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MRAD2220 - Outcome 4 > Contrast Enhanced Imaging Procedures > Flashcards

Contrast Enhanced Imaging Procedures Flashcards

1
Q

What is ERCP

A

Endoscopic Retrograde Cholangiopancreatography

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2
Q

What does retrograde mean

A

Against typical flow

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3
Q

From an imaging standpoint, what is the primary function of the liver?

A

Production of bile

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4
Q

Where does bile go after the liver?

A

collected by bile ducts and carried to either:
- gallbladder for storage
- into duodenum

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5
Q

What does the biliary system consists of?

A

Bile ducts and the gallbladder

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6
Q

How many ducts come from the liver and what are they?

A

2 ducts, hepatic ducts, left and right

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7
Q

Right and left hepatic ducts join into ________ duct

A

common hepatic duct

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8
Q

Common hepatic duct unites with what?

A

the Cystic duct

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9
Q

Common hepatic duct and cystic duct join to form what?

A

Common Bile duct

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10
Q

What duct is connected to the gallbladder?

A

Cystic Duct

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11
Q

Common bile duct joins what duct before emptying into duodenum?

A

Pancreatic duct

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12
Q

What is the opening into the duodenum called for the hepatopancreatic duct?

A

Hepatopancreatic Ampulla
(ampulla of vater)

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13
Q

What controls the ampulla of vater?

A

Sphincter of Oddi

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14
Q

Functions of Gallbladder are?

A
  • storage of bile
  • concentration of bile (hydrolysis, choleliths)
  • contraction when stimulated (by cholecystokinin CCK)
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15
Q

Why do we perform PA projections for the biliary system?

A

Anatomy is mostly anterior, therefore reduces OID in PA

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16
Q

What position assists in gallbladder drainage?

A

Supine

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17
Q

What are the indications for ERCP

A

To diagnose biliary and pancreatic pathologic conditions

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18
Q

True or false, ERCP can be diagnostic or therapeutic

A

True

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19
Q

Patient’s stomach and duodenum must be empty, so how long must patient’s fast prior to exam?

A

6-8 hours

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20
Q

After the exam, what does the patient need?

A

Make sure the patient has a ride home

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21
Q

First step of ERCP procedure is insertion of the endoscope, what is done to make this easier?

A

throat is sprayed with a local anesthetic

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22
Q

Where does the endoscope end?

A

At the duodenum

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23
Q

Dense contrast strength demonstrates what?

A

Small ducts

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24
Q

Dilute contrast strength demonstrates what?

