Special Procedures with Contrast PDF

SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST CONTRAST MEDIA Purpose: 1. Opacification 2. Visualization 3. Contrast Study SPECIAL PROCEDURES with CONTRAST Kinds of Contrast Media 1. Positive 2. Negative SPECIAL PRO...

SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST CONTRAST MEDIA Purpose: 1. Opacification 2. Visualization 3. Contrast Study SPECIAL PROCEDURES with CONTRAST Kinds of Contrast Media 1. Positive 2. Negative SPECIAL PROCEDURES with CONTRAST Reaction of Contrast Media 1. Histamin Imbalance - occurs patient cannot tolerate contrast media 2. Hemodynamic - occurs upon injection SPECIAL PROCEDURES with CONTRAST 3. Psychosomatic Reaction - mild transient effect associated with patient anxiety, fatigue, state of dehydration 4. Technique - includes extravasation with burning pain, hematoma numbness and vascular constriction 5. Pyrogenic - a reaction without tends to cause a rise in body temperature SPECIAL PROCEDURES with CONTRAST Effects of Hemodynamic Reaction 1. Systemic shock - sudden drop of blood pressure after injection of the cm 2. Myocardial Infarction 3. Renal Shut-down 4. Immediate reaction - hypertension - Urticaria SPECIAL PROCEDURES with CONTRAST Effects of Contrast Media on organs 1. Chemotoxic 2. Idiosyncratic - reaction caused by speed of injection or amount of medium injected. SPECIAL PROCEDURES with CONTRAST Major Reaction 1. Cardiac arrest 2. Severe bronchial spasms – prolonged contraction of muscle in the wall of the bronchi. 3. Severe Hypertension SPECIAL PROCEDURES with CONTRAST Local Reaction 1. Pain 2. Burning sensation 3. Itching 4. Vomiting 5. Rashes 6. Increased salivation 7. Increase of tears 8. Chocking SPECIAL PROCEDURES with CONTRAST Factors in Selecting the appropriate Contrast Media 1. Must be non-toxic when administered 2. Must produce adequate contrast 3. Must have suitable viscosity - quality of a sticky fluid 4. Must have suitable persistence  SPECIAL PROCEDURES with CONTRAST Method of introducing Contrast Media 1. Ingestion 2. Retrograde admin. 3. Intrathecal – intro. c.m. into a sheath 4. Parenteral – injecting into the blood stream – the most common – IV or intra-arterial SPECIAL PROCEDURES with CONTRAST Properties of BaSo4 1. Absorbs water 2. High atomic 3. in soluble in water and stable 4. can not be absorbed in the GIT 5. Non-toxic 6. it has the virtue of being relatively cheap SPECIAL PROCEDURES with CONTRAST UGI System Alimentary Canal begins at the: 1. Oral cavity 2. Pharynx 3. Esophagus 4. Small intestine 5. Large intestine, which terminates at the 6. Anus SPECIAL PROCEDURES with CONTRAST Accessory Organ of Digestion 1. Salivary Gland 2. Pancreas 3. Liver 4. Gallbladder SPECIAL PROCEDURES with CONTRAST Functions of Digestive System 1. Intake and/or digestion of food 2. Absorb digested food particles 3. Eliminate any unused material in the form of semi-solid waste product. SPECIAL PROCEDURES with CONTRAST Sialography - Radiographic Examination of the salivary glands and ducts using water- soluble iodinated contrast media - to demons. salivary glands and calculi in their ducts SPECIAL PROCEDURES with CONTRAST Indications: 1. Inflammatory lessions (obstructed or not obstructed) 2. Pain or swelling in the area 3. Palpable mass 4. Calculi 5. Strictures 6. Tumor 7. Infection 8. Dryness of mouth & eyes SPECIAL PROCEDURES with CONTRAST 1. Plain Films - to determine the presence of calculi and calcified cervical glands - 2 ml syringe - lemon juice - to promote salivation, to identify to orifice of the duct - 1-2 ml contrast media SPECIAL PROCEDURES with CONTRAST 3 Pairs of Salivary Glands 1. Parotid (Stensen’s duct) 2. Submandibular / submaxillary (wharton’s duct) 3. Sublingual (Bartholins duct) SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST 1. Parotid Gland – demonstrate stone formation. 1. AP 2. Lateral 3. Lateral Oblique SPECIAL PROCEDURES with CONTRAST 1. AP - supine/head rotated away 50 / C.R. level of the lower lip SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST 2. Lateral - semi-prone / extends the neck / R.P. 1” / 2.5 cm superior to the mandibular angle - demonstrate bony structure and any calcific deposit or swelling in the areas of parotid gland - demonstrate the three pairs of salivary gland SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST 3. Lateral Oblique (PA Tangential) - PA / head rotated 10-150 towards lateral surface of the mandibular ramus. SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST Submandibular 1. Lateral 2. Infero-superior 3. Lateral Oblique SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST Nasopharyngography – Radiographic Examination of nasopharynx following instillation of the contrast media. Indications: 1. Assess the extent of nasopharygeal tumor 2. Investigate carcinoma SPECIAL PROCEDURES with CONTRAST 2 Ways 1. Continuous breathing modified valsalva 2. Contrast media is introduced / instilled through the nostrils Premedication: - Atrophine / 30 mins. Before exam to suppress nasopharyngeal & buccal secretions SPECIAL PROCEDURES with CONTRAST C.M. = Dionosil aqueous, 8-10 ml Procedure: 1. SMV - OML 40-450 to horizontal 2. Lateral SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST PHARYNGOGRAPHY - to identify abnormalities during the active progress of deglutition  GUNSON METHOD - Synchronizing the exposure with the height of the swallowing studies of the pharynx and superior esophagus. - tying a dark colored shoestring snugly around the patient’s throat above the thyroid cartilage. SPECIAL PROCEDURES with CONTRAST Functions: 1. Acts as passageway of food 2. Air passage from nasal cavity of mouth to larynx 3. Resonating chamber for the sounds produced in the larynx - it extends form the base of the skull to the cricoid cartilage and situated behind the nose, the mouth and upper part of the throat SPECIAL PROCEDURES with CONTRAST 3 Parts of the Pharynx 1. Nasopharynx – lies behind the nose and above the soft palate 2. Oropharynx – lies behind the mouth and extends from the soft palate to the epiglottis, it is common to both respiratory and alimentary tracts SPECIAL PROCEDURES with CONTRAST 3. Laryngopharynx – extends from the upper border of the epiglottis to the lower border of the cricoid cartilage where it continues to the esophagus. - connects with the oropharynx above and the esophagus below SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST Indications: 1. Demonstrate tumor 2. “ abscess 3. “ presence of F.B. Procedures: 1. AP 2. Lateral SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST Laryngography – Radiographic examination of the larynx Indications: 1. demonstrate muscular weakness due to disease 2. to demonstrate edema or fibrosis, investigation of the malignancy SPECIAL PROCEDURES with CONTRAST Preparation: - NPO for 5 hours - Contrast Media * Dionosil 10-15 ml.  SPECIAL PROCEDURES with CONTRAST 1. Quiet inspiration – test abduction of the vocal cords. SPECIAL PROCEDURES with CONTRAST 2. Normal Phonation – test adduction of the vocal cords. – patient is instructed to take a deep breath and then exhaling slowly phonate a high or low pitched SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST 3. Inspiratory phonation/reverse phonation/aspirant maneuver - demonstrate of the laryngeal ventricle - exhale completely and then slowly inhaling to make harsh, stridulous sound SPECIAL PROCEDURES with CONTRAST  SPECIAL PROCEDURES with CONTRAST 4. Valsalva maneuver - shows complete closure of the glottis - test the elasticity and functional integrity of the glottis.  SPECIAL PROCEDURES with CONTRAST 5. Modified Valsalva- test the elasticity of the hypopharynx and piriform SPECIAL PROCEDURES with CONTRAST Esophagography / Ba. Swallow - demonstrate pharynx and esophagus - indirectly investigate suspected lesions of the heart and great vessels SPECIAL PROCEDURES with CONTRAST * Length 10” / 25-30 cm - it is located posterior to the trachea and pharynx - anterior to the vertebral column - passes through the diaphragm in front of the aorta to enter the stomach SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST 3 Segments of the esophagus 1. Cervical segment 2. Thoracic segment 3. Intra-abnormal segment SPECIAL PROCEDURES with CONTRAST 2 Phases employed 1. Filling phase - to distend the lumen of the esophagus - ratio 2:1 or 3:1 2. Mucosal phase - demonstrate the mucosal pattern of the esophagus - 4:1 ratio SPECIAL PROCEDURES with CONTRAST Indications: 1. Dysphagia 2. Barrets eso. / syndrome * stricture in the distal esophagus * developed peptic ulcer in the distal 3. Thyroid gland enlargement 4. Esophageal carcinoma – Ca of the esophagus SPECIAL PROCEDURES with CONTRAST 5. Mediastenal mass 6. Chalasia - condition abnormal relaxation of the gastro-esophageal junction - heart burn, retrosternal pain, regurgitation and eructation. - oral ejection of gas or air from the stomach; belching SPECIAL PROCEDURES with CONTRAST 6. Achalasia - condition abnormal constriction of the Gastroesophageal junction 7. Hiatal hernia - protrusion of the stomach through the wall of the diaphragm 8. Cardiomegally 9. FB CONTRAINDICATION 1. Suspected leakage from the esophagus into the mediastenum or pleural or peri-toneal cavities. 