Fluoroscopy Flashcards by Emily Mott

“snapshot imaging” acquiring a single image of a particular structure

Static imaging

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“live” radiography - allows for observation of movement

Dynamic imaging

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Synonymous with Optimization for Radiation Protection (ORP)

ALARA

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Three cardinal principles of radiation protection

Time, distance, shielding

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The tract from the mouth to the anus which food passes and is processed within the body

Alimentary canal

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Mid region of the abdomen

umbilical region

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Upper mid region of the abdomen

epigastric region

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Lower mid region of the abdomen

Hypogastric region

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Lower bilateral regions of the abdomen

right/left iliac regions

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Upper bilateral regions of the abdomen

right/left hypochondriac regions

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Created in the liver and travels through the hepatic ducts into the common hepatic duct and then into the cystic duct and is finally stored in the gallbladder

Bile

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Bile mixes with pancreatic enzymes from the main pancreatic duct in the _______ and is released into the proximal duodenum through the ______

Ampulla of Vater; Sphincter of Odi

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Contrast agents _____ the absorption of x-rays as they pass through the body

increase

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Contrast agents affect _______ so we can see the tissues of interest better and apart from surrounding tissues

Differential absorption

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The difference in how different materials absorb the X-rays in the beam produces the contrast that generates the detail of the image.

Differential absorption

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For a typical medical diagnostic image, the X-ray interaction with matter is primarily through the ______ and ______

Photoelectric Effect; Compton Scattering

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A drug used to slow stomach motility and constrict the gallbladder to increase bile flow

Glucagon

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Radiopaque contrast media used to help diagnose problems in the alimentary tract

Barium sulfate

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mixture of very small particles distributed evenly throughout the water

Colloidal suspension

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Barium and iodinated compounds are considered ____ contrast agents

positive

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Air is considered a _____ contrast agent

negative

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Radiographic examination specifically of the pharynx and esophagus is termed:

esophagogram, or barium swallow

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procedure designed to study the distal esophagus, stomach, and duodenum in one examination

Upper gastrointestinal series (UGI)

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Same procedure as the UGI, however, the exam continues until the contrast agent reaches the Ileocecal juncture at which time the radiologist may wish to take some spot images using a balloon paddle

Upper Gastrointestinal Series (UGI) with Small Bowel Follow Through

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Esophagography Routine images

PA/AP, RAO/LPO, Lateral

Esophagram CR entrance

Perpendicular to IR at T-6 (2-3" below jugular notch)

Obliquity RAO/LPO for esophagram

35 - 40 degrees

If the esophagus is over the vertebral column, ___ rotation is needed.

If the esophagus is over the heart, ____ rotation is needed

Less

______ contrast should be used if a perforation is suspected or if there is concern for surgery for an esophagram

water soluble

A ___ image may be taken to better demonstrate the upper esophagus without superimposition of the arms and shoulders

Twinning (Swimmers)

Expose on [inspiration/expiration] for AP/PA esophagram

expiration

patient is asked to take in a deep breath and then bear down is if trying to move their bowels while holding their breath

Valsalva maneuver

patient exhales and then tries to inhale against a closed glottis

Mueller maneuver

while supine, the patient drinks water through a straw. A positive test is indicated when barium/water refluxes back into the esophagus

Water test

A paddle is placed beneath a prone patient and then inflated as needed to provide pressure

Compression technique

while performing fluoroscopy, the cardiac orifice is monitored while the patient bends over and touches their toes

toe-touch maneuver

Routine images for upper GI series

PA/AP, RAO/LPO, right lateral

Anatomy demonstrated on upper GI series

distal esophagus, stomach, proximal duodenum

Obliquity and CR entrance for RAO upper GI series: sthenic body type

45-55 degrees at L1

Obliquity and CR entrance for RAO upper GI series: Asthenic body type

40 degrees 2' below L1

Obliquity and CR entrance for RAO upper GI series: hypersthenic body type

70 degrees 2" above L1

CR entrance for PA upper GI series: sthenic body type

L1 1" left of the vertebral column

CR entrance for PA upper GI series: asthenic body type

2" below L1

CR entrance for PA upper GI series: hypersthenic body type

2" above L1 and more midline

CR entrance for right lateral upper GI series: sthenic body type

L1 at the lower lateral rib margin and 1” to 1.5” anterior tot the MCP

CR entrance for right lateral upper GI series: asthenic body type

2" above L1

CR entrance for right lateral upper GI series: hypersthenic body type

2" below L1

Obliquity and CR entrance for LPO upper GI series: asthenic body type

30 degrees 2" below L1 and more midline

Obliquity and CR entrance for LPO upper GI series: sthenic body type

45 degrees level of L1

Obliquity and CR entrance for LPO upper GI series: hypersthenic body type

60 degrees 2" above L1

CR entrance for AP upper GI series: sthenic body type

L1 between midline and left lateral margin of abdomen

CR entrance for AP upper GI series: asthenic body type

2" below L1 and more midline

CR entrance for AP upper GI series: hypersthenic body type

2" above L1

Routine images for small bowel series/follow through

AP or PA

Images are then taken every ___ for the first hour and shown to the radiologist for a small bowel series

15 to 20 minutes

The CR should enter midline of the patient and ______ for the first hour, and then _____ after the first hour

