SIALOGRAPHY  denser, slower absorption, can

cause and difficult to

 Function – examination of the salivary glands completely evacuate
and ducts using oil based or water soluble
iodinated contrast media  Ethiodol, sinographin

 Procedural Steps 4. Take radiographs

1. Preliminary radiograph 5. Secretory stimulant

- scout film - to stimulate rapid evacuation of the CM

- to check patient preparation, 6. Post-procedure radiographs

positioning, radiographic technical
- 10 min after to confirm evacuation of
factor and underlying pathology such
CM
as calculi and calcified cervical glands

2. Secretory stimulant

Parotid Gland
- 2-3 min before the sialographic
procedure
AP or PA Tangential
- have the patient suck on a wedge of
- PP – supine or prone, head ↻ away 5°
fresh lemon to promote salivation and affected side. if prone, rest head on
open the duct for ready identification forehead and chin to show the entire
of its orifice for easier passage of the gland or rest on chin to show
cannula of catheter
Stensen’s duct
3. Injection of contrast - RP– level of the lower lip, lat surface
of mandibular ramus
- Manual pressure

- CR – ⊥
- Hydrostatic pressure. water-soluble
iodinated agent, syringe barrel w/
- SS – stone formation in the parotid
plunger removed attached to a drip
gland and ducts
stand set at a distance of 28” above
the level of the patient mouth Lateral

- amounts - PP – semi prone, extends the neck,

MSP & IOML ∥ to IR, IPL ⊥ to IR
 Parotid = 0.5-1.5 ml
- RP – 1” superior to the mandibular
 Submandibular = 0.2-0.5 ml angle

 Dionosil aqueous 8-10 ml - SS – bony structures and any calcific

deposit or swelling in the areas of
- water-based agents
parotid gland, shows the 3 pairs of
 iodinated can be ionic or non- salivary glands
ionic, is less dense, absorbed
faster and leaves no residue Iglauer ~ Lateral

- PP – suggested depressing the floor of

 Conray, Hypaque, Isovue,
the mouth to displace the
Renographin
submandibular gland below the
- oil-based agents mandible
1
 - RP – inferior margin of the gonion - SS – abnormalities of chewing and
swallowing mechanism in children
- CR – ⊥
O’Hara ~ Cleft Palate Series
- SS – a simple maneuver to increase the
visibility of a salivary calculus - PP –seated lateral upright position

Lateral Oblique ~ Function PA - RP – nasopharynx

- PP – head ↻ 10-15 ° toward - Shots –phonate the following sounds:

- RP – lateral surface of the mandibular d-a-h, m-m-m, s-s-s, and e-e-e

ramus
- SS – the range of movement of the soft
Submandibular and Sublingual Glands palate and the position of the tongue
during each of the above sounds
Lateral
NASOPHARYNGOGRAPHY
- PP – patients head in true lateral
position Function – examination of nasopharynx

Inferosuperior Indications – assess the extent of

nasopharyngeal tumor and investigate
- PP – OML 40-45° to horizontal
carcinoma

- SS – this position gives unobstructed Premedications – Atropine 30 min before the

image of sublingual gland regions examination to suppress nasopharyngeal and
buccal secretions, also used in patients with
- CR – 15-20 ° cephalad
bradycardia
- RP – midway b/n mandibular angle.
Plain Procedures
PALATOGRAPHY
Plain Lateral
Bloch & Quantrill
- PP– direct lateral
- PP – patient is seated laterally
- RP – nasopharynx, .75” ante to EAM
- RP – nasopharynx
- Shot – during intake of deep breath
- shot 1 – swallow small amount of through the nose
BaSO4 to coat inferior surface of soft
- SS– hypertrophy of the pharyngeal
palate and uvula
tonsils or adenoids
- shot 2 – inject .5 ml creamy BaSO4 into
Positive Contrast Procedures
each nostril to coat sup surf of soft
palate and post nasopharynx
SMV & Lateral ~ using Iodized Oil or Barium
- SS – investigate suspected tumors of Paste
the soft palate by a positive contrast - PP – supine, OML 40-45° from
technique
horizontal by elevating shoulder and
extending neck
Morgan
- CR– 15-20 °s b/n gonion for SMV,
- PP – child chews a barium-
horizontal to nasopharynx for lateral
impregnated chocolate fudge