2. Aspiration into the bronchial tree SPECIAL PROCEDURES with CONTRAST Procedures performed to detect ESOPHAGEAL REFLUX 1. Breathing exercises - valsalva maneuver 2. Mueller maneuver - patient exhale and tries to inhale against a closed glottis SPECIAL PROCEDURES with CONTRAST 3. Water test - swallow a mouthful of water through a straw 4. Compression technique - compression paddle - prone * to provide pressure SPECIAL PROCEDURES with CONTRAST 5. Toe – touch maneuver - study possible regurgitation into the eso. from the stomach - eso. Reflux & hiatal hernias SPECIAL PROCEDURES with CONTRAST Procedure: 1. AP / PA 2. RPO/35-400 – esophagel varices are better seen 3. LPO 4. RAO – to throw the esophagus clear of the spine  SPECIAL PROCEDURES with CONTRAST 1. AP  SPECIAL PROCEDURES with CONTRAST 2. Lateral  SPECIAL PROCEDURES with CONTRAST 3. RAO SPECIAL PROCEDURES with CONTRAST  SPECIAL PROCEDURES with CONTRAST 2. RPO SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST 1. Demonstrate esophageal varices /patient exhale fully and then follow the barium = avoid inhaling until the exposure has been made 2. Demonstrate entire esophagus  SPECIAL PROCEDURES with CONTRAST BODY HABITUS (Classification) 1. Hypersthenic 2. Sthenic 3. Hyposthenic 4. Asthenic SPECIAL PROCEDURES with CONTRAST 1. Hypersthenic - level of the stomach is approximately T9 to T12 - doudenal bulb is at the level of T11 to T12 2. Sthenic - Stomach is at the level from T10 to T11 to L2 - doudenal bulb is at the level of L2 SPECIAL PROCEDURES with CONTRAST 1. Hypersthenic – body of one massive build which represent the upper extreme, stomach & GB occupy high, almost horizontal in position only 5% fits into this. - level of the stomach is approximately T9 to T12 - doudenal bulb is at the level of T11 to T12 SPECIAL PROCEDURES with CONTRAST 2. Sthenic – modification / Predominant type - 50% of patient fits into this type - Stomach is at the level from T10 to T11 to L2 - doudenal bulb is at the level of L2 SPECIAL PROCEDURES with CONTRAST 3. Asthenic – extremely slender build type, stomach and GB are low vertical and near the midline represent lower extreme about 10% - stomach is at the level of T11 to L4 - doudenal bulb is at the level of L3 SPECIAL PROCEDURES with CONTRAST 4. Hyposthenic – modification of extreme asthenic 35% - stomach is approximately T11 to L5 or even lower - doudenal bulb is at the level of L3 or L4 SPECIAL PROCEDURES with CONTRAST UGIS Air Barium Distribution in Stomach If an individual swallows a barium sulfate and mixture, along with some air, the position of the person’s body determines the distribution of the barium and air barium within the stomach. SPECIAL PROCEDURES with CONTRAST A. Supine - the fundus of the stomach is in the lowest part, where the heavy barium settles. B. Prone Position - the fundus is in the highest position, causing the air to fill this part of the stomach. SPECIAL PROCEDURES with CONTRAST C. Erect Position - air raises to fill the fundus, whereas barium descends by gravity to fill the pyloric portion of the stomach. Peristaltic Activity 1. The passage of solid or semisolid food from the mouth to the stomach it take from 4 to 8 seconds, whereas liquids pass in about 1 second. SPECIAL PROCEDURES with CONTRAST 2. Waves of muscular contraction in esophagus 1 to 8 seconds. 3. Churned or mixed with stomach fluid into semifluid mass termed CHYME in 2 to 6 hours. 4. Gastric emptying rate after an average meal is 2 to 6 hours. 5. Chyme normally takes 3 to 4 hours to pass through the entire small intestine. SPECIAL PROCEDURES with CONTRAST Pediatric UGI Preparation - Infant under 1 year old: NPO for 4 hours - Children older than 1 year old: NPO for 6 hours SPECIAL PROCEDURES with CONTRAST Barium Meal / UGIS - Radiographic Examination of the GIT Stomach – dilated sac like portion of the digestive tract extending from the esophagus to the small intestine. - from the greek word GASTER - dilated portion of the alimentary canal - reservoir for swallowed foods & fluids SPECIAL PROCEDURES with CONTRAST Barium Meal / UGIS - Examination of the GIT/ function * Distal esphagus * Stomach * Doudenum SPECIAL PROCEDURES with CONTRAST INDICATIONS 1. Bezoar - mass of undigested material trapped in the stomach. A. Trichobezoar - ingested hair B. Phytobezoar - ingested veges, fiber or seeds SPECIAL PROCEDURES with CONTRAST Radiographic Apperance: - light coating of BaSo4 2. Diverticula - weakening & blind out pouching of a portion of the mucosal wall 3. Emesis - an act of vomiting - identify the cause for vomiting SPECIAL PROCEDURES with CONTRAST 4. Gastritis - inflammation of the lining or mucosa A. Acute - severe pain/discomfort B. Chronic - intermittent * diet * stress SPECIAL PROCEDURES with CONTRAST 5.Dyspepsia - uncomfortable feeling of fullness, nausea & bloating 6.GI hemorrhage 7. Upper abdominal mass 8. Partial obstruction SPECIAL PROCEDURES with CONTRAST 9. Hiatal Hernia - congenital - weakening of muscle 10. Sliding of Hiatal Hernia - degree of herniation - radio. Sign SPECIAL PROCEDURES with CONTRAST Schatzke’s ring - ringlike constriction at the distal esophagus 11. Ulcers - erosions of the stomach or duodenal mucosa 12. weight loss SPECIAL PROCEDURES with CONTRAST TYPES OF ULCERS 1. Peptic - ulceration of mucous membrane - causes: of the acid gastric juice 2. Duodenal - is a peptic ulcer - frequent in the 2nd and 3rd aspect of duodenum SPECIAL PROCEDURES with CONTRAST 3. Gastric - ulcer of gastric mucosa 4. Perforating Ulcer - ulcer of the entire thickness of the wall of the stomach and intestines. SPECIAL PROCEDURES with CONTRAST 4 Parts of Stomach 1. Cardia 2. Fundus – lies above a horizontal