FINALS Flashcards
rad. study of the biliary system (Liver, gallbladder and biliary ducts)
CHOLEGRAPHY
Procedures included in cholegraphy
- Cholecystography
- Cholangiography
- Cholecystangiography/ Cholecystocholangiography
Routes in cholegraphy
- Mouth
- Injection to vein
- Direct injection to ducts
Indications of cholegraphy
- FX of the liver
- Patency & condition of the biliary ducts
- Concentrating and emptying power of the gallbladder
- R/O calculi or stones formed in the biliary tract
Different types of body habitus
- Hypersthenic
- Sthenic
- Hyposthenic
- Asthenic
rad. examination of the gallbladder through the oral admin of contrast media
ORAL CHOLECYSTOGRAM
Contraindications of cholecystogram
- Vomiting or diarrhea
- Pyloric obstruction
- Malabsorption syndrome
- Severe jaundice
- Liver dysfunction
- Hepatocellular disease
- Hypersensitivity to iodinated contrast media
When should laxatives be given to a patient having OCG
24 hrs before injestion/injection of CM
What kind of meal should be given to a patient having OCG
fat free meal
On a OCG procedure, CM is given in a _____ dose approx. _______ hrs after _______ meal on the _______ before exam
single, 2-3, evening, night
The usual single dose form given to patients who will have an OCG
3 g in form of 4-12 tablets
Clinical indications of OCG
Biliary calculi
CHolecystitis
Neoplasms
Biliary stenosis
stones in biliary ducts
Choledocholithiasis
– abnormal calcifications in gallbladder
Cholelithiasis
Procedures in OCG
A. Recumbent PA Proj. (Scout
B. Upright PA Proj
C. PA Oblique (LAO)
D. R. Lat.
E. AP Proj (R. Lat Decub)
Answer the following:
Recumbent Pa Projection (scout)
IP
BP
MSP
RP
CR
RESP
SS
A. Recumbent PA Proj. (Scout)
IR: 10x12 LW
BP: Prone Position
MSP: R. side of abdomen centered on midline of grid/table
RP: Last rib
CR: Perpendicular to RP
RESP: Suspended expiration
SS: Somewhat opacified gallbladder
Answer the following:
Upright PA Proj
IP
BP
MSP
RP
CR
RESP
SS
IR: 8x10 LW
BP: Upright Position, anterior side of body resting against IR
MSP: R. side of the abdomen centered on midline of grid/table
RP: 2-4 inches below last rib
CR: Horizontally directed to RP
RESP: Suspended expiration
SS: Axial representation of the opacified gallbladder
Answer the following:
PA OBLIQUE (LAO)
IP
BP
MSP
RP
CR
RESP
SS
IR: 8x10 LW
BP: Recumbent position
MSP: With px in the prone posi, elevate R side to the desired degree of obliquity (15° - 40°).
RP: At the level of the last rib
CR: Perpendicular to RP
RESP: Suspended expiration
SS: Shows opacified gallbladder free from self-superimposition
Answer the following:
R LAT
IP
BP
MSP
RP
CR
RESP
SS
IR: 8x10 LW
BP: Recumbent position
MSP: Px lies on the R side
RP: level of the last rib
CR: Perpendicular to RP
RESP: Suspended expiration
SS: Differentiate gallstones from renal stones and separate superimposition of gallbladder and the vertebrae in exceptionally thin px
Answer the following:
AP PROJECTION (R. LAT DECUBITUS)
IP
BP
MSP
RP
CR
RESP
SS
IR: 8x10 or 10x12 LW
BP: Lat. recum. position
MSP: Place px on the R side w/ body elevated 2 to 3 Inches
RP: Level of the last rib
CR: Horizontally directed to RP
RESP: Suspended expiration
SS: Demo stones that are heavier than bile and that are too small to be visible
Procedure where its indications include:
- Investigate biliary ducts of cholecystectomized pxs
- Investigate biliary ducts & gallbladder of non-cholecystectomized pxs when these structures are not visualized by OCG
- Severe vomiting & diarrhea
Intravenous cholangiography
Contraindications of intravenous cholangiography
- Px who have liver disease
- Non-intact biliary ducts
- Obstructive jaundice
Employed for pre-op rad exam of biliary tract
PERCUATENOUS TRANSHEPATIC CHOLANGIOGRAPHY (PTC)
what kind of needle is used in PTC
CHIBA “SKINNY” NEEDLE
- performed during surgery to
Demo anatomy of the biliary ductal system, drainage into the duodenum, and any residual stones in the biliary ducts. - may be performed before or following surgical removal of the gallbladder.