2
 - Shot 1 – Preliminary SMV & Lateral Gunson

- Shot 2 – Contrast SMV & Lateral - synchronizing the exposure with the
height of swallowing act of deglutition
- patient can now sit up and blow nose studies of the pharynx and superior
esophagus
- additional studies in upright depending
on physician Templeton and Kredel
- SS – extent of nasopharyngeal tumors o satisfactory filling is usually obtained if
the exposure is made as soon as
Chittinand, Patheja & Wisenberg ~ using
anterior movement is noted in Gunson
Micropaque Powder

- PP – seated only, contrast media is

sprayed through the nostrils
LARYNGOPHARYNGOGRAPHY

- CR – 15-20 °s b/n gonion for SMV, Function – examination of the larynx.

horizontal to nasopharynx for lateral
Indications – Demonstrate muscular weakness
- Shot 1 – Preliminary SMV & Lateral due to disease, edema or fibrosis, and
investigation of themalignancy
- Shot 2 – Two contrast SMV (rest +
modified Valsalva’s maneuver) & Preparation – NPO for 5 hours
lateral
Agent – Dionosil 10-15ml
- Shot 3 – Follow-up chestshould not
reveal barium in lungs Quiet inspiration

- SS – extent of nasopharyngeal tumors o ER – tests abduction of the vocal cords

PHARYNGOGRAPHY o SS – open abducted vocal cordswith an

uninterrupted column of air extending
Function –to identify abnormalities during from the laryngeal vestibule inferiorly
the active progress of deglutition into the trachea

Indications – demonstrate tumor, abscess Normal expiratory phonation

and presence of foreign body
o ER – test adduction of the vocal cords
Agent – negative the

AP & Lateral o PP – the pt is asked to take a deep

breath and while exhaling slowly
o hold the BaSO4 bolus in the mouth until
phonate either a high pitch e-e-e- or
signaled and then to swallow the bolus
a low pitch
in one movement

o SS – closed adducted vocal cordsjust

AP & Lateral ~ Mucosal Study
above the break in the air column at
o ask the patient to refrain from the close rima glottis
swallowing again
Power, Holtz And Ogural
o can be taken during the modified
Valsalva's maneuver for double Inspiratory phonation
contrast delineation o reverse phonation or aspirant
maneuver
3
 o SS –laryngeal ventricle PP – 35-40° body rotation, top of the
cassette is 1-2”above the shoulders
Valsalva Maneuver
RP – T6 or T7
- ER – test the elasticity and functional
integrity of the glottis SS – esophagus is seen free from
superimposition, b/n the vertebrae of
- SS – complete closure of the glottis. the heart.

Modified Valsalva Maneuver RAO Single Contrast

- ER – test the elasticity of the o SS – esophageal lumen and lesion
hypopharynx and piriform partial obstructing esophagus

RPO/35-40 °.
ESOPHAGOGRAPHY o SS – esophageal varices are better
seen.
Function – demonstrate pharynx and
esophagus, indirectly investigate suspected Lateral views
lesions of the heart and great vessels
o PP – centering with the tube straight
Indications – dysphagia, barrets esophagus center 2 to 3” inferior to jugular notch.
syndrome (strictures in the distal esophagus),
developed peptic ulcer in the distal esophagus, o SS – esophagus filled with contrast
esophageal carcinoma, chalasia, impaired medium, the ribs posterior of the
swallowing mechanics, foreign body vertebrae should be superimposed
obstruction, esophageal reflux, esophageal showing patient wasn’t ↻
varices (dilation of veins), anatomical
anomalies (either acquired or congenital due
to lifestyle) Procedures to Detect Esophageal Reflux
Contraindications – suspected leakage from
Breathing exercise
the esophagus into the mediastinum or pleural
or peritoneal cavities, aspiration into the o Valsalva manuever
bronchial tree
Mueller manuever
Procedural Steps
o PP – patient exhale and tries to inhale
1. Filling phase – to distend the lumen of the against a closed glottis
esophagus, suspension 2:1 or 1:1
LPO ~ Water test
2. Mucosal phase-demonstrate the mucosal
o PP – Swallow a mouthful of water
pattern of the esophagus suspension 3:1 or
through a straw
4:1

