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2220: Specialized Radiographic Procedures > Tets 3: Contrast Enhanced Imaging Procedures > Flashcards

Tets 3: Contrast Enhanced Imaging Procedures Flashcards

1
Q

Endoscopic Retrograde Cholangiopancreatography (ERCP)

A

the use of a fiberoptic endoscope passed into the duodenum and the injection of dye up into the bile ducts in the direction opposing or against normal bile flow to visualize the bile ducts (cholangio) and pancreatic duct (pancreato)

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2
Q

How should gallbladder be imaged?

A
  • PA to reduce OID
  • supine for gallbladder drainage
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2
Q

Liver Primary Function (from imaging standpoint)

A
  • the production of bile
  • bile is collected by ducts and carried to gallbladder for storage or passes into duodenum
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3
Q

Bile Route in Biliary System

A
  1. right and left hepatic ducts in the liver
  2. common hepatic duct
  3. common hepatic duct which unites with cystic duct
  4. forms the common bile duct
  5. pancreatic duct
  6. pancreatic and common bile duct empty into the duodenum via the hepatopancreatic ampulla (ampulla of Vader)
  7. ampulla controlled by sphincter of hepatopancreatic ampulla/sphincter of Oddi
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4
Q

Functions of the Gallbladder

A
  • storage of bile
  • concentration of bile (hydrolysis, choleliths/gallstones)
  • contraction when stimulated (cholecystokinin/CCK)
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5
Q

ERCP Prep

A
  • pts stomach and duodenum must be empty (fats for 6-8 hrs prior)
  • physician must be aware of pts allergies
  • pt needs to be driven home
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5
Q

ERCP Indications

A
  • can be diagnostic or therapeutic
  • used to diagnose biliary and pancreatic pathologic conditions
  • useful method when ducts are not dilated and ampulla is not obstructed
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6
Q

ERCP Procedure

A
  • pts throat is sprayed with a local anesthetic to make passage of endoscope easier
  • performed by passing a fibre optic endoscope through the mouth into the duodenum under fluoroscopy
  • the hepatopancreatic ampulla (ampulla of Vader) is cannulated
  • contrast is injected into the common bile duct (contrast strength determined by doctor, dense: demonstrates small ducts, dilute: demonstrates small stones)
  • spot and conventional images are taken as indicated
  • oblique spot images may be taken to prevent overlap of the common bile duct and pancreatic duct
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7
Q

ERCP Post Procedural Care

A
  • food and drink prohibited to minimum one hr after exam
  • food may be withheld for up to 10 hrs after procedure to minimize irritation to the stomach and bowel
  • do not leave pt unattended for at least one hour after exam
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8
Q

ERCP Contraindications

A
  • pancreatic pseudocyst: contrast injection may cause inflammation or rupture of the cyst (sonography of the upper abdomen prior to endoscopy can be used to rule this out)
  • acute infection of the biliary system
  • elevated creatinine or BUN levels
  • history of iodine sensitivity during another exam does not contraindicate the use of contrast for ERCP but pt use still be watched carefully
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9
Q

Hysterosalpingogram Performed To:

A
  • determine size, shape and position of the uterus and uterine tubes
  • delineate lesions such as polyp, sub mucous tumour masses or fistulous tracts
  • investigate latency of the uterine tubes in pts who are unable to conceive
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10
Q

When should a Hysterosalpingogram be performed?

A
  • 10 days after onset of menstruation because the endometrium is least congested and there is less risk of irradiating fertilized ovum
  • performed by OBGYN with rad present
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11
Q

Hysterosalpingogram Patient Prep

A
  • empty bladder
  • irrigate vagina and clean perineal region, as instructed with supplies provided by radiologic tech
  • intestinal tract should be cleaned before exam, laxative administered for constipation, cleaning enemas before exam (recommended), meal preceding exam withheld
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12
Q

Hysterosalpingogram Procedure

A
  • preliminary scout made
  • pt in lithotomy positon
  • speculum placed in vagina
  • uterine cannula place din cervix
  • contrast injected via cannula (fills uterus, spills into peritoneal cavity if tubes are patent)
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13
Q

Contrast Studies pf Urinary System

A
  • to demonstrate the renal parenchyma, CM is needed, followed by imaging by either xray or CT
  • two filling techniques: retrograde and antegrade
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13
Q

Tech Role in Hysterosalpingogram

A
  • set up sterile tray
  • add sterile items to tray (syringes, needles)
  • select and open indicated contrast medium
  • have sterile gloves available for OBGYN
  • assist OBGYN and rad
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14
Q

Retroperitoneal Structures

A

kidneys and ureters

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15
Q

Infraperitoneal Structures

A
  • distal ureters
  • urinary bladder
  • urethra
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16
Q

