Transcript Assorted Contrast Exams

Unit 9
Radiography of the Biliary System
RDSC 233
and assorted contrast examinations
Bontrager page numbers in white
Anatomy
D
Done
I
Infrequent
RE
Rare or extinct
Procedures covered in unit 9
Oral Cholecystogram (OCG) 519-537 for all GB & biliary
Surgical Cholangiogram
T-tube Cholangiogram
Percutaneous Transhepatic Cholangiogram (PTC)
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Intravenous Cholangiogram (IVC)
Myelography 734-738
Sialography 739-741
Dacrocystography
Arthrography 726-730
Lymphangiogram 677 & 690
Hysterosalpingography (HSG) 731-733
Cavernosogram & Spongiosogram
Atlas of Human Anatomy
Second edition (276)
Need to know
Gallbladder: fundus, body, neck
Cystic duct
Rt. & Lt. hepatic duct
Common hepatic duct
Common bile duct
Ampulla of Vater
Sphincter of Oddi
Pancreatic duct (of Wirsung)
Duodenal papilla (of Vater) in
descending or 2nd part.
Atlas of Human Anatomy
Second edition (277)
Note worthy
Variations in
biliary anatomy
Oral Cholecystogram (OCG)
I
Prior to ultrasound proving its value in hepatic and biliary imaging, the OCG
was a common examination for diagnosis of cholelithiasis (gallstones). It
was often done in conjunction with an UGI
Patient Prep: Fatty meal day before (empties GB).
Fat free evening meal.
Contrast:
Four or six tablets or capsules taken
NPO:
in ½ hour intervals
at midnight. No fats after contrast
is taken (or contrast is flushed from
contractions of GB)
Calcium stones (opaque) seen in recumbent spots
The examination begins with fluoroscopy.
A 4-on-1 film is done upright, followed by
a 4-on-1 supine. Inspiration, expiration,
compression, and changes in position are
used to free the GB from bowel gas, ribs,
and the spine, to visualize hard to see
stones.
Cholesterol stones (lucent) seen in recumbent spot. Note the stratification of the stones.
Oral Cholecystogram (OCG)
Following fluoroscopy, overhead films are often taken. Note the relationship
of the GB to the 12th rib on these examples.
The LAO is the
gallbladder film.
Why? Consider
the position of
the gallbladder
relative to the
spine.
Right lateral
decubitus
provides a
horizontal
beam
Why right, and
not left?
The PA is usually
routine.
Post fatty
meal.
Gallbladders were
made for using a
cylinder cone.
Bacon & eggs
(or x-nog)
to demonstrate
contractibility.
Operative, Surgical, or Immediate Cholangiogram
D
Surgical cholangiograms are done to find residual stones in the hepatic or
common bile ducts after a cholecystectomy (removal of the GB) that
is done as a laparotomy, (surgical opening of abdomen) or laprascopic surgery.
Iodine contrast is hand injected by the surgeon, through a catheter inserted
into the opening that was the cystic duct.
This cholecystectomy
was performed through
an incision, as evidenced
by the hemostats.
Two films are taken. The
first injection is a few CCs
to fill the biliary tree.
The second spills contrast
into the duodenum,
When the patent must be supine, the RPO position assuring that nothing is
frees the biliary tree of superimposition on the spine missed.
T-Tube Cholangiogram
One side of
T in common
hepatic duct.
One side of
T in common
bile duct.
D
When the gallbladder is removed stones may
be missed. If residual stones are suspect a TTube is left in the bile ducts. Bile drains through
it, and the tube provides access to remaining
stones without reopening the incision.
T-tube cholangiograms
are performed under
fluoroscopy. Positions
for filming are AP and
RPO.
When draining bile and
preparing for the
contrast injection it is
imperative to keep air
out of the tube. Air
bubbles look like
cholesterol stones.
Air
Stones?
T-Tube Cholangiogram
Stone Basket Removal
A basket catheter, passed through
the T-Tube, can snare and remove
residual stones.
Percutaneous Transhepatic Cholangiogram (PTC)
I
RE
When obstruction
casues dilation
of the biliary tree,
and cessation of
bile excretion,
jaundice results.
Access to the biliary
tree may be gained
by direct needle
puncture through
the liver (transhepatic).
Iodine contrast is injected and obstructions
are demonstrated by a filling defect, or by
a columniation of contrast to the point of
obstruction.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
D
An ERCP is a fairly common examination that gains access to the bile ducts
and pancreatic duct through catheterization via a duodenoscope. It is
performed by a gastroenterologist, under
Duodenoscope
fluoroscopic control.
Injection cannula
Cystic duct with spiral valves
The potential for stone removal makes
an ERCP diagnostic and theraputic
Intravenous Cholangiogram (IVC)
RE
When the gallbladder did not visualize
using the oral contrast of the OCG,
a liquid iodine preparation could be
drip infused. Concentration in the bile
ducts was minimal, so tomograms
were taken in the RPO position.
The exam could take over an hour,
and the patient could not move in
the slightest.
Biliary Sent
Atlas of Human Anatomy
Second edition (148)
Need to know
Dura mater
Arachnoid mater
Subarachnoid space
Pia mater
Spinal cord and nerves
Myelography
I
Radiographic examination of the spinal cord and associated
spinal nerves using iodine contrast. Herniation of intervertebral
disk material is the primary indication.
Non-ion iodine contast is injected into the subarachnoid space.
Contrast
Spinal nerve
Encroachment on the spinal cord or nerves is demonstrated as a filling
defect. Disk material, tumors, subluxed vertebra, or fracture fragments
impressing the vertebral canal will create such defects on a myelogram.
