Sialography Techniques in Radiology

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Questions and Answers

What position should the patient be in for an effective sialography of the parotid gland?

Recumbent with feet elevated

Supine with head tilted backward

Standing with arms raised

Sitting upright with neck extended (correct)

How can better detail be obtained when studying the parotid gland during sialography?

By manipulating the patient's jaw

By having the patient puff out their cheeks (correct)

By using a lower dose of contrast material

By having the patient hold their breath

What is the primary purpose of contrast media in diagnostic imaging?

To measure physiological parameters

To enhance subject contrast in anatomical areas (correct)

To reduce exposure to radiation

To provide therapeutic support during surgery

What angle should the patient's median sagittal plane (MSP) be set to during the lateral projection of the parotid gland?

15 degrees to the image receptor Signup and view all the answers

Which of the following is a characteristic of radiopaque contrast media?

Appears white on radiographs Signup and view all the answers

Which image projection is most effective for visualizing the sublingual gland unobstructed?

Axial projection Signup and view all the answers

What is the primary purpose of performing palatography?

To investigate suspected tumors of the soft palate Signup and view all the answers

Which physical state of contrast media is used for gallbladder studies?

Tablets Signup and view all the answers

During sialography for parotid gland, what happens if the patient holds their breath during exposure?

It enhances the image quality for calculi visibility Signup and view all the answers

What is a key feature of iodine-based contrast media?

Examination of a wide variety of organs and systems Signup and view all the answers

What anatomical structures are well visualized during a lateral projection of the parotid and submandibular glands?

Bony structures and calcific deposits Signup and view all the answers

Which type of contrast media would be classified as negative contrast?

Air Signup and view all the answers

What is the effect of increasing the atomic number of contrast media?

Enhances the contrast in radiographs Signup and view all the answers

What is the CR (central ray) orientation for the submandibular gland during the lateral projection?

Perpendicular to 1 inch superior to the mandibular angle Signup and view all the answers

What is the role of barium sulfate in radiography?

For visualization of the gastrointestinal tract Signup and view all the answers

Which statement is true about oil-based contrast media?

They are suitable for myelogram studies Signup and view all the answers

What is the primary purpose of the Compression Paddle Technique in medical imaging?

To provide pressure to the stomach region Signup and view all the answers

In the RAO position for an esophagogram, what is the appropriate angle of the MSP to the IR?

35 to 40 degrees Signup and view all the answers

Which imaging technique is performed to study possible regurgitation into the esophagus?

Toe-touch maneuver Signup and view all the answers

What must occur in a patient’s stomach prior to an upper gastrointestinal examination?

The stomach must be empty Signup and view all the answers

Why is it desirable for the colon to be free of gas and fecal material before an upper gastrointestinal examination?

To prevent interference with imaging of the stomach Signup and view all the answers

In the lateral position for an esophagogram, what should the CR be perpendicular to?

T5-T6 Signup and view all the answers

What is the recommended diet preparation for preventing gas formation before an upper gastrointestinal study?

A soft, low-residue diet Signup and view all the answers

During an upper gastrointestinal study, how are food and fluid withheld from the patient?

From the evening meal until the exam Signup and view all the answers

What is the purpose of administering a fatty meal following the visualization of the gallbladder (GB)?

To cause contraction of the gallbladder Signup and view all the answers

In which position is the patient placed during the oral cholecystogram to facilitate the best drainage of the gallbladder?

Right posterior oblique (RPO) position Signup and view all the answers

Which technique is recommended for enhanced visualization of the biliary ducts prior to the examination?

Utilizing Biloptin capsules taken multiple times Signup and view all the answers

What is the primary reason for utilizing the PA projection in oral cholecystography?

To determine the presence and location of opacified gallbladder Signup and view all the answers

Which contrast medium is absorbed rapidly allowing visualization of the biliary ducts within 1.5 hours?

Ipodate calcium Signup and view all the answers

What positioning angle is required for asthenic patients during the LAO position to optimize visualization?

40° Signup and view all the answers

Why is the right lateral position used during the oral cholecystogram?

To differentiate gallstones from renal stones or calcified lymph nodes Signup and view all the answers

What is the recommended kVp range to be used during the oral cholecystogram?

70-80 kVp Signup and view all the answers

What is the typical change in position of the kidneys when a person moves from supine to upright?

They drop 2 inches Signup and view all the answers

What is the standard amount of urine in the bladder that initiates the desire for micturition?

250 ml Signup and view all the answers

Which of the following is NOT a common side effect following an IV injection of iodinated contrast media?

Severe headache Signup and view all the answers

What should be confirmed before withdrawing contrast media from the vial?

Expiration date Signup and view all the answers

When should glucophage (metformin) be withheld in relation to iodinated contrast media administration?

48 hours before and after Signup and view all the answers

What is the purpose of ureteral compression during an intravenous urography procedure?

To enhance filling of the pelvocalyceal system Signup and view all the answers

What is the normal range for BUN (Blood Urea Nitrogen) indicating kidney function?

8-25 mg/100 ml Signup and view all the answers

Within what time frame do most reactions to contrast media occur after administration?

Within the first 5 minutes Signup and view all the answers

What imaging technique is performed to assess the range of movement of the soft palate?

Nasopharyngography Signup and view all the answers

Which method is used to synchronize exposure during deglutition studies?

Gunson method Signup and view all the answers

What is the purpose of using a thick, creamy mixture of barium sulfate in pharyngography?

To provide contrast for swallowing actions Signup and view all the answers

What type of contrast media is suggested for demonstrating nasopharyngeal tumors?

Finely ground barium sulfate Signup and view all the answers

During nasopharyngography, what position should the central ray (CR) be directed to achieve optimal imaging?

15°-20° cephalad to nasopharynx Signup and view all the answers

Which maneuver is performed to fill the nasopharynx with air prior to imaging?

Deep breath through the nose Signup and view all the answers

What characteristic does the Valsalva maneuver provide during pharyngeal imaging?

All of the above Signup and view all the answers

Which projection is recommended for visualizing the nasopharynx with negative contrast?

Upright lateral projection Signup and view all the answers

What is the primary function of the Compression Paddle Technique during imaging?

To provide pressure to the stomach region Signup and view all the answers

Which projection demonstrates the entire contrast-filled esophagus free from superimposition of the heart and vertebra?

RAO position Signup and view all the answers

In the lateral position for an esophagogram, how should the exposure be made?

During a rapid and continuous swallow Signup and view all the answers

What adjustment is made to ensure an upper gastrointestinal examination can be performed?

Ensure the stomach is free from food and gastric juice Signup and view all the answers

What is the reason for ensuring the colon is free of gas and fecal material before an upper gastrointestinal examination?

It prevents image artifacts and ensures clear visualization Signup and view all the answers

What is the recommended patient preparation for an upper gastrointestinal examination?

Soft, low-residue diet for two days Signup and view all the answers

What angle should the central ray (CR) be directed perpendicular to in the lateral projection of an esophagogram?

T5-T6 Signup and view all the answers

How long prior to an upper gastrointestinal examination should a patient refrain from food and fluid intake?

8 to 9 hours Signup and view all the answers

Which method is best used to demonstrate the axial projection of the rectum and sigmoid?

Barium Enema Axial Projection Chassard-Lapine Method Signup and view all the answers

What angle should the central ray (CR) be set to during the Billing's method of barium enema?

30-35 degrees Signup and view all the answers

What is the primary function of a colostomy?

To form an artificial passage for feces Signup and view all the answers

Which of the following is a purpose of defecography?

To assess defecation dysfunction Signup and view all the answers

When performing a barium enema in the ventral decubitus position, what part of the colon is primarily demonstrated?

The ascending colon Signup and view all the answers

What is the standard capacity of an adult bladder when completely full?

500 ml Signup and view all the answers

Which of the following procedures uses 100% weight/volume barium sulfate paste during evaluation?

Defecography Signup and view all the answers

In the Oppenheimers method for barium enema, what is the CR direction and angle?

12 degrees caudad Signup and view all the answers

What is the primary objective of the modified Valsalva maneuver?

To assess the elasticity of the laryngeal structures Signup and view all the answers

What sound should a patient produce during the expiratory phonation test?

A high pitched 'eee' Signup and view all the answers

Which anatomical feature is tested during the modified Valsalva maneuver?

The hypopharynx and piriform recesses Signup and view all the answers

What is the method used in tomolaryngography?

It employs a rapid- travel linear sweep during exposure. Signup and view all the answers

In the modified Valsalva maneuver, which position should the patient adopt?

Nostril pinched and mouth closed Signup and view all the answers

Which function does Valsalva's maneuver NOT demonstrate?

Open vocal cords Signup and view all the answers

What is the first step in performing the inspiratory phonation?

Completely exhale and then inhale Signup and view all the answers

What does laryngopharyngography primarily assess?

Anatomical structures of the laryngopharynx Signup and view all the answers

What is the primary advantage of using the right lateral decubitus position in an oral cholecystogram?

It positions the gallbladder away from adjacent gas-containing loops of the intestine. Signup and view all the answers

Which projection in an oral cholecystogram is specifically designed to show small stones that cast no individual shadows?

PA upright projection Signup and view all the answers

In intravenous cholangiography, which position is recommended for an AP oblique projection of the biliary ducts?

RPO position (15 to 40 degrees) Signup and view all the answers

What is the purpose of performing an oral cholecystogram using the PA upright projection?

To assess gallbladder mobility and detect small stones. Signup and view all the answers

How does the positioning of the gallbladder vary in the right lateral decubitus compared to the upright position?

It gravitates toward the dependent right side in the decubitus position. Signup and view all the answers

Which type of patients may benefit from intravenous cholangiography due to their inability to retain oral contrast?

Patients experiencing vomiting or diarrhea. Signup and view all the answers

What does the identification of 'stratification or layering of gallstones' indicate in an oral cholecystogram?

The presence of various sizes of gallstones. Signup and view all the answers

What is the primary goal of using the right lateral decubitus position during an oral cholecystogram?

To ensure that heavy stones accumulate in a detectable area. Signup and view all the answers

What is the purpose of performing endoscopic retrograde cholangiopancreatography (ERCP)?

To indicate abnormalities in the biliary system or pancreas Signup and view all the answers

Which statement accurately describes thick barium?

It is well-suited for coating the mucosal lining of the esophagus. Signup and view all the answers

What is a potential use for double contrast techniques in radiology?

To enhance the diagnosis of specific upper GI diseases Signup and view all the answers

What type of contrast media would be classified as negative contrast?

Gas crystals and swallowed air Signup and view all the answers

Which method may be used to introduce a soluble-iodinated CM into the main pancreatic duct?

Direct injection through the transduodenal catheterization Signup and view all the answers

What is the main purpose of performing operative pancreatography?

To rule out abnormalities of the pancreas Signup and view all the answers

What is the expected outcome of placing a patient in the Trendelenburg position during ERCP?

It enhances the filling of intrahepatic ducts with contrast media. Signup and view all the answers

What does double contrast imaging specifically help identify in the upper gastrointestinal tract?

Tumors, polyps, and diverticula Signup and view all the answers

What is the primary purpose of hypotonic duodenography?

To evaluate post bulbar duodenal lesions Signup and view all the answers

Which of the following is NOT a contraindication for performing a small intestinal series?

Malabsorption syndrome Signup and view all the answers

How is barium administered for the electrolysis technique in small bowel studies?

By direct injection through an intestinal tube Signup and view all the answers

What dietary preparation is required before undergoing a small intestinal series?

Low-residue diet for 2 days Signup and view all the answers

What is indicated by performing an enteroclysis double CM small bowel procedure?

Bowel ileus Signup and view all the answers

What is the primary characteristic of achalasia?

Reduced peristalsis in the distal esophagus Signup and view all the answers

What is the interval for obtaining radiographs in a small bowel only series after ingestion of barium?

Every 30 minutes for 2 hours Signup and view all the answers

Which imaging technique is preferred for demonstrating esophageal reflux?

Video fluoroscopy Signup and view all the answers

Which technique requires temporary drug-induced duodenal paralysis?

Hypotonic duodenography Signup and view all the answers

What abnormality is specifically associated with Barrett's esophagus?

Replacement of normal epithelium with columnar-lined epithelium Signup and view all the answers

In a UGI-small bowel combination study, when is the first PA projection of the proximal small bowel performed?

30 minutes after initial barium intake Signup and view all the answers

Which symptom is most commonly associated with esophageal varices?

Hematemesis Signup and view all the answers

What is a significant test indicating the presence of esophageal reflux?

Swallowing a mouthful of water through a straw Signup and view all the answers

Which of the following is a common cause of esophageal reflux?

Excessive intake of aspirin and caffeine Signup and view all the answers

Which imaging modality is preferred to detect esophageal carcinoma?

Esophagogram and endoscopy Signup and view all the answers

Which condition involves a large out-pouching of the esophagus above the esophageal sphincter?

Zenker’s diverticulum Signup and view all the answers

What is the purpose of administering a fatty meal after the satisfactory visualization of the gallbladder?

To cause contraction of the gallbladder for functional assessment. Signup and view all the answers

In which position should the patient be placed for optimal drainage of the gallbladder during the oral cholecystogram?

Right lateral position Signup and view all the answers

What is the recommended kVp setting for an oral cholecystogram?

70-80 kVp Signup and view all the answers

Which contrast media is absorbed rapidly to visualize the biliary ducts within 1.5 hours?

Ipodate calcium Signup and view all the answers

What angle of patient rotation is recommended for asthenic patients during the LAO position?

40° Signup and view all the answers

What is the primary goal of the PA projection in oral cholecystography?

To determine the presence of opacified gallbladder. Signup and view all the answers

How often are radiographs obtained after the fatty meal during the oral cholecystogram?

Every 15 minutes Signup and view all the answers

What does the right lateral position best demonstrate during an oral cholecystogram?

Opacified gallbladder away from the vertebral column Signup and view all the answers

What is the primary reason for performing ureteral compression during intravenous urography?

To enhance the visualization of the renal pelves and calyces. Signup and view all the answers

Which of the following conditions would contraindicate the use of ureteral compression?

Nephrolithiasis (urinary stones). Signup and view all the answers

During intravenous urography, at what time is the nephrogram typically taken after the administration of contrast media?

1 minute. Signup and view all the answers

What position is generally preferred for the full KUB (Kidneys, Ureters, Bladder) imaging during a 5-minute interval?

Supine. Signup and view all the answers

What is the central ray (CR) orientation for the AP projection nephrogram taken 60 minutes after injection?

Midway between the xiphoid tip and iliac crests. Signup and view all the answers

In nephrotomography, what is the primary purpose of the examination?

To rule out renal hypertension. Signup and view all the answers

What does the erect post-void imaging best demonstrate in relation to kidney positioning?

Nephroptosis (positional change of kidneys). Signup and view all the answers

What is the unique aspect of retrograde urography in relation to contrast media administration?

Contrast media is introduced directly into the pelvicalyceal system against the flow. Signup and view all the answers

What is the main purpose of restricting smoking and chewing gum before an examination?

To avoid excessive fluid accumulation in the stomach Signup and view all the answers

What characterizes a biphasic examination?

It combines single-contrast and double-contrast methods on the same day Signup and view all the answers

Which of the following statements about the barium meal is true?

Barium meal typically reaches the rectum within 24 hours Signup and view all the answers

What is one key advantage of the double-contrast method over the single-contrast method?

It allows for better visualization of small lesions Signup and view all the answers

During the single-contrast examination, what is one of the radiologist's actions after asking the patient to swallow the barium?

Manipulating the stomach through the abdominal wall Signup and view all the answers

What is the focus of fluoroscopy during the upper gastrointestinal examination?

Studying the abdominal organs and their movements Signup and view all the answers

What does the term 'rugae' refer to in the context of gastrointestinal imaging?

Folds within the stomach lining Signup and view all the answers

Which technique is applied to improve the examination of the duodenal bulb during fluoroscopy?

Observing the filling and emptying process of the duodenal bulb Signup and view all the answers

What is the purpose of instructing the patient to roll over a few times after administering a gas-producing substance during the examination?

To coat the mucosal lining of the stomach. Signup and view all the answers

Which body habitus describes a stomach that is high and transverse, with the pyloric portion at the level of T11-T12?

Hypersthenic Signup and view all the answers

What advantage does the biphasic gastrointestinal examination offer?

It improves the accuracy of diagnosis without significantly increasing cost. Signup and view all the answers

Why might a patient be given glucagon or other anticholinergic medications before an examination?

To relax the gastrointestinal tract for better visualization. Signup and view all the answers

What is the recommended position to place a patient in for initially administering barium during an upper gastrointestinal examination?

Upright position Signup and view all the answers

What characteristic of barium suspensions is important for effective coating of the stomach walls?

Low viscosity and ability to flow freely Signup and view all the answers

In which body position does the air-barium distribution change, especially in relation to the fundus of the stomach?

Supine position: barium fills the fundus Signup and view all the answers

What is the typical contrast preparation for a double contrast examination?

250% weight/volume barium suspension Signup and view all the answers

What is the main purpose of performing ureteral compression during an intravenous urography procedure?

To ensure adequate filling of the renal pelves and calyces Signup and view all the answers

Which position is preferred for the 5-minute full KUB during intravenous urography?

Supine position Signup and view all the answers

What is typically contraindicated when considering ureteric compression?

Presence of urinary stones Signup and view all the answers

In nephrotomography, what is primarily ruled out during the examination?

Renal hypertension Signup and view all the answers

Which projection is best suited to demonstrate nephroptosis during intravenous urography?

Erect post void Signup and view all the answers

What is the purpose of retrograde urography?

To evaluate urinary system non-functionality Signup and view all the answers

Which position involves a 30-degree body rotation during intravenous urography?

RPO and LPO positions Signup and view all the answers

Where should the central ray (CR) be directed for an AP projection nephrogram?

Midway between the xiphoid tip and iliac crests Signup and view all the answers

What is the primary purpose of performing a retrograde urogram?