Procedures with Single Contrast Compression technique

AP o ER – to provide pressure

RAO Recumbent o PP – prone, uses pneumatic

compression paddle
ER – always used to demonstrate
variceal distention of the esophageal Toe-touch maneuver
veins

4
 o ER – study possible regurgitation into - 3:1 BaSO4 suspension
the esophagus from the stomach
Movements of the Stomach
o SS – esophageal reflux & hiatal hernias
- supine position

 the fundus of the stomach is in

UPPER GAISTROINTERSTINAL SERIES the lowest part, where the
heavy barium settles
Function – radiographic examination of the
GIT, distal esophagus, stomach and duodenum  fundus +

Indications – bezoar (light coating BaSo4),  pylorus -

diverticula, emesis, gastritis, dyspepsia, GI
- prone position
hemorrhage, upper abdominal mass, partial
obstruction, hiatal hernia, sliding hiatal hernia  fundus is in the highest
(Schatzke’s ring), hypertrophic pyloric position, causing the air to fill
stenosis (HPS), ulcers this part of the stomach
Contraindications – Complete large bowel
 fundus –
obstruction, history of bowel perforation &
laceration.  pylorus +

Preparation: - erect position

1. Light evening meal  air raises to fill the fundus

whereas barium descends by
2. Laxatives if not contraindicated by
gravity to fill the pyloric
administering. portion of the stomach

3. NPO after meal (6-8 hrs) 1 hr. delayed film purpose:

4. No smoking on or before the - determine gastric emptying

examination
- know how much barium was left
5. No breakfast
- determine presence of ascaris
Negative Agent:
6hrs. delayed film purpose:
1. Allowing the patient to sip barium
mixture by - in cases of suspected pyloric stenosis

2. 2 straw one outside and another inside - to assess gastric emptying rate

3. Instruct the patient to breathe to his 24 hrs. delayed film purpose:

mouth or swallow air after ingestion of
- if under suspicion in the small
barium mixture
intestine, appendix, or colon.
4. Gas producing tablets, Gastroluft/EZ
gas UGIS – Scout Film

5. Carbonated drink diluted with Barium AP or PA

Positive Agent: - PP – Supine or prone, patient lies flat on

his back or abdomen, MSP to the midline,
- 2:1 BaSO4 suspension respiration suspended

5
 - IR– 2’’ above the xiphoid, 2-3“ above the IR – center at the level of L1 - L2 (about
iliac crest 1-2” above the lower rib margin)

- RP – 4” left of the pylorus PP – upright or supine

RP – L1 if supine, L3 if upright

UGIS – Distal End of Esophagus Left Lateral

RAO or LAO CR – 45 °s should be sufficient for the

sthenic patient, but the ° of angulation can
- PP – continuous swallowing or mouthful of vary from 30 to 60°s.
BaSO4, to the patient instructing not to
swallow until told to do so RP – L3, fundus

SS – best visualization of the pyloric canal,

left retrogastric space, anterior and
UGIS – Stomach and Duodenum: Mucosal Phase posterior aspects of stomach, duodenal
bulb in the hypersthenic patient
PA projection ~ Recumbent position

- SS – demonstrate filling of the distal half

LAO projection ~ LPO position
of the stomach and double contrast of SS – contrast study of the pylorus and the
fundus, relationship of stomach and bulb to separate superimposition b/w the
retrogastric space bulb and vertebral filling of the fundus,
lesser curve
- note – stomach moves superiorly 1.5-4”
according to the patient‘s habitus RP – level of L1, midway bet. Xiphoid tip
& lower margin of ribs, m/w b/n the
- PP – prone = center the IR about 1-2”
midline of body & left lat. Margin of
above the lower rib margin at the level of
abdomen
L1-L2

