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Questions and Answers
What is the technique used in a Single Contrast Study of the colon?
What is the technique used in a Single Contrast Study of the colon?
The colon is filled with barium, and a series of x-rays are taken to demonstrate the entire colon.
What is a contraindication for an Intravenous Urography (IVU)?
What is a contraindication for an Intravenous Urography (IVU)?
Water-soluble non-ionic iodinated contrast media is commonly used in Hysterosalpingography (HSG).
Water-soluble non-ionic iodinated contrast media is commonly used in Hysterosalpingography (HSG).
True
Patient preparation for HSG should include avoiding sexual intercourse from the onset of her period to the day of the exam and also rule out ________.
Patient preparation for HSG should include avoiding sexual intercourse from the onset of her period to the day of the exam and also rule out ________.
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What is the radiological study that employs a contrast agent to determine pathologies of the oesophagus?
What is the radiological study that employs a contrast agent to determine pathologies of the oesophagus?
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What are the indications for a barium swallow? (Select all that apply)
What are the indications for a barium swallow? (Select all that apply)
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Complete obstruction is a contraindication for a barium swallow. (True/False)
Complete obstruction is a contraindication for a barium swallow. (True/False)
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To avoid barium peritonitis, if there is suspicion of a fistula in the abdomen, _______ contrast agent should be used instead of barium.
To avoid barium peritonitis, if there is suspicion of a fistula in the abdomen, _______ contrast agent should be used instead of barium.
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Match the following barium swallow positions with their demonstrations:
Match the following barium swallow positions with their demonstrations:
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What are alternative terms for the studies mentioned in the content?
What are alternative terms for the studies mentioned in the content?
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What is the goal of cystography and/or urethrography?
What is the goal of cystography and/or urethrography?
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Indications for cystography include evaluation of recurrent urinary tract infections, vesicoureteral reflux, bladder contour, bladder diverticula, suspected rupture, fistulae, integrity of postoperative anastomoses, bladder outlet obstruction, incontinence, hematuria, and __________.
Indications for cystography include evaluation of recurrent urinary tract infections, vesicoureteral reflux, bladder contour, bladder diverticula, suspected rupture, fistulae, integrity of postoperative anastomoses, bladder outlet obstruction, incontinence, hematuria, and __________.
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Fluoroscopy can optimize diagnostic yield, especially during voiding studies. True or False?
Fluoroscopy can optimize diagnostic yield, especially during voiding studies. True or False?
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Match the indications with the corresponding study:
- Recurrent urinary tract infections
- Vesicoureteral reflux
- Bladder diverticula
- Suspected rupture
- Fistulae
- Incontinence
- Hematuria
- Neoplasia
Match the indications with the corresponding study:
- Recurrent urinary tract infections
- Vesicoureteral reflux
- Bladder diverticula
- Suspected rupture
- Fistulae
- Incontinence
- Hematuria
- Neoplasia
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Study Notes
Fluoroscopic Procedures
Barium Swallow
- A barium swallow is a radiological study that employs a contrast agent to determine pathologies of the esophagus.
- Also referred to as esophagram in the USA.
- Uses barium sulphate, Gastrografin, or Ominipaque (Iohexol).
- Indications:
- Odynophagia (painful swallowing)
- Dysphagia (difficulty with swallowing)
- Narrowing or irritation of the esophagus
- Hiatal hernia
- Gastroesophageal reflux disease (GERD) or GORD
- Anemia
- Blood-stained vomitus
- Assessment of tracheo-esophageal fistula
- Unexplained weight loss
- Contraindications:
- Complete obstruction
- Perforation (especially after recent surgery)
- Recent gastric or esophageal surgery
- Complications:
- Leakage of barium from an unsuspected perforation
- Allergic reaction or anaphylaxis
- Constipation
- Aspiration of barium
- Major complications:
- Barium peritonitis (leakage of barium from an unsuspected perforation)
Barium Meal
- A diagnostic test used to detect abnormalities of the stomach and duodenum.
- Methods:
- Double contrast: demonstrates mucosal pattern and abnormality
- Single contrast: used for children or very ill adults
- Indications:
- Unexplained weight loss
- Abdominal mass
- Gastrointestinal hemorrhage
- Unexplained iron-deficiency anemia
- Partial duodenal obstruction
- Assessment of site of perforation
- Gastrointestinal reflux
- Contraindications:
- Large bowel obstruction
- Immediate or impending gastric/abdominal surgery
- Anatomy:
- Stomach
- Duodenum
- Preparation:
- Check patient identification
- Check for pregnancy
- Patient must be fasted for 6-8 hours
- Medical history should be taken
- Appropriate laboratory results and other examinations must be reviewed prior to the examination
- The procedure should be explained to the patient prior to the examination
- The patient must sign a consent form for the examination
Barium Follow Through
- Demonstrates the small bowel from the duodenum to the ileocecal region.