To evaluate the collecting system in specific patients Signup and view all the answers

Which solution is used for retrograde urogram procedures?

Sodium iodide and sodium bromide Signup and view all the answers

What is a recommended instruction for patients prior to urethrogram procedures?

Inhale deeply and suspend respiration at full expiration Signup and view all the answers

What position adjustment is recommended during a pyelogram to prevent contrast medium from escaping into the ureter?

Lower the head of the table 10-15 degrees Signup and view all the answers

Why is it important for the patient to drink a large amount of water before a retrograde urogram?

To ensure sufficient urine excretion for testing Signup and view all the answers

What imaging technique is employed to demonstrate a perinephritic abscess?

Lateral projection Signup and view all the answers

What might be indicated if a retrograde urogram is performed on a patient with renal insufficiency?

Evaluation of collecting system abnormalities Signup and view all the answers

What tool is used to catheterize the ureter for retrograde urograms?

Cystoscope Signup and view all the answers

What is the primary objective of performing hysterosalpingography?

To demonstrate the patency of the oviduct Signup and view all the answers

At what point in the menstrual cycle should a hysterosalpingography be scheduled?

About 10 days after the start of menstruation Signup and view all the answers

Which imaging technique is specifically used to identify congenital malformations and fistulas in the pelvic area?

Vaginography Signup and view all the answers

What is the purpose of placentography?

To investigate the placenta in cases of previa Signup and view all the answers

What does cerebral angiography primarily assess?

The blood vessels of the brain Signup and view all the answers

Which method is utilized to measure the pelvic dimensions during pelvimetry?

Colcher-Sussman method Signup and view all the answers

What is the recommended arrangement when conducting myelography?

Introduction of contrast media at level of L3 - L4 Signup and view all the answers

Which imaging technique avoids use until after the eighteenth week of gestation due to risks?

Fetography Signup and view all the answers

What type of contrast media is characterized by its ability to appear white on radiographs?

Positive contrast media Signup and view all the answers

Which of the following types of contrast media is considered radiolucent?

Air Signup and view all the answers

What determines the effectiveness of contrast media in enhancing subject contrast?

The concentration of atoms Signup and view all the answers

Which physical state of contrast media is NOT appropriately used for gall bladder studies?

Gas Signup and view all the answers

What is barium sulfate typically used for in radiographic procedures?

Examination of the esophagus Signup and view all the answers

Which of the following statements about iodinated contrast media is true?

It can be used for various organ examinations including the kidneys and heart. Signup and view all the answers

Which of the following is NOT a physical state of contrast media?

Gel Signup and view all the answers

Which contrast medium is known for being used in myelogram and bronchogram studies?

Pantopaque Signup and view all the answers

What is the purpose of the Toe-touch maneuver during an esophagogram?

To visualize the cardiac orifice and observe possible regurgitation Signup and view all the answers

In the RAO position for an esophagogram, what is the correct orientation of the central ray?

Perpendicular to the T5-T6 intervertebral space Signup and view all the answers

What is required of the stomach prior to conducting an upper gastrointestinal examination?

It must be empty by withholding food and water for 8 to 9 hours Signup and view all the answers

During the lateral position for an esophagogram, when should exposure be made for optimal visualization?

While the patient drinks contrast media through a straw in rapid succession Signup and view all the answers

What is the purpose of administering a fatty meal during an oral cholecystogram?

To cause the gallbladder to contract and provide functional information. Signup and view all the answers

In the LAO position for an oral cholecystogram, what is the recommended degree of patient rotation for hypersthenic patients?

15° Signup and view all the answers

What dietary preparation is recommended before an upper gastrointestinal study to minimize gas formation?

Soft, low-residue diet for 2 days Signup and view all the answers

Which technique is recommended for optimal visualization of the biliary ducts before the oral cholecystogram examination?

Taking Biloptin capsules before the examination. Signup and view all the answers

Which projection is designed to demonstrate the entire contrast-filled esophagus without superimposition?

RAO position Signup and view all the answers

What is the primary reason for using the right lateral position in an oral cholecystogram?

To differentiate gallstones from renal stones. Signup and view all the answers

What is the recommended patient position for demonstrating the upper esophagus during a Swimmer’s lateral technique?

Lateral position with arms outstretched Signup and view all the answers

What is the appropriate kVp range for an oral cholecystogram?

70-80 kVp Signup and view all the answers

Why is it crucial for the colon to be free of gas and fecal material before an upper gastrointestinal examination?

To facilitate clearer imaging and avoid obscuring structures Signup and view all the answers

When should a follow-up dose of contrast medium be given if the gallbladder is not visualized initially?

After 10-12 hours. Signup and view all the answers

Which projection in an oral cholecystogram is designed to demonstrate the opacified gallbladder away from the vertebral column?

Right Lateral Position Signup and view all the answers

How long does it take for ipodate calcium to allow visualization of the gallbladder post-administration?

3-4 hours Signup and view all the answers

What is the primary requirement for a contrast medium concerning safety?

It must be non-toxic and safe where administered. Signup and view all the answers

Why is barium sulfate mixed with cold tap water during administration?

To reduce irritation and aid in retention during the examination. Signup and view all the answers

What is a characteristic property of barium sulfate?

It cannot be absorbed by the gastrointestinal tract. Signup and view all the answers

What type of barium sulfate does not contain flavoring and additives?

Plain BaSO4 Signup and view all the answers

Which of the following properties affects the dilution rate of a contrast medium in blood?

Viscosity Signup and view all the answers

What kind of contrast agents do ionic contrast media contain?

Negatively charged salts that ionize in solution. Signup and view all the answers

What is the recommended water temperature for mixing barium sulfate for patient comfort?

Room temperature water (85°-90° F) Signup and view all the answers

What adverse reactions to contrast media have been associated with?

Osmolality levels. Signup and view all the answers

What body position best demonstrates the left colic flexure and the descending colon during a barium enema?

RPO Position Signup and view all the answers

In the AP Axial Oblique Projection for a barium enema, how should the central ray (CR) be oriented?

30°-40° cephalad to 2 inches inferior and 2 inches medial to right ASIS Signup and view all the answers

What is the primary purpose of the Trendelenburg position during a barium enema?

Separate redundant and overlapping loops of the bowel Signup and view all the answers

Which projection best demonstrates an elongated view of the rectosigmoid area during a barium enema?

PA Axial Projection Signup and view all the answers

For the Right Lateral Decubitus position during a barium enema, where should the central ray (CR) be directed?

To the level of the iliac crests Signup and view all the answers

What aspect of the colon is best visualized in the LPO position during a barium enema?

Right colic flexure Signup and view all the answers

What is the significance of using the Left Lateral Decubitus position during a barium enema?

To demonstrate air-filled loops of the bowel Signup and view all the answers

During a barium enema, what is the primary feature of the AP Projection?

Air-filled transverse colon Signup and view all the answers

What type of contrast media appears white on a radiograph?

Radiopaque media Signup and view all the answers

What are the primary components that affect the ability of contrast media to enhance subject contrast?

Atomic number and atom concentration Signup and view all the answers

In which physical state is barium sulfate commonly used for gastrointestinal studies?

Powder Signup and view all the answers

Which of the following is true regarding iodinated contrast media?

It can visualize organs like the kidneys and brain. Signup and view all the answers

Which of the following contrast media would be used for a bronchogram study?

Pantopaque Signup and view all the answers

How do radiolucent contrast media appear on a radiograph?

Black and decreased density Signup and view all the answers

What type of studies are iodinated contrast media primarily used for?

Cardiovascular and gastrointestinal examinations Signup and view all the answers

Which effect does the atomic number of a contrast medium have on imaging?

It determines the opacity and contrast on radiographs. Signup and view all the answers

What is Cholecystitis primarily characterized by?

Acute or chronic inflammation of the gallbladder Signup and view all the answers

Which stone type appears as negative filling defects in imaging?

Cholesterol stones Signup and view all the answers

What is a common complication associated with cholelithiasis?

Cholecystitis Signup and view all the answers

Which imaging modalities are most effective in demonstrating neoplasms of the gallbladder?

CT and ultrasound Signup and view all the answers

What preliminary dietary restriction is recommended before an oral cholecystogram?

Avoiding all food after a light meal Signup and view all the answers

What is choledocholithiasis?

Gallstones in the common bile duct Signup and view all the answers

Which of the following is a contraindication for an oral cholecystogram?

Hypersensitivity to iodinated contrast media Signup and view all the answers

What could result from biliary stenosis?

Acute cholecystitis and jaundice Signup and view all the answers

What is a critical requirement for a contrast medium used in vascular applications?

It must have a suitable viscosity. Signup and view all the answers

Why is barium sulfate generally mixed with cold tap water during administration?

It reduces irritation to the colon. Signup and view all the answers

Which property of barium sulfate is primarily responsible for its use in imaging the gastrointestinal system?

Its ability to absorb water. Signup and view all the answers

What type of contrast medium is characterized by ionizing in solution and causing discomfort to patients?

Ionic CM. Signup and view all the answers

What factor is related to the adverse reactions to contrast media?

Osmolality of the solution. Signup and view all the answers

Which of the following is NOT a property of barium sulfate?

It can be absorbed by the GIT. Signup and view all the answers

What effect does cold barium suspension have when used in enemas?

Stimulates tonic contraction of the anal sphincter Signup and view all the answers

What are stabilizing agents such as sodium carbonate used for in barium sulfate preparations?

To prevent flocculation during administration. Signup and view all the answers

What is the purpose of the Gordon Method in imaging the stomach?

To demonstrate an open high transverse stomach for hypersthenic patients Signup and view all the answers

What is the recommended CR angle for the Guglianini method when imaging an infant's stomach?

20 to 25 degrees cephalad Signup and view all the answers

In the RAO position, what is the primary demonstration achieved?

Polyps and ulcers of the pylorus without superimposition Signup and view all the answers

What is a key feature of the right lateral position in gastrointestinal imaging?

Best view of the pyloric canal and duodenal bulb Signup and view all the answers

What is the purpose of using a 30 to 60 degrees rotation in the LPO position?

To demonstrate the fundic portion of the stomach filled with barium Signup and view all the answers

In which position is the stomach located higher than in PA and RAO?

Right lateral position Signup and view all the answers

The CR should be directed to which vertebra in the right lateral position?

L1, 1-1½ inches anterior to MCP Signup and view all the answers

Which imaging technique allows demonstration of the stomach in infants?

Guglianini method Signup and view all the answers

What is the capacity of most enema bags when fully distended?

3 quarts Signup and view all the answers

What is the recommended temperature range for barium sulfate used in enema procedures?

85° to 90° F Signup and view all the answers

In which patient position should the enema tip be inserted?

Sims' position Signup and view all the answers

What is a common weight/volume ratio for a double contrast barium examination?

75% to 95% Signup and view all the answers

For optimal comfort and effectiveness in imaging, what temperature of water is most often recommended for mixing with barium sulfate?

Room temperature water (85°-90° F). Signup and view all the answers

What is the angle at which the tube should be inserted during an enema procedure?

35 to 40 degrees Signup and view all the answers

Which colon section fills with barium when the patient is in the supine position?

Ascending colon Signup and view all the answers

What is the primary advantage of a lateral (rectum) view in barium enema procedures?

Best demonstrates polyps and strictures Signup and view all the answers

What does the Modified Valsalva maneuver primarily test?

The elasticity of the hypopharynx and piriform recesses Signup and view all the answers

Which action is performed during the Valsalva maneuver?

Bear down as if trying to move the bowels Signup and view all the answers

What is the purpose of performing a laryngopharyngography?

To visualize the laryngeal ventricle during phonation Signup and view all the answers

During which phonation is the larynx adducted?

Expiratory phonation test Signup and view all the answers

What anatomical structure does tomolaryngography primarily study?

The laryngopharyngeal structures Signup and view all the answers

What does the expiratory phonation test demonstrate?

Effective closure of the glottis Signup and view all the answers

Which structure is distended with air during the Modified Valsalva maneuver?

Piriform recesses Signup and view all the answers

Which action should be taken to perform inspiratory phonation?

Exhale completely and then inhale sharply Signup and view all the answers

In which position does the stomach move forward and downward by 3-6 inches?

Right lateral recumbent Signup and view all the answers

What is the purpose of withholding food and drinks before a contrast study of the small intestine?

To prevent gas formation Signup and view all the answers

Which central ray (CR) location is appropriate for an asthenic patient during a PA projection of the stomach?

2 inches below L1 Signup and view all the answers

Why should an immobilization band not be used for standard radiographic projections of the stomach?

It can create filling defects Signup and view all the answers

What is the impact of position change from supine to upright on the stomach's location?

Stomach moves superiorly Signup and view all the answers

Which projection best demonstrates the size and position of the stomach?

PA upright position Signup and view all the answers

What is the greatest visceral movement of the stomach observed in which type of patients?

Asthenic patients Signup and view all the answers

What is the correct CR location for a hypersthenic patient during a PA projection of the stomach?

2 inches above L1 Signup and view all the answers

What is the primary function of bile in the digestive system?

To emulsify and break down fat globules Signup and view all the answers

What are the three primary functions of the gallbladder (GB)?

Store, concentrate, and contract when stimulated Signup and view all the answers

How is bile transported from the liver to the duodenum?

Through the common bile duct and pancreatic duct Signup and view all the answers

What morphological feature is characteristic of the gallbladder referred to as 'Strawberry GB'?

Presence of cholesterol or cholesterol gallstones Signup and view all the answers

What is the internal diameter of the common bile duct (CBD)?

Similar to a drinking straw Signup and view all the answers

What happens at the Hepatopancreatic Ampulla?

Common bile duct and pancreatic duct join before entering the duodenum Signup and view all the answers

How does the position of the gallbladder change in hypersthenic individuals during full expiration?

Moves laterally and superiorly Signup and view all the answers

What is the length of the cystic duct connecting the gallbladder to the common bile duct?

3-4 cm Signup and view all the answers

What is the primary purpose of administering glucagon during a complete reflux examination?

To relax the intestine Signup and view all the answers

What defines the double-contrast method of examining the large intestine?

Administration of barium sulfate followed by a gaseous enema Signup and view all the answers

What is the recommended rate for administering barium during the procedure?

100 ml/min Signup and view all the answers

Which position is preferred for imaging to achieve a higher degree of visibility during a contrast study?

Prone position Signup and view all the answers

What complication is associated with injecting air during the double contrast method?

Bowel perforation Signup and view all the answers

What volume of barium suspension is typically required to fill both the colon and small intestine during a complete reflux examination?

4500 ml Signup and view all the answers

Which technique utilizes a retention enema tip for thorough filling during a barium examination?

Complete reflux examination Signup and view all the answers

What is a common side effect related to the discomfort experienced by patients during the procedure?

Increased patient discomfort Signup and view all the answers

What is the purpose of introducing an iodinated contrast agent into the common bile duct during operative cholangiography?

To evaluate biliary duct patency and detect calculi. Signup and view all the answers

Which imaging technique is used to examine the status of the hepato-pancreatic ampulla during post-operative cholangiography?

Post-operative delayed and T-tube cholangiography. Signup and view all the answers

What is typically done to ease the passage of the endoscope during Endoscopic Retrograde Cholangiopancreatography (ERCP)?

The patient's throat is sprayed with a local anesthetic. Signup and view all the answers

During post-operative cholangiography, what angle should the patient be positioned at for optimal visualization?

15-20 degrees RPO. Signup and view all the answers

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

Water-soluble contrast medium. Signup and view all the answers

What is the primary advantage of using ERCP in assessing the biliary and pancreatic ducts?

It allows direct intervention for stone removal. Signup and view all the answers

What should be prohibited for at least one hour after ERCP to avoid complications?

Food and drink. Signup and view all the answers

What is the significance of performing oblique spot radiographs during ERCP?

To prevent overlap of the common bile duct and pancreatic duct. Signup and view all the answers

Which projection is most likely to be utilized for demonstrating deeper portions of the parotid and submandibular glands?

Oblique Projection Signup and view all the answers

What is the CR (central ray) position required for lateral projection of the parotid gland?

1 inch superior to the mandibular angle Signup and view all the answers

Which method increases the visibility of salivary calculus during imaging of the parotid gland?

Placing the index finger on the back of the tongue Signup and view all the answers

What structure is particularly well demonstrated in a lateral projection of the parotid gland?

Calcification deposits Signup and view all the answers

In which technique would the patient be advised to swallow a small amount of thick creamy barium sulfate?

Palatography Signup and view all the answers

During an axial projection using the intraoral method, where should the CR intersect?

The second molar Signup and view all the answers

What specific aspect is investigated through sialography of the parotid gland?

Presence of calculi Signup and view all the answers

What anatomical feature is best visualized when the patient's neck is extended during imaging?

Mandibular ramus Signup and view all the answers

What is the primary function of bile in the digestive system?

To emulsify fats Signup and view all the answers

Which structure transports bile from the liver to the gallbladder?

Cystic duct Signup and view all the answers

How much bile does the liver typically secrete per day?

800-1,000 ml Signup and view all the answers

What are the primary functions of the gallbladder?

Store, concentrate, contract Signup and view all the answers

What is the length of the common bile duct?

7.5 cm Signup and view all the answers

Which condition is associated with an enlarged gallbladder and jaundice due to obstruction?

Courvoisier gallbladder Signup and view all the answers

What anatomical feature corresponds to the cystic duct's pathway?

It joins the common hepatic duct. Signup and view all the answers

How does the position of the gallbladder differ between hypersthenic and asthenic body types during respiration?

Hypersthenic: moves laterally, Asthenic: moves inferiorly Signup and view all the answers

What angle should the central ray be directed when using the Gordon method for hypersthenic patients?

35 to 45 degrees cephalad Signup and view all the answers

In what position is barium ideally visualized in the fundic portion of the stomach?

LPO position Signup and view all the answers

Which position requires a greater degree of body rotation for hypersthenic patients?

