Special Radiographic Examinations PDF

SPECIAL RADIOGRAPHIC EXAMINATIONS CHAPTER II. G.I.TRACT SIALOGRAPHY CM- H2o solution, iodinated contrast media- injected into the main ducts Indications: Inflammatory lesions and tumors,Extent of salivary fistula,Localize diverticula, strictures & calculi Procedure: ◦ Prel...

SPECIAL RADIOGRAPHIC EXAMINATIONS CHAPTER II. G.I.TRACT SIALOGRAPHY CM- H2o solution, iodinated contrast media- injected into the main ducts Indications: Inflammatory lesions and tumors,Extent of salivary fistula,Localize diverticula, strictures & calculi Procedure: ◦ Prelim Procedure: detect condition demonstrable w/o the use of C.M. Establish exposure factors ◦ 2-3 mins before procedure- secretory stimulant is administered, opens the duct for ready identification of the orifice & and for easy passage of cannula and catheter ◦ Repeated upon the completion of the exam - stimulate rapid evacuation of C.M. ◦ Film made 10 mins after procedure – verify clearance of C.M  PAROTID GLAND ◦ TANGENTIAL 8X10XWISE Ppx- recumbent or seated AP or PA supine Head rotated towards the side being examined Parotid gland perpendicular Center parotid Head resting on occiput Mandibular ramus parallel to the longitudinal axis of the body PA tangential Ppx- prone Rotate the head so that the parotid gland examined is perpendicular to film Center parotid Head resting on forehead and nose CR- perpendicular RP- outer surface of the mandibular ramus  PAROTID & SUBMAXILLARY GLANDS LATERAL Ppx- semi prone or seated erect Pp- Parotid- extend head Center 1” above gonion MSP rotated forward 15° frm 2 lateral Submaxillary- center inferior margin of the angle of the mandible Head true lateral CR- perpenpendicular RP- mid point of the film *IGLAUER MANUEVER SUBMAXILLARY & SUBLINGUAL FILM- occlusal Ppx- seated or supine Seated- px in a chair w/ suitable headrest Occlusal plane vertical, perpendicular to the tube Supine- elevate thorax Head in full extension, head on vertex flexed knees CR- perpendicular RP- film ; understructed view of sublingual gland PALATOGRAPHY BLOCK and QUANTRILL – Suspected tumors Procedure: 1st Exp : ingest Thick Baso4 2nd Exp: 0.5 ml injection of CM for each nasal cavity Lateral Center Nasopharynx Morgan: evaluates abnormalities of chewing and swallowing in children Cleft Palate studies : range of motion of the soft palate, phonation of specified vowel sound “dah, “mmm”, sss”, eee’ NASOPHARYNGHOGRAPHY- hypertrophy of pharyngeal tonsils and adenoid tumors Negative CM introduce air to the nasopharyn by breathing through your nose Lat Positive Contrast Nasopharyngography ◦ CM: - iodized oil or Baso4 paste with pressure blower ◦ Scout SMV,Lat Procedure: ◦ Local anesthetics ◦ Administer CM ◦ Obtain SMV CR midway between mandible w/ 15-20 deg ceph angle ◦ Lateral crosstable ◦ Px is asked to blow his nose ◦ Chest X-ray Chittinand et al PrelimFilm; Lateral and SMV Procedure ◦ Wet each nostrils ◦ Apply micropaque powder using a blower connected to a pressurize blower ◦ Obtain Two VSM, rest and Valsalva and Lat ◦ Px is ask to blow his nose ◦ Chest Xray after and 24 hours radiographs PHARYNGOGRAPHY Negative Contrast Pharyngography GUNSON METHOD- excellent and practical suggestion for synchronizing the exposure w/ the height of the swallowing act of deglutition studies of the pharynx and upper esophagus C.M.- thick creamy BaSo4 PROCEDURE: Tie a dark colored shoestring (metal tips removed) snugly around the px throat above the thyroid cartilage PROJECTIONS : AP & Lat LANRYNGOPHARYNGOGRAPHY Negative CM Studies -AP Supine or seated Quiet inspiration- open chords Normal expiratory phonation high pitched ee or aahh- close vocal cords Inspiratory phonation – adducts vocal cords and balloons ventricles True Valsalva – elasticity and functional integrity of glottis Mod Valsalva- elasticity of hypopharynx and piriform recess Positive contrast studies – AP/Lat CM. Ethiodized oil Procedure: Physician injects CM by means of curved metal lip cannula Spot or conventional