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Contrast Studies

• Presents information on contrast studies, gastrointestinal tract, mouth, and salivary glands.
• Contrast studies are radiographic examinations using a contrast medium.

Mouth (Oral Cavity)

• The oral cavity’s main area is bordered by the inner surfaces of the upper and lower teeth.
• The oral cavity’s roof is made up of the soft and hard palates.
• From the soft palate’s posterior part hangs the palatine uvula, a small conical process.
• The oral cavity’s floor is the tongue
• The oral cavity connects to the pharynx posteriorly.

Accessory Organs of the Oral Cavity (Mouth)

• Saliva glands are accessory organs in the oral cavity that include the parotid, submandibular, and sublingual glands.
• Saliva consists of 99% water, the rest is made up of solutes/salt.
• The salivary glands secrete 1000-1500ml daily.

Sialography

• Radiographic examinations of the salivary glands and ducts using contrast medium are termed sialography.
• The radiopaque contrast medium is injected into the main duct flowing into the traglandular ductules.
• Sialography is used to demonstrate inflammatory lesions and tumors.
• Useful in determining salivary fistulae extent and localize diverticulae, strictures, and calculi.

Pathologic Conditions

• Calculus: An abnormal concretion of mineral salts.
• Epiglottitis: Inflammation of the epiglottis.
• Fistula: An abnormal connection between two internal organs or an organ and the body surface.
• Foreign Body: Foreign material in the airway.
• Salivary Duct Obstruction: A condition that prevents saliva passage through the duct.
• Stenosis: Narrowing or contraction of a passage.
• Tumor: New tissue growth where cell proliferation is uncontrolled.

Sialography steps

• The radiopaque medium is injected into the main duct and flows into the trainglandular ductules.
• Enables demonstrations of the surrounding glandular parenchyma, and the duct system.
• Preliminary radiographs are needed to detect conditions without contrast and establish optimum exposure.

Continued sialography steps

• Two to three minutes before sialography, administer a secretory stimulant to open the duct for ready orifice identification and easier cannula/catheter passage.
• Have the patient suck a fresh lemon wedge to stimulate secretions.
• Following examination, have the patient suck another lemon wedge for rapid contrast evacuation.
• Take a radiograph about 10 minutes post-procedure to verify contrast removal, if needed.

Parotid Gland: Tangential Position

• Technical factors include 8x10 length wise.
• Position the patient recumbent or seated.

AP Body Position

• Radiographic images can visually capture orbit, the zygomatic arch, the mandibular ramus and the parotid gland area

PA Body Position

• The position of the patient during this radiographic procedure results in a right cheek distended with air in the mouth
• No abnormal findings have been noted in the region of parotid gland in the image supplied

Respiration for Parotid gland studies

• Parotid gland studies enhance detail, for demonstration of calculi specifically.
• Have the patient fill the mouth with air and puff the cheeks out as much as possible.
• If that cannot be done, suspend respiration during exposure.

Central Ray

• Should be perpendicular to the plane of the film.
• Direct the plane along the lateral surface of the mandibular ramus.

Structures Shown

• Soft tissue density.
• Mastoid process.
• Opacified parotid gland.
• Mandibular ramus

Evaluation Criteria

• Soft tissue density should be visible for proper evaluation.
• Most of the parotid gland should be demonstrated lateral to, and clear of, the mandibular ramus.
• The mastoid should overlap only the upper part of the parotid gland.

Parotid and Submaxillary Glands: Lateral Position

• Utilize 8x10 length wide technical factors.
• Position the patient semi-prone or seated upright.

Part Position

• Extend the patient’s neck so that the space between the cervical area of the spine and the mandibular rami are clear.
• Center the film to a point about 1 inch superior to the mandibular angle.
• Adjust the head so that the midsagittal plane is rotated forward around 15 degrees from the true lateral position.

Submandibular Gland - Patient Preparation & Positioning

• Ensure the film is centered to the lower border of the angle of the mandible.
• Adjust the patient's head to a true lateral position.
• Iglauer recommends depressing the mouth floor, in order to displace the submandibular gland below the mandible.
• If gentle and safe for the patient, use the user’s finger(s) to press down on the back of the patient's tongue on affected side.
• Breathing should be held, pending the exposure

Central Ray & Structures Shown (Submandibular Glands)

• Direct the central ray perpendicular to the film’s center, 1 inch superior to the mandibular angle.
• This provides the visualization of the parotid gland
• To view the submandibular gland, direct the central ray to the inferior margin of the mandibular angle.
• Bony structures and calcific deposits/swellings in the parotid and submandibular areas are demonstrated.