RAO position Signup and view all the answers

What anatomical structure is best demonstrated in the right lateral position?

Pyloric canal and duodenal bulb Signup and view all the answers

What is the appropriate body rotation for achieving a C-loop in profile during the RAO position?

40 to 70 degrees Signup and view all the answers

What angle is recommended for the central ray when performing the Guglielmini method in infants?

20 to 25 degrees cephalad Signup and view all the answers

What condition demonstrates the pyloric canal most effectively?

Air in the pylorus Signup and view all the answers

During a UGIS, what is the correct orientation of the CR for the right lateral position?

Directed 1-1/2 inches below L1 Signup and view all the answers

What is the main purpose of utilizing the Wolf method during radiographic examinations?

To ensure more consistent results in visualizing gastroesophageal herniations Signup and view all the answers

What anatomical structure is best demonstrated using the RAO position in the context of upper gastrointestinal studies?

Duodenum and jejunum Signup and view all the answers

What advantage does the semicylindrical radiolucent compression device offer in the Wolf method?

It allows ease of barium ingestion through a straw Signup and view all the answers

During which phase should the exposure be made in the RAO position for optimal filling of the esophagus?

Third or fourth swallow Signup and view all the answers

Which method is used to produce both a compression and non-compression study of the gastric mucosa?

Fluoroscopic examination with a compression paddle Signup and view all the answers

What effect does the partial Trendelenburg position have on the stomach's position?

Elevates the stomach superiorly and to the left Signup and view all the answers

What measurement characteristics are associated with the semicylindrical radiolucent compression device used in the Wolf method?

22 inches in length, 10 inches in width Signup and view all the answers

What is the degree of caudad angulation of the central ray during the RAO position for optimal imaging?

10-20 degrees Signup and view all the answers

What is the main purpose of using iodized oil in the examination of fistulas in the small intestine?

To fill the fistulous tract during imaging Signup and view all the answers

Which preparation of barium is recommended for a single contrast esophagogram?

30% - 50% weight/volume suspension Signup and view all the answers

What technique is used to observe deglutition in patients during the esophagogram?

Patient swallowing multiple mouthfuls of barium Signup and view all the answers

Which barium preparation is used specifically during the mucosal phase of an esophagogram?

4:1 barium preparation Signup and view all the answers

What is a characteristic of the filling phase during an esophagogram?

It is used to distend the esophagus lumen Signup and view all the answers

How is the colon prepared for the demonstration of colonic fistulae?

Filled with a full amount of water and part barium Signup and view all the answers

What is typically done before administering barium to observe esophageal abnormalities?

Patients take a cup of barium suspension in the left hand Signup and view all the answers

Which is true regarding the delay of barium in the esophagus during imaging?

It may be delayed in the lower part when swallowed at full expiration Signup and view all the answers

What primarily determines the ability of contrast media to enhance subject contrast in imaging?

The atomic number and concentration of the medium Signup and view all the answers

Which type of contrast media appears black on a radiograph?

Air and carbon dioxide Signup and view all the answers

Which of the following contrast media is classified as radiopaque?

Iodine Signup and view all the answers

What is a common application for barium sulfate in medical imaging?

Upper gastrointestinal studies Signup and view all the answers

In what physical state is iodinated contrast media typically found?

Liquid Signup and view all the answers

Which atomic number is associated with iodinated contrast media?

53 Signup and view all the answers

Which of the following represents a physical state of contrast media intended for use in myelogram and bronchogram studies?

Oil Signup and view all the answers

Which of the following options correctly categorizes carbon dioxide contrast media?

Negative contrast Signup and view all the answers

What is the main function of bile in the digestive system?

To emulsify fats Signup and view all the answers

How does the cystic duct function in bile transportation?

It transports bile from the gallbladder to the duodenum Signup and view all the answers

Which part of the gallbladder is the broadest section?

Fundus Signup and view all the answers

What condition is characterized by an enlarged and palpable gallbladder associated with obstructive jaundice?

Courvoisier's gallbladder Signup and view all the answers

What is the maximum volume of bile that the gallbladder can typically hold?

30-40 cc Signup and view all the answers

What anatomical configuration does the common bile duct have?

7.5 cm in length with an internal diameter similar to a drinking straw Signup and view all the answers

During which phase does the gallbladder contract upon stimulation?

Stimulation phase Signup and view all the answers

In which condition does the gallbladder display a 'sandpaper' appearance?

Due to roughened mucous membrane and gallstones Signup and view all the answers

What is the typical time frame for maximum opacification during intravenous cholangiography?

30 to 40 minutes Signup and view all the answers

What is a contraindication for performing intravenous cholangiography?

Patients with liver disease Signup and view all the answers

Which technique is preferred for demonstrating the biliary system in cases of obstructive jaundice?

Ultrasonography Signup and view all the answers

What is a common risk associated with percutaneous transhepatic cholangiography (PTC)?

Bile leakage Signup and view all the answers

What is the main purpose of operative cholangiography during a cholecystectomy?

To investigate the patency of the bile ducts Signup and view all the answers

During percutaneous transhepatic cholangiography, how is the skinny needle positioned for insertion?

Parallel to the floor Signup and view all the answers

What is the primary use of the Chiba needle in PTC procedures?

For drainage catheter placement Signup and view all the answers

What volume of contrast media is typically introduced into the common bile duct during operative cholangiography?

6-8 cc Signup and view all the answers

How does the stomach move when a patient is in the upright position?

Stomach moves forward and downward 3-6 inches Signup and view all the answers

What is the purpose of withholding food and drinks before a small intestine study?

To reduce gas formation Signup and view all the answers

Where should the central ray (CR) be directed for a standard PA projection of a sthenic patient?

At L1 and 1 inch left of the vertebral column Signup and view all the answers

Which patient body type experiences the greatest visceral movement when transitioning between prone and upright positions?

Asthenic patients Signup and view all the answers

What impact does applying an immobilization band have during standard radiographic projections of the stomach and intestines?

It causes filling defects and interferes with emptying Signup and view all the answers

What is the common diet preparation recommended before an upper gastrointestinal examination?

Soft residue diet Signup and view all the answers

For hypersthenic patients, where should the central ray (CR) be directed during a PA projection?

At L1 and 2 inches above L1 Signup and view all the answers

Which of the following positions does NOT result in the stomach moving backward towards the abdominal wall?

Upright position Signup and view all the answers

What is the main purpose of using glucagon during a complete reflux examination?

To relax the intestine and reduce pain Signup and view all the answers

Which of the following best describes the two-stage double-contrast procedure for examining the colon?

Barium sulfate is used first, followed by evacuation and then air or gas Signup and view all the answers

Which position is primarily used to allow abdominal compression in imaging to separate overlapping bowel loops?

Prone position Signup and view all the answers

What is the primary disadvantage of administering air or methylcellulose for a small bowel examination?

Potential for bowel perforation Signup and view all the answers

During a complete reflux examination, why is it important to lower the enema bag to the floor?

To drain the colon before filming Signup and view all the answers

Why is a large amount, approximately 4500ml, of barium suspension typically required during a complete reflux examination?

To ensure complete filling of the colon and small intestine Signup and view all the answers

What is the purpose of using a retention enema tip during imaging procedures?

To achieve better retention of barium in the bowel Signup and view all the answers

What is a significant benefit of the double-contrast method in examining the large intestine?

It allows for better visualization of smaller polyps Signup and view all the answers

What specific technique is employed to improve visibility of salivary calculus during imaging of the parotid gland?

Index finger placement on the back of the tongue Signup and view all the answers

Which anatomical features are best visualized using the axial projection intraoral method?

Entire sublingual gland and ducts Signup and view all the answers

During the lateral projection for the submandibular gland, the CR should be directed perpendicular to which point?

1 inch superior to the mandibular angle Signup and view all the answers

What is the main reason for making the patient suspend respiration during sialography of the parotid gland?

To minimize motion artifact Signup and view all the answers

Which imaging projection is necessary to assess deeper portions of both the parotid and submandibular glands?

Oblique projection Signup and view all the answers

What position should the patient's neck assume during the lateral projection of the parotid gland?

Extended to clear the mandibular ramus Signup and view all the answers

What does palatography primarily investigate?

Tumors of the soft palate Signup and view all the answers

Which structure is primarily shown in a well-executed lateral projection of the parotid gland?

Parotid gland and duct Signup and view all the answers

What is the primary purpose of administering glucagon during a complete reflux examination?

To relax the intestine Signup and view all the answers

Which method of examining the large intestine involves both a barium sulfate suspension and a gaseous medium?

Double-contrast method Signup and view all the answers

What complication may arise from injecting air or methylcellulose for double contrast?

Bowel perforation Signup and view all the answers

What is the significance of positioning a patient in the Trendelenburg position during imaging?

To aid in visualization of retrogastric portions Signup and view all the answers

What volume of barium suspension is typically used during a complete reflux examination?

4500 ml Signup and view all the answers

What is the advantage of using a prone position during small bowel imaging?

Separates overlapping bowel loops Signup and view all the answers

Which type of enema tip is utilized in a complete reflux examination?

Retention enema tip Signup and view all the answers

What method is employed to diminish discomfort during the filling of the bowel?

Administration of diazepam Signup and view all the answers

What is the primary advantage of using the right lateral decubitus position in an oral cholecystogram?

It places the gallbladder away from adjacent gas-containing loops. Signup and view all the answers

Which statement accurately describes the use of the upright PA position during oral cholecystography?

It allows for assessment of gallbladder mobility. Signup and view all the answers

When performing an intravenous cholangiography, what is the recommended patient position for the preliminary radiograph?

Supine position Signup and view all the answers

What is the primary purpose of using an oral cholecystogram in patients non-cholecystectomized?

To visualize biliary ducts not seen through other methods Signup and view all the answers

What do the right lateral decubitus and upright positions help demonstrate in an oral cholecystogram?

Stones that are lighter than bile through stratification Signup and view all the answers

What effect does the fatty meal have on the gallbladder during an oral cholecystogram?

It leads to gallbladder contraction for functional assessment. Signup and view all the answers

In intravenous cholangiography, what technique is utilized to project the biliary ducts effectively?

An RPO position angled between 15 to 40 degrees Signup and view all the answers

What clinical scenario would necessitate the use of intravenous cholangiography instead of an oral cholecystogram?

Patient inability to retain orally administered contrast Signup and view all the answers

What is the reason for placing the patient in the RPO position during the oral cholecystogram?

To ensure the gallbladder drains effectively. Signup and view all the answers

Which technique is recommended for enhanced visualization of the biliary ducts?

Using Telepaque after a fatty lunch. Signup and view all the answers

What is the importance of the layering or stratification of gallstones in OCG?

It helps visualize small stones that may be missed on other projections. Signup and view all the answers

What is the function of Ipodate calcium in the oral cholecystogram procedure?

It allows for rapid absorption and visualization of biliary ducts. Signup and view all the answers

Which projection best delineates between gas in the bowel and radiolucent stones in the gallbladder?

LAO Position. Signup and view all the answers

What is the prescribed exposure factor range for the oral cholecystogram?

70-80 kVp. Signup and view all the answers

What is the typical procedure if non-visualization of the gallbladder occurs on the first day of imaging?

Conduct a second imaging session with a new contrast dose. Signup and view all the answers

What is the recommended number of capsules for Biloptin to enhance visualization before the examination?

10-12 capsules. Signup and view all the answers

What is the primary reason for compressing the kidneys during intravenous urography?

To retard flow of opacified urine into the bladder Signup and view all the answers

In which scenario is ureteric compression contraindicated?

When the patient has a colostomy Signup and view all the answers

What is the recommended position for a full KUB (Kidneys, Ureters, Bladder) exam during the 5-minute interval of an intravenous urography?

Supine position Signup and view all the answers

What anatomical projection is best for visualizing nephroptosis?

Erect post-void projection Signup and view all the answers

During nephrogram imaging, when is the central ray (CR) positioned?

Midway between xiphoid tip and iliac crests Signup and view all the answers

What is the main purpose of retrograde urography compared to other imaging techniques?

To provide non-functional examination of the urinary system Signup and view all the answers

Which of the following describes the CR position for the AP projection during intravenous urography?

Midway between xiphoid tip and iliac crests Signup and view all the answers

Which condition is typically diagnosed through nephrotomography?

Renal hypertension Signup and view all the answers

What is the purpose of the toe-touch maneuver in diagnostic imaging?

To study possible regurgitation into the esophagus Signup and view all the answers

In the RAO position for esophagogram, what is the optimal central ray (CR) orientation?

Perpendicular to T5-T6 Signup and view all the answers

What is the recommended preparation for a patient undergoing an upper gastrointestinal study?

Low-residue diet for 2 days Signup and view all the answers

During the lateral position for an esophagogram, how should the entire esophagus be visualized?

While the patient drinks contrast medium Signup and view all the answers

What is the recommended amount of barium used in a colonic fistula demonstration?

One-third the amount of barium ordinarily used Signup and view all the answers

Why is it important to have an empty stomach before an upper gastrointestinal examination?

To ensure accurate visualization of the stomach and small intestine Signup and view all the answers

What is indicated by proper CR alignment during the PA/AP projection of an esophagogram?

Esophagus is clearly visible through thoracic vertebrae Signup and view all the answers

Which preparation is used for a single contrast esophagogram?

Weight/volume suspension of 30%-50% Signup and view all the answers

In the swimmer's lateral position, what advantage does it provide?

Enhanced demonstration of the upper esophagus Signup and view all the answers

In the esophagogram, what is the purpose of the filling phase?

To distend the lumen of the esophagus Signup and view all the answers

What should be done if a patient cannot comply with the fasting requirement before an upper gastrointestinal examination?

Consult the physician for alternative preparations Signup and view all the answers

For a double contrast esophagogram, which substance is added to the barium mixture?

Carbon dioxide crystals Signup and view all the answers

How is the esophagus visualized during fluoroscopy in an esophagogram?

By asking the patient to swallow barium while being observed Signup and view all the answers

What is the best barium preparation to demonstrate the mucosal pattern of the esophagus?

4:1 barium preparation Signup and view all the answers

What method is employed to visualize lesions in the esophagus during an esophagogram?

Implementing various breathing maneuvers Signup and view all the answers

When barium is swallowed at the end of full expiration, what happens?

It gets delayed in the lower esophagus Signup and view all the answers

What is the primary characteristic of non-ionic contrast media?

It does not ionize in solution. Signup and view all the answers

Which method is NOT used for performing a sensitivity test to check patient tolerance to contrast media?

Oral Method Signup and view all the answers

Which contrast medium is associated with the trade name 'Ultravist'?

Iopamidol Signup and view all the answers

What role does a secretory stimulant play in the sialography procedure?

To open the salivary duct for easier cannulation. Signup and view all the answers

What technique is used for the introduction of contrast media during sialography?

Hydrostatic pressure. Signup and view all the answers

What is the typical volume of contrast medium used for a sensitivity test?

1 cc Signup and view all the answers

Which of the following is performed to determine the extent of salivary gland inflammatory lesions?

Sialography Signup and view all the answers

During the sialography procedure, which action is taken after the examination to stimulate contrast medium evaluation?

Patient sucks on a lemon wedge. Signup and view all the answers

What is the main purpose of the RPO position during a barium enema?

To visualize the left colic flexure and descending colon. Signup and view all the answers

When using the PA projection for a barium enema, what aspect of the colon is opacified?

The entire colon including flexures. Signup and view all the answers

In a trendelenburg position during a barium enema, what is the primary purpose?

To separate overlapping loops of the bowel. Signup and view all the answers

What is the correct angulation of the central ray for the AP axial projection in a barium enema?

30-40 degrees cephalad. Signup and view all the answers

What anatomical area is best visualized in the LPO position during a barium enema?

The right colic flexure and ascending colon. Signup and view all the answers

In the left lateral decubitus position during a barium enema, which side of the colon is primarily evaluated?

The medial side of the ascending colon. Signup and view all the answers

Which projection is recommended to obtain an elongated view of the rectosigmoid area during a barium enema?

PA axial projection. Signup and view all the answers

In a right lateral decubitus position, what is the principal reason for the orientation of the CR?

To highlight the 'up' medial side of the ascending colon. Signup and view all the answers

What is the primary advantage of using the Barium Enema in the ventral decubitus position?

It best demonstrates the 'up' lateral side of the ascending colon. Signup and view all the answers

Which projection method is most valuable for double-contrast examinations of the colon?

Barium enema axial projection Signup and view all the answers

What is the purpose of using the Billing's method during a barium enema?

To demonstrate the recto-sigmoid area. Signup and view all the answers

Which of the following describes defecography?

A functional study during evacuation and rest phases. Signup and view all the answers

What is the typical volume of urine that the adult bladder can hold when full?

500 ml Signup and view all the answers

In which position is the CR angled 30°-35° cephalad in the context of colostomy studies?

LAO position Signup and view all the answers

What is the purpose of using a special injector mechanism during defecography?

To instill barium directly into the rectum. Signup and view all the answers

What is the primary function of a colostomy?

To create an opening for fecal passage. Signup and view all the answers

What is the main function of the Hepatopancreatic sphincter?

To regulate bile flow into the duodenum Signup and view all the answers

Which body habitus places the gallbladder lower and medial at the level of the iliac crest?

Asthenic Signup and view all the answers

What is cholecystography primarily used to visualize?

The anatomy and function of the gallbladder Signup and view all the answers

Which of the following statements is true about cholelithiasis?

It involves the presence of gallstones. Signup and view all the answers

What is the primary route for administering contrast media for gallbladder studies?

By mouth Signup and view all the answers

During an oral cholecystogram, what type of contrast media is typically ingested?

Iopanoic acid Signup and view all the answers

Which condition is characterized by inflammation of the gallbladder?

Cholecystitis Signup and view all the answers

What anatomical structure is primarily studied in cholangioography?

Biliary ducts Signup and view all the answers

What is the primary purpose of ureteral compression during an intravenous urography procedure?