- Indications:
- Partial obstruction
- Abdominal masses
- Failed small bowel enema
- Ulcer
- Post-operative ileus (use of gastrografin)
- Crohn’s disease
- Suspected small bowel neoplasm
- Suspected small bowel obstruction that has been managed conservatively
- Technique:
- Aim is to deliver a single column of barium into the small bowel
- If performed in conjunction with a barium meal, continues after the meal procedure
- Prone abdomen taken every 20 minutes during the first hour of patient drinking solution
- Subsequent radiographs taken at 30 minutes until the colon is reached
Barium Enema
- Indications:
- Ulcerative colitis
- Crohn’s disease
- Infection or inflammation
- Obstructions and polyps
- Cancer
- Unusual bloating or lower abdominal pain
- Changes in bowel movements
- Contraindications:
- Suspected bowel perforation
- Severe ulcerative colitis
- Pregnancy
- Toxic megacolon
- Acute abdominal pain
- Preparation:
- Patient must be on a light diet prior to the exam
- Castor oil or Mist Sennco in the evening after the last meal
- Anatomy:
- Large intestine
- Technique:
- Single Contrast Study
- Double Contrast Study
Intravenous Urography (IVU)
- A radiological procedure used to visualize abnormalities of the urinary system.
- Indications:
- Repeated infections
- Renal colic
- Flank pain
- Trauma
- Retention and decreased urinary output
- Kidney stones
- Renal cell carcinoma
- Polycystic kidneys
- Contraindications:
- General contraindications to contrast agent
- Hepato renal syndrome
- Pregnancy
- Blood urea raised above a certain defined or normal level
- Anuria, or absence of urine excretion
- Diabetes, especially diabetes mellitus
- Severe hepatic or renal disease
- Patients taking certain medications
- Patient preparation:
- Abdominal preparation
- Projections:
- Control
- Immediate
- 5 minutes
- 10 minutes/15 minutes
- 20 minutes
- Post-void
Hysterosalpingography (HSG)
- A radiographic examination of the female reproductive system.
- Indications:
- Female infertility
- Recurrent spontaneous abortions
- Congenital uterine anomalies
- Post-operative evaluation of tubal ligation
- Investigation of uterine pathologies
- Contraindications:
- Pregnancy
- Acute pelvic inflammatory or infectious conditions
- Active vaginal bleeding
- Recent cervical dilation and curettage
- Recent tubal or uterine surgery
- Sensitivity to contrast
- Contrast media:
- Water-soluble non-ionic iodinated contrast media (Omipaque, Iohexol, Iopamiro, Ultravist)
- Oil-based contrast (Lipidol)
- Equipment and accessories:
- Speculum
- Cannula
- Tenaculum
- Uterine sound
- Patient preparation:
- The procedure is done during the proliferative phase of the menstrual cycle
- The patient must be advised to avoid sexual intercourse from the onset of her period to the day of the exam
- β-HCG test (Beta human chorionic gonadotropin tests) should be carried out.### Patient Preparation for HSG
- 40mg of Buscopan is given to the patient an hour prior to the exam to reduce pain from cramps
- Mild analgesics and prophylactic antibiotics may be given to prevent pain and potential infections
- The patient may be asked to empty their bladder to prevent displacement of the uterus and uterine tubes
Procedure for HSG
- Informed consent is obtained before the procedure starts
- The patient is placed in lithotomy position with legs bent at the knee or supported with stirrups
- The patient is draped with sterile towels and the perineum is cleaned with antiseptic solution
- A vaginal speculum is inserted and the cervix is localized and cleaned with antiseptic solution
- The cervix is cannulated, and dilation with a balloon catheter helps to occlude the cervix
- A tenaculum may be necessary to aid in insertion and fixation of the cannula or catheter
- The patient is placed in a slight Trendelenburg position to facilitate the flow of contrast media into the uterine cavity
Injecting Contrast Media
- A syringe filled with contrast media is attached to the cannula or balloon catheter
- Using fluoroscopy, the radiologist/radiographer slowly injects contrast media into the uterine cavity
- If the uterine tubes are patent, contrast media flows from the distal ends of the tubes into the peritoneal cavity
- About 10-20ml of contrast is used to fill the uterine cavity
Film Series
- An initial collimated scout image is taken with the patient in lithotomy position
- A series of collimated images may be obtained during injection of contrast media
- 4 spot films may be taken, including:
- Early filling phase
- Fully distended uterus
- Tubal filling phase
- Peritoneal spillage
Complications of HSG
- Pain from uterus dilation and peritoneal spillage
- Infection
- Bleeding
- Vascular intravasation
- Uterine perforation
- Contrast reactions
After Care for HSG
- Antibiotics may be given to fight or prevent infection
- Pain medicine may be needed to alleviate pain
- Vaginal care includes using vaginal pads for 1-2 days, washing with soap and water, and changing pads as needed
Cystography and Urethrography
- Cystography and urethrography involve imaging the bladder and/or urethra before, during, and after administration of contrast via urethral or cystostomy catheter
- The goal is to detect anatomic and/or functional abnormalities of the lower urinary tract
Indications for Cystography and Urethrography
- Cystography:
- Recurrent urinary tract infections
- Vesicoureteral reflux
- Bladder contour
- Bladder diverticula
- Suspected rupture
- Fistulae
- Integrity of postoperative anastomoses or suture lines
- Bladder outlet obstruction
- Incontinence
- Hematuria
- Neoplasia
- Urethrography:
- Urethral diverticula
- Urethral strictures
- Bladder outlet or urethral obstruction
- Trauma
- Recurrent urinary tract infection
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Description
This quiz covers various fluoroscopic procedures and techniques including barium studies, intravenous urogram, hysterosalpinography, and retrograde urethrogram. It is designed for radiology students and professionals.