- PP – upright = center the IR 3-6” lower

LPO projection ~ LAO projection
than L1-L2 PP – head end lowered

- note – the greatest visceral movement b/w 25-30° ↻ to demons. hiatal

the prone and the Upright positions occurs hernia/esophageal regurgitation.
in asthenic patients
10-15° ↻ slightly toward pt. to place
- RP – L2, level of pylorus & duodenal bulb gastroesophageal junction

RAO position ~ RPO projection CR – 45 ° for asthenic pt

- SS – pyloric canal and duodenal bulb, AP projection ~ Trendelenburg position

antrum , greater curvature. gastric
peristalsis usually more active ER – best AP projection of the retrogastric
portion of the duodenum
- CR – ⊥ to L2
PP – 15-20° trendelenburg position
- PP – 40-70° ↻
SS – antrum body, well-filled fundic
Right Lateral projection ~ Recumbent position portion and usually double-contrast
delineation of the body, pyloric portion,
SS – duodenal loop duodenojejunal junction
and duodenum
& right retrogastric space

6
 modifications: the abdomen and just below the
costal margin, ask the patient to
1. Gordon’s Manuever ~ Prone ingest barium suspension in rapid,
continuous swallows
SS – bulb and pylorus of
hypersthenic patients, filling of the RP – T6/T7
distal half of the stomach and
double-contrast fundus CR –10-20° caudally

ER – for hyperstenic pt 6. Guglielmo

PP – prone SS – demonstrate minimal hiatal

hernia
CR – 35-45° cephalad

RP – 4” to the left of pylorus

UGIS – HYPOTONIC DUODENOGRAPHY
2. Gugliantini ~ Prone
Function – evaluation of post bulbar duodenal
SS – stomach lessions& for the detection of pancreatic
disease, this xamination done in UGIS
PP – Same as above but for infants
especially emphasizes to the duodenal loop,
CR – 20-25° cephalad for abdominal masses affecting the C-Loop

3. Hamptons ~ Oblique Supine Indications – duodenitis, hepatitis, pancreatitis,

abdominal mass affecting the c-loop
SS – leaf-like pattern of the
pylorus and the bulb Preparation – same as UGIS

PP – LPO position, 45° right side Agent: Barium suspension 33-50%

elevation
Methods used:
RP – level of pylorus
1. Intubation Method
4. Poppel’s Method ~ Right Lateral View
2. Tubeless requiring drug-induced
SS – retrogastric and evaluate duodenal paralysis
pancreatic mass
Procedure
PP – Right lateral recumbent
1. Ask patient to ingest the Ba and take
Shot 1 – horizontally if supine exposures of the stomach, take AP
then LAO using 10x12
Shot 2 – perpenduicular if lateral
2. Injection of probanthine or buscopan
5. Wolf Method ~ Modified Trendelenburg solution intramuscularly to relax the
Position duodenum
SS –small lesions, sliding hiatal
3. 15 minutes after injection take
hernia, superior stomach and distal projection of C-loop (AP, LAO, RPO)
esophagus
4. Process the film immediately for
PP – 40-45°RAO, thorax centered confirmation
to midline, apply greater intra-
abdominal pressure by placing 5. 1 hr. delayed film
compression device horizontally to
7
 Note: 11. Carcinoid tumors – tumor of small bowel

- the use of hypotonic duodenography 12. Chron’s Disease

has decreased in recent years.
RA: cobblestone or string sign-severe cases
- when lesions lying beyond duodenum
13. Spree – intestinal malabsorption disease
are suspected we use double contrast
involving inability to absorb certain proteins
gastrointestinal examinlation
and dietary fat
- when pancreatic disease is suspected,
14. Whipple’s disease
CT or needle biopsy

BIPHASIC EXAM - disorder of the proximal small

bowel
the biphasic gastrointestinal examination - Distorted loops of small intestine
incorporates the advantages of both the single 15. Lymphoma
contrast and double-contrast upper
- RA: stacked coin
gastrointestinal examinations, with both
examinations performed on the same day
16. Adenocarcinoma
SMALL INTESTINAL SERIES - RA: napkin rings