films are taken THYROID GLAND Indication Thyroid Enlargement Motaba and Kikuchi CM: 2 ml Ethiodized oil by direct injection ESOPHAGOGRAPHY, ESOPHAGOGRAM or BARIUM SWALLOW No preliminary preparation CM- BaSO4 ( single or double contrast) Double contrast, low viscosity, High density barium Thin barium; for strictures of esophagus Thick barium; for intralumenal lesions 30 to 50% Indications: Obstruction of tumor, masses Zenkers Diverticulum Strictures or fistula GERD Esophageal varices Localization of foreign body Achalasia Barrets esophagus Hiatal hernia Positions: PA RAO ( 35-45°) LATERAL  Esophageal Varices Px is asked to- exhale fully to swallow the bolus -take a deep breath & while holding breath to swallow bolus and perform valsalva maneuver Toe Touch Manuever- demonstration of esophageal regurgitation on of suspected hiatel hernia CM- thick BaSo4 -under flouro - px w/ breathing maneuvers Cardiac Esophagogram- relationship bet heart & esophagus CM- thick BaSO4 Position: LL , RAO (55-60°) DEMONSTRATION OF ESOPHAGEAL REFLUX ❑ Breathing technique Valsalva maneuver Mueller maneuver ❑ The water test ❑ Compression paddle technique ❑ Toe touch maneuver U.G.I.S U.G.I.S- radiographic exam of distal esophagus, stomach, and duodenum ◦ Contraindications- bowel perforation ulcerations, rupture viscous the use of BaSO4 is contraindicated, water soluble iodinated contrast media may be used. ◦ Indications- Bezoar, Diverticula, Emesis, Gastric carcinoma, Gastritis, Hiatal hernia, Ulcers ❑ Schatzki’s ring- a sliding hiatal hernia produce a radiographic sign which is a ringlike constriction at the distal esophagus PREPARATIONS OF PX 1. Low residue diet for 2 days- to prevent gas formation as a result of excessive fermentation of intestinal contents 2. Cathartic or Laxative 3. Withheld smoking after midnight-nicotine stimulates gastric secretions as well as salivation 4. NPO after midnight- 8 hrs prior exam 5. Enema before exam- NSS or plain H20 (lukewarm)  GENERAL G.I. EXAM PROCEDURE ◦ Single contrast- 30 to 50% W/V range ◦ Double contrast – high contrast W/V range up to 25% ◦ Bi phasic G.I. exam-single & double contrast -both exams performed on the same day -double contrast performed first -On comparison, px is given an 15% w/v BaSO4 & a single contrast exam is performed -this approach increases the accuracy of diagnosis ◦ HYPOTONIC DEUDONOGRAPHY- primary diagnostic tool to evaluate post bulba duodenal lesions & detection of pancreatic disease Positions Employed for U.G.I.S Upright PA- (14x17) 10x12 – demo type & relative positions of stomach Upright LL-10 x 12 – demo left retrogastric space Recumbent PA- 10x12- demo gastrodeudenal surfaces situated in the frontal plane ◦ Transversely placed stomach ◦ CR- 20-25° ceph (Gugliantini)-infants /pediatric px ◦ CR-35-45° ceph (Gordon)- adults RAO posn- (one or more position) ◦ serial studies taken 30 to 40 sec interval ◦ pyloric canal, duodenal bulb ◦ peristalsis is usually more active in this position  Recumbent RL —demo duodenal loop in profile, duodenal junction in the R retrogastric space Recumbent AP -slight rotation of px towards the left ◦ -demo retrogastric posn of deudenumas a result of displacement of the stomach ◦ -investigates lesions of the anterior and posterior walls of the stomach Variations: LPO Trendelenburg Lower head end of the table 10-15° and rotating the px slightly towards the right side to place the gastroesophageal junction in profile to the right of the spine -demo esophageal regurgitations & hiatal hernia MINIMAL HIATAL HERNIAS 1. WOLF METHOD- requires the use of semi cylindrical (one flat side) radioparent compression device ; used to apply intraabdominal pressure – 14x17 Lwise Ppx- 40-45° RAO Place compression device just below the coastalmargin CR- long axis of the px back RP- T6 or T7 Inst- ingest BaSO4 in rapid continuous swallow MINIMAL HIATAL HERNIAS SOMMER-FOEGELLE METHOD- requires the use of a specially constructed 34° < board w/a 10x12 stationary grid & cassette tray Ppx- prone on