A

Small stones

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25
Why might we take oblique spot images?
To prevent overlap of common bile duct and pancreatic duct
26
Contraindications for ERCP
- Pancreatic pseudocyst (may rupture, sonography can rule this out tho) - Acute infection of biliary system - Elevated creatinine or BUN levels - History of iodine sensitivity, (not a FULL contraindication, just watch the patient carefully)
27
What are the post procedural care steps? | for HSG
- foods/drinks prohibited for a minimum 1 hr after exam - Can stop eating 10 hours max to lower irritation to stomach and small bowel - do NOT leave patient unattended for at least 1 hour after exam
28
What is HSG?
Hysterosalpingogram
29
What anatomy should be noted? | during HSG
- ovaries - uterine/fallopian tubes - uterus - vagina
30
What's the average size of fallopian tubes?
3-5" long and smaller diameter at uterine end
31
Why do we do HSGs?
- determine size, shape and position of the uterus and uterine tubes - Identify lesions like polyps, submucous tumor masses, or fistulous tracts - Investigate patency of uterine tubes in pts who can't conceive
32
What is patency?
If a vessel is open
33
When should HSGs be scheduled?
approximately 10 days after onset of menstruation
34
Why are HSGs schedules ~10 days after menstruation onset?
- endometrium is least congested - least risk of irradiating fertilized ovum
35
Who performs HSGs?
OBGYN, rad will be present to image the exam tho
36
Before the HSG procedure, the patient should:
- empty bladder - irrigate vagina and clean perineal region
37
Intestinal tract should be cleaned before exam, how?
- laxative given for constipation - cleansing enema (recommended) - No meals before exam
38
What position is the patient in for HSG?
lithotomy position
39
Where do we inject the contrast for HSG?
- fills uterus via cannula - 'spills' into peritoneal cavity if tubes are patent
40
What is the role of an X-ray tech during HSG
- set up sterile tray - add sterile items to tray - select and open indicated CM - have sterile gloves ready for OBGYN - assist rad and obgyn
41
Why are contrast studies of urinary system (CSUS) performed?
- To demonstrate renal parenchyma - CM is needed - Imaged by either x-ray or ct
42
What are the two filling techniques?
- Antegrade - Retrograde
43
Where would the kidneys be found?
- Posterior to ribs, liver and spleen - halfway b/w xiphoid and crest - or b/w T11-T12 and L3 (nephroptosis)
44
Structures of the urinary system can be either ____ or ____ peritoneal
Retroperitoneal or Intraperitoneal
45
What structures are retroperitoneal?
- Kidneys - Ureters
46
What structures are Intraperitoneal?
- Distal Ureters - Urinary Bladder - Urethra
47
Why do we use lower concentration of CM for CSUS?
Because large volume of CM is needed to fill the bladder
48
Why do we use higher concentration of CM for CSUS?
Used for excretory urography
49
Adverse reactions to CM are usually ____
Mild and short
50
What are the characteristic reactions to CM?
- feeling of warmth - flushing - Hives, sometimes
51
What are the occasional reactions to CM?
- nausea - vomiting - Edema of respiratory mucous membranes
52
How do we prep the intestinal tract for CSUS?
- Low residue diet for 1-2 days before exam - light evening meal on day before exam - If indicated, non-gas forming laxative is used - NPO after midnight the day of the exam
53
Do we perform bowel prep in infants and children?
NOT ATTEMPTED, adult prep depends on patient condition
54
Patient Preparation steps for CSUS:
- Pt should be well hydrated
55
Hydration is extra important for patients with:
- Diabetes - Multiple Myeloma - High Uric Acid Levels
56
Why is hydration extra important for those patients?
- Increased risk of CM-induced renal failure if dehydrated
57
What are the 4 urinary system procedures?
- Intravenous Urography (IVU) - Retrograde Urography - Cystography - Cystourethrography (male or female)
58
Indication for retrograde urography?
- For evaluation of collecting system in patients with renal insufficiency or contrast sensitivity
59
What projection is taken for retrograde urography?
AP supine
60
What does an AP retrograde urography image demonstrate?
- CM within kidneys and ureters
61
What is retrograde cystography?
- nonfunctional radiographic exam of the urinary bladderq
62
what are the prelim preparations for retrograde cystography?
- Protect the table from urine soilage - place pt on table for catheterization - position patient for prelim image and first cystogram
63
What projections are taken for retrograde cystography?
- AP supine - posterior oblique
64
Indications for retrograde cystography?
- Vesicoureteral Reflux - Recurrent lower UTI - Neurogenic bladder - Bladder trauma (like perforation post-op) - Lower urinary tract fistulae - Urethral stricture - Posterior urethral valves
65
What are the contraindications of Retrograde Cystography?
Related to catheterization of urethra, usually because catheterization could worsen patient condition
66
How much CM is used for retrograde cystography?
150-500mL
67
What is the purpose of Voiding cystourethrography?
- Functional study of the bladder and urethra
68
When do we perform voiding cystourehtrography?
Right after routine cystogram, catheter is removed and imaged WHILE voiding
69
Whats the difference when performing voiding cystourethrography between males and females?
Females = AP Males = 30 degree RPO
70
Cystogram central ray is...
2" superior to pubic symphysis
71
What are the routine projections of cystograms?
AP axial and Posterior Oblique
72
whats the CR for AP axial cystogram?
10-15 degrees caudad
73
What angle is the patient is positioned into for posterior oblique of cystogram?
45-60 degrees LPO/RPO
74
Evaluation criteria for AP cystogram:
- Urinary bladder not Superimposed by pubic bones
75
Eval crit for posterior oblique cystogram
- urinary bladder not superimposed by lower limbs
76
What are the specific evaluation criteria for males for cystograms?
- Distal ureter, bladder and proximal urethra on male must be included

MRAD2220 - Outcome 4 (4 decks)

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