Indications:
17. Celiac Disease - a form of sprue

1. Pain  Contraindications – Complete obstruction,

Suspected Perforation, Dehydration
2. Diarrhea

3. Bleeding  Procedure:

1. Oral / By mouth
4. Partial obstruction

2. Complete Reflux exam

5. Abdominal mass

3. Intubation Exam
6. Failed small bowel enema

7. Enteritis 4. Enteroclysis

8. Giardiasis – infection of the lumen of SI

9. Ileus – Obstruction of SI) Oral method

Prep – NPO 6 hrs

Adynamic/paralytic - cessation of peristalsis

CM – 16oz/150-300ml
Mechanical Obstruction-due to tumor,adhesion or
hernia
PP – supine or prone, MSP to midline
RA: herringbone or circular staircase ER – study the form and function of small
bowel, detect any abnormal conditions
10. Meckel’s diverticulum

CR – ⊥
saclike out pouching of the intestinal wall

RP – L2 early radiographs, iliac crest for

located proximal to the ileocecal valve
delayed exposures
Birth defect
Shots:

8
 1. 15mins. prevent or relieve post-op distention or to
deflate or decompress an obstructed small
2. 30mins. intestinal tube.

3. 45mins. - Diagnostically

4. 60mins (usually completed) - The tube can be readily passed if the

patient can be elevated almost to a setting.
Complete Reflux
Patient in rag posmon where gastric
- Prep – Glucagon may be administered to peristalsis is active.
relax intestines, Diazepam/Valium anti-
anxiety to diminish discomfort during
initial filling LOWER GI SERIES

- CM – Filling of small bowel about 4500mL

Function – study the form & function of LI,
to fill the colon and small intestines detect any abnormal conditions

- Miller : Localization of the small bowel Barium-Air distribution

hemorrhage; complete reflex small bowel
examination 1. Supine

Enteroclysis - transverse and sigmoid filled with air

- procedure in which the CM is introduce - descending and ascending colon filled with
into the duodenum to examine small bowel barium

- Sellink tube with stiff wire is advanced to 2. Prone

the end of the duodenum at the duodeno-
- transverse and sigmoid filled with barium.
jejunal angle near the ligament of Treitz.

- descending, ascending colon and rectum

- 30 ml of barium with 60 ml of water
filled with air.
- no cleansing enema
Positive Agent
- low residue diet
- 500-1200 ml BaSO4
Intubation Method
- 5 °C (40-45 °F) Cold Mixture – gives
- A procedure in which a tube is inserted anesthetic effect on the colon and
through the nose and passed into the longer CM retention, but cold water
stomach may lead to colonic spasm

- To relieve post-operative distention or - 29-30 °C (85-90 °F) Warm mixture

deflate on decompress an obstructed small
- single contrast – 15%-25% W/V
bowel

- double contrast – 75%-95% W/V

- Miller-abbot

Negative CM
- Water soluble iodinated or thin baso4

- Therapeuticailly - room air, nitrogen, CO2

- 90 cc of air, less irritation, stimulates

- Tube is connected to a suction system for
tonic contraction of the anal sphincter
continuous siphoning of the 9-5 and fluid
contents of gi tract the purpose is to Sim’s Position – 35-40°
9
Enema container is normally 36” (90cm) above - Procedure :
the table top to avoid undue discomfort to the
- insert BaSo4 into the rectum with patient
patient or 18-24” (45-60cm) above the level
of anus in trendelenburg position.