2” above the iliac crest; at the iliac crest

On a barium enema, the air shows up as ____ on a radiograph

black

On a barium enema, the barium shows up as ____ on a radiograph

white

When the patient is prone, the ______ fills with barium

transverse colon

CR entrance for barium enema

level of iliac crest

Suspend respiration and expose on ____ for barium enema

expiration

Obliquity and CR entrance for RAO barium enema

35-45 degrees at the level of the iliac crest, 1" to the left of the MSP

Obliquity and CR entrance for LAO barium enema

35-45 degrees at the level 1”-2” above the iliac crest and 1” to the right of the MSP

The ____ is open without superimposition and the descending colon is well visualized on LAO barium enema

left colic flexure

Obliquity and CR entrance for LPO/RPO barium enema

35-45 degrees at iliac crest 1" to the elevated side

For the LPO, the ____ are open without superimposition

right colic flexure, the ascending colon, and the sigmoid colon

For the RPO, the ____ is open without superimposition and the descending colon is well visualized

left colic flexure

CR entrance for lateral rectum barium enema

level of the anterior ASIS and MCP

CR entrance for barium enema - post evacuation

iliac crest at MSP

CR entrance for AP axial barium enema

30 - 40 degrees cephalad, 2" below the ASIS

CR entrance for decubitus barium enema

level of ASIS

Which portion of the small bowel is characterized by a feathery appearance?

Jejunum

Which aspect of the stomach is most posterior?

Fundus

Types of digestive movement characteristic of the large intestine include:

Peristalsis, haustral, churning

The widest portion of the large intestine is the:

Cecum

The three bands of longitudinal muscle that cause pouch-like appearance of the large intestine are termed:

Taenia coli

The shortest segment of the small intestine is the:

duodenum

The junction between the esophagus and stomach is termed:

Esophagogastric junction

The correct order of the segments of the colon, beginning with the cecum, is:

Ascending, hepatic flexure, transverse, splenic flexure, descending, sigmoid

The correct order for the distal part of the stomach is pyloric:

Antrum, canal, orifice

The body of the stomach is between the:

Cardiac notch; incisura angularis

In which abdominal quadrant is the duodenum located?

Right upper

How many segments make up the duodenum?

Outer layer of the seromembranous sac that encloses the abdominopelvic cavity

parietal peritoneum

The distal portion of the stomach is called the:

Pyloris

Which structure creates an indentation along the margin of the mid-esophagus?

Aortic arch

Where is the angular notch located?

Distal stomach on the lesser curvature

In which body type are the large intestines located higher and more toward the lateral aspects of the body?

Hypersthenic

The esophagus terminates at the level of:

T11

The longitudinal gastric folds of the stomach are termed:

Rugae

The coordinated, rhythmic, serial contraction of smooth muscle that forces food through the digestive tract defines:

Peristalsis

T/F: If a retention-type enema tip is used, it should be removed after fluoroscopy is completed and before x-ray projections are taken to better visualize the rectal region.

False

Negative contrasts are [radiopaque/radiolucent]

Radiolucent

[x] is the most common type of positive-contrast medium used for studies of the GI system.

Barium sulfate

When positioning the tube for an axial image of the sigmoid colon, the CR is angled [x].

30 to 40 degrees

When taking a RPO image during a barium enema, if the left colic (splenic) flexure is not on the image the CR might have to be centered [x]

higher

When positioning the LPO for a Barium Enema, the CR enters 1 inch lateral to the [x] side of MSP.

elevated

The distinctive appearance of the large intestine anatomy are pouches called [x]

Haustrum

The RAO of the stomach projection / position in a double contrast UGI (done after fluoroscopy as an after film with the radiographic tube) will demonstrate the fundus filled with [x]

Barium

The LPO of the stomach projection / position in a double contrast UGI (done after fluoroscopy as an after film with the radiographic tube) will demonstrate the body of the stomach filled with [x]

Air

One part barium sulfate to one part water would be a [x] consistency barium

Thin

In the large intestine, during an air contrast barium enema, when the patient is prone, barium fills the [x] colon

Transverse

In the large intestine, during an air contrast barium enema, when a person is supine, air rises to fill structures that are most [x]

Barium sulfate [dissolves/does not dissolve] in water

does not dissolve

A contrast agent that is classified as radiolucent will produce [light/dark] areas on the image

dark

How long, at a minimum, must the patient be NPO prior to an upper GI series?

8 hours

How many segments make up the duodenum?

Four

In which quadrant does the terminal ileum connect with the large intestine?

RLQ

The initial insertion of the rectal enema tip should be pointed toward the:

Umbilicus

The shortest segment of the small intestine is the:

Duodenum

If the patient is in the prone position, what portion of the stomach will appear radiopaque if a double contrast study was performed?

Body

What contraindication(s) exist in the use of barium sulfate?

Suspected perforation

Where is the esophagus demonstrated on a properly positioned PA oblique projection of the esophagus when the patient is positioned in a 35- to 40-degree RAO position?

Between the heart and vertebral column

At the end of an esophagram or UGI study, the performing provider may check for reflux by taking images after having the patient ingest some _________

Water

In this pathology of the colon, one section of colon "slides" over another section of colon

intussusception