OPERATIVE CHOLANGIOGRAPHY
Biliary tract examination that is performed by way of the T shaped tube left in the common bile duct
POST-OPERATIVE CHOLANGIOGRAPHY
Another name for post-operative cholangiography
DELAYED/T-TUBE CHOLANGIOGRAPHY
Indications for post-op cholangiography
- Demo caliber & patency of ducts
- Status of sphincter of HPA
- Presence of residual/previously undetected stones
diagnose biliary and pancreatic pathologic conditions
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)
What is sprayed on the patients throat during ERCP
local anesthesia
How long should the patient be not allowed to drink/eat on ercp
1 hr before exam
cm used depends on gastroentero/radiologists
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)
rad demo of nasopharynx ff. the instillation of contrast media
NASOPHARYNGOGRAPHY
Indications of nasopharyngography
- Carcinoma
- Lymphosarcoma & angiofibroma
malignant neoplastic disorders of lymphoid tissue
Lymphosarcoma
small, reddish brown or even flesh-colored,
smooth, shiny papules present over the sides of the nose and medial portions of the cheeks.
Angiofibroma
WAYS TO STUDY NASOPHARYNX
+/- CM
How is +CM introduced during nasopharyngography
continuous breathing technique & modified valsalva maneuver
How is -CM introduced during nasopharyngography
introduced through nostril
What is the premed for nasopharyngography and when is it given?
ATROPINE – given 30 minutes before exam
What is the rationale behind the use of atropine during nasopharyngography?
suppress nasopharyngeal and buccal secretions
Cm used in nasopharyngography
Dianosil Aqueous (8-10ml)
Topical anesthetic used in nasopharyngography
Lignocaine 4%
Positioning for nasopharyngography
SMV PROJECTION
Answer the following:
SMV Projection (nasopharyngography)
BP
PP
OML
RP
CR
BP: Supine
PP: Shoulder elevated to extend neck
OML: 40-45° to the horizontal plane
RP: Midway between mandibular angles
CR: 15-20° cephalad
Post procedural care for nasopharyngography
Upon completion, let px sit up and blow the nose (For evacuation of CM)
rad exam of pharynx using either barium mixture/air
PHARYNGYOGRAPHY
Clinical indications of pharyngography
- demo tumor
- demo abscess
- demo presence of foreign body
WAYS TO STUDY PHARYNX
- Continuous quiet breathing & valsalva method
- Use of paste barium mixture (4:1)
Answer the following
AP PROJECTION (PHARYNX)
BP
PP
MSP
RP
CR
BP: Recumbent supine/erect
PP: Chin up (prevent mandibular shadow from obscuring the contrast filled pharynx)
MSP: Centered on the film
RP: Laryngeal prominence (Adam’s Apple)
CR: Horizontally directed or perpendicular
Answer the following
LAT PROJECTION (PHARYNX)
BP
IPL
MSP
RP
CR
FFD
BP: Lat posi Erect/Recumbent
PP: Extend chin to clear space bet. mandible & cervical spine
IPL: ┴ IR
MSP: // to IR
RP: Laryngeal prominence (Adam’s Apple)
CR: Horizontally directed or perpendicular
FFD: 72” (Erect position)
- synchronizing the exposure with the height of the swallowing act in deglutition studies
Gunson’s method
consists of tying a dark-colored shoestring (metal tips removed) snugly around the patient’s throat above the thyroid cartilage.