Evaluation Criteria (Submandibular Glands)

• Mandibular rami should be free of overlap with cervical vertebrae for best viewing of the parotid gland in superimposition over the ramus.
• Mandibular rami/mandibular angles must be superimposed unless tube angulation or head rotation is used for the specific submandibular gland study

Submandibular and Sublingual Glands - Intraoral Position (Occlusal)

• Place the side marker on one corner of the film’s exposure surface.
• Place intraoral film packet transversely in the mouth, long-axis oriented with the anterior borders of the mandibular rami.
• Guide the patient to delicately close the mouth, so that the packet is secured in its position for the procedure

Central Ray & Structures Shown (Intraoral Position)

• For intraoral, direct a perpendicular CR, aiming towards the film plane, specifically at the intersection within the sagittal and coronal planes, running via 2nd molars
• Visualization of the floor of the mouth is demonstrated, showcasing the sublingual gland regions, duct as well as the anteromedial region of the submandibular gland locations

Evaluation Criteria (Intraoral Position)

• Soft tissue density of the floor of mouth as criterion to measure and assess the quality of the procedure
• Both the left and right mandible, and the dental/alveolar arches, need to be symmetric in intraoral procedures for effectiveness
• The goal is to showcase all sublingual glands. Along with the film that includes the lower molars, portions of the user’s submandibular glands ought to be visible too

Anterior Part of the Neck

• Examines the anatomical composition of the anterior neck.

Neck Composition

• Occupies area between the skull and the thorax.
• The thyroid consists of two lobes attached at their lower thirds via a narrow median portion called the isthmus.
• Parathyroid area has ovoid bodies, two located on each side (superior and inferior)

Pharynx Function & Sections

• Is 12.5cm long, digestive tube located to the nose, mouth, & larynx. Has 3 parts:
  1. Nasopharynx: Positioned posterior to the bony nasal septum, nasal cavities, and soft palate
  2. Oropharynx: Directly posterior to oral cavity and extends from the inferior of the soft palate to the epiglottis.
  3. Laryngopharynx/hypopharynx: Extends from the height of the epiglottis to the lower border of the larynx

Larynx

• Is the organ of the voice, and also a division of the respiratory system
• It supports the passage of air between the pharynx and the trachea

Deglutition

• Soft palate closes off the nasopharynx during swallowing to prevent substances from regurgitation in the nose.
• The epiglottis is depressed to cover the laryngeal opening. Vocal folds or cords come together to close off the epiglottis.

Palatography

• Bloch and Quantrill investigated suspected tumors of the soft palate by a positive contrast technique.
• In examination, the patient is seated laterally before a vertical grid device with the nasopharynx at the cassette center.
• For the first palatogram, instruct the patient to swallow a bit of creamy barium sulfate suspension.
• The purpose is to then coat inferior locations of the soft palate with a thin layer of contrast material.
• Next, apply the barium suspension directly into each of the nasal cavity's nostrils to examine the remaining structures
• In this second "lateral position", the superior surfaces of the soft palate & the posterior wall of the nasal openings are now visible after opacification through contrast materials (about to 0.5ml of contrast, per nostril)

Palatography Variations

• Morgan described a strategy to uncover anomalies involved in swallowing of children; a chocolate fudge and barium mix!
• Cleft palate studies are taken while patients are still seated but turned sideways, while all actions are centered at areas of the nasal cavity.
• Exposure made during certain sounds to see a range of soft palate and tongue positioning (during phonation). Sounds include “d a h,” "m-m-m", and "s-s-s, and “e-e-e”

Palatography Cont.

• 'Randall P, O' Hara AE, Bakes FP developed: A simple roentgen exam of the soft palate (for those exhibiting a poor speech quality)

• 'O' Hara AE -developed Radiography analysis/assessment of the ones dealing w. a cleft palate,

Pharyngography

• Is radiographic investigative study that utilizes contrasts (like air or barium mixtures)
• In events occurring during swallowing,
  • the nasopharynx needs to shut at the same instant breathing is impeded/obstructed, preventing the escape of food up to the nasal passages during an oral swallow -Laryngeal muscles are contracted towards closing around, and uplifting/raising the voice area by using the epiglotis
  • Peristalsis is crucial in sweeping toward food along different regions from which are pharynx while opening the upperesophageal sphincter in coordination

Ways of studying the pharynx

• Use both contenous quitre breathing technique and vasalva method
• Use paste barium mixture

AP AND LAT Projection

• Positions used to examine the anatomy of the anterior part of the neck

Images of the lateral pharynx and larynx are showcased

• The radiographic results of an image are affected by the subject's phonation

Gunson method

• Consists of tying a dark shoelace to the patient, just above Adam's apple

Synchronizing Deglutition Studies

• Templeton and Kredel suggest satisfactory filling is usually obtained if the exposure is made as soon as anterior movement is noted.