Contrast Media for Urinary Studies

A
  • lower concentrations required for bladder studies because of large amount required to fill bladder
  • higher concentrations used for excretory urography
  • nonionic media less likely to cause adverse reaction
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17
Q

Preparation of Intestinal Tract for Urinary Studies

A
  • clear demonstration of urinary system requires intestinal tract to be free of gas and fecal material
  • bowel prep is not attempted in infants and children
  • adult prep depends on pt condition
  • when time permits a low residual diet for 1-2 days before exam
  • light evening meal on day before exam
  • non-gas forming laxative, when indicated the day before exam
  • NPO after midnight the night before exam
  • pt should be well hydrated, especially important for patients with diabetes, multiple myeloma and high uric acid levels (these increase patients risk for contrast induced renal failure if dehydrated)
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18
Q

Retrograde Urography

A
  • requires cauterization of ureters
  • contrast injected directly into pelvicalyceal system
  • provides improved opacification of renal collecting system
  • little physiologic information provided
  • indicated for evaluation of collecting system in pts with renal insufficiency or contrast sensitivity
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19
Q

Retrograde Urography AP Projection

A
  • demonstrates contrast within kidneys and ureters
  • physician may tilt the head off the table t enhance visualization of structures
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20
Q

Retrograde Cystography Preliminary Preparation

A
  • protect the table from urine soilage: accompany pt to lavatory, provide pt with supply for perineal care, instruct pt to empty their bladder
  • place pt on exam table for catheterization
  • after catheter is place, position pt for preliminary image and the first cystogram (AP supine)
  • physician removes catheter clamp, drains bladder and introduces contrast (150-500mL, AP and oblique projections done)
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21
Q

Retrograde Cystography

A
  • nonfunctional radiography exam of urinary bladder
  • usually performed via retrograde contrast administration
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22
Q

Retrograde Cystography Indications

A
  • vesicoureteral reflux
  • recurrent lower urinary tract infection
  • neurogenic bladder
  • bladder trauma (perforation after surgery)
  • lower urinary tract fistulae
  • urethral stricture
  • posterior urethral valves
23
Q

Retrograde Cystography Contraindications

A

related to catheterization of urethra

24
Q

Voiding Cystourethrography

A
  • purpose: functional study of the bladder and urethra
  • performed after routine cystogram
  • catheter removed and imaged while voiding
25
Q

Cystogram

A
  • CR 2 inches superior to pubic symphysis
  • AP: 10-15 degrees caudad
  • posterior oblique: 45-60 degree
26
Q
A
27
Q

Evaluation Criteria Cystogram

A
  • AP: urinary bladder not superimposed by pubic bones
  • posterior obliques: urinary bladder not superimposed by lower limbs
  • distal ureter, bladder and proximal urethra (male) to be included
28
Q

Stomach Orientation in Hypersthenic

A
  • higher and more horizontal
  • duodenal bulb o the right of midline, level of T11-T12
28
Q

Stomach Orientation in Asthenic

A
  • lower and more midline
  • duodenal bulb at midline, level of L3-L4
29
Q

Stomach Orientation in Sthenic

A
  • duodenal bulb to the right of midline, level of L1-L2
30
Q

Barium Sulphate

A
  • positive
  • radiopaque
  • absorbs more x-rays
  • BaSO4
  • thick barium: 3:1 or 4:1 ratio with water
  • thin barium: 1:1 ratio with water
31
Q

Colloidal Suspension

A
  • never dissolves in water
  • rate of separation varies by brand
  • contraindication: perforated viscus or pre surgical procedure
32
Q

Barium Swallow

A
  • procedure: using contrast to visualize and evaluate the esophagus
  • contrast: barium (most common) or non ionic, water soluble iodinated contrast
  • can be double or single contrast
  • done upright when possible
  • NPO after midnight
32
Q

Water-Soluble Iodinated 
Contrast Media

A
  • indications: perforated viscus, pre surgical procedure
  • contraindications: hypersensitivity to iodine
33
Q

Barium Swallow AP/PA Projection

A
  • patient is erect to recumbent
  • CR: T5/T at midsagittal plane
34
Q

Barium Swallow AP/PA Oblique Projection

A
  • body rotated 35-40 degrees
  • RAO or LPO
  • CR: T5/T6 2 inches lateral to the midsagittal plane on the elevated side
  • esophagus seen between the vertebrae and the heart
35
Q

Barium Swallow Lateral Projection

A
  • patient erect ot recumbent
  • right or left side down, arms raised
  • CR: T5/T6
  • area form lower part of the neck to esophagogastric junction is shown
36
Q

Stomach and Duodenum PA Projection

A
  • pt prone
  • CR: midsagittal plane at the level of L/L1 (lower if pt is upright)
  • barium will sit in the lower portion of the stomach
37
Q