- clamp BasO4 tubing, place patient in

Preliminary Preparation:
horizontal position, ↻ patient then instill air
1. Light evening meal the night before the
Indications:
examination

1. Change in Bowel habit

2. Laxative or cleansing enema before
retiring if not contraindicated.
2. Pain
3. Enema should be done properly until 3. Mass
return flow is clear. if the patient is
constipated use a low pressure enema. 4. Obstruction
cleansing enema shall be prohibited in pt.
having diarrhea, gross bleeding, symptoms 5. Colitis–inflammatory of large intestines
of obstruction
6. Ulcerative Colitis – RA: cobblestone or
4. NPO after midnight stovepipe in severe form

7. Diverticulum - common to adults 40 yrs.

Two methods
Old
1. Single contrast method
RADIOGRAPHIC APPEARANCE: Saw-tooth
- colon is examined with barium
sulfate only 8. Neoplasm - Benign tumor

2. Double contrast method RADIOGRAPHIC APPEARANCE: applecore or

napkin ring
- demonstration of intraluminal lesions
such as polyps 9. Polyps- sac like projection that project inward

Double Contrast Media Administration 10. Volvulus- twisting of a portion of the intestine

Welin Technique - common to male 20-50 y/o

RADIOGRAPHIC APPEARANCE: BEAK

- instill BaSO4 up to the left colic angle

11. Intussusception
- instill air until BaSO4 reached right colic
angle
- telescoping / invagination of one part of
- lower the enema bag to drain the excess intestine into another
BaSO4 from the colon finally, instill large
- common in infants 2 y/o
amount of air
RADIOGRAPHIC APPEARANCE: mushroom shaped
Miller technique and claw appearance
- Single stage procedure
Contraindications – Toxic megacolon,
- 7-pump method pseudomembranous colitis, recent rectal
biopsy, incomplete bowel prep, recent Ba.
- to demonstrate the tonus of the colon and meal, large bowel obstruction, viscus
most of the abnormalities laceration, appendicitis

10
Types of Laxatives: RPO

1. Irritant Laxatives o SS – splenic angle and descending

colon
-Castor Oil
o PP – 15-25° rotation
2. Saline Laxative
PA Axial
-Magnesium sulfate
o SS – rectosigmoid, rectum
-Magnesium Citrate
o CR – 30-40° ↓
Contraindications to Laxatives – Gross bleeding,
severe diarrhea, obstruction, inflammatory o RP – level of the ASIS
conditions
Right Lateral Decubitus
Positions:
o SS – air filled medial side of the
AP/ PA ascending portion and lateral side
of descending portion
o SS – entire colon
Left Lateral Decubitus
o PP – trendelenburg position helps
to separate redundant or o SS – air filled lateral side of the
overlapping loops of the bowel ascending colon and medial side of
the descending colon
o RP – Iliac crest
Post-Evacuation
LAO
o SS – residual amount of CM, small
o SS – splenic angle + descending polyps and defects
colon
MODIFICATIONS:
o PP – 35-45° rotation
Jacknife
RAO
o SS – rectum, rectosigmoid junction
o SS – hepatic angle + ascending and and sigmoid
sigmoid colon
o CR – ⊥
o PP – 35-45° rotation
o RP – LS region at the level of
Left Lateral greater trochanter

o SS – polyps, strictures, fistula & Welin technique

rectosigmoid colon
-Early diagnosis of ulcerative colitis, regional
o RP – 5-7cm. above the level of the
colitis and polyps
pubic symphysis in the MSP
-demonstrateIntraluminal lesion
LPO
-1800-2000cc
o SS – hepatic angle + ascending
and sigmoid colon * to obtain proper distention of colon

o PP – 15-20° rotation Billings modification

11
-Supine/ASIS/CR 35-450 to prevent overlapping - pt preparation
loops and to separate sigmoid colon
* bec. H2 O remaining in the rectum dilutes the CM
Robins modification
-measures anorectal angle
-demonstrate lateral view of the recto- sigmoid
* the angle b/w the long axis of the anal canal
colon without overlapping

- true lateral/2inch posterior to midaxillary plane

GALLBLADDER AND BILIARY DUCT

-CR vertically passing to RP and with MP of film.

 Gallbladder
Oppenheimer’s Modification

-for RECTOSIGMOID.  Pear-shaped

 7-8cm long, 3cm wide

-Supine, 120 caudad, RP 1” proximal to upper
boarder of symphysis pubis.  Holds 30-40cc of bile.

-FS 10x12 LW Parts of GB.