Gunson’s method
rad exam of larynx
Laryngography
Clinical indications of laryngography
- demo paresis
- demo edema/fibrosis
(weakening of a muscle or group of muscles)
paresis
Most useful view to visualize the larynx is soft tissue
LATERAL VIEW
Procedure for laryngography
px prep
premed
cm
- PX PREP: NPO 5 hours
- PremED: Atropine 30 minutes before exam
- CM: Dianosil 10-15ml
During AP Projection, what can you see on a laryngography procedure
Larynx is filled w/ air and trachea is overlying the cervical spine of the median plane of the body
During Lateral Projection, what can you see on a laryngography procedure
voice box is filled and free of bony superimposition
exam of lower respiratory tract; gives excellent demo of bronchial tree
BRONCHOGRAPHY
These indications are for what procedure?
- Bronchiectasis
- Other obstructions of lower bronchial tree
- Recurrent hemoptysis
Bronchography
Contraindications for bronchography
- Impairment of pulmonary fx
- Recent pneumonia
- Active tuberculosis
- Known allergies
What are the 2 contrast used in bronchography?
omnipaque and dianosil
Contrast media that is
- Low osmolaric water based contrast medium
- Rapidly absorbed from bronchi and causes less irritation to mucosal lining than other CM
Omnipaque
Contrast media that is
- Oil-based compounds
- Viscosity and inability to mix with bronchial secretions sometimes prohibit good coverage
- Residual oily CM can sometimes cause fever
Dianosil
Prelim film for bronchography
Chest PA
Positioning for bronchography
AP, oblique and lateral projections. Sometimes Trendelenburg
How is CM expelled out after a bronchography exam?
- After exam, CM is expelled out by asking px to cough
Post procedure care for bronchography
Bronchospasm and impaired respiratory function should be checked by observation up to 4 hours post-examination.
– rad exam of ventricle
Ventriculography
type of cm used in ventriculography
negative CM
What kind of frame is used in ventriculography
stereotactic frame
rad exam of spinal cord by using CM injected into the intrathecal space
myelography
These indications are for
- Herniated nucleus pulposus
Lesion that may be present w/in spinal canal or may protrude into the canal
- Cancerous or benign tumors
- Cysts
- Possible bone fragments
Myelography
Contraindications for myelography
- Blood in the cerebrospinal fluid (CSF)
- Arachnoiditis
- Increased intracranial pressure
- Recent lumbar puncture
Contrast media used in myelography
Omnipaque and Isovist
Measurement of omnipaque for myelography
9-15 ml
During myelography, Injectable sedative or muscle relaxant usually is administered _______hour before the examination.
one
Method of needle placement for myelography
- Lumbar Puncture (l3-l4)
- CISTERNAL PUNCTURE (C1-C2)
Position for lumbar puncture
left lat position
Position for cisternal puncture
Px may be seated in an erect/prone, with head flexed to open interspinous spine
What are the POSITIONING: CERVICAL REGION during myelography?
- Horizontal beam lat
- Swimmers lat horizontal beam
What are the POSITIONING THORACIC REGION during myelography?
- R. Lat Decub. – AP/PA Projection w/ horizontal beam
- L. Lat Decub – AP/PA Projection w/ horizontal beam
- R/L Lateral – vertical beam
What are the positioning for lumbar region during myelography?
Semierect Lat – horizontal beam
rad exam of individual intervertebral disks
discography
another term for discography
nucleography
indications for nucleography?
- Investigate internal disk lesions
- px only given local anesthetic to remain fully conscious
contrast media for nucleography?
- performed with a small quantity of one of the water-soluble, iodinated media injected into the center of the disk by way of a double-needle entry.
rad exam of fallopian tubes & uterus
HYSTEROSALPINOGRAPHY
A procedure that can both be diagnostic & therapeutic
Hysterosalpinography
indications of hysterosalpinography
- study infertility
- Abnormal gynecological conditions
These contraindications are for what procedure?
