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MEDIMAGE 301 > Fluoroscopy > Flashcards

Fluoroscopy Flashcards

1
Q

Key principles of patient care in radiology

A

Efficiency & organization to minimize patient discomfort.

Clear communication throughout the procedure.

Recognizing and troubleshooting errors to avoid repeats.

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2
Q

What is the minimum lead equivalence for a lead apron?

A

0.5mm Pb equivalence to reduce radiation exposure.

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3
Q

What personal protective equipment (PPE) should be worn in fluoroscopy?

A

Lead apron (0.5mm Pb)

Thyroid shield

Eye protection (lead glasses if available)

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4
Q

How should the image receptor (IR) be positioned in fluoroscopy?

A

As close to the patient as possible to reduce dose and improve image quality.

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5
Q

Why is time important in fluoroscopy?

A

Longer exposure increases radiation dose, so use shortest fluoroscopy time possible.

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6
Q

What emergency procedures should be considered in fluoroscopy?

A

Recognizing adverse reactions (e.g., contrast reactions).

Knowing radiation overexposure protocols.

Being prepared for equipment malfunctions.

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7
Q

What are key aspects of quality assurance (QA) in radiology?

A

Regular equipment calibration.

Checking radiation shielding (e.g., lead aprons for cracks).

Monitoring dose levels for optimization.

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8
Q

What is barium contrast made of?

A

Barium sulfate (BaSO₄), atomic number 56.

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9
Q

Why is barium better than water-soluble contrast for GI studies?

A

Better mucosal coating for detailed imaging.

Low cost compared to other agents.

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10
Q

What is a major risk of using barium contrast?

A

If there is a bowel perforation, barium can escape into the gut and cause peritonitis.

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11
Q

Why should CT be delayed after using barium contrast?

A

Barium can take up to 2 weeks to clear, potentially interfering with CT imaging.

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12
Q

What is Omnipaque 300/350?

A

An iodine-based contrast medium (CM) with an atomic number of 53.

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13
Q

What are the administration routes for iodine-based contrast?

A

Can be given intravenously, orally, or rectally.

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14
Q

Why is knowledge of contrast media (CM) reactions important?

A

Allergic reactions (e.g., rash, anaphylaxis) can occur.

Can cause contrast-induced nephropathy (CIN) in at-risk patients.

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15
Q

When is iodine-based contrast (e.g., Gastrografin) preferred over barium?

A

Threatening perforation
Suspected partial or complete stenosis (obstruction)

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16
Q

Why is barium usually superior for GI studies?

A

Barium provides better mucosal coating than water-soluble contrast agents.

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17
Q

What are some minor reactions to iodine-based contrast?

A

Flushing
Nausea, vomiting
Pruritus (itching)
Metallic taste
Light-headedness
Mild urticaria (hives)

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18
Q

How are minor contrast reactions managed?

A

Close observation and reassurance.

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19
Q

What are some moderate reactions to iodine-based contrast?

A

Moderate to severe urticaria
Tachycardia or bradycardia
Hypotension
Bronchospasm & wheezing

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20
Q

How are moderate contrast reactions managed?

A

Prompt treatment with close observation (e.g., antihistamines, IV fluids, oxygen if needed).

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21
Q

What are some severe reactions to iodine-based contrast?

A

Laryngeal edema (swelling of the throat)
Marked hypotension
Loss of consciousness
Cardiopulmonary arrest

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22
Q

What is the digestive function of the pancreas?

A

It produces enzymes that assist in the breakdown of food.

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23
Q

What is the digestive function of the liver?

A

The liver produces bile, which aids in fat digestion.

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24
Q

What is the function of the gallbladder?

A

The gallbladder collects, stores, and concentrates bile for digestion.