Stomach and Duodenum

A
  • procedure: using contrast to visualize and evaluate the stomach and duodenum
  • also called S&D, UGI, Barium Meal
  • single contrast: used only for small children or very ill pts
  • double barium: barium sulphate and gas granules
  • pt prep: NPO from midnight
38
Q

Stomach and Duodenum AP Projection

A
  • pt supine
  • CR: midsagittal plane at the level of L1/L2 (lower if pt upright)
  • barium will sit t the top/upper part of the stomach
39
Q

Stomach and Duodenum Right Anterior Oblique

A
  • pt prone and rotated 40-70 degrees
  • CR: midsagittal plane at the level of L1/L2 (lower if pt upright)
  • gastric peristalsis more active this position
  • barium will be demonstrated in the pylorus and lower body
40
Q

Stomach and Duodenum Left Posterior Oblique

A
  • pt supine and rotated 30-60 degrees
  • CR: midsagittal plane at the level of L1/L2 (lower if pt upright)
  • barium will be demonstrated in the fundus
41
Q

Small Bowel Follow Through AP/PA

A
  • pt supine or prone
  • images taken after specific time intervals (15 minutes, 30 minutes, etc)
  • use time markers or annotate
  • demonstrates small intestine progressively filling with barium until it reaches the ileocecal valve
  • CR: will change as exam progresses (begins above crest, ends at crest, approx.)
41
Q

Stomach and Duodenum Right Lateral

A

right retrogastric space, pyloric canal, duodenal bulb, allows barium into the pylorus and duodenal bulb

42
Q

Small Bowel Follow Through

A
  • procedure: to visualize and evaluate the function of the small bowel
  • contrast: barium sulphate most often
  • frequently done immediately following an S&D
  • prep: NPO after midnight
  • spot images may be taken to better visualize any suspicious areas
  • compression pebble can be used to separate loops of bowel
42
Q

Stomach and Duodenum Left Lateral

A

left retrogastric space, allows air in the pylorus and duodenal bulb

43
Q

Barium Enema Contrast Media

A
  • commercially prepared Baum sulphate products generally used of routine retrograde exams
  • high density barium sulphate: newest product, absorbs more radiation, useful for double contrast exams
  • air or carbon dioxide may be used for double contrast exams, carbon dioxide is more rapidly absorbed
  • water soluble iodinated agents may be orally administered when retrograde filling is contraindicated (usually not satisfactory for double contract studies)
44
Q

Barium Enema

A
  • procedure: using contrast to visualize and evaluate the large bowel
  • single contrast: thinner barium
  • double contrast: thicker barium and air
  • prep: low residual diet, laxatives, bowel must be free of fecal matter
44
Q

Barium Enema Clinical Indications

A
  • ulcerative colitis
  • diverticulosis/diverticulitis
  • neoplasm
  • volvulus
  • intussusception
  • appendicitis
45
Q

Barium Enema AP/PA

A
  • CR: midline at iliac crests
  • demonstrates entire colon including both flexures and the rectum
  • PA position pushes the bowel laterally
46
Q

Barium Enema Right Anterior Oblique/Left Posterior Oblique

A
  • pt rotted 35-45 degrees
  • CR: 1-2 inches lateral from midline on elevated side at the level of the iliac crest
  • demonstrates right colic flexure, ascending colon and sigmoid
47
Q

Barium Enema Left Anterior Oblique/ Right Posterior Oblique

A
  • pt rotated 35-45 degrees
  • CR: 1-2 inches lateral to the midline on the elevated side, at the level of the iliac crest
  • demonstrates left colic flexure, descending colon
48
Q

Barium Enema AP/PA Axial

A
  • AP CR: 30-40 degrees cephalic, entering 2 inches below ASIS
  • PA CR: 30-40 caudad, exiting ASIS
  • demonstrates the rectosigmoid area
49
Q

Barium Enema Right Lateral Decubitus: AP/PA

A
  • double contrast
  • horizontal beam, CR entering at level of iliac crest
  • demonstrates medial aspect of ascending and lateral aspect of descending colon
50
Q

Barium Enema Rectum Lateral

A
  • CR: level of ASIS on midcoronal plane, often done cross table
  • demonstrates the rectum and distal sigmoid portion
51
Q

Barium Enema Left Lateral Decubitus: AP/PA

A
  • double contrast
  • horizontal beam, CR entering at the level of the iliac crest
  • demonstrates the lateral aspect of the ascending colon and medial aspect of the descending colon
51
Q

Barium Enema Post Evacuation AP/PA Projection

A

performed after the patient empties their bowels

52
Q

Barium Enema Lateral Projection
Rt or Lt ventral decubitus position

A
  • double contrast
  • pt is prone with left or right side against the vertical grid device
  • CR is horizontal and perpendicular to the IR entering the midcoronal plane of the body at the level of the iliac crests
  • structure shown: lateral projection of the colon (rectum)

2220: Specialized Radiographic Procedures (3 decks)

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