- Pelvic inflammation
- Vaginal/cervical infection accompanied by purulent discharge
- Immediate premenstrual/ postmenstrual phase
- Active uterine bleeding
- Pregnancy
Hysterosalpinography
Contrast media used in hysterosalpinography?
-Ethiodol
- Hypaque
- Lipiodol
- Sinografin
- Renografin
For a hysterosalpingography procedure, when should the exam take place/be scheduled?
The exam should be scheduled between the 4th and 10th day following the onset of menstruation
What position should a scout film for hysterosalpingography be in?
AP
What are the projections for Hysterosalpingography?
AP, PA, oblique and lateral
What is the reference point for hysterosalpingography?
2 inches above symphysis pubis for frontal projections
rad exam of female pelvic organs by intraperitoneal gas
Pelvic pneumography
another term for pelvic pneumography
gynecograpy/ pangynecography;
CM into vaginal canal
VAGINOGRAPHY
indications for a vaginography?
- Congenital malformations
- Vesicovaginal fistulas
- Enterovaginal fistulas
They indicated that the use of a thin barium sulfate mixture for investigation of fistulous communications w/ intestine
Lambie, Rubie, Dann
rad exam of the prostate gland
prostatography
PROSTATOGRAPHY: AP PROJECTION
IR
BP
PP
RP
CR
IR: 8x10 LW
BP: Prone
PP: MSP aligned to center of the table
RP: 2” superior to SP
CR: Directed 20-25 degrees cranially
– rad exam of seminal ducts
EPIDIDYMOVESICULOGRAPHY
Another term for epididymovesiculography
vesiculography & epididymography
The following are the indications for what?
- Investigation of selected abnormalities such as:
Cysts
Abscesses
Tumors
Inflammation
Sterility
Epididymovesiculography
CM used in epididymovesiculography
- Water soluble, iodinated
CM - Gaseous CM – for improvement of contrast in the exam of extrapelvic structures
rad exam of lacrimal system
DACRYOCYSTOGRAPHY
composed of 2 lacrimal glands & ducts w/c tears pass through nose
Lacrimal system
small oval shaped gland located at each lat. Side of rood of orbits of the eyes
Lacrimal glands
minute orifices w/r tears pass from the gland
Puncta Lacimalia
Indications for dacryocystography
- Defective development
- Stenosis
- Chronic Mucosal thickening
- Obstructive epiphora (watery eyes)
CM used in dacryocystography
- 0.5 to 2 mL Lipiodol fluid
- Oil based, iodinated CM
(Ethiodized oil)
What are the 5 procedures/positioning done in dacryocystography?
Water’s method
Caldwell’s method
Lateral projection
Straight AP Projection
Rhese’s Method
Answer: DACRYOCYSTOGRAPHY: WATERS M
BP
MSP
OML
RP
CR
BP: Prone or seated upright
MSP: Centered to midline of IR
OML: 37° to IR (Nose 3⁄4” away from the IR)
RP: Lower orbital margin
CR: Directed to RP
Answer: DACRYOCYSTOGRAPHY: CALDWELLS
BP
MSP
OML
CR
BP: Prone or seated upright
MSP: Centered to midline of IR
OML: Perpendicular to IR
CR: 15° caudally at Nasion
Answer: DACRYOCYSTOGRAPHY: LAT. PROJ
BP
MSP & IOML
CR
IPL
BP: Prone or seated upright
MSP & IOML: // to the IR
CR: 15° caudally at Nasion
IPL: Perpendicular to IR
What is the degree of rotation of the head for it to be separated from the shadows of bilaterally opacified ducts in lateral projection
10-15 deg
Answer: DACRYOCYSTOGRAPHY: STRAIGHT AP PROJECTION
FS
BP
MSP
IOML
RP
CR
FS: 8x10 LW
BP: Supine
MSP: centered midline Of table
IOML: perpendicular to table
RP: Nasion
CR: Perpendicular to RP
*Directed at RP 15-23° caudally
FFD: 36-40”
ANSWER: DACRYOCYSTOGRAPHY: RHESE METHOD (3 POINT LOWER LANDING)
FS
BP
PP
MSP
AML
RP
CR
FFD
FS: 8x10 LW
BP: Prone recumbent
PP: Head resting on nose, chin and cheek
MSP: forms an angle of 53° to the horizontal
AML: perpendicular to table
RP: Centered to the orbit
CR: Perpendicular to RP
FFD: 36-40”
rad exam of salivary glands
SIALOGRAPHY
another term for sialography
ptyalography
Per day, how many liters of saliva are produced per day?