junction of stomach and esophagus 3. Body 4. Pyloric Portion SPECIAL PROCEDURES with CONTRAST Contraindications: 1. Complete large bowel obstruction 2. History of bowel perforation and laceration SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST 2 Openings 1. Cardiac Orifice – esophagus and stomach 2. Pyloric Orifice – stomach and small intestine  SPECIAL PROCEDURES with CONTRAST Stomach Habitus 1. Eutonic or Normotonic – incisura and pylorus are at same level 2. Hypotonic – pylorus is higher than incisura angularis by 1 cm 3. Steerhorn – incisura is higher by 1 cm. than the pylorus SPECIAL PROCEDURES with CONTRAST - NPO 6-8 hrs 6 hrs. delayed - in cases of suspected pyloric stenosis - to assess gastric emptying rate 24 hrs. delayed - if under suspicion in the small intestine, appendix, ` or colon SPECIAL PROCEDURES with CONTRAST BaSo4 Preparation 1 yr. = 2 to 4 oz. 1- 3 yrs. = 4 to 6 oz. 3 – 10 yrs. = 6 t0 12 oz. Older than 10 yrs. = 12 to 16 oz. - 30 – 50% Weight Volume - 50-80 ml. – esophagus. & mocusal pattern of stomach - 300 ml – stomach & duodenum - 100 g/ 8 oz of water  SPECIAL PROCEDURES with CONTRAST Single Contrast – to demonstrate gross pathology only * children * very ill patient SPECIAL PROCEDURES with CONTRAST Double Contrast - demonstrate mucosal pattern of the stomach and to detect small lession - Gas producing tablets is given - rotate the patient 3600 * to coat gastric mucosa  SPECIAL PROCEDURES with CONTRAST 1. PA – demonstrate the relationship of stomach and retrogastric space - AP (Antrum/Body)  SPECIAL PROCEDURES with CONTRAST PA Single Contrast  SPECIAL PROCEDURES with CONTRAST PA Double Contrast  SPECIAL PROCEDURES with CONTRAST 2. RAO – demonstrate pyloric canal and duodenal bulb - Antrum / Greater curve / peristalsis of the stomach  SPECIAL PROCEDURES with CONTRAST RAO Single Contrast  SPECIAL PROCEDURES with CONTRAST RAO Double Contrast  SPECIAL PROCEDURES with CONTRAST 3. RLR – demonstrate duodenal loop, duodeno jejunal junction - demonstrate the right retrogastric space  SPECIAL PROCEDURES with CONTRAST RLR Single Contrast  SPECIAL PROCEDURES with CONTRAST RLR Double Contrast  SPECIAL PROCEDURES with CONTRAST Variations 1. LPO – demonstrate hiatal hernia - head lower by 25-300 / 10-150 body rotation  SPECIAL PROCEDURES with CONTRAST LPO Double Contrast SPECIAL PROCEDURES with CONTRAST Modifications: 1. Gordons Manuever – demonstrate pylorus and the bulb – prone – C.R. 35 – 450 cephalad - Greater and lesser curvatures -antral portion of the stomach. SPECIAL PROCEDURES with CONTRAST  SPECIAL PROCEDURES with CONTRAST 2. Gugliantini – infant – prone * to demonstrate the stomach – C.R. 20 – 250 cephalad SPECIAL PROCEDURES with CONTRAST 3. Hamptons – demonstrate leaf like pattern of the pylorus and the bulb – LPO 4. Poppel’s method – demonstrate retrogastric and evaluate pancreatic mass – Right lateral recumbent SPECIAL PROCEDURES with CONTRAST 5. Wolf Method – applying greater intra abdominal pressure – demonstrate small lesions, sliding gastro esophageal herniations – RAO – rotated body 40-450 – R.P. T6 / T7 –C.R. 10- 200 caudally SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST BIPHASIC EXAM - gastrointestinal examination wherein single & double contrast study performed at the same day. END SPECIAL PROCEDURES with CONTRAST SIS/ Ba. Meal follow through - extends from the pyloric sphincter of the stomach to the ileocecal valve - Length averages about 22 ft. (61/2)meter - Proximal 1 ½ “ (4 cm) - Distal part 1” (2-5 cm) - duodenum is 8-10 (20-25 cm.) SPECIAL PROCEDURES with CONTRAST Parts of Small Intestine 1. Duodenum - the 1st part, shortest, widest - 8-10” (20-25 cm) - located RUQ & LUQ 2. ILEUM - RLQ & LLQ - longest portion of SI - 2.5 cm diameter SPECIAL PROCEDURES with CONTRAST 3. Jejunum - LUQ & LLQ - 3-3.5 cm diameter SPECIAL PROCEDURES with CONTRAST Procedure: 1. Oral / by the mouth 2. Complete reflux exam 3. Intubation exam 4. Enteroclysis  SPECIAL PROCEDURES with CONTRAST Indications: 1. Pain 2. Diarrhea 3. Bleeding 4. Partial obstruction 5. Abdominal Mass 6. Failed small bowel enema 7. Enteritis – inflammation of SI 8. Giardiasis – infection of the lumen of SI 9. Ileus 10. Meckel’s diverticulum - Saclike outpouching of the intestinal wall - birth defect SPECIAL PROCEDURES with CONTRAST Contraindications: 1. Complete obstruction 2. Suspected Perforation 3. Dehydration SPECIAL PROCEDURES with CONTRAST Procedures: 1. AP 2. Complete Reflux - filing of small bowel about 4500 ml. to fill the colon and small intestines - glucagon may be administered to relax the intestines - Diazepam * to diminish discomfort during initial filling SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST 3. Enteroclysis - procedure in which the cm is introduce into the duodenum to examine small bowel - special polythene Tube (Bilbao or sellink tube) intro. to the esophagus into the stomach - 30 ml of barium with 60 ml of water - 1200 ml - no cleansing enema - low residue diet SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST 4. Intubation Method - A procedure in which a tube is inserted through the nose and passed into the stomach - To relieve post-operative distention or deflate on decompress an obstructed small bowel - Miller-Abbot - water soluble iodinated or thin BaSo4 SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST Hypotonic Duodenography - evaluation of post bulbar duodenal lessions & for the detection of pancreatic disease Indications: - Duodenitis - Hepatitis - Pancreatitis - Abdominal mass affecting the C-Loop SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST Large Intestine/B-E/Lower GI Tract - study the form & function of LI - detect any abnormal conditions - 5 to 5 1/2 ft. (1 ½ to 3” diameter)  SPECIAL PROCEDURES with CONTRAST Large Intestine/B-E/Lower GI Tract SPECIAL PROCEDURES with CONTRAST 2 Methods 1. Single contrast method - in which the colon is examined with barium sulfate only - 40-450F - reduction of intussusception * common to infancy * Prolapsed of 1 part of the intestine SPECIAL PROCEDURES with CONTRAST  SPECIAL PROCEDURES with CONTRAST 2. Double Contrast Method - demons. the colon & the Cecum - demons. of intraluminal lessions such as polyps - Cleansing Enema shall be prohibited to patient having * Diarrhea * Gross Bleeding * Symptoms of obstruction SPECIAL PROCEDURES with CONTRAST BaSo4 = 500-1200 ml Warm = 85-900F (29-300 C) Cold = 410F (50C) - 15% – 25% WV single contrast - 75% - 95% WV double contrast SPECIAL PROCEDURES with CONTRAST  SPECIAL PROCEDURES with CONTRAST Reasons: - to produce less irritation - stimulates tonic contraction of the anal sphincter * container is normally 90cm (36”) above the table top - to avoid undue discomfort to the px. *18-24” (45-60 cm above the level of the anus) * 90 cc of air SPECIAL PROCEDURES with CONTRAST Sim’s Position - (35-400) because this position relaxes the abdominal muscles which decreases intra- abdominal pressure on the rectum and makes relaxation of the anal sphincter.  SPECIAL PROCEDURES with CONTRAST Indications: 1. Change in Bowel habit 2. Pain 3. Mass 4. Obstruction 5. Colitis - inflammatory of LI - saw-troth appearance of “jagged” SPECIAL PROCEDURES with CONTRAST 9. Polyps - sac like projection that project inward 10. Volvulus - twisting of a portion of the intestine - most common to male 20-50 yrs, old - sign appearance “BEAK” 11. Intussesception - telescoping / invagination of one part of intestine into another - common in infants 2 yrs old - “mushroom shaped” appearance SPECIAL PROCEDURES with CONTRAST 6. Ulcerative Colitis - severe form - cobblestone appearance - develop stovepipe colon 7. Diverticulum - common to adults 40 yrs. old 8. Neoplasm - Benign tumor - “apple-core or napkin ring” appearance  SPECIAL PROCEDURES with CONTRAST Contraindications: 1. Toxic megacolon 2. Pseudomembranous colitis 3. Rectal biopsy 4. Incomplete bowel prep. 5. Recent ba. Meal  SPECIAL PROCEDURES with CONTRAST Positions: 1. AP/PA 2. LAO 3. RAO 4. Left Lateral 5. LPO 6. PA AXIAL 7. Right lateral decubitus  SPECIAL PROCEDURES with CONTRAST 1. PA – demonstrate the entire colon – Trendelenburg position helps to separate redundant / overlapping loops of the bowel  SPECIAL PROCEDURES with CONTRAST PA Single Contrast PA Double Contrast  SPECIAL PROCEDURES with CONTRAST 2. LAO – 35-450 rotation – Demonstrate the spleenic flexure and descending portion  SPECIAL PROCEDURES with CONTRAST LAO Single Contrast LAO Double Contrast  SPECIAL PROCEDURES with CONTRAST 3. RAO – Demonstrate the hepatic flexure & ascending portion of the colon and sigmoid portion of the colon  SPECIAL PROCEDURES with CONTRAST RAO Single Contrast RAO Double contrast  SPECIAL PROCEDURES with CONTRAST 4. Left Lateral - demonstrates polyps, strictures, fistula & rectosigmoid – R. P. 5-7 cm. above the level of the pubic symphesis in the MAP  SPECIAL PROCEDURES with CONTRAST LL Single Contrast LL Double Contrast  SPECIAL PROCEDURES with CONTRAST PA axial – demonstrate the rectosigmoid, rectum – prone/level of the ASIS/ 30-400  SPECIAL PROCEDURES with CONTRAST PA axial Single Contrast PA axial Double Contrast  SPECIAL PROCEDURES with CONTRAST RPO – demonstrate the spleenic flexure and descending colon - 15 -250 body rotation  SPECIAL PROCEDURES with CONTRAST RPO Single Contrast RPO Double Contrast  SPECIAL PROCEDURES with CONTRAST LPO - to demonstrate hepatic flexure and the ascending and sigmoid portion of the colon - 15-250 body rotation  SPECIAL PROCEDURES with CONTRAST LPO Single Contrast LPO Double Contrast  SPECIAL PROCEDURES with CONTRAST Right Lateral Decubitus – to show the ”up” medial side of the ascending colon & lateral side of descending portion  SPECIAL PROCEDURES with CONTRAST RLD Double Contrast  SPECIAL PROCEDURES with CONTRAST Left Lateral Decubitus - demonstrate the “up” medial side of the descending colon and the lateral side of the ascending colon  SPECIAL PROCEDURES with CONTRAST LLD Double Contrast  