To retard flow of opacified urine into the bladder Signup and view all the answers

Which position is preferred for obtaining a full KUB during an intravenous urography procedure?

Supine position Signup and view all the answers

What should be avoided when considering ureteral compression?

A colostomy Signup and view all the answers

During nephrotomography, what is the rotation angle of the body to obtain the RPO and LPO positions?

30 degrees Signup and view all the answers

What is the primary purpose of retrograde urography?

To provide a non-functional examination of the urinary system Signup and view all the answers

What is a key characteristic of the AP projection nephrogram taken 60 minutes after contrast injection?

Highlights the renal pelves and calyces Signup and view all the answers

Which of the following conditions indicates the need for caution or a change in performance during an IVU?

All of the above Signup and view all the answers

What does the erect post void projection best demonstrate?

Nephroptosis Signup and view all the answers

What happens to the stomach when a patient is in the right lateral recumbent position during a radiographic study?

The stomach moves forward and downward. Signup and view all the answers

In which patient body type is the greatest visceral movement observed between the prone and upright positions?

Asthenic patients Signup and view all the answers

Why should food and drinks be withheld after midnight prior to a UGIS examination?

To ensure the stomach is empty. Signup and view all the answers

What is the recommended central ray (CR) position for a sthenic patient during a PA projection of the stomach?

CR to L1 and 1 inch left of the vertebral column. Signup and view all the answers

What is the primary purpose of the Wolf method in radiographic examinations?

To apply greater intraabdominal pressure for better visualization. Signup and view all the answers

In the RAO position for an upper gastrointestinal series, what is the role of the central ray?

It is directed perpendicular to the long axis of the patient's back. Signup and view all the answers

What preparation is necessary for a colon before a small intestine study?

A cleansing enema to clear the colon. Signup and view all the answers

Which specific advantage does the semicylindrical radiolucent compression device offer during the Wolf method?

It does not require table angulation. Signup and view all the answers

During which position does the pylorus move closer to the lumbar spine?

Right lateral recumbent position Signup and view all the answers

How does the stomach fill with barium and air in the hypersthenic body type?

With barium filling the body and pylorus. Signup and view all the answers

During a UGIS examination, what is the purpose of positioning the patient in a Partial Trendelenburg position?

To enhance the filling of the fundus with barium. Signup and view all the answers

What effect does applying an immobilization band during standard radiographic projections have?

It may cause filling defects in the duodenal bulb. Signup and view all the answers

What technique is utilized for demonstrating gastric mucosa after fluoroscopic evaluation?

The pneumatic paddle technique. Signup and view all the answers

When making exposures during the RAO position, when should the radiologist take the shot for optimal esophagus visualization?

During the third or fourth swallow. Signup and view all the answers

What is the effect of inflation and deflation of the pneumatic paddle during imaging?

It demonstrates both compression and non-compression studies of the pyloric area. Signup and view all the answers

What is the expected central ray angulation when utilizing the Wolf method in the RAO position?

10-20 degrees caudad. Signup and view all the answers

What is the purpose of injecting creamy barium into each nasal cavity during nasopharyngography?

To coat the superior surface of the soft palate and posterior wall of the nasopharynx Signup and view all the answers

Which method is indicated to assess the extent of nasopharyngeal tumors?

Injection of iodized oil Signup and view all the answers

What should the patient's orientation be for the SMV projection?

Shoulders elevated and neck extended Signup and view all the answers

What is the significance of performing the modified Valsalva maneuver during the mucosal phase?

It allows double contrast delineation Signup and view all the answers

During pharyngography, when should the bolus contrast medium (CM) be projected into the pharynx?

At the height of anterior laryngeal movement Signup and view all the answers

What is a primary characteristic of the Gunson method in imaging?

It synchronizes exposure with swallowing Signup and view all the answers

Which of the following is NOT a respiratory maneuver used in the studies of laryngo-pharyngeal structures?

Reverse breathing Signup and view all the answers

What is the purpose of using a thick, creamy mixture of water and barium sulfate in pharyngography?

To provide better coating of the pharyngeal lining Signup and view all the answers

Study Notes

Sialography

For better detail, patients should fill their mouths with air & puff their cheeks.
Parotid gland and ducts can be viewed lateral to and clear of mandibular rami.

Lateral Projection

Extend patients neck so space between cervical and rami are cleared.
MSP at 15 degrees to IR.
CR perpendicular to inferior margin of angle of mandible.
CR perpendicular to 1 inch above mandibular angle.
Demonstrates calcific deposit, swelling of the parotid and submandibular glands.

Oblique Projection

Used to view the deeper portions of the parotid and submandibular glands.

Axial Projection - Intraoral Method

Vertex to plane of film.
CR intersection of MSP & CR passing through the second molar.
VSM for submandibular gland region, demonstrates tumors or lesions lateral to the floor of the oral cavity.
Shows the floor of the mouth, entire sublingual gland and ducts, anteromedial part of the submandibular gland.
The only projection providing an unobstructed view of the sublingual gland.

Palatography

Uses positive contrast technique.
Patient lateral with nasopharynx centered to IR.
1st palatogram: swallow small amount of thick barium sulfate to coat inferior surface of the soft palate and uvula.

Contrast Media

Diagnostic agents instilled into body orifices or injected into the vascular system, joints, and ducts to enhance subject contrast.
A material ingested or injected for visualization of the organ.
Serves as both a diagnostic and therapeutic aid.
Enhance subject contrast depends on atomic number of the CM and atoms concentration of the element/volume of the medium.

Types of Contrast Media

Radiopaque: Appears white (decreased density) on the radiograph.
Radiolucent: Appears black (increased density) on the radiograph.

Four Physical States of Contrast Media

Oil: Used in myelogram and bronchogram studies
Tablets: Used in gallbladder studies
Powder: Used in GIT, esophogram, barium enema, and small intestinal studies
Liquid: All iodinated and non-ionic contrast medium

Positive Contrast Media

BASO4 (Barium Sulfate): Used for examining the esophagus, small intestine AND upper GI series.
Iodinated Form: Examines the GI, kidneys, gallbladder, pancreas, heart, brain, uterus, spinal column, arteries, veins and joints.

Oral Cholecystogram (OCG)

CM is given 2-3 hours after the evening meal.
Absorption time is 10-12 hours.
Visualization of the biliary ducts in 1.5 hours, and visualization of the GB in 3-4 hours.
Patient must refrain from chewing gum and smoking until after exams.
70-80 kVp should be used.

Fatty Meal (Post Motor Meal)

Given after satisfactory visualization of the GB
Causes GB to contract.
Study of the extrahepatic ducts.
RPO position preferred.
Radiographs are obtained in the RPO position every 15 minutes.

Additional Techniques (OCG)

For better visualization of the ducts:
- Biloptin: 12 capsules at normal time, or 6 capsules 10-12 hours before the examination plus 6 capsules 3 hours before
- Telepaque: 3-6 tablets 4 hours after a fatty lunch the day preceding the examination, and then a full dose of 6 tablets after a fat-free meal in the evening.

PA Projection (Scout) - (OCG)

CR perpendicular to level of L2
2 inches to right of MSP

PA Projection (OCG)

Demonstrates presence and location of the GB.
Choleliths.
Correctness of exposure factors.
Milk calcium bile.

LAO Position (OCG)

Rotate patient 15°-40°.
Greater obliquity for asthenic patients (40°) than for hypersthenic (15°)
Demonstrates opacified GB away from the vertebral column.
Ideal projection to differentiate gas in the bowel from radiolucent stones in the GB.
Most common basic position of the GB.
Oblique GB with less foreshortening and self- superimposition

Right Lateral Position (OCG)

Differentiates gallstones from renal stones or calcified mesenteric lymph nodes.
Demonstrates opacified GB away from the vertebral column and bowel loops.

Esophagogram

Compression paddle technique: placed under the patient in the prone position, the paddle is inflated to provide pressure to the stomach region.
Toe-touch maneuver: performed to study possible regurgitation into the esophagus from the stomach. The cardiac orifice is observed fluoroscopically. Esophageal reflux and hiatal hernias are demonstrated in this technique.

RAO Position (Esophagogram)

MSP 35-40 degrees to IR.
CR perpendicular to T5-T6.
Demonstrates the entire contrast filled esophagus without superimposition of the heart and vertebra.
Best single projection of a barium-filled esophagus.

Lateral Position (Esophagogram)

Patient facing the radiographer
CR perpendicular to T5-T6.
Entire esophagus between the thoracic spine and heart.
Demonstrates the entire esophagus; exposure is made while the patient is drinking the CM through a straw in a rapid and continuous swallow.

Swimmer's Lateral (Esophagogram)

Allows better demonstration of the upper esophagus without superimposition of the arms and shoulders.

AP/PA Projection (Esophagogram)

CR 1 inch inferior to sternal angle (T5-T6).
Esophagus must be adequately demonstrated through the superimposed thoracic vertebra.

Upper Gastrointestinal

Stomach must be empty for examination of the upper gastrointestinal tract (the stomach and small intestine).
Desirable to have the colon free of gas and fecal material.
Preparation consists of a soft, low-residue diet for 2 days to prevent gas formation from excessive fermentation of the intestinal contents.
Cleansing enemas can be given to ensure a properly prepared colon.
Withhold food and water after midnight for 8-9 hours before the examination.
When a small intestine study is to be made, food and fluid are withheld after the evening meal.

Urinary System

Kidneys extend from the level of the superior border of T12 to the level of the transverse processes of L3 in persons of sthenic build.
Respiratory movement of 1 inch, and normally drop no more than 2 inches in change from supine to upright position..

Urography

Radiographic examination of the urinary system.
CM introduced to the bloodstream by intravenous injection (IVU) or catheterization (RGP).
Ionic and non-ionic are the two CM used.

IVU

The most common SRE of the urinary system.
Also referred to as IVP, which refers only to renal pelpes.
Commonly referred to as IVU or excretory urography.
A functional test of the urinary system.

Purpose of IVU

Visualize the collecting portion of the urinary system.
Assess the functional ability of the kidneys.

Before IVU

Empty bladder before the examination.
- A full bladder can rupture
- Urine dilutes the CM.

Procedure for IVU

Empty bladder before examination.
Ureteral compression can be used to enhance filling of the pelvocalyceal system and proximal ureters.
Compression should be applied to the distal ends of the ureters.

Notes About IVU

Glucophage (metformin) should not be given iodinated CM 48 hours before the procedure and withheld for another 48 hours after the procedure
Patients should never be left alone after IV injection of CM.
The physician must be summoned immediately for any moderate or severe reaction.

Preparing CM

Before withdrawing CM from the vial:
- Confirm the correct contents
- Check expiration date
- Read the label very carefully.
- Empty bottles should be shown to the radiologist.
Use an 18-20 gauge butterfly needle for 50-100 ml of CM.
Use a 23-25 gauge needle for pediatric patients.

Notes About Reactions to CM

Most reactions to contrast media occur within the first 5 minutes after administration.
CM appears at the pelvocalyceal system 2-8 minutes after administration.
15-20 minutes after injection is the greatest concentration of CM in the kidneys.

Oral Cholecystogram (OCG)

The OCG is a radiographic examination that uses a contrast medium (CM) to visualize the gallbladder (GB) and biliary ducts.
The patient is given a preliminary diet to ensure that the GB is empty and the CM can be visualized well.
The initial CM dose is given 2-3 hours after the evening meal, and the patient must refrain from chewing gum and smoking until after the exam.
The CM is absorbed over 10-12 hours, with visualization of the biliary ducts in 1.5 hours and the GB in 3-4 hours.
A fatty meal is given after the GB is adequately visualized to stimulate GB contraction and provide additional diagnostic information about its functional ability.
The fatty meal consists of commercially available bars or eggs and milk or eggnog.
Radiographs are taken in the RPO position every 15 minutes to assess GB drainage.
Alternative CM dosage recommendations are available for certain brands like Biloptin and Telepaque.

PA Projection - Scout (OCG)

The central ray (CR) is perpendicular to the level of L2, which is approximately half an inch above the lowest margin of the rib cage and 2 inches to the right of the mid-sagittal plane (MSP).

PA Projection (OCG)

The PA Projection helps determine the presence and location of the opacified GB, identify choleliths, and assess the accuracy of exposure factors.
This projection is best for demonstrating milk calcium bile.

LAO Position (OCG)

The patient is rotated 15-40 degrees, with a greater obliquity (40°) for asthenic patients and a lesser obliquity (15°) for hypersthenic patients.
This position is ideal for visualizing the opacified GB away from the vertebral column, differentiating gas in the bowel from radiolucent stones in the GB, and demonstrating the most common basic position of the GB.
The oblique positioning minimizes foreshortening and self-superimposition compared to the PA projection.

Right Lateral Position (OCG)

This position is used to differentiate gallstones from renal stones or calcified mesenteric lymph nodes.
It demonstrates the opacified GB away from the vertebral column and bowel loops.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

ERCP is typically indicated if both clinical and radiographic findings suggest abnormalities in the biliary system or pancreas.
An OCG, ultrasound examination, or IVC is typically performed before ERCP.
The Trendelenburg position is used to fill the intrahepatic ducts with CM, while a semi-erect position fills the lower end of the common bile duct (CBD).

Operative Pancreatography

This is a surgical-radiographic procedure in which a soluble-iodinated CM is introduced into the main pancreatic duct (duct of Wirsung) to assess pancreatic abnormalities.
The CM can be introduced via reflux filling from an injection into the CBD or direct injection through transduodenal catheterization of the duct.

Digestive System

Both radiolucent and radiopaque contrast mediums are used to visualize the gastrointestinal tract.
Radiolucent CM includes air, carbon dioxide, gas crystals, and gas bubbles in the stomach.
Calcium and magnesium citrate carbonate crystals are commonly used to produce carbon dioxide gas.
Barium sulfate is the most commonly used radiopaque CM for the GI system.

Thick Barium

The mixture uses a 3:1 ratio of barium sulfate to water.
It is more difficult to swallow and descends slowly, making it suitable for coating the mucosal lining of the esophagus.

Thin Barium

The mixture uses a 1:1 ratio of barium sulfate to water.
It is easier to swallow and better for studying the entire GI tract.

Double Contrast

This technique enhances the diagnosis of upper GI pathologies by using a high-density barium sulfate coating for the stomach mucosa and negative CM like calcium or magnesium citrate crystals.
The gas forces the barium against the mucosa, improving visualization of the mucosal pattern and aiding in identifying polyps, diverticula, and ulcers.

Abdominal Fistulae and Sinuses

Fistulae are abnormal passages between two internal organs.
Sinuses are abnormal channels leading to abscesses.

Esophagogram Indications

Esophagograms are performed to diagnose various esophageal pathologies.

Achalasia

Achalasia is a motor disorder of the esophagus characterized by reduced peristalsis in the distal two-thirds of the esophagus.
It is also known as cardiospasm.

Barrett’s Esophagus

In Barrett’s Esophagus, the normal squamous epithelium of the lower esophagus is replaced with columnar-lined epithelium and ulcer tissue.
Nuclear medicine (Tc-99m pertechnetate) is the modality of choice for diagnosing this pathology.

Carcinoma

Adenocarcinoma is the most common type of esophageal cancer, and carcinosarcoma presents as a large, irregular polyp.
Esophagograms and endoscopy are the primary modalities for detecting these tumors.
CT scans are used for tumor staging and determining metastasis beyond the esophageal mucosa.

Dysphagia

Dysphagia refers to difficulty swallowing.
Video and digital fluoroscopy are the preferred modalities for diagnosing dysphagia.

Esophageal Reflux

Esophageal reflux is the backward flow of gastric contents into the esophagus and is commonly reported by patients as heartburn.
Increased intake of aspirin, alcohol, caffeine, and smoking can contribute to reflux.

Esophageal Varices

Esophageal varices are dilated veins in the distal esophagus, appearing radiographically as wormlike or cobblestone patterns.
They are best visualized in the recumbent position.

Foreign Bodies

Food boluses or metallic objects may become lodged in the esophagus.

Zenker’s Diverticulum

A large out-pouching of the esophagus located just above the esophageal sphincter.

Esophagogram Recumbent Position

The recumbent position promotes complete contrast filling of the esophagus, particularly the proximal portion, by allowing the barium column to flow against gravity.
It is routinely used to demonstrate esophageal varices.

Techniques for Demonstrating Esophageal Reflux

Breathing exercises, particularly the Valsalva maneuver and Mueller maneuver, are employed.
The water test, performed in the supine and LPO position, involves observing barium regurgitation into the esophagus after swallowing water.
Compression studies focus on specific areas of the gastrointestinal tract.

UGIS (Upper Gastrointestinal Series)

The serial and mucosal studies use double contrast techniques to visualize the upper GI tract.

Hypotonic DuodenoGRAPHY

Hypotonic DuodenoGRAPHY uses intubation for the evaluation of post-bulbar duodenal lesions and pancreatic diseases.
A tubeless technique with drug-induced duodenal paralysis allows double contrast examination without interference from peristaltic activity.

Small Intestinal Series (SIS)

The SIS is used to evaluate the form and function of the small intestine, detect abnormal conditions, and is performed by administering barium sulfate orally, by reflux filling with a barium enema, or by direct injection via an intestinal tube (electrolysis).
Patients must adhere to a low-residue diet for two days before the SIS and must be NPO for eight hours before the exam.
It is important to avoid smoking and chewing gum, and to empty the bladder before the exam to prevent displacement of the ileum.

UGI-Small Bowel Combination

The first cup of barium (8 ounces) is ingested and the time is noted.
A routine stomach study is performed, followed by the ingestion of the second cup of barium.
Thirty minutes after the initial barium intake, a PA projection of the proximal small bowel is performed.
The first SIS radiograph is taken 15 minutes after the UGIS.
Radiographs are obtained every 15-30 minutes during the first two hours of the SIS, followed by hourly intervals until the ileo-cecal valve is reached.