approx. 1-1.5 L/day
abnormal connection bet. 2 organs
fistula
Ways of studying the glands?
- Right after injection
- Post motor
What should be sucked/eaten 2-3 minutes before a sialography?
fresh wedge of lemon
During a tangential projection of a parotid gland (sialography), where is the head resting?
Head is resting on occiput.
What projection of sialography has the head resting on the occiput?
AP projection
Which projection has the head resting on the chin (sialography)
PA Projection
This projection clears the space between the cervical spine and the mandibular rami
Lateral projection of parotid gland
During the lateral projection of the parotid gland, what is the MSP?
15° toward the IR from a true lateral position
Procedure in which the film placement is at the center occlusal w/in the mouth
Axial projection intraoral method submandibular and sublingual gland
*This is the only projection that gives an unobstructed image of the sublingual gland regions.
AXIAL PROJECTION
INTRAORAL METHOD
SUBMANDIBULAR& SUBLINGUAL GLAND
rad exam of paranasal sinuses
anthrography
what are the different sinuses?
(frontal, maxillary, ethmoidal, sphenoid)
Sinus below sella turcica
sphenoid
w/in lateral mass of ethmoid bone
ethmoid sinus
another term for ethmoid sinus
labyrinth sinuses
largest sinus and is present at birth
maxillary sinus
another term for maxillary sinuses
ANTRUM OF HIGHMORE
sinus posterior to glabella, larger in men than in women
frontal
CM for anthrography
LIPIODOL FLUID OF HYPAQUE 85
indication for anthrography
Chronic Sinusitis
What are the positionings for anthrography?
Straight ap upright
Water’s method
lateral projection
caldwell’s method
this positioning for anthrography demonstrates fluid level
STRIAGHT AP UPRIGHT
another name for water’s method
Mahoney’s Method
best positioning for anthrography
lateral projection
- Best positioning for frontal & ethmoidal sinuses
CALDWELL
What is the ff for STRAIGHT AP UPRIGHT ON ANTHROGRAPHY
MSP
RP
CR
SS
MSP: Centered to the VCH
RP: Nasion
CR: Directed horizontally
SS: Height of maxillary antrum & air is demonstrated
What is the ff for WATERS ON ANTHROGRAPHY
MSP
OML
RP
CR
SS
MSP: Centered to the VCH
OML: forms an angle of 37°
RP: Acanthion
CR: Directed horizontally
SS: Filling of the posterior aspect of the maxillary sinus
What is the ff for LATERAL PROJECTION ON ANTHROGRAPHY
MSP
IOML
RP
CR
SS
MSP: // to film
IOML: Perpendicular to the film
RP: Zygomatic bone or outer canthus of the eye
CR: Directed horizontally
SS: There will be filling of posterior aspect of the maxillary sinus
What is the ff for CALDWELL ON ANTHROGRAPHY
MSP
RP
CR
MSP: Centered to the midline of the VCH
RP: Nasion
CR: Directed 12-15° caudally
Rad exam of synovial joints
arthrography
CM used in arthrography
- radiolucent –CM
-radiopaque +CM - combination of CM which is the most common
positioning for arthrography
ap, lat