SPECIAL PROCEDURES with CONTRAST Post-Evacuation - demons.residual amount of CM small polyps and defects  SPECIAL PROCEDURES with CONTRAST Chassard Lapine /Jacknife - demonstrate the rectum, recto sigmoid junction and sigmoid SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST Welin Technique - early diagnosis of ulcerative colitis, regional colitis & Polyps - to demons. Intraluminal lessions - 1800-2000 cc *to obtain proper distention of the colon SPECIAL PROCEDURES with CONTRAST Billings modification - to prevent overlapping loops - supine/ASIS/CR 35-450 Robins modification - demonstrate lateral view of the recto- sigmoid colon without overlapping  SPECIAL PROCEDURES with CONTRAST COLOSTOMY - surgical procedure to from an artificial opening to the intestine - usually abdominal wall - colon is the common site of disease - performed to diver fecal materials - when there is a malignancies of the lower bowel & rectum - low residue 24 to 48 hours SPECIAL PROCEDURES with CONTRAST Post-Op Enema - determine the efficacy of tx in cases of diverticulitis - to detect new or recurrent lession DEPECOGRAPHY - performed with a defecational disfunction - patient preparation * because H2O remaining in the rectum dilutes the CM SPECIAL PROCEDURES with CONTRAST -measures anorectal angle * the angle between the long axis of the anal canal SPECIAL PROCEDURES with CONTRAST Oral Chole (Graham’s Exam) - demonstrate the GB & assess its function - Pear shaped (right-upper quadrant) - 7-10 cm long, 3 cm wide - hold 30-40cc of bile Function: 1. Store 2. Concentrate bile 3. Contract when stimulated SPECIAL PROCEDURES with CONTRAST Chole – Prefix of bile Cysto – prefix of bladder Cholecystography - radiographic investigation of the GB Cholangiography - radiographic study of the biliary ducts SPECIAL PROCEDURES with CONTRAST Choleliths – Gallstone Cholelithiasis – condition of having Gallstone Cholecystitis – inflammation of the GB Cholecystectomy – removal of GB SPECIAL PROCEDURES with CONTRAST Cholecystangiography/ Cholecystocholangioraphy - radiographic examination of the GB and biliary ducts Contrast Media - Priodax - Biloptin - Iopanoic acid - Teridax - Iopdate Calcium - Bilopaque - Cholografin SPECIAL PROCEDURES with CONTRAST  SPECIAL PROCEDURES with CONTRAST Patient Preparation: 1. avoidance of laxatives for 24 hoursbefore ingestion or injection of the medium 2. NPO 6-8 hrs 3. Fat free for 1-2 days 4. Telepaque cm (6 tabs) (12 tabs) 5. Not less than (10-12 hrs) 6. Food forbidden/H2O is encouraged SPECIAL PROCEDURES with CONTRAST C.M. 1. Telepaque – Ioponoic - 6 tabs 2. Cholebrin/iocetanic acid - 6 tabs 3. Biloptin/Sodium iopadate - 6 tabs 4. Solu-biloptin/Calcium iopadate- 3g /sachet SPECIAL PROCEDURES with CONTRAST Purpose: 1. To determine the function of liver its ability to remove the cm from the blood stream & excrete it at the bile 2. To determine the patency of the billiary ducts 3. To evaluate the contracting and emptying power of the GB 4. To detect billiary calculi SPECIAL PROCEDURES with CONTRAST Indications: 1. Nausea 2. Heartburn 3. Vomitting 4. Cholelithiasis * condition having abnormal calcifications or stones in GB 5. Milk Calcium bile * biliary stones in the GB * PA scout film SPECIAL PROCEDURES with CONTRAST 7. Non-visualization 8. Cholecystitis - acute or chronic inflammation of the GB - blockage is due to stone lodge in the neck of the GB 9. Biliary stenosis - narrowing of one of the biliary ducts 10. Congenital anomalies SPECIAL PROCEDURES with CONTRAST Contraindication: 1. Hepatorenal disease with renal impairment 2. Active GI disease * vomitting, severe diarrhea 3. Pyloric obstruction 4. Severe Jaundice 5. Liver dysfunction 6. Hypersensitivity to iodinated cm 7. Pregnancy SPECIAL PROCEDURES with CONTRAST Procedure: 1. AP 2. Oblique (RAO) 3. Post motor meal - to evaluate the contracting power of the GB 4. Erect LAO 5. Right Lateral Decubitus SPECIAL PROCEDURES with CONTRAST AP - demons. presence and location of GB - presence of choleliths SPECIAL PROCEDURES with CONTRAST RAO - Delineate bet, gas trapped in bowel from radioluscent stone in GB - 15-300 body rotation SPECIAL PROCEDURES with CONTRAST Fatty Meal Post Motor Meal SPECIAL PROCEDURES with CONTRAST Erect LAO - demons. Floating gall stones - 200 body rotation Right Lateral Decubitus - demons. Stone heavier than bile - stones lighter than bile can be visualize only by stratification / layering / dropping SPECIAL PROCEDURES with CONTRAST Cholangiography (Choledocography) - to demonstrate the hepatic and common bile ducts during operation and particular reference to patency and retained calculi. SPECIAL PROCEDURES with CONTRAST 1. Operative Cholangiography - c.m. is introduced directly to the CBD SPECIAL PROCEDURES with CONTRAST 2. Post-operative (T-Tube) - CM is introduced through the T-tube - done 10 days after surgery - RPO - water soluble CM - 25-30% concentration SPECIAL PROCEDURES with CONTRAST Percutaneous Cholangiography - to visualize