Small Bowel Only Series

The patient ingests two cups of barium sulfate.
The initial radiograph is taken 15 or 30 minutes after ingestion.
Radiographs are taken every half hour for the first two hours.
After two hours, radiographs are taken at one-hour intervals.

Enteroclysis Double Contrast Small Bowel Procedure

Contrast medium is injected into the duodenum to examine the small bowel.
The CM is injected through a BILBAO or SELLINK tube into the terminal duodenum.
This procedure helps slow the flow of opacified urine into the bladder, ensuring adequate filling of the renal pelves and calyces.

Intravenous Urography (IVU) Procedure

IVU is a radiographic examination that uses intravenous injection of a contrast medium to visualize the urinary tract.
All exposures are taken at the end of expiration.
The Trendelenburg position can be used as an alternative to compression devices for patients who contraindicate ureteric compression.

Basic IVU Protocol

The protocol includes a nephrogram, 5-minute and 15-minute full KUBs, 20-minute obliques, and a post-void examination.

IVU AP Projection - Nephrogram

The CR is positioned midway between the xiphoid tip and iliac crests.

IVU Nephrotomography

Nephrotomography is primarily performed to rule out renal hypertension.

IVU RPO and LPO Positions

The CR is perpendicular to the iliac crests.
The body is rotated 30 degrees.
The kidney farthest from the image receptor (IR) is in profile, with the ureter nearest the IR projected away from the vertebral spine.

IVU Post-Void

The CR is perpendicular to the iliac crests.
This projection demonstrates an enlarged prostate, prolapse bladder, and ureteral reflux.

Erect Post-Void IVU

This projection best demonstrates nephroptosis (positional change of the kidneys).

IVU AP Projection - Ureteric Compression

The CR is positioned midway between the xiphoid tip and iliac crests.
This projection is best for demonstrating pyelonephritis.

Retrograde Urography

Retrograde Urography is a non-functional examination of the urinary system, considered an operative procedure.
CM is introduced directly retrograde (backward against the flow) into the pelvicalyceal system.
The examination is performed under aseptic conditions.

Upper Gastrointestinal Exam

Prior to an Upper GI exam, patients may be advised to avoid smoking and chewing gum after midnight to prevent excess fluid from accumulating in the stomach, which could dilute the barium suspension.
Two main methods are used to examine the stomach: single-contrast and double-contrast.
A biphasic examination combines both methods in a single day.
The barium meal usually reaches the ileocecal valve in 2-3 hours, the last portion in 4-5 hours, and reaches the rectum within 24 hours.

Single-Contrast Method

Uses 30-50% weight/volume barium suspension.
Begins with the patient in the upright position.
The radiologist may first examine the heart and lungs fluoroscopically and observe the abdomen for food or fluid in the stomach.
The patient swallows two or three mouthfuls of barium while the radiologist examines and exposes spot films of the esophagus.
The radiologist manipulates the stomach to coat the gastric mucosa.
The patient drinks the remaining barium suspension, allowing for observation of stomach filling and further examination of the duodenum.

Double-Contrast Method

Provides clear visualization of the mucosal lining.
Begins with the patient in the upright position.
The patient is given a gas-producing substance to distend the stomach.
A small amount of high-density barium suspension is then given.
Barium suspensions with weight/volume ratios up to 250% are used.
The patient is placed in the recumbent position and instructed to turn from side to side to ensure even coating of the stomach walls.
Glucagon or other anticholinergic medications may be given intravenously or intramuscularly to relax the gastrointestinal tract, improving visualization.

Biphasic Examination

Combines the advantages of both the single-contrast and double-contrast methods.
The patient first undergoes a double-contrast examination.
After completion, the patient is given a 15% weight/volume barium suspension, and a single-contrast examination is performed.

Body Habitus

Hyperstenic: Stomach is high and transverse, pyloric portion at midline, duodenal bulb to the right of midline.
Hypostenic/Asthenic: J-shaped stomach, low and vertical, pyloric portion to the left of midline.
Sthenic: Stomach is intermediate, pyloric portion near midline.

Air-Barium in the Stomach

Supine: Fundus (lowest portion) is filled with barium.
Prone: Fundus is in the highest position, barium is in the pylorus.
Air-Barium demonstrates the location of the barium and gas within the stomach.

Intravenous Urography Procedure

Respiration: All exposures are made at the end of expiration.
Trendelenburg: Similar effect to compression device without risk to the patient.
Compression: Generally contraindicated in cases of urinary stones, abdominal mass or aneurysm, colostomy, suprapubic catheter, or traumatic injury.

Basic IVU Protocol

Nephrogram: 1-minute after start of injection.
5-minute: Full KUB, supine is the preferred position.
15-minute: Full KUB, supine position.
20-minute obliques: LPO and RPO positions, ureters away from the spine.
Post-void: Taken after patient has voided, demonstrates bladder.

Additional IVU Projections

AP Projection: CR midway between the xiphoid tip and iliac crests.
Nephrotomography: Primarily performed to rule out renal hypertension.
RPO & LPO Positions: CR perpendicular to iliac crests, body rotated 30 degrees.
Post-Void: CR perpendicular to iliac crests, demonstrates enlarged prostate or prolapsed bladder.
Erect Post-Void: Demonstrates nephroptosis (positional change of kidneys).

Ureteric Compression

CR midway between xiphoid tip and iliac crests.
Best demonstrates pyelonephritis.

Retrograde Urography

Non-functional examination of the urinary system.
Contrast medium is introduced directly into the pelvicalyceal system.
Requires catheterization of the ureter.
Performed in a specially equipped cystoscopic radiology room.

Indications for Retrograde Urography

Used to determine the localization of urinary calculi or other types of obstruction.
Indicated for evaluation of the collecting system in patients with renal insufficiency or who are allergic to iodinated contrast media.

Retrograde Urography Procedures

Preliminary radiograph showing the urethral catheter in position.
Pyelogram: 3-5 ml of solution fills the average normal renal pelvis, head of the table lowered 10-15 degrees to prevent contrast from escaping into the ureter.
Urethrogram: Patient inhales deeply and suspends respiration at the end of full expiration.
Additional Views: RPO or LPO, Lateral (demonstrates anterior displacement of kidney or ureter), Cross-Table Lateral (demonstrates ureteropelvic region).

Hysterosalpingography

SRE of the fallopian tube, ovaries, and uterus using positive contrast medium.
Demonstrates the patency of the oviduct in cases of infertility.
Scheduled about 10 days after the start of menstruation.
Contrast media: liopodol, skiodan, kayopaque, salpix.
Projections: AP, PA, oblique, and lateral.

Pelvic Pneumography

Also known as gynecography or pangynecography.
Radiologic examinations of the female pelvic organs using intraperitoneal gas insufflation.

Vaginography

Used to investigate congenital malformations and conditions such as vesicovaginal and enterovaginal fistulas.

Fetography

Demonstration of the fetus in utero.
Avoided until after the 18th week of gestation due to the risk of radiation-induced fetal malformations.
Used to confirm suspected fetal death, determine fetal presentation and position, distinguish single vs. multiple pregnancies, and detect suspected developmental abnormalities.

Placentography

Radiographic examination of the uterus walls to locate the placenta in cases of suspected placenta previa.

Discography

SRE of the intervertebral disk.
Contrast medium is injected into the center of the disk using a double entry needle.

Cerebral Angiography

SRE of the blood vessels in the brain.
Contrast medium is injected into the carotid artery.
Indications include intracranial aneurysm, vascular lesion, or tumor.

Myelography

SRE of the central nervous system, specifically the spinal cord.
Contrast medium is introduced into the subarachnoid space at the level of L3-L4.
Contrast media: Iopaniro (iodized oil).
Projections: AP, PA, R & L oblique, and cross-table lateral.

Colcher-Sussman Pelvimetry

AP and lateral projections are employed.
Uses the Colcher-Sussman pelvimeter, a metal ruler with centimeter markings.
Center the ruler at the gluteal fold, 10 cm below the superior border of the symphysis pubis.

Definition of Contrast Media

Diagnostic agents instilled into body orifices or injected into the vascular system to enhance subject contrast in anatomic areas where there is low subject contrast.
A material that is ingested or injected into the body for visualization of the organ.
Substance having either a higher or lower atomic number than the surrounding tissues which are used to represent organs of the body which are not visualized in a plain radiography.
Serves as a diagnostic and therapeutic aid to physicians to visualize certain tissues/organ.
The ability of the CM to enhance subject contrast depends on the atomic number of CM and the atoms concentration of the element/volume of the medium.

Types of Contrast Media

Radiopaque:
- Appears white (decreased density) on the radiograph (e.g., Barium sulfate, iodine).
- Known as positive contrast media.
- Composed of elements with high atomic number.
Radiolucent:
- Appears black (increased density) on the radiograph (e.g., air, nitrogen, carbon dioxide).
- Known as negative contrast media.
- Composed of elements with low atomic number.

Four Physical States of Contrast Media

Oil:
- Examples: Pantopaque, Dionosil
- Used in Myelogram and Bronchogram Studies.
Tablets:
- Examples: Biloptin (Iopodate), Telepaque, (Iopanoic Acid) Cholebrine (iocetamic acid) Bilisectan (Iodoalphanoic acid) and Cistobil.
- Used in Gall Bladder Studies.
Powder:
- Example: Barium Sulfate (Baryntgen)
- Used in GIT, Esophogram, Barium Enema, and Small Intestinal Studies.
Liquid:
- Example: All iodinated and non-ionic contrast medium.

Positive Contrast Media

BaSO4 (Barium Sulfate)
- For examining the esophagus, small intestine, and upper GI series.
- It is the most common type of contrast used in imaging of the GI system.
Iodinated Form
- Used in examinations of the GI, kidneys, gallbladder, pancreas, heart, brain, uterus, spinal column, arteries, veins, and joints.
- Atomic number of 53.

Important Factors in Selecting Contrast Medium

Non-toxic and safe locally where administered.
Procedure adequate contrast.
Suitable viscosity.
Suitable persistence.
Miscibility or immiscibility as appropriate.

Physiochemical Properties

Water solubility: In vascular applications, an immediate dilution with blood occurs.
Viscosity: A measure of the fluidity of solutions, measured in millipascals (mPa) per second. The higher the viscosity of the solution, the longer it will take for the contrast medium to be diluted by blood.
Osmolality: Adverse reactions to CM have been related to osmolality. It is a measure of the total number of particles in a solution/kg of water.

Barium Sulfate

BaSO4 – 1 atom of barium, 1 atom of sulfur, and 4 atoms of oxygen.
The most common type of contrast used in imaging of the GI system.
It's an inert powder composed of crystals (colloidal suspension) that has a tendency to clump and come out of suspension (flocculation).
Stabilizing agents such as sodium carbonate or sodium citrate are used to prevent this.
Atomic number of 56.
Absorbs water.
Has a high atomic number.
Insoluble in water.
It cannot be absorbed by the GIT.
Non-toxic.
Has a relative contraindication in the GIT.

Types of Barium Sulfate

Commercial: Has flavorings and additives (e.g., Barodense, Barosperse, Barytgen)
Plain BaSo4: Has a very unpalatable taste but its advantage lies in the fact that it adheres well on the mucosa of the organ.

Barium Sulfate Properties

It's generally recommended that barium sulfate is mixed with cold tap water (40°-45° F) to reduce irritation to the colon and aid the patient in holding the enema (increase retention of CM) during the examination.
Room temperature water (85°-90° F) is recommended by most experts to produce a more successful examination with maximal patient comfort.
The RT should never use hot water because it may scald (burn) the mucosal lining of the colon.

Ionic Contrast Media

Contrast agent salts of electrically negatively charged acids containing iodine that ionizes in solution and causes more patient discomfort.

Oral Cholecystogram (OCG)

Preliminary Diet:
- CM is given 2-3 hours after the evening meal.
- Absorption time is 10-12 hours.
- Ipodate calcium is rapidly absorbed and allows visualization of the biliary ducts in 1.5 hours and visualization of the GB in 3-4 hours.
- Patients must refrain from chewing gum and smoking until after exams.
- 70-80 kVp should be used.
- Non-visualization on the first day may result in a 2-day study with a second dose of CM.

Oral Cholecystogram (OCG) Fatty Meal (Post Motor Meal)

Given after satisfactory visualization of the GB.
Consists of commercially available bars or eggs & milk or eggnog.
Causes the GB to contract, and additional diagnostic information can be obtained - functional / contracting ability of GB.
Study of the extrahepatic ducts.
Patient is placed in an RPO position so that GB can best drain.
Radiographs are obtained in the RPO position every 15 minutes.

Additional Techniques for Oral Cholecystogram (OCG)

For better visualization of the ducts, manufacturers make the following recommendations:
- Biloptin: 12 capsules at the usual time or 6 capsules 10-12 hours before the examination plus another 6 capsules 3 hours before.
- Telepaque: 3-6 tablets are taken 4 hours after a fatty lunch on the day preceding the examination, and then a full dose of 6 tablets after a fat-free meal in the evening.

Oral Cholecystogram (OCG): PA Projection (Scout)

CR perpendicular to the level of L2 (1/2 – 1 inch above the lowest margin of the rib cage) and 2 inches to the right of the MSP.

Oral Cholecystogram (OCG): PA Projection

Determine presence and location of opacified GB.
Choleliths.
Correctness of exposure factors.
Best demonstrate milk calcium bile.

Oral Cholecystogram (OCG): LAO Position

Rotate the patient 15°-40°.
Greater obliquity (40◦) for asthenic patients than for hypersthenic (15◦).
Best demonstrates opacified GB away from the vertebral column.
Ideal projection to delineate between gas in the bowel and radiolucent stones in the GB.
The most common basic position of the GB.
Oblique GB, with less foreshortening and self-superimposition than in PA.

Oral Cholecystogram (OCG): Right Lateral Position

Used to differentiate gallstones from renal stones or calcified mesenteric lymph nodes.
Demonstrates opacified GB away from the vertebral column and bowel loops.

EsophagoGram

Compression Paddle Technique: Placed under the patient in the prone position, the paddle is inflated to provide pressure to the stomach region.
Toe-touch maneuver: Performed to study possible regurgitation into the esophagus from the stomach. The cardiac orifice is observed fluoroscopically. Esophageal reflux and hiatal hernias are demonstrated in this technique.

EsophagoGram: RAO Position

MSP 35 to 40 degrees to IR.
CR perpendicular to T5-T6 (2-3 inches below jugular notch).
Demonstrate the entire contrast-filled esophagus free from superimposition of the heart and vertebra.
Best single projection of barium-filled esophagus.

EsophagoGram: Lateral Position

Place the patient in the lateral position facing the radiographer.
CR perpendicular to T5-T6 (2-3 inches below jugular notch).
Entire esophagus between thoracic spine and heart.
2 to 3 exposures in rapid succession before the CM passes into the stomach if it is swallowed at the end of full inhalation.
For demonstration of the entire esophagus; exposure is made while the patient is drinking the CM through a straw in a rapid & continuous swallow.

EsophagoGram: Swimmer’s Lateral

Allows better demonstration of the upper esophagus without superimposition of the arms and shoulders.

EsophagoGram: AP/PA Projection

CR 1 inch inferior to sternal angle (T5-T6).
The esophagus must be adequately demonstrated through the superimposed thoracic vertebrae.

Upper Gastrointestinal

The stomach must be empty for an examination of the upper gastrointestinal tract (the stomach and small intestine).
It is also desirable to have the colon free of gas and fecal material.
Preparation usually consists of a soft, low-residue diet for 2 days to prevent gas formation from excessive fermentation of the intestinal contents.
Cleansing enemas may be given to ensure a properly prepared colon.
An empty stomach is ensured by withholding both food and water after midnight for a period of 8 to 9 hours before the examination.
When a small intestine study is to be made, food and fluid are withheld after the evening meal.

Barium Enema

Lateral (Rectum) Robin’s Modification:
- CR perpendicular, 1 inch medial to ASIS.
- Demonstrates the rectum in a vertical projection.

Barium Enema: RPO Position

35- 45 degree rotation from the table.
Best demonstrates the left colic flexure and the descending colon.
Similar image can also be seen in LAO position.

Barium Enema: LPO Position

35- 45 degree rotation from the table.
Best demonstrates the right colic flexure and the ascending and sigmoid portions of the colon.
Similar image can also be seen in RAO position.

Barium Enema: AP Projection

Air-filled transverse colon filled.
Opacified colon including flexures and rectum.

Trendelenburg Position

Separates redundant and overlapping loops of the bowel.

Barium Enema: PA Projection

Barium filled transverse colon filled.
Opacified colon including flexures and rectum.

Barium Enema: AP Axial / AP Axial Oblique Projection - Butterfly Position

AP Axial Projection:
- CR 30- 40 degrees cephalad to 2 inches inferior to ASIS.
AP Axial Oblique Projection:
- LPO position (30°-40°) body rotation.
- CR 30°- 40° cephalad to 2 inches inferior and 2 inches medial to right ASIS.
- Best demonstrates an elongated view of the rectosigmoid area than on other views.

Barium Enema: PA Axial / PA Axial Oblique Projection - Butterfly Position

PA Axial Projection:
- CR 30◦-40° caudad to the level of ASIS.
- Best demonstrates an elongated view of the rectosigmoid area than on other views.
PA Axial Oblique Projection:
- RAO position (35°-45°) body rotation.
- CR 30°- 40° caudad to ASIS and 2 inches to the left of lumbar spinous process.
- Best demonstrates an elongated view of the rectosigmoid area than on other views.

Barium Enema: Right Lateral Decubitus

CR horizontal to the level of the iliac crests.
Best demonstrates the "up" medial side of the ascending colon and the lateral side of the descending colon when the colon is inflated with air.
Air-inflated portion of the colon is of primary importance.