Nasopharyngography

• Consists of a procedure or demo. in regard to the areas of the nasal cavity, through insta-filling of different contrasts.
• Clinical indications include the detection of:
  • carcinoma
  • lymphosarcoma
  • angio-fibroma
• Also useful to see where lesions lie.

Chittinand, Patheja, and Wisenberg-

• Described an opaque-contrasts used for the areas of different nasal openings that means it is a procedure in the nasal cavity regions, where the ones were not made to keep different parts at awkward extension. And instead kept the neck at reasonable location for the entire duration of the test as much possible

Studying the Pharynx

• Two broad strategies include;
  • CM by continous breathing technique and modified vasalva maneuver
  • negative CM introduced or instilled through the nostril

Anatomic & Physiologic Maneuvers

• The Anatomic Maneuver: patient is is supine position but with a head fully extended to make space for nasal region
• The Physiologic Maneuver: keep an eye on telling the patient keep not swallowing along the test.

Premidication in contrast studies

• A drug, Atropine, for example, may be given 30-minutes ahead; suppresses secretions in buccal & nasophayngeal
• You also need material made for this kind of setting...
• Next part requires proper materials include aqueous Dionosil
• Need to assess whether films are appropriate
• And, to look for the regions in the submentovertical positions/locations

Positioning

• To find submento- regions
• In general, . the user will have a supine face Then take in action local medication.
  • Also they might be positioned in angles of about fortyfive degrees to a general axis (that runs across the shoulders
• Aim to remember those locations for most durations

Submentovertical

• Before/following filling in with the contrast-aim to acquire data by use projections, with "CR" to the midway point of the areas for the jaw location, w angles,
• In some, lateral may work, with areas made horizontal across the nasal.
• Once done, ask whoever's in the study to use the nostrils to remove anything, left is swallowed

Laryngography-

• Use Radio evaluation around the vocals though having contrasts filled to those parts. Indications, clinically may suggest the following:
• To demo - paresis Then, to have demonstration at regions along the edema

NOTE: Try to envision any images of the vocals, that are in soft tissue, to asses whether there are any midline structures that are obsured along the cercival regions. These vertebraes can vary across the image and settings.

Contrast studies - Patient prep.

• Don’t allow the ones at patients to take in anything in 5hr window as much as user can prep-with some drug such a atropine, just ahead for examination of parts- so it's about 30 mins, ahead. That suppress fluids the mucus membrane release-that may keep from getting accurate results.. . Or that lead to spasms from vocals.

Can also sedate w. a Omnepon.

• Need prep that contrast "med" for it. Dion osil is also, the best case. May need

10-15ml

Technique

• Larynx and other sections- must have users or patients that spray the materials directly through the usage anaesthetic materials; these lidocaine is 4percent..the lanyngeal materials, the ones to push a bit forward past the throat to cause insoirations. Need earlier films/demo/ for that location!

• Should there be some visualizations, then consider all parts

• If needed (spot film) there may need deep force

• Or at times, the patient.say particular vowels to have those portions be visualized, like ones at "A and E"

Visualization

• Assess the locations of the subject; either using AP/PA to see where airways are located . Then, to see structures are set for it. Make use to see if spine and other airways set.

Lateral, will show the vocals from obstructions along bone. Or airways.

Radiographic features of pharynx and adams apple

• To ensure normal function in swallowing related act, see if: a dark shoelace has been tied snugly aorund the patients neck, above the apples.

Images for that region often demonstrate what function (of parts are affected during procedure)

"TEM and Kredel" suggests that a better option may be take pictures upon any forward shifts

NASO... GRAPH"Y"--

• Radio visualization during those periods requires you inject CM
• Should clinical events show the need/interest, then note - for different carcinoma actions, may see some indication, to get the position for where lesions sit

C & P and W" -

• They had an ability for opaque contrasting actions, to get to nasal cavities, to make sure things are okay
• Or if the neck are in great extension/extension, and not really in comfortable view."

Studying Methods of Areas

• Two methods are used for the study areas . One with, (through, CM along with breathing acts as assessment during the region. One assessment with all "negatively” charged "cms" With patient lying straight, with neck extended, and for the users of them and make those procedures to see for parts... like if you are testing a vocal...then be wary of saying something during process

Use premedications- with one use material (Atropine) half an hour beforehand, to supress and reduce any fluid for buccal region. Then also use Dio aq (the material)

• "Sub/mento- regions are assessed by:
• 45 degree angle to horizontal region"

What comes after esophagus? After the neck region of the human anatomy is assessed?

• You reach what comes next, to reach the "digestive region".

Stomach

• Its a section across intestines that is located across what runs across what the gullet, and areas of what makes the intestines (small)
• It is an section, organ set in the area... That can change with its environment,

Stomach is characteristically:

1. j sectioned.

"Has specific placements across quadrants. Below diaphragm