the billiary tract where the c.m. is directly through the lateral abdominal wall into the intra-hepatic bile ducts via thin flexible needle. - done when the patient with jaundice of unknown cause. - pre-op radiographic exploration of the biliary tract / duct SPECIAL PROCEDURES with CONTRAST  SPECIAL PROCEDURES with CONTRAST Intravenous cholecystangiography - to investigate the biliary ducts system and particularly in a patient whose GB has been removed - 30 ml cm intravenously - if GB is present a fatty meal maybe given SPECIAL PROCEDURES with CONTRAST URINARY SYSTEM Rhandel M. Rogelio,RRT “Just don’t give up trying to do what you really want to do. When there is love and inspiration I don’t think you can go wrong” SPECIAL PROCEDURES with CONTRAST KIDNEY - pair of grandlike organs - lying retroperitoneal space - posteriorly on either side of the vert. column - upper portion of the abdomen - remove waste materials from the blood and eliminate waste in the urine - bean shaped organs SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST Kidney Functions 1. Control water balance 2. Control blood PH 3. Control electrolyte balance 4. Excretion of waste product and drugs 5. Control of blood pressure 6. Activation of vitamin D  SPECIAL PROCEDURES with CONTRAST Ureters - retroperitoneal and run over the psoas muscle, 5 cm from midline - lies anterior to the kidney  SPECIAL PROCEDURES with CONTRAST Bladder - hollow muscular organ, lies behind the symphesis pubis - acts as reservoir for urine and a contractile organ to expel urine - average capacity is 500 ml.  SPECIAL PROCEDURES with CONTRAST Urethra - infraperitoneal structures - Male 18-20 cm - Female 4 cm SPECIAL PROCEDURES with CONTRAST Divided into 3 areas: 1. Prostatic part 2. Membranous part 3. Spongy part  SPECIAL PROCEDURES with CONTRAST IVP / IVU Excretion Urography: - suspected Urinary pathology - demonstrate the anatomy and to some extent physiology and urinary tract. - it visualizes the minor and major calyceas, renal pelvis, ureters and UB SPECIAL PROCEDURES with CONTRAST ⚫ Percutaneous antegrade Pyelography ⚫ Retrograde urography ⚫ Cystoscopy ⚫ Percutaneous renal puncture ⚫ Angiographic procedures of kidney and adrenals SPECIAL PROCEDURES with CONTRAST Indications: - calculi - infections - tumors - cysts - malformation of the UT - Obstruction - Strictures - Trauma - Non-functioning kidney SPECIAL PROCEDURES with CONTRAST Contraindications: - renal failure - severe hearth disease - Pregnancy - Hypersensitivity  SPECIAL PROCEDURES with CONTRAST Preparation: - NPO 6-8 hrs. - 50-100 ml of cm - refrain from drinking fluids - to dehydrate the patient and thus avoid dilution of cm  SPECIAL PROCEDURES with CONTRAST No restrictions of fluid to patient : 1. Diabetic patient 2. Renal failure 3. Children Recommended doses: Children Neonates - 4.0 ml/kg. Babies - 3.0 ml/kg. Small Children - 1.5 ml/kg. SPECIAL PROCEDURES with CONTRAST Scout Film - verify patient prep. - determine exposure - verify positioning - Detect any abnormal calcifications SPECIAL PROCEDURES with CONTRAST  SPECIAL PROCEDURES with CONTRAST ⚫ Routine 1. AP urogram 2. RAO and LAO 3. Prone 4. Postvoiding SPECIAL PROCEDURES with CONTRAST Procedure: 1. Immediate 10-14s after injection-to show the nephrogram (renalparenchyma renal tubules) 2. 1 min (Renal area) to see the nephrogram - enables to see any filling defect - renal parenchyma SPECIAL PROCEDURES with CONTRAST 2. 5 min. (Renal area) - enables to see early calyceal filling or filling defects 3. Compression - slow the drainage of urine from the calyceal system and fill out the calyces to give clearer image - position midline in the upper margin of the sacrum SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST  SPECIAL PROCEDURES with CONTRAST Compression Band should not applied to: 1. Renal Failure 2. Obstruction 3. Children 4. Patient who had a recent abdominal surgery SPECIAL PROCEDURES with CONTRAST 4. 10 mins. (renal area) - to show the filled calyces 5. 15 mins. - to demonstrate the ureters 6. 20 minutes - show the drainage of the kidneys, ureters and bladder filling  SPECIAL PROCEDURES with CONTRAST 7. 30 mins and 45 mins - to open out the calyces or remove overlying opacities  SPECIAL PROCEDURES with CONTRAST 8.Post Micturation - show the quality of emptying any abdominal bladder shapes or reflux - 150 - assess bladder emptying SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST 9. Delayed 24 hours in cases of obstructive uropathy Additional Views: 1. Tomo – to remove overlying gas shadows or to identify of the extent of filling defects SPECIAL PROCEDURES with CONTRAST Dosage Protocol for children 0-1 yr. - 3 ml./kg. 1-2 yrs. - 30 ml./kg. 2-8 yrs. - 40 ml./kg. 8-18 yrs. - 50 ml./kg.  