Atlas of Human Anatomy
Second edition (55)
Need to know
Parotid glands
Stensen’s (parotid) duct
Submandibular glands
Wharton’s (submandibular) duct
Sublingual gland
Bartholin’s (sublingual) ducts
Caruncle
Sialography
I
Sialograms are radiographic investigations of the
salivary ducts and glands for obstructions caused
by tumors or calculi.
Sucking on a lemon promotes salivation
Cannula in and makes the ducts easier to find and
Stensen’s cannulize.
duct
Cannula in
Wharton’s
duct
Parotid gland
Shown on
xerographic
paper
A cardboard film in the mouth may demonstrate calculi in Bartholin’s
ducts and the sublingual glands from an inferosuperior projection.
Submandibular
gland
Atlas of Human Anatomy
Second edition (77)
Need to know
Orbital part of lacrimal gland
and ducts
Lacrimal sac
Nasolacrimal duct
Inferior nasal meatus
Dacrocystogram
I
lacrimal cannula
Radiographic examination of
the lacrimal apparatus.
The lacrimal duct is cannulized
with a lacrimal cannula (may be
used for a sialogram). Contrast
is injected.
If contrast spills into the
nasopharynx, the lacrimal duct
is patent.
contrast in the
nasopharynx
Atlas of Human Anatomy
Second edition (477,48049)
Need to know
Synovial membranes
Articular cartlages
Menisci
Bursa
Ligaments
Arthrography
D
Radiographic examination of synovial joints
Knees and shoulders are done most frequently, though
tempromandibular (TMJ), hips, ankles, elbows, and wrists are possibilities.
Both air (negative) and iodine contrast
may be injected by a radiologist.
The part is exercised and stressed
to maximize the visibility of tears
in menisci, the joint capsule,
or ligaments.
Overhead films are those
routine for the part being
examined.
Tear in the medial
meniscus of the knee
Arthrography
D
Spot films are typically
taken during arthrograms.
Because the part of
interest is small, and
numerous views and
stressing of the part
is required, many
exposures may be taken.
Here 9 on 1s are taken
on a 9” x 9” spot film.
Atlas of Human Anatomy
Second edition (321,249)
Need to know
Lymph vessels and nodes
Lymphangiogram
I
Radiographic examination of the lymphatic system, primarily for lymphoma.
1. Inject blue dye between toes to localize lymph channels
2. Cut down to lymph vessel on dorsum of foot.
3. Contrast is injected slowly (45 minutes to an hour) due to the fragility
of lymph vessels. Pediatric needles are used.
4. Films are taken the same day, though
the contrast will not travel much
further than the abdominal nodes.
5. The patient returns in 24 hours
for a full set of films, abdominal
and thoracic, in frontal, oblique,
and lateral positions.
First day films show mostly
lymph channels.
Lymphangiogram
24 hour films show nodes.
Atlas of Human Anatomy
Second edition (337-346)
Need to know
Uterus: fundus & body
Cervix
External and internal
cervical os
Fallopian tube (ovaduct)
Frimbriae
Hysterosalpingography (HSG)
I
Radiographic examination primarily done
to assess patency of the fallopian tubes
in cases of infertility.
Done in the lithotomy positon. Gynecologist
prepares for injection by speading the vaginal canal with a speculum.
A catheter with an acorn or balloon tip seals the external os. Contrast is
injected into the body of the uterus
Fallopian tubes
Contrast
in body of
uterus
Catheter
Catheter
Hysterosalpingography
After filling the uterus
and fallopian tubes,
the contrast will spill
into the peritoneal
cavity, which is the sign
of patent ovaducts.
The most common
gynecological problem
is a benign tumor
called a leiomyoma
(uterine fibroma or
fybroid tumor are common,
though improper names).
Because the pressure
of the contrast may
clear the tubes of
a blockage, a
hysterosalpingogram
may be a theraputic
as well as a diagnostic
examination.
These benign tumors of the
uterine muscle become troublesome when they become numerous or large, and sometimes
begin to bleed. Here an extraordinarily large, calcified leiomyoma.
Atlas of Human Anatomy
Second edition (356, 338, 362)
Need to know
Corpus cavernosa of penis
Corpus spongiosum of penis
Bulb of penis
Crus of penis
Cavernosogram & Spongiosogram
RE
Injection of iodine contrast into the corpus cavernosa or spongiosum to
evaluate inflammation (cavernositis) or failures of the erectile tissue to
fill or drain.
The quiz you may never take (as a quiz)
1. What is the name of the condition of having gallstones?
2. When doing an OCG, what body position best demonstrates the
gallbladder free of superimposition of the spine
3. What is the name for the surgical removal of the gallbladder?
4. What is the name for surgically incising the abdominal cavity?
5. If a surgical cholangiogram demonstrates a large portion of
the duodenum with contrast, which film in the series is it?
6. When doing a surgical cholangiogram, what body position best
demonstrates the gallbladder free of superimposition of the spine?
7. What is a T-Tube? Where is it located?
The quiz you may never take (as a quiz)
8.
What procedure is a stone basket catheter associated with?
9.
Who is the medical specialist that performs an ERCP?
10. What is the name of the endoscopic instrument used for an ERCP?
11. What is the name of the space where contrast in injected for a
myelogram?
12. At what vertebral interspace is a lumber puncture commonly
performed?
13. Name the three glands associated with a sialogram
14. What is demonstrated on a dacrocystogram
15. What does “patent” mean?
The quiz you may never take (as a quiz)
16. What are the two most common arthrogram examinations?
17. What kind of joint is examined by arthrography?
18. What examination of the female reproductive tract is done to
assess the patency of the fallopian tubes
19. What is the sign of patent tubes in the examination named in 18?
20. What are the names of the erectile tissues of the penis?
21. What is a radiographic examination of the lymphatic system called?
22. What is injected to localize lymph channels, and where is it injected?