Barium Enema: Left Lateral Decubitus

CR horizontal to the level of the iliac crests.
Best demonstrates the "up" medial side of the descending colon and the lateral side of the ascending colon, particularly useful during air contrast examinations.

Definition of Contrast Media

Contrast media (CM) are substances that are instilled into body orifices or injected into the vascular system, joints and ducts to enhance subject contrast in areas of low subject contrast.
CM is a material ingested or injected into the body for visualization of an organ.
CM is a substance with a higher or lower atomic number than the surrounding tissues which helps visualize organs that are not visible in a plain radiograph.
CM serves as a diagnostic and therapeutic aid to physicians.
The ability of CM to enhance subject contrast depends on the atomic number of the CM and the atoms concentration of the element/volume of the medium.

Types of Contrast Media

Radiopaque CM appears white (decreased density) on the radiograph and is composed of elements with high atomic numbers.
Radiolucent CM appears black (increased density) on the radiograph and is composed of elements of low atomic numbers.

Four Physical States of Contrast Media

Oil contrast media are used in Myelogram and Bronchogram studies. Examples: Pantopaque, Dionosil
Tablets contrast media are used in Gall Bladder Studies. Examples: Biloptin (Iopodate), Telepaque, (Iopanoic Acid) Cholebrine (iocetamic acid) Bilisectan (Iodoalphanoic acid) and Cistobil
Powder contrast media are used in GIT, Esophogram, Barium Enema, and Small Intestinal Studies. Example: Barium Sulfate (Baryntgen)
Liquid contrast media is used for all iodinated and non-ionic contrast medium.

Positive Contrast Media

Barium Sulfate (BaSO4) is used for examinations of the esophagus, small intestine, and upper GI series.
Iodinated Forms of CM are used in examinations of the GI, kidneys, gallbladder, pancreas, heart, brain, uterus, spinal column, arteries, veins and joints.
Most iodinated forms of CM have an atomic number of 53.

Important Factors in Selecting Contrast Medium

It must be non-toxic and safe both locally and systemically.
It must produce adequate contrast.
It must have a suitable viscosity.
It must have a suitable persistence.
It must have miscibility or immiscibility as appropriate.

Physiochemical Properties of Contrast Media

Water Solubility: In vascular applications, immediate dilution with blood is necessary.
Viscosity: Viscosity is a measure of the fluidity of solutions and is measured in millipascals (mPa) per second. The higher the viscosity of the solution, the longer it takes for the CM to be diluted by blood.
Osmolality: Adverse reactions to contrast media have been related to osmolality. Osmolality is a measure of the total number of particles in a solution/kg of water.

Barium Sulfate

BaSO4 is a compound composed of 1 atom of barium, 1 atom of sulfur and 4 atoms of oxygen.
It is the most common type of contrast used in imaging of the GI system.
It is an inert powder composed of crystals (colloidal suspension) that has a tendency to clump and come out of suspension (flocculation).
Stabilizing agents such as sodium carbonate or sodium citrate are used to prevent flocculation.
It absorbs water and has a high atomic number.
It is insoluble in water and cannot be absorbed by the GIT.
It is non-toxic and has a relative contraindication in the GIT.

Types of Barium Sulfate

Commercial Barium Sulfate: These types of contrast media have flavoring and additives. Examples: Barodense, Barosperse, Baryntgen
Plain BaSO4: Plain barium sulfate has a very unpalatable taste but its advantage lies in the fact that it adheres well on the mucosa of the organ.

Barium Sulfate Considerations

Barium sulfate is generally recommended to be mixed with cold tap water (40°-45° F) to reduce irritation to the colon and aid the patient in holding the enema (increase retention of CM) during the examination.
Room temperature water (85°-90° F) is recommended by most experts to produce a more successful examination with maximal patient comfort.
Hot water should never be used because it may scald (burn) the mucosal lining of the colon.

Ionic Contrast Media

Ionic CM are contrast agent salts of electrically negatively charged acids containing iodine that ionizes in solution and causes more patient discomfort.

Biliary System Indications

Cholelithiasis: Gallstones/calculi in the gallbladder. This is the most common abnormality diagnosed during an Oral Cholecystogram (OCG).
Choledocholithiasis: Calculi in the common bile duct (CBD).
Cholecystitis: Acute or chronic inflammation of the gallbladder. This is a common complication of cholelithiasis.
Biliary Neoplasm: Gallbladder carcinoma is rare, however it is aggressive and spreads to the liver, pancreas and GI tract.
Biliary Stenosis: Narrowing of the CBD.

Oral Cholecystogram (OCG) Contraindications

Advanced hepatorenal disease
Active gastrointestinal disease
Hypersensitivity to iodinated CM
Pregnancy

Oral Cholecystogram (OCG) Preliminary Diet

Avoidance of laxatives 24 hours before ingestion of CM.
Avoidance of all food after receiving the CM.
Noon meal rich in simple fats.
Light evening meal that is fat free (oral media is administered 3 hours after the evening meal).
CM given 10-12 hours prior to the procedure.
Evening meal that is fat free to prevent the possibility of continued emptying of the gallbladder (GB) and release of radiopaque bile.

Upper Gastrointestinal Series (UGIS)

PA Axial Projection - Gordon Method: CR 35 to 45 degrees cephalad. Best demonstrates and opens up the high transverse stomach for hypersthenic patients. Greater and lesser curvatures in profile.
PA Axial Projection - Gugliantini Method: 20 to 25 degrees cephalad for demonstration of the stomach in infants.
RAO Position: Body rotated 40-70 degrees. Best demonstrates the pyloric canal and the duodenal bulb free of superimposition of the pylorus because gastric peristalsis is usually more active when the patient is in this position.
LPO Position: Body rotated 30 to 60 degrees (45 degrees). Demonstrates the fundic portion of the stomach filled with barium.
Right Lateral Position: Best image of the pyloric canal and the duodenal bulb in patients with a hypersthenic habitus. Demonstrates anterior and posterior aspects of the stomach, the pyloric canal and the duodenal bulb.

Barium Enema

SRE of the large intestine: Insert enema tip in Sims' position with the patient leaning forward on the left side. This position relaxes the abdominal muscle, decreasing intra-abdominal pressure on the rectum and making relaxation of the anal sphincter less difficult.
Height: 18-24 inches (45-60 cm) above the level of the anus.
Tube insertion: Tube inserted for a total distance of 3 ½ to 4 inches (8.7 to 10 cm) during exhalation, directed anteriorly 1 – 1 ½ inch following curve of rectum and slightly superiorly.

Barium Enema: Enema Solutions

Capacity: Most enema bags have a capacity of 3 quarts (3000 ml) when fully distended.
Tubing: The tubing is approximately 6 feet long.
Single Contrast: 12% to 25% for weight/volume.
Double Contrast: 75% to 95% weight/volume ratio is common.
Temperature: Barium sulfate temperature for enema should be below body temperature (85°to 90° F or 29° to 30° C).
Cold Temperature Consideration: Cold barium enema suspensions about 41°F (5°C) have been recommended.

Barium Enema: Positioning

Supine: Air rises to the most anterior portion of the large intestine, including the transverse colon and sigmoid colon. Barium fills the ascending colon and descending colon.
Prone: Air fills the rectum, ascending colon and descending colon. Barium fills the transverse colon.
Lateral (Rectum) - Robin’s Modification: True lateral position. CR to MCP between ASIS and posterior sacrum. Most important modification in barium enema. Demonstrates a direct lateral view of the recto-sigmoid colon without superimposition.

Laryngopharyngography

Normal (Expiratory): This test shows the abducted (open) vocal cords during quiet inspiration and the adducted (closed) vocal cords during phonation.
Quiet Inspiration: Inhale slowly and show the open vocal cords.
Phonation: Take a deep breath and exhale slowly. Make a high “eee” or low pitched “aah” sound. This shows the closed vocal cords.
Inspiratory Phonation: Exhale completely, then slowly inhale to produce a harsh, stridulous sound while vocalizing “e”. This adducts the vocal cords, moves them inferiorly, and makes the ventricle bulge.
Valsalva’s Maneuver: Inhale deeply and hold your breath. Push as if straining to have a bowel movement. This forces air against the closed vocal cords, increasing pressure in the chest and abdomen. This test shows complete closure of the glottis and is used to evaluate its elasticity and function.
Modified Valsalva’s Maneuver: Pinch your nostrils with the thumb and forefinger of one hand and close your mouth. Make a slight effort to blow your nose, holding it for a few seconds. Test the elasticity of the hypopharynx and piriform recesses. This shows the glottis closed and the hypopharynx and piriform recesses distended with air.

Tomolaryngography

Uses a rapid-travel linear sweep and exposures made during the first half of the arc (40-50 degrees) to prevent overlapping shadows from facial bones and teeth.
Examines the laryngopharyngeal structures before or after the introduction of radiopaque contrast media.

Biliary System

The biliary system involves the production, transport, and storage of bile.
The liver produces bile.
The gallbladder stores bile.
The liver is the largest solid organ in the human body and occupies most of the right upper quadrant (RUQ) and right hypochondrium. The right and left lobes are separated by the falciform ligament.
The liver secretes 800 to 1000 milliliters (ml), or 1 quart, of bile per day.
Bile's main function is to help digest fats by emulsifying, or breaking down, fat globules.

Bile Flow

Bile is created in the small lobules of the liver and flows through the right or left hepatic ducts.
The right and left hepatic ducts join to form the common hepatic duct.
Bile travels to the gallbladder through the cystic duct.
Bile can also flow directly to the duodenum through the common bile duct, which joins with the pancreatic duct (duct of Wirsung).

Gallbladder

The gallbladder is a pear-shaped sac with three parts:
- Fundus: The distal (lower) end and the broadest part of the gallbladder.
- Body: The main section of the gallbladder.
- Neck: The narrow proximal (upper) end that connects to the cystic duct.
The cystic duct is 3 to 4 centimeters (cm) long.
The gallbladder is 7 to 10 cm long, 3 cm wide, and holds 30 to 40 cubic centimeters (cc) of bile.
The three primary functions of the gallbladder are to:
- Store bile.
- Concentrate bile.
- Contract when stimulated.

Gallbladder Variations

Fish Scale Gallbladder: Has a fish scale appearance due to multiple cysts in the mucosa.
Strawberry Gallbladder: Has a strawberry appearance because of cholesterol deposits or cholesterol gallstones.
Sandpaper Gallbladder: Has a roughened condition of the mucous membrane associated with gallstones.
Courvoisier Gallbladder: An enlarged and palpable gallbladder in a patient with carcinoma of the head of the pancreas. This is usually associated with jaundice due to obstruction at the common bile duct (CBD).

Gallbladder Positioning

Hypersthenic: On full expiration, the gallbladder moves laterally and superiorly 1 to 3 inches (2.5 to 7.6 cm).
Asthenic: On full inspiration, the gallbladder moves medially and inferiorly 1 to 3 inches (2.5 to 7.6 cm).

Common Bile Duct (CBD)

The common hepatic duct, which drains the liver, joins with the cystic to form the CBD.
It's 7.5 cm in length and has an internal diameter similar to a drinking straw.
The CBD descends behind the superior part of the duodenum and the head of the pancreas to enter the second, or descending, portion of the duodenum.
The CBD and pancreatic duct join to form the hepatopancreatic ampulla, also called the ampulla of Vater.
This is the narrowest part of the passageway and a common site for gallstones to become lodged.

Operative – Immediate Cholangiography

A 15 to 20 degree right posterior oblique (RPO) position is helpful in visualizing the biliary ducts away from the spine, especially in hyposthenic patients.
An iodinated contrast agent is introduced into the CBD to evaluate its patency and the patency of the hepatopancreatic ampulla.
Any calculi (gallstones) can be detected and removed before surgery is complete

Post-Operative Cholangiography

Also called "delayed" and "T-tube" cholangiography, this is performed using a T-shaped tube left in the CBD for post op drainage.
Evaluates the caliber (size) and patency of the ducts, the status of the sphincter of the hepatopancreatic ampulla, and the presence of residual or previously undetected stones or other pathologies.
Water-soluble contrast media (25% to 30% concentration) is used.
Scout films are obtained, and the examination is performed under fluoroscopic guidance or overhead projection.
A 15 to 20 degree RPO position is used.
Lateral projections are obtained to demonstrate the anatomical branching of the hepatic duct and to detect any abnormalities not seen in the RPO projection.
The clamp is not removed from the T-tube until the examination is complete.
The T-shaped tube is left in the CBD for post surgical drainage.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

This is a special X-ray procedure that images the biliary and main pancreatic ducts.
ERCP is useful when the biliary ducts aren’t dilated and there’s no obstruction at the ampulla.
ERCP is performed by passing a fiberoptic endoscope through the mouth into the duodenum under fluoroscopic control.
The patient’s throat is sprayed with a local anesthetic to ease passage of the endoscope. This can cause temporary pharyngeal paresis, so food and beverages are usually prohibited for at least 1 hour after the procedure.
Food may be withheld for up to 10 hours after the procedure to minimize irritation of the stomach and small bowel.
After the endoscopist finds the hepatopancreatic ampulla (ampulla of Vater), a small cannula is passed through the endoscope and placed into it.
Once the cannula is in place, contrast media is injected into the common bile duct
Oblique spot radiographs may be obtained to prevent overlapping of the common bile duct and pancreatic duct.

Air-Barium in the Stomach

This is a standard visualization technique for the stomach.
The erect posture allows barium to fill the fundus of the stomach, while air fills the pylorus.
Conversely, in the right lateral recumbent position, air fills the fundus and barium fills the pylorus.

Stomach Positioning

Upright: The stomach moves downward and the pylorus is closer to the lumbar spine.
Right Lateral Recumbent: The stomach moves forward.
Supine: The stomach moves superiorly.
Prone: The stomach moves slightly downward.
Left Lateral Upright: The pylorus is closer to the abdominal wall.

Upper Gastrointestinal Series (UGIS)

This procedure examines the distal esophagus, stomach, duodenum, and proximal jejunum.
Food and beverages are withheld after midnight, 8 to 9 hours before the examination.
If a small bowel study is also being performed, food and beverages are withheld after the evening meal.
A cleansing enema is given to clear the colon and make the study more efficient.
The patient is given one full cup (2 ounces) of barium sulfate.

UGIS - PA Projection

PA Recumbent: Used for radiographic studies of the stomach and duodenum. The central ray (CR) is directed to L1. The stomach moves superiorly 1 ½ to 4 inches (3.8 to 10 cm). This position does not adequately visualize the unfilled fundic portion of the stomach.
PA Upright: Demonstrates the size, shape, and position of the stomach but not the fundic portion. The CR is directed to 3 to 6 inches below L1-L2.

UGIS - PA Projection Considerations

The greatest visceral movement between the prone and upright positions occurs in asthenic patients .
It is important to avoid using immobilization bands during standard radiography of the stomach and intestines, as this can cause filling defects and disrupt the emptying and filling of the duodenal bulb.

CR Positioning for UGIS

Sthenic: The CR is located at L1 and 1 inch to the left of the vertebral column
Asthenic: The CR is located 2 inches below L1.
Hypersthenic: The CR is located 2 inches above L1.

UGIS - PA Double Contrast Effect

Air or Methylcellulose is injected to distend the stomach and provide a double contrast effect. Barium fills the body and pylorus, with air remaining in the fundus.
Barium is given at a rate of 100 ml/min.
Disadvantages:
- Increased patient discomfort.
- The potential for bowel perforation.

Intubation Method - Single Contrast Media

Also known as a small bowel enema.
This method uses a nasogastric tube to introduce contrast media for therapeutic and diagnostic purposes.
Therapeutic Uses: (Miller-Abbott tube) to relieve post-operative distention and small bowel obstructions.

Complete Reflux Examination

Complete reflux filling of the small bowel is achieved.
Glucagon is administered to relax the intestinal muscles.
Diazepam (valium) may also be given to reduce discomfort during the early stage of filling.
A 15% weight volume barium suspension is often used, requiring a large amount of suspension, about 4500 ml, to fill the colon and small bowel.
A retention enema tip is used and the patient is placed in the supine position.
Barium is allowed to flow until it's present in the duodenal bulb.
The enema bag is then lowered to the floor to drain the colon before imaging of the small intestine.

Small Intestine Series (SIS) - Imaging Positions

Prone: This position allows abdominal compression to separate various bowel loops for better visualization.
Supine: This position takes advantage of the superior and lateral shift of the barium-filled stomach to visualize the retrogastric portions of the duodenum and jejunum.
Trendelenburg: This position helps to separate overlapping loops of ileum.
Reverse Trendelenburg: This position helps prevent potential compression and overlapping of intestinal loops.

Large Intestine

There are two basic radiographic methods for examining the large intestine using contrast enemas.
- Single-Contrast: The colon is examined with a barium sulfate suspension only.
- Double-Contrast: This method, either two-stage or single-stage, uses a barium suspension followed immediately by an air enema or another gaseous enema after evacuation of the barium.

Large Intestine - Barium and Air

Barium demonstrates the anatomy and tonus of the colon and most of the abnormalities it’s subject to.
Air distends the lumen (cavity) of the bowel and creates a transparent shadow that allows better visualization of the bowel lining.

Parotid Gland

The parotid gland is lateral to the mandibular ramus.
To improve visualization, the patient can be instructed to fill their mouth with air and puff their cheeks out.
Alternatively, the patient can suspend respiration during exposure.

Lateral Projection

The patient's neck is extended to clear the space between the cervical spine and the rami.
The MSP is 15 degrees to the IR.
CR perpendicular to the inferior margin of the angle of the mandible.
The CR should be perpendicular to 1 inch (2.5 cm) superior to the mandibular angle.
This projection demonstrates bony structures, calcific deposits, and swelling of the parotid and submandibular glands.

Oblique Projection

This projection demonstrates the deeper portions of the parotid and submandibular glands.