SPECIAL PROCEDURES with CONTRAST Hypertensive IVP - increased of Blood Pressure, caused an increase of excretion rate SPECIAL PROCEDURES with CONTRAST Urethrograms - examination of the urethra to see the caliber of the urethra SPECIAL PROCEDURES with CONTRAST Indications: 1. Strictures 2. Tears 3. Congenital abnormalities 4. Fistulas 5. After surgery 6. Diverticulae 7. Urethral valves Contraindications: 1. UTI SPECIAL PROCEDURES with CONTRAST Retrograde Urethrography - examination of the ureters and pelvicalyceal system Indications: 1. Identify if an opacity is in the ureter. 2. Previous examinations show an obstruction but the cause cannot be identified. Contraindications: 1. Current UTI / Strictures SPECIAL PROCEDURES with CONTRAST Procedure: 1. Control – identify the position of a calculus to identify the tip of any catheters. 2. 350 Oblique (RPO) - full length Cystoscope is passed per urethra and bladder SPECIAL PROCEDURES with CONTRAST Retrograde Pyelography - non-functional examination of the U.S. directly into the pelvicalyceal system - to demonstrate the kidneys and ureters in cases of doubtful lessions. - uretric catheter is introduced via urethra and bladder into the ureteric orifice. - 35 cc of cm SPECIAL PROCEDURES with CONTRAST Indications: 1. Demonstrate of the site, length lower limit the nature of an obstructive lessions 2. Demonstrate of the pelvicalyceal system after unsatisfactory excretion urograms Contraindications: 1. UTI SPECIAL PROCEDURES with CONTRAST Cystoscopy - non-functional examination of the U.S. - demons. the bladder urethra and ureteric reflux - cm 150 ml  SPECIAL PROCEDURES with CONTRAST ⚫ Routine Examination 1. AP projection 2. RPO and LPO 3. Lateral projection 4. Voiding cystourethrogram 5. PA projection 6. Chassard-lapine  SPECIAL PROCEDURES with CONTRAST - to detect bladder tumours a double contrast with air or gas insufflation is used. SPECIAL PROCEDURES with CONTRAST VCUG - study of the urethra and evaluate the patients ability to urinate Indications: 1. Trauma or involuntary loss of urine  SPECIAL PROCEDURES with CONTRAST MALE (VCUG) - to demonstrate the urethra and bladder neck - 150 ml. + 20 ml. of oily medium SPECIAL PROCEDURES with CONTRAST FEMALE (VCUG) - 150 ml. of cm + 20 ml. of more dense oily - to outline the base of the bladder and urethral catheter in site. - demonstrate defects in bladder mechanism. SPECIAL PROCEDURES with CONTRAST AP - during micturation - demonstration defects in bladder mechanism. Urography - Rad. Investigation of the renal drainage or collecting system. SPECIAL PROCEDURES with CONTRAST MALE REPRODUCTIVE ORGAN SPECIAL PROCEDURES with CONTRAST Vesiculography - is Rad. Examination of the seminal ducts which is used to investigate the abnormalities such as: 1. Cysts 2. Abscesses 3. Tumors 4. Inflammation 5. Sterility - demonstrate the vas deferens & seminal vesicle using c.m. SPECIAL PROCEDURES with CONTRAST  FEMALE REPRODUCTIVE SYSTEM SPECIAL PROCEDURES with CONTRAST Hysterosalpingography - to determine the uterus & uterine tube - to delineate such lessions as polyps submucous tumours masses & fistula tract - to investigate the patency of the uterine tube - to demonstrate the uterus & the fallopian tube and investigation of the infertility SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST Vaginography - to investigate the congenital abnormalities, vaginal fistulas and other pathologic conditions of the vagina Fetography - demonstrate the fetus in the uteru. This shall be taken18 weeks after gestation - detect suspected abnormalities of development - confirm suspected fetal death - determine the presentation and position of fetus - determine whether the pregnancy is single or multiple SPECIAL PROCEDURES with CONTRAST RADIOGRAPHIC PELVIMETRY  SPECIAL PROCEDURES with CONTRAST ⚫ Pelvimetry - Demonstrating the architecture of the maternal pelvis - Comparing the size of the fetal head with the size of the maternal bony outlet SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST Discography - demonstrate lumbar intervertebral disks by injection of 0.5 ml./lumbar puncture needle Encephalography - demonstrate the ventricular & cisternal system the brain by injection of a gas or air into the lumbar subrachnoid space or directly into the cisterna magna. SPECIAL PROCEDURES with CONTRAST ERCP - a method where the pancreatic duct is directly catheterized from the ascending duodenum via flexible fiber optic endoscope - examine biliary and pancreatic ducts - passed through the mouth to the doudenum SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST Indications: - Assess pathologies either in biliary or pancreatic duct - Provide therapy to alleviate certain pathologic conditions Contraindications: - Acute pancreatitis - Cholangitis - Pseudocyst SPECIAL PROCEDURES with CONTRAST Procedures: - Topical anesthetic sprayed to the throat * to facilitate passage of the endoscope Contrast Media - H2O based iodinated CM SPECIAL PROCEDURES with CONTRAST SPECIAL PROCEDURES with CONTRAST Myelography - demonstrate lessions of the spinal canal and cord - inject into 3rd & 4th LV - 3-6 ml. of cm YOU WILL BE A RRT IN 2023! 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