrast media + 20 ml of a more dense oily medium.
    • Highlight the base of the bladder and the urethral catheter in situ.
    • Demonstrate defects in bladder mechanism.

    AP Projection - VCUG

    • During micturation.
    • Demonstrate defects in bladder mechanism.

    Urography

    • Radiographic investigation of the renal drainage or collecting system.
    • Note: The text you provided is a list of procedures, and the detailed description of each procedure is often lacking. It might be helpful to refer to additional resources for a comprehensive study of each procedure

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    Special Procedures with Contrast PDF

    Description

    Test your knowledge on the contrast procedures related to the digestive system, including the anatomy and functions of the alimentary canal and accessory organs. Learn about techniques like sialography and the characteristics of absorbent materials used in radiographic examinations.

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