Axial Projection - Intraoral

The patient's vertex should rest on the plane of the film.
The CR should intersect the MSP and pass through the second molar.
This projection demonstrates the floor of the mouth, the entire sublingual gland and ducts, and the anteromedial part of the submandibular gland.
It provides an unobstructed view of the sublingual gland.

Palatography

This technique uses positive contrast to investigate suspect tumors of the soft palate.
The patient is in a sitting lateral position with the nasopharynx centered to the IR.
For the first palatogram, the patient is asked to swallow a small amount of thick, creamy barium sulfate to coat the inferior surface of the soft palate and uvula.

Biliary System

The liver secretes 800–1,000 ml or 1 qt of bile per day.
The major function of bile is to aid in digestion of fats by emulsifying or breaking down fat globules.
Bile is formed in the small lobules of the liver and travels through the right or left hepatic ducts.
The right and left hepatic ducts join to form the common hepatic duct.
Bile is carried to the gallbladder (GB) via the cystic duct.
Bile can also be carried directly to the duodenum via the common bile duct (CBD), which joins the pancreatic duct (duct of Wirsung).

Gallbladder (GB)

The GB is a pear-shaped sac composed of three parts:
- Fundus: the distal and broadest part of the GB.
- Body: the main section of the GB.
- Neck: the narrow proximal end that continues as the cystic duct.
The cystic duct is 3-4 cm long.
The GB is 7-10 cm long, 3 cm wide, and holds 30-40 cc of bile.
The primary functions of the GB include:
- Storage
- Concentration
- Contraction (when stimulated)
Different types of GB include:
- Fish scale: multiple cysts of the mucosa.
- Strawberry: cholesterol/cholesterol gallstones.
- Sandpaper: presence of gallstones, roughened condition of the mucous membrane.
- Courvoisier: Enlarged, palpable GB associated with carcinoma of the head of the pancreas.
  - Associated with jaundice due to obstruction of the CBD.

GB - Position

The position of the GB changes depending on habitus:
- Hypersthenic: GB moves laterally and superiorly 1 to 3 inches (2.5 to 7.6 cm) on full expiration.
- Asthenic: GB moves medially and inferiorly 1 to 3 inches (2.5 to 7.6 cm) on full inspiration.

Common Bile Duct (CBD)

The common hepatic duct (draining the liver) joins with the cystic duct to form the CBD.
The CBD is 7.5 cm long and has an internal diameter of a drinking straw.
The CBD descends behind the superior portion of the duodenum and the head of the pancreas to enter the second or descending portion of the duodenum.
The CBD and pancreatic ducts form a common passageway called the hepatopancreatic ampulla or Ampulla of Vater.
The Ampulla of Vater is the narrowest part of the passageway and a common site of gallstone impaction.

Abdominal Fistulae and Sinuses

To explore fistulae and sinuses in the abdominal region, the intestinal tract should be free of gas and fecal material.
Oblique projections demonstrate the full extent of sinus tracts.
Modified gastrointestinal procedures detect the origin of colonic fistulae.
Iodized oil is frequently used in conjunction with a thin suspension of barium sulfate.
To demonstrate a colonic fistula, the colon is filled with an enema containing the full amount of water and about one-third the amount of barium than is typically used.
To demonstrate a fistula of the small intestine, the patient ingests a thin barium suspension.
The fistulous tract is then injected with iodized oil.

Esophagogram

A special radiographic examination of the esophagus and pharynx using single or double contrast media (CM).
Also called barium swallow.
No preparation is needed.
For full column, single CM technique, a 30%–50% weight/volume suspension is used.
If double CM is being used, barium, or carbon dioxide crystals are used.
For double CM a low viscosity, high density barium developed for double-contrast gastric examinations is used.
Esophagograms typically use thin and thick barium.

Esophagogram - Single CM

A scout film is obtained in an upright position.
The patient drinks the barium suspension on request.
The patient swallows multiple mouthfuls of barium to observe deglutition and identify any abnormalities.
Breathing maneuvers are done under fluoroscopic observation to demonstrate any lesions.

Esophagogram - Double CM

A free-flowing high-density barium is used.
A gas-producing substance (usually carbon dioxide crystals) is added to the barium mixture or is given by mouth immediately before barium suspension administration.
The same procedures are performed as with single CM, and delayed images can be obtained on request.

Esophagogram - Filling Phase

Used to distend the lumen of the esophagus to demonstrate the entire length.
Use a 2:1 or 3:1 barium preparation.

Esophagogram - Mucosal Phase

Used to demonstrate the mucosal pattern of the esophagus.
Use a 4:1 barium preparation,

Esophagogram - Barium Transit Time

If barium is swallowed at the end of full inspiration, it passes through the esophagus more slowly.
If barium is swallowed at the end of full expiration, it is delayed in the lower part for several seconds.

UGI Series (UGIS) - Anatomy

Different habitus affect the appearance of the pyloric canal and duodenal bulb:
- Asthenic/Hyposthenic patients: The pyloric canal and duodenal bulb are in profile
- Sthenic Patients: The pyloric canal and duodenal bulb are partially superimposed by the prepyloric portion of the stomach.
- Hypersthenic Patients: The pyloric canal and duodenal bulb are completely superimposed by the prepyloric portion of the stomach.

UGIS - PA Axial Projection

Gordon Method:
- The CR is angled 35 to 45 degrees cephalad.
Best demonstrates and opens up the high transverse stomach in hypersthenic patients.
The greater and lesser curvatures are in profile.
Gugliantini:
- 20 to 25 degrees cephalad.
Used for demonstration of the stomach in infants.

UGIS - RAO Position

Body rotated 40-70 degrees. (Hypersthenic patients require a greater degree of rotation than sthenic and asthenic patients).
The C-loop is in profile but superimposed on the lumbar vertebra.
Air is seen in the fundus.
Barium is seen in the body, pylorus, and duodenum.
Best demonstrates polyps, ulcers of the pylorus, and serial studies must be taken at 30–40 second intervals.
This position produces the best visualization for the pyloric canal and the duodenal bulb, as the pylorus is usually less superimposed and gastric peristalsis is more active.

UGIS - LPO Position

Body rotated 30 to 60 degrees (45 degrees).
Demonstrates the fundic portion of the stomach filled with barium.
A good position for double contrast of the body, pylorus, and duodenal bulb.

UGIS - Right Lateral Projection

Upright Left Lateral:
- Demonstration of:
- The left retrogastric space.
Recumbent Right Lateral:
- Demonstration of:
  - The right retrogastric space.
  - The duodenal loop, and the duodenojejunal junction.
Demonstrates the anterior and posterior aspects of the stomach, the pyloric canal, and duodenal bulb.
Demonstrates the C-loop.
The stomach is located higher in this position than in PA and RAO.
CR to L1 1 to 1 1/2 inches anterior to the MCP.

UGIS - AP Projection

The stomach moves superiorly and to the left in this position.
Partial Trendelenburg:
- Helps to fill the fundus with barium in thin, asthenic patients.
Full Trendelenburg:
Demonstrates a hiatal hernia.
Best AP projection of the retrogastric portion of the duodenum and jejunum.

UGIS - Wolf Method

A modification of the Trendelenburg position.
The technique was developed to create greater intra-abdominal pressure to demonstrate small, sliding gastroesophageal herniations through the esophageal hiatus.
A semicylindrical radiolucent compression device is used.
The patient is in a 40 to 45-degree RAO position.
Exposure should be made during the third or fourth swallow.
The CR is perpendicular to the long axis of the patient’s back, centered at the level of either T6-T7.
The position usually results in a 10 to 20-degree caudad angulation of the CR.

UGIS - RAO Serial and Mucosal Studies

A pneumatic paddle demonstrates the gastric mucosa after fluoroscopic examination.
The paddle is placed under the pyloric sphincter and duodenal bulb and inflated for an image.
Radiographs are taken as the paddle is deflated.
Fluoroscopic portion of the examination is performed by a radiologist.
This method demonstrates compression and non-compression studies of the pyloric end of the stomach and the duodenal bulb at different stages of filling and emptying.

Contrast Media

Contrast media (CM) are diagnostic agents used to enhance subject contrast in areas of low subject contrast.
CM are instilled into body orifices or injected into the vascular system, joints, and ducts.
The ability of CM to enhance contrast depends on the atomic number of the CM and the concentration of atoms per volume of the medium.
Radiopaque CM appears white on radiographs due to a decreased density.
Radiolucent CM appears black on radiographs due to an increased density.
Radiopaque CM are composed of elements with high atomic numbers (e.g., barium sulfate, iodine).
Radiolucent CM are composed of elements with low atomic numbers (e.g., air, nitrogen, carbon dioxide).
CM can be used for diagnostic and therapeutic purposes to visualize specific tissues or organs.

Types of Contrast Media

Four physical states of CM include oil, tablets, powder, and liquid.
Oil CM (e.g., Pantopaque, Dionosil) are used in myelograms and bronchograms.
Tablets are used in gallbladder studies (e.g., Biloptin, Telepaque, Cholebrine, Bilisectan, Cistobil).
Barium sulfate powder (e.g., Baryntgen) is used in studies of the gastrointestinal tract, esophagus, barium enema, and small intestinal studies.
Liquid CM encompass all iodinated and non-ionic contrast mediums.

Positive Contrast Medica

Barium sulfate (BaSO4) is used in examinations of the esophagus, small intestine, and upper gastrointestinal tract.
Iodinated CM are used in examinations of the gastrointestinal tract, kidneys, gallbladder, pancreas, heart, brain, uterus, spinal column, arteries, veins, and joints.
The atomic number of iodine is 53.

Biliary System

The liver secretes 800-1,000 ml of bile per day.
Bile aids in the digestion of fats by emulsifying fat globules.
Bile is formed in the small lobules of the liver and travels through the right or left hepatic ducts to the common hepatic duct.
The cystic duct carries bile to the gallbladder.
The common bile duct carries bile to the duodenum, where it joins the pancreatic duct.

Gallbladder

The pear-shaped gallbladder has three parts: a fundus, body, and neck.
The cystic duct, 3-4 cm long, connects the gallbladder to the common bile duct.
The gallbladder is 7-10 cm long and 3 cm wide, holding 30-40 cc of bile.
The gallbladder’s three primary functions are to store, concentrate, and contract when stimulated.
The gallbladder can exhibit various appearances, including fish scale, strawberry, sandpaper, and Courvoisier.

Common Bile Duct

The common bile duct is formed by the union of the common hepatic duct and the cystic duct.
It is 7.5 cm in length and has an internal diameter similar to a drinking straw.
The CBD descends behind the duodenum and the head of the pancreas, eventually entering the duodenum.
The CBD and pancreatic duct combine to form the hepatopancreatic ampulla, also known as the ampulla of Vater, which is a narrow passageway and a common site for the impaction of gallstones.

Intravenous Cholangiography

Intravenous cholangiography is a technique used for visualizing the biliary system.
Contrast media is injected intravenously, and radiographs are taken at 10-minute intervals until satisfactory visualization is achieved.
Maximum opacification usually takes 30-40 minutes.
Intravenous cholangiography is typically not indicated for patients with liver disease or biliary duct abnormalities.
Ultrasonography has become the preferred technique for examining the biliary system in cases of obstructive jaundice and post-cholecystectomy.

Percutaneous Transhepatic Cholangiography (PTC)

PTC is a pre-operative technique used to examine the biliary tract.
It is more invasive than other forms of cholangiography, involving a direct puncture of the biliary ducts.
PTC is used for patients with jaundice when the ductal system is dilated, but the cause of obstruction is unclear.
The procedure has increased in frequency due to the availability of the Chiba needle.
PTC can be used to place a drainage catheter for treating obstructive jaundice.
Indications for PTC include obstructive jaundice, stone extraction, and biliary drainage.
Risks include liver hemorrhage, pneumothorax, and bile leakage.

Operative Cholangiography

Operative cholangiography is performed during cholecystectomy to investigate bile duct patency, the functional status of the sphincter of the hepatopancreatic ampulla, and the presence of undetected biliary calculi.
Contrast media (6-8 cc) is injected into the CBD, and a small catheter is inserted into the cystic duct remnant.

UGIS

UGIS (Upper Gastrointestinal Series) is a radiographic examination of the esophagus, stomach, duodenum, and proximal jejunum.
Patients should refrain from food and beverages after midnight 8-9 hours prior to the examination.
A soft residue diet for two days before the examination helps prevent gas formation.
A cleansing enema is administered to ensure a properly prepared colon.

Stomach

The position of the stomach changes with body position:
- Upright: Stomach moves downward 3-6 inches.
- Right Lateral Recumbent: Stomach moves forward, with the pylorus closer to the lumbar spine.
- Supine: Stomach moves superiorly.
- Prone: Stomach moves slightly downward.
- Left Lateral Upright: Stomach moves backward, with the pylorus closer to the abdominal wall.

PA Projection

The PA projection is used to examine the stomach and duodenum.
The CR is directed to L1 for recumbent studies.
The CR should be 3-6 inches below L1-L2 for upright studies.
The greatest visceral movement between prone and upright positions occurs in asthenic patients.
An immobilization band should not be used, as it can cause filling defects and interfere with emptying and filling of the duodenal bulb.

Small Intestinal Studies

Food and drinks are withheld after evening meals in preparation for small intestinal studies.
A single contrast method uses a barium sulfate suspension to examine the colon.
A double contrast method involves two stages: first, with a barium sulfate suspension, and second, with an air enema or another gaseous enema.
In the two-stage double-contrast procedure, the colon is examined with a barium sulfate suspension, followed by an air enema after evacuation of the barium suspension.

Large Intestine

The barium sulfate suspension demonstrates the anatomy and tonus of the colon and most abnormalities.
The gaseous medium distends the lumen of the bowel and makes it visible through transparency.

Parotid Gland

Radiographic studies of the parotid gland are often performed to demonstrate calculi
For better results during a sialography for the parotid gland, the patient should fill their mouth with air and puff their cheeks out as much as possible.

Lateral Projection of the Parotid and Submandibular Gland

The lateral projection is often used to demonstrate bony structures, swelling of the parotid and submandibular glands, and calcific deposits.
The lateral projection is also used to evaluate for calcific deposits inside the parotid and submandibular glands.

Axial Projection (Intraoral Method)

The axial projection is used to demonstrate the axial view of the floor of the mouth.
The axial projection demonstrates the anteromedial part of the submandibular gland, the entire sublingual gland and its ducts, and provides an unobstructed view of the sublingual gland.

Palatography

Palatography is a radiographic study of the soft palate.
It is performed to investigate suspected tumors of the soft palate.

Oral Cholecystography (OCG)

The patient is given a fatty meal after an oral cholecystogram (OCG) to cause the gallbladder (GB) to contract, providing visual information on functional/contracting ability of the GB.

Oral Cholecystography (OCG) - PA Projection

The PA projection of the OCG is used to determine the location and presence of the opacified GB, choleliths, and to evaluate exposure factors.
This position best demonstrates milk calcium within the bile.

Oral Cholecystography (OCG) - LAO Position

The LAO position for an OCG is used to demonstrate the opacified GB away from the vertebral column.
The LAO position is useful for delineating between gas in the bowel and radiolucent stones in the GB.
This is the most common basic position of the GB.

Oral Cholecystography (OCG) - Right Lateral Position

The right lateral position for an OCG is used to demonstrate the opacified GB away from the vertebral column and bowel loops.
This position is used to differentiate GB stones from renal stones or calcified mesenteric lymph nodes.

Oral Cholecystography (OCG) - Right Lateral Decubitus

The right lateral decubitus position is used to demonstrate the fluid and calculi levels of the GB, as well as the opacified GB away from the vertebral column.
This position is also used to demonstrate multiple small stones that may not be visible in other projections.
The right lateral decubitus position can demonstrate the stratification or layering of gallstones.

Oral Cholecystography (OCG) - PA Upright Position

The upright PA position is used to demonstrate the stratification or layering of gallstones.
The upright PA position is used to demonstrate the axial representation of the opacified GB as well as the mobility of the GB.
This position also helps differentiate papilloma or tumor shadows from cholesterol calculi shadows.

Intravenous Cholangiography

Intravenous cholangiography is used to investigate the biliary ducts of cholecystectomized patients.

Intubation Method (Single CM)

Single CM is also known as a small bowel enema.
This method is used to introduce contrast media via a nasogastric tube for both therapeutic and diagnostic purposes.

Complete Reflux Examination

Complete reflux filling of the small bowel is achieved using a retention enema tip in a supine position.
The procedure is often used to diagnose small bowel obstruction and is used in combination with Glucagon to relax the intestine and Diazepam to reduce discomfort.

Large Intestine

The single-contrast method uses barium sulfate to examine the large intestine.
The double-contrast method uses barium sulfate suspension followed by an air enema or another gaseous enema.
This double-contrast method is often used to reveal the anatomy and tonus of the colon and its abnormalities.

Intravenous Urography (IVU)

An intravenous urography (IVU) uses contrast media to outline the kidneys, ureters, and bladder.
The patient should hold their breath at the end of expiration for all radiographic images.
IVU are often used to evaluate the presence of renal hypertension.

Intravenous Urography (IVU) - AP Projection (Nephrogram)

The AP projection of the IVU is used to take a nephrogram, which is a series of radiographic images taken at 1, 5, and 15 minutes after contrast injection.

Intravenous Urography (IVU) - RPO/LPO Positions

The RPO and LPO positions are used to demonstrate the kidney farthest from the image receptor (IR) in profile and the ureter nearest to the IR away from the vertebral spine.

Intravenous Urography (IVU) - Post Void

The post-void image is taken after a patient has voided. These images can demonstrate enlarged prostate or prolapse bladder, ureteral reflux and nephroptosis (postional changes in kidneys).

Intravenous Urography (IVU) - Ureteric Compression

Ureteric compression images are often used to demonstrate pyelonephritis.

Retrograde Urography

Retrograde urography is considered an operative procedure that uses contrast media introduced retrograde, meaning backward against the flow, into the pelvicalyceal system. It is often used to evaluate the urinary system in non-functional cases.