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25
What are the main hepatic ducts?
Right hepatic duct Left hepatic duct Common hepatic duct (formed by the right and left ducts)
26
What is the function of the cystic duct?
It connects the gallbladder to the common bile duct.
27
Where does the common bile duct drain?
It enters the duodenum, carrying bile for digestion.
28
What is the function of the pancreatic duct?
It joins the common bile duct, allowing pancreatic enzymes to enter the duodenum.
29
What are some conditions that may cause biliary obstruction?
Congenital anomalies (e.g., choledochal cysts) Cholecystitis (inflammation of the gallbladder) Polyps Cholelithiasis (gallstones) Strictures Choledocholithiasis (stones in the common bile duct) Malignant tumours Jaundice (persistent and not improving)
30
What is ERCP?
A fluoroscopic procedure where an endoscope cannulates the ampulla of Vater and iodinated contrast is injected retrograde into the common bile duct.
31
What are the two main purposes of an ERCP?
Diagnostic – Identifies biliary and pancreatic duct pathology. Therapeutic (IR procedure) – Can remove stones, place stents, or dilate strictures.
32
What are absolute contraindications for ERCP?
Unstable cardiopulmonary, neurologic, or cardiovascular status. Existing bowel perforation.
33
What gastrointestinal conditions may impede access during ERCP?
Oesophageal stricture. Oesophageal diverticulum.
34
Why is acute pancreatitis typically a contraindication for ERCP?
ERCP can worsen pancreatic inflammation, making the condition more severe.
35
What laboratory tests are required before an ERCP?
Complete blood count (CBC). Coagulation studies. Liver function tests.
36
What are the fasting (NPM) requirements for ERCP?
Nil per mouth (NPM) overnight to prevent aspiration.
37
What medications are used before ERCP?
Atropine (1 hour before) – Reduces secretions. Xylocaine spray – Anaesthetizes the throat to ease endoscope insertion. Glucagon IV (10 min before) – Relaxes the duodenum to aid cannulation.
38
What contrast media is used for ERCP, and how is it diluted?
Omnipaque 350, typically diluted 14 mL Omnipaque 350 + 6 mL sterile saline.
39
Where can biliary stones be located?
Common bile duct (CBD). Cystic duct.
40
How are common bile duct (CBD) stones typically removed?
ERCP is used to remove most CBD stones.
41
Why might some common bile duct stones not be removable via ERCP?
Some stones are too large to be pulled through the sphincter of Oddi.
42
What procedure can help remove large common bile duct stones?
Sphincterotomy – a surgical cut to widen the sphincter of Oddi, allowing stone removal.
43
How is the patient's gag reflex managed during ERCP?
The back of the throat is sprayed with a local anesthetic to numb the gag reflex.
44
Why is glucagon given during ERCP?
It acts as an antispasmodic to reduce duodenal spasms and relax the sphincter of Oddi for endoscope passage.
45
Describe the path of the endoscope in ERCP.
Mouth → Oesophagus → Stomach. Through the pyloric sphincter into the descending duodenum. A cannula is inserted into the ampulla of Vater → Common bile or pancreatic duct.
46
How is cannula placement verified during ERCP?
Fluoroscopy is used to confirm correct positioning in the bile or pancreatic duct.
47
Why is the patient kept NBM (nil by mouth) after ERCP?
The throat remains numb, increasing the risk of aspiration.
48
When can a patient leave the recovery area after ERCP?
Once they have fully regained consciousness.
49
What are the main complications of ERCP?
Post-ERCP pancreatitis, Bleeding, Infection, Perforation
50
What imaging modalities can be used to investigate the biliary system?
Ultrasound (US), CT Scan, Magnetic Resonance Cholangiopancreatography (MRCP), Radionuclide Cholangiography (Cholescintigraphy)
51
What is MRCP?
A non-invasive MRI exam that visualizes the gallbladder, biliary tree, and pancreatic duct.
52
Why is MRCP often performed before ERCP?
MRCP helps determine if a therapeutic ERCP is necessary.
53
How does MRCP differ from ERCP?
MRCP is purely diagnostic (non-invasive). ERCP is both diagnostic & therapeutic (invasive, allows intervention).
54
When is MRCP preferred over ERCP?
MRCP is used in patients with renal complications or allergy to iodinated contrast.
55
What is a T-Tube Cholangiogram?
A T-tube is surgically placed into the cystic duct stump and advanced into the common hepatic and common bile duct for biliary drainage and visualization.
56
What does a T-Tube Cholangiogram visualize after gallbladder removal?
It visualizes the bile ducts to ensure drainage of bile and detect any remaining stones or sludge after cholecystectomy.
57
What is the primary purpose of a T-Tube Cholangiogram?
To rule out the presence of stones in the biliary tree post-cholecystectomy and to assess biliary leaks.
58
What contrast media is used in a T-Tube Cholangiogram?
Omnipaque 300/350 is used, with 20 mL diluted contrast media injected into the T-tube for imaging.
59
What is the purpose of injecting contrast media into the T-tube during the cholangiogram?
The contrast media helps visualize the bile ducts, check for stones, and assess for biliary leaks after gallbladder removal.
60
When is a T-Tube commonly inserted?
A T-tube is commonly inserted during a cholecystectomy to aid in bile drainage and prevent bile leakage post-surgery.
61
What is a Hysterosalpingogram (HSG)?
A special X-ray procedure used to examine the uterus and fallopian tubes. Contrast dye is injected into the uterus via the cervix. X-rays show if the fallopian tubes are open and assess uterine shape. Commonly used in infertility investigations.
62
What are the contraindications for Hysterosalpingography?
Pregnancy, Acute/subacute pelvic inflammatory disease, Active uterine bleeding
63
When should the Hysterosalpingogram booking be made to exclude pregnancy?
It should be scheduled during the first 7–12 days of the menstrual cycle to exclude pregnancy.
64
What patient preparations are required for Hysterosalpingography?
Consent, Explanation, Reassurance
65
What are the characteristics of water-soluble iodinated contrast media used in HSG?
Easily absorbed, Does not leave residue in the uterus or peritoneal cavity
66
Why was oil-based iodinated contrast media historically used in HSG?
It was used due to slower absorption but had the risk of oil embolus.
67
Describe the initial steps of the Hysterosalpingography procedure.
Patient is placed in the lithotomy position. Vaginal speculum is inserted. A cannula or catheter is placed into the cervical canal. A balloon catheter or suction cap may be used to prevent spillage.
68
How much contrast media is used in Hysterosalpingography, and what is the expected outcome if the fallopian tubes are patent?
5 mL is slowly introduced into the uterus. An additional 5 mL may be required to fill the fallopian tubes. If patent, there will be spillage into the peritoneal cavity.
69
How are fluoroscopic images taken during Hysterosalpingography?
The patient is supine, and images are taken. If necessary, the patient may be gently turned into an oblique position to clear overlying anatomy for further imaging.
70
What aftercare is provided to the patient after Hysterosalpingography?
A sanitary pad is provided. The patient is directed to the bathroom.
71
What pain management may be recommended after Hysterosalpingography?
Analgesics may be recommended depending on the level of discomfort or pain.
72
What contraceptive advice is given to a woman after Hysterosalpingography?
The woman may be advised to protect against pregnancy and use contraception until the next menstrual cycle.
73
What should a woman do if she experiences heavy bleeding or extreme discomfort after Hysterosalpingography?
She should be advised to seek medical attention if heavy bleeding or extreme discomfort continues.

MEDIMAGE 301 (11 decks)

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