Contrast Media

Non-ionic contrast media is safer, less painful, and better tolerated by patients
Ultravist (Iopromide), Iopamiro (Iopamidol), Omnipaque (Iohexol), Amipaque (Metrizamide), Isovist (Iotrolan) are all non-ionic contrast media

Sensitivity Test

A sensitivity test is performed to check a patient’s tolerance to contrast media
A 1 cc dose of contrast media is given to the patient
Antihistamine is injected into the patient to prevent allergic reactions
The sensitivity test can be performed using the scleral, sublingual, intradermal, or intravenous methods

Methods of Administering Contrast Media

Direct methods include barium enema, retrograde pylography, and cystoscopy
Indirect methods include oral administration (through the mouth) and parenteral administration (through injection)

Sialography

Sialography is a radiologic examination of the salivary glands and ducts using contrast media
The radiopaque medium is injected into the main duct and flows into the intra-glandular ductules
Sialography is used to demonstrate inflammatory lesions, tumors, salivary fistulae, diverticulae, strictures, and calculi
The examination is performed one salivary gland at a time
A secretory stimulant is given to the patient 2-3 minutes before the procedure to open the duct and facilitate access
The patient should suck on a wedge of fresh lemon before and after the procedure to stimulate salivary flow
Radiographs are taken 10 minutes after the procedure to verify clearance of the contrast medium

Sialography: Contrast Media Introduction

The contrast medium can be introduced using manual pressure with a syringe or hydrostatic pressure
Hydrostatic pressure is achieved by attaching a syringe barrel (without the plunger) to a drip stand and setting it 28 inches (70 cm) above the patient's mouth
The filling procedure is performed under fluoroscopic guidance and spot radiographs are taken

Parotid Gland: Tangential Projection

Supine: The patient's head is rotated towards the side being examined, and the CR is perpendicular to the lateral surface of the mandibular ramus
Prone: The patient's head is resting on their chin and rotated AWAY from the side being examined; if the parotid (Stensen's) duct does not need to be visualized, the patient's head can rest on their forehead and nose

Abdominal Fistulae and Sinuses

The intestinal tract should be free of gas and fecal material for optimal visualization of fistulae and sinuses
Oblique projections are helpful for demonstrating the full extent of a sinus tract
Modified gastrointestinal procedures can help detect the origin of colonic fistulae
Iodized oil is frequently used in conjunction with a thin suspension of barium sulfate
To demonstrate a colonic fistula, the colon is filled with an enema containing the full amount of water and only one-third of the usual amount of barium
For demonstration of a fistula of the small intestine, the patient ingests a thin barium suspension, and the fistulous tract is injected with iodized oil

Esophagogram

This radiographic examination of the esophagus and pharynx uses single or double contrast media
It is also known as a barium swallow
No special preparation is required
For a full column using single contrast media, a 30%-50% weight/volume suspension is useful
For double contrast, barium or carbon dioxide crystals are used
A low viscosity, high density barium developed for double contrast gastric examination is used in double contrast esophagography
Esophagography generally uses thin and thick barium suspensions

Esophagogram: Single Contrast Media

A scout film is taken in an upright position
The patient is instructed to drink a cup of barium suspension as requested, and to swallow several mouthfuls so that the act of deglutition can be observed
Various breathing maneuvers are done under fluoroscopic observation to demonstrate lesions

Esophagogram: Double Contrast Media

A free-flowing, high density barium suspension is used
A gas-producing substance, such as carbon dioxide crystals, is added to the barium mixture or given by mouth immediately before the barium suspension is administered
The same procedure as for the single contrast esophagogram is performed and delayed images may be taken if necessary

Esophagogram: Filling Phase

This phase is used to distend the lumen of the esophagus and demonstrate its entire length
A 2:1 or 3:1 barium preparation is used

Esophagogram: Mucosal Phase

This phase is used to demonstrate the mucosal pattern of the esophagus
A 4:1 barium preparation is used

Esophagogram: Barium Swallowing Techniques

Barium passes through the esophagus more slowly if it is swallowed at the end of full inspiration
Barium is delayed in the lower part of the esophagus if it is swallowed at the end of full expiration

Esophagogram: Additional Techniques

Compression Paddle Technique:* This technique is performed with the patient prone, and a paddle is inflated beneath the patient to provide pressure to the stomach region.
Toe-Touch Maneuver:* This maneuver is performed to study possible regurgitation into the esophagus from the stomach. The cardiac orifice is observed fluoroscopically. This technique can be used to demonstrate esophageal reflux and hiatal hernias.

Esophagogram: RAO Position

MSP 35° to 40° to the IR
CR perpendicular to T5-T6 (2-3 inches below the jugular notch)
Demonstrates the entire contrast-filled esophagus free from superimposition of the heart and vertebrae
The best single projection of a barium-filled esophagus

Esophagogram: Lateral Position

The patient is placed in the lateral position facing the radiographer
2-3 exposures are made in rapid succession before the CM passes into the stomach if it is swallowed at the end of full inhalation
For demonstration of the entire esophagus, exposures are made while the patient is drinking the CM through a straw in a rapid and continuous swallow
Demonstrates the entire esophagus between the thoracic spine and heart

Esophagogram: Swimmer's Lateral

This position allows for better demonstration of the upper esophagus without the superimposition of the arms and shoulders

Esophagogram: AP/PA projection

CR is 1 inch inferior to the sternal angle (T5-T6)
The esophagus must be adequately demonstrated through the superimposed thoracic vertebrae

Upper Gastrointestinal Tract

The stomach must be empty for an examination of the upper gastrointestinal tract
The colon should be free of gas and fecal material
For preparation, the patient should follow a soft, low-residue diet for 2 days to minimize gas formation
Cleansing enemas may be given to ensure a properly prepared colon
Food and water should be withheld for 8-9 hours prior (after midnight) to the examination
If a small intestine study is to be performed, food and fluids should be withheld after the evening meal

Barium Enema: Lateral (Rectum): Robin’s Modification

This position is useful for demonstrating the rectum

Barium Enema: RPO Position

This position demonstrates the left colic flexure and descending colon
A similar image can be obtained in the LAO position

Barium Enema: LPO Position

This position demonstrates the right colic flexure, ascending colon, and sigmoid colon,
A similar image can be obtained in the RAO position

Barium Enema: AP Projection

This position shows the filled transverse colon and opacified colon including flexures and rectum

Barium Enema: Trendelenburg Position

This position separates redundant and overlapping loops of the bowel

Barium Enema: PA Projection

This position shows the filled transverse colon and opacified colon including flexures and rectum

Barium Enema: AP Axial/AP Axial Oblique Projection: Butterfly Position

AP Axial Projection
- CR 30-40 degrees cephalad to 2 inches inferior to ASIS
AP Axial Oblique Projection
- LPO position (30°- 40°) body rotation
- CR 30°- 40° cephalad to 2 inches inferior and 2 inches medial to the right ASIS
- This position provides an elongated view of the rectosigmoid area than other views

Barium Enema: PA Axial/PA Axial Oblique Projection: Butterfly Position

PA Axial Projection
- CR 30°-40° caudad to the level of ASIS
PA Axial Oblique Projection
- RAO position (35°-45°) body rotation
- CR 30°- 40° caudad to ASIS and 2 inches to the left of the lumbar spinous process
- This position provides an elongated view of the rectosigmoid area than other views

Barium Enema: Right Lateral Decubitus

CR horizontal to the level of the iliac crests
This position demonstrates the "up" medial side of the ascending colon and the lateral side of the descending colon when the colon is inflated with air
The air-inflated portion of the colon is of primary importance

Barium Enema: Left Lateral Decubitus

CR horizontal to the level of the iliac crests
This position demonstrates the "up" lateral side of the ascending colon and the medial side of the descending colon when the colon is inflated with air
The air-inflated portion of the colon is of primary importance

Barium Enema: Ventral Decubitus

CR at the level of the iliac crests
This position demonstrates the "up" posterior portions of the colon and is most valuable in double-contrast examinations

Barium Enema: Axial Projection: Chassard-Lapine Method

This method demonstrates an axial projection of the rectum, rectosigmoid junction, and sigmoid
Providing a right angle view to the AP projection, this position demonstrates the anterior and posterior surfaces of the lower portion of the bowel and allows the coils of the sigmoid to be projected free from overlapping.

Barium Enema: Billing’s

This position is used for demonstrating the recto-sigmoid area
Performed with the patient supine, with the CR 35°-45° midway between the ASIS
Helps prevent overlapping loops and separates the sigmoid colon.

Barium Enema: Oppenheimers

This position is performed with the patient supine, with the CR 12° caudad to the upper border of the symphysis pubis.

Barium Enema: Fletchers Modification

This position is performed in the LAO position (30°-35°), with the CR 30°-35° cephalad 1 inch proximal to the upper border of the symphysis pubis.

Colostomy

This general term refers to the surgical procedure of creating an artificial opening to the intestine, usually through the abdominal wall, for fecal passage
Post-operative contrast studies can determine the efficacy of treatment in cases of diverticulitis, ulcerative colitis, and to detect any new or recurrent lesions
Regional terms include colostomy, cecostomy, ileostomy, and jejunostomy

Defecography

This is a functional study of the anus and rectum during defecation and rest phases
Performed for patients with defecation dysfunction
It is also known as evacuation proctography or dynamic rectal examination
A 100% weight/volume barium sulfate paste with a special injector mechanism is used to instill the barium directly into the rectum
Lateral projections are obtained during defecation by spot filming
This evaluation includes measurements of the anorectal angle and the angle between the long axis of the anal canal and rectum

Urinary System

Kidneys normally excrete 1 to 2 liters of urine per day
The adult bladder can hold approximately 500 ml of fluid when completely full

Nasopharyngography

Performed using positive and negative contrast media to visualize the nasopharynx
Upright lateral projection is used with negative contrast media, demonstrating adenoids or hypertrophy of the pharyngeal tonsil
Central ray is directed 1.9 cm anterior to the external auditory meatus
Positive contrast media is used to assess the extent of nasopharyngeal tumors
Positive contrast media includes iodized oil and finely ground barium sulfate
Preliminary radiographic projections are SMV and upright lateral
Upon completion, patient sits up and blows through the nose to evacuate contrast media

SMV Projection

Elevate shoulders to extend the neck
OML is 40-45 degrees to the horizontal plane
CR is 15-20 degrees cephalad

Upright Lateral Projection

CR is directed horizontally to the nasopharynx

Pharyngography

Performed with an ingestible contrast medium of a thick, creamy mixture of water and barium sulfate
Fluoroscopy is used, with spot radiographs taken during deglutition, the act of swallowing
Bolus of contrast media must be projected into the pharynx at the height of laryngeal movement
Shortest exposure time must be selected
Mucosal phase study requires patient to refrain from swallowing barium sulfate again
Modified Valsalva's maneuver is used for double contrast delineation

Gunson Method

Practical technique for synchronizing exposure with the height of swallowing during deglutition studies of the pharynx and superior esophagus
Dark-colored shoestring is tied around the patient's throat above the thyroid cartilage

Laryngopharyngography

Stationary or tomographic negative contrast studies of the air-containing laryngopharyngeal structures
Studies are performed in frontal and lateral directions
Performed during respiratory and stress maneuvers
Includes 5 maneuvers: quiet inspiration, normal phonation, inspiratory phonation, Valsalva maneuver, and
At the terminal opening of the passageway into the duodenum is a circular muscle fiber called the hepatopancreatic sphincter or sphincter of Oddi which relaxes when CCK levels increase in the bloodstream

Biliary Tree

GB location varies based on body habitus
Hypersthenic: GB is higher and more lateral, 15-20 degree LAO rotation to separate GB from spine
Sthenic/Hyposthenic: GB is located halfway between the xiphoid tip and lower lateral rib margin, 20-25 degree LAO rotation to separate GB from spine
Asthenic: GB is lower and medial at the level of the iliac crest, 35-40 degree LAO rotation to separate GB from spine

Biliary System

Cholegraphy is a general term for radiographic study of the biliary system
Cholecystography is SRE of the gallbladder, also known as a cholecystogram
Cholangiography is the SRE of the biliary ducts, also known as a cholangiogram
Cholecystangiography is the SRE of the gallbladder and biliary ducts, also known as a cholecystocholangiography or a cholecystocholangiogram
Choleliths are gallstones
Cholelithiasis is the condition of having gallstones
Cholecystitis is the inflammation of the GB
Cholecystectomy is the surgical removal of the GB

Administration

Oral administration: absorbed through the intestines and carried to the liver through the portal vein
IV injection: most commonly injected at the antecubital veins and passes through the heart into the arterial circulation
Direct injection into the ducts: during biliary tract surgery or through an indwelling tube

Oral Cholecystography (OCG)

Most common SRE to study the GB
Purpose is to study the anatomy and function of the biliary system
Contrast media is ingested orally during the evening before the examination
Sodium ipodate (Biloptin) is the most widely used oral contrast media
Iopanoic acid (Telepaque) is another oral contrast media
Oral contrast media used for visualization of the GB is called a cholecystopaque

Indications for OCG

Function of the liver: assesses the liver's ability to remove contrast media from the bloodstream and excrete it with bile

Stomach

Stomach movement varies by patient position
Upright: moves downward 3-6 inches
Right Lateral Recumbent: moves forward, pylorus closer to lumbar spine
Supine: moves superiorly
Prone: moves downward
Left Lateral Upright: moves backward, pylorus closer to abdominal wall

Upper Gastrointestinal Series (UGIS)

SRE of the distal esophagus, stomach, duodenum, and proximal jejunum
Food and drinks are withheld 8-9 hours before the examination
Soft residue diet is required for 2 days to prevent gas formation
Cleansing enema is given to cleanse the colon
2 ounces of Barium Sulfate is ingested

UGIS PA Projection

Patient is in a PA recumbent position to visualize the stomach and duodenum
CR is at L1
The stomach moves superiorly 3.8-10 cm
PA upright position demonstrates size, shape and position of stomach but does not adequately visualize the fundus
CR is 3-6 inches below L1-L2

PA Projection Considerations

Greatest visceral movement between prone and upright positions occurs in asthenic patients
Immobilization band should not be used because it can create filling defects and interfere with emptying and filling of the duodenal bulb
CR placement varies based on body habitus
Sthenic: CR at L1, 1 inch left of vertebral column
Asthenic: CR 2 inches below L1
Hypersthenic: CR 2 inches above L1

UGIS right Lateral Position

PA and left lateral are better for visualizing the fundus
Right lateral is superior for visualizing the duodenal bulb

UGIS AP Projection

Stomach moves superiorly and to the left
Table tilt used to visualize hiatal hernia
Full or partial Trendelenburg for demonstration of hiatal hernia
Full Trendelenburg is best for demonstrating hiatal hernia
Best AP projection for visualizing the retrogastric portion of the duodenum and jejunum

Wolf Method

Modification of the Trendelenburg position to apply greater intraabdominal pressure
Semicylindrical compression device is used
Patient is placed in 40-45 degree RAO position
Exposure is made during the 3rd or 4th swallow
CR perpendicular to the long axis of the patient's back and centered at the level of T6-T7
This technique results in a 10-20 degree caudad angulation of the central ray

RAO Serial Compression Study

Pneumatic paddle is used to demonstrate the gastric mucosa after fluoroscopic examination
Paddle is placed under pyloric sphincter and duodenal bulb
One radiograph is taken with the paddle inflated, then additional images are taken as the paddle is deflated
Fluoroscopic portion is performed by a radiologist
This method demonstrates compression and non-compression studies of the pyloric end of the stomach and the duodenal bulb at different stages of filling and emptying

Intravenous Urography (IVU)

Procedure primarily used to evaluate the kidneys, ureters, and bladder
Contrast media is injected intravenously
CM travels through the heart into the arterial circulation and enters the liver via the hepatic artery and portal vein
CM is excreted through the kidneys and will fill the renal pelvis and calyces
IVU is considered contraindicated in patients with an abdominal mass or aneurysm, urinary stones, a colostomy, a suprapubic catheter, or traumatic injury

IVU Procedure

All exposures are taken at the end of expiration
Trendelenburg position is an alternative to ureteral compression
KUB is taken before injection to evaluate for stones or other pre-existing conditions

IVU Basic Protocol

Nephrogram: taken 1 minute after the start of injection to visualize the renal parenchyma
5 minute projection: supine is preferred, full KUB to visualize the calyces and renal pelvis
15 minute projection: supine is preferred, full KUB
20 min obliques: LPO and RPO are performed to evaluate the ureters, LPO projects the left ureter away from the spine and RPO projects the right ureter away from the spine
Post-void: taken after patient has voided to demonstrate the bladder, can also be helpful in evaluating for ureteral reflux or other abnormalities

IVU AP Projection

CR is midway between the xiphoid tip and iliac crests
Single AP projection of the kidney taken 60 minutes after injection

Nephrotomography

Performed to rule out renal hypertension

IVU RPO and LPO Positions

CR perpendicular to iliac crests
30 degree body rotation
Kidney farthest from the image receptor is in profile
Ureter closest to the image receptor is projected away from the vertebral column

IVU Post-Void

CR is perpendicular to iliac crests
Demonstrates enlarged prostate or bladder prolapse
Evaluates ureteral reflux

Erect Post-Void

Best demonstrates nephroptosis (positional change of kidneys)

IVU AP Projection Ureteric Compression

CR midway between xiphoid tip and iliac crests
Best demonstrates pyelonephritis

Retrograde Urography

Nonfunctional examination of the urinary system
Contrast media is introduced directly retrograde into the pelvicalyceal system
Operative procedure combining urologic and radiologic procedures in a sterile environment

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Description

This quiz covers various sialography techniques used in radiology, focusing on different projection methods such as lateral, oblique, and axial projections. You'll learn about patient positioning, imaging details, and the anatomical structures visualized during these procedures. Enhance your understanding of how to effectively visualize salivary glands and ducts.