FLETCHER’S MODIFICATION a. Fundus – distal and broadest part

0
-LAO position, 30-35 cranially, RP 2” medial to
b. Body – main section
ASIS.
c. Neck – narrow proximal end
-FS 10x12 LW
Functions of GB:
COLOSTOMY- surgical procedure to from an
artificial opening to the intestine A. To store bile

-usually abdominal wall B. To concentrate bile

-Colon is the cmmon site of disease C. To contract when stimulated

-Performed to diver fecal materials CCK – Cholecystokinin- hormones secreted

in the GB
-When there is malignancies of lower bowel &
rectum Biliary System

-low residue 24 to 48 hours  R hepatic + L. Hepatic = Common hepatic

duct
Indications:
 Cystic duct (1 ½ “) + Common hepatic duct
- asses proper healing, obstruction, leakage (1 ½ “) = Common bile duct (3”)

-for presurgical evaluation  Common bile duct + pancreatic duct =

Post-Op Enema hepatopancreatic ampulla (ampulla of
vater) SphinctherOddi.
- determine the efficacy of treatment in cases of
Cholecystangiography/ Cholecystocholangioraphy
diverticulitis
- radiographic examination of the GB and biliary
- to detect new or recurrent lesion
ducts.
DEFECOGRAPHY
Contrast Media: Priodax, iopanoic acid, iopdate
- performed with a defecationaldisfunction calcium, cholografin, biloptin, teridax, bilopaque
12
  Endobil – meglumineiodoxamate -  Biligram- meglumineioglycamate
100ml
INDICATIONS
 Biliscopin – meglumineiotoxate -
30ml 1. Nausea

2. Heartburn
Methods of Study

3. Vomitting
1. OCG

4. Choledocholithiasis
2. Operative & post

5. Cholelithiasis
3. ERCP

4. IV cholagiography *condition having abnormal calcification of stone

in GB due to increase bilirubin, cholesterol or
5. PTC calcium.

Oral Chole (Graham’s Exam) Composition of gallstone

Purpose: • Pure cholesterol-appears as negative

filling defects within the opacified bile
1. To determine the function of liver its ability to
remove the cm from the bloodstream & excrete it • Calcium deposits- appears either solitary
at the bile calculi or in the form of milk of calcium,
seen even in a plain film
2. To determine the patency of the billiary ducts
6. Milk Calcium bile
3. To evaluate the contracting and emptying
power of the GB * biliary stones in the GB

4. To detect billiary calculi * PA scout film

Patient Preparation: 7. Non-visualization

1. avoidance of laxatives for 24 hours before 8. Cholecystitis- acute or chronic inflammation of

ingestion or injection of the medium the GB

2. NPO 6-8 hrs - blockage is due to stone lodge in the neck of the
GB
3. Fat free for 1-2 days
9. Biliary stenosis
4. Telepaque cm (6 tabs) (12 tabs)
- narrowing of one of the biliary ducts
5. Not less than (10-12 hrs)
10. Congenital anomalies
6. Food forbidden/H2O is encouraged
Contraindication:
CM used:
1. Hepatorenal disease with renal impairment
 Telepaque- ioponoic -6tabs
2. Active GI disease*vomitting, severe diarrhea
 Cholebrin/iocetanic acid -6tabs
3. Pyloric obstruction
 Biloptin/sodium iopadate -6tabs
4. Severe Jaundice
 Solu-biloptin/calcium iopadate-3g/1sachet
5. Liver dysfunction
13
6. Hypersensitivity to iodinated cm 3. Demons. CBD abnormalities when oral
chole in normal.
7. Pregnancy
Contraindications :

1. Hepatorenal disease
Procedure:
2. Oral chole w/n the previous week
AP/PA Scout film
Direct Cholangioraphy
 SS – presence and location of gallbladder,
choleliths and to differentiate papilloma or 1. Operative/immediate
other tumor shadows from cholesterol
calculi shadows -Remove all calculi in the biliary

-CM is introduced directly to the CBD.Introduced

RAO POSITION
byMirizzi
 SS – Delineate b/n gas trapped in bowel
from radiolucent stone in GB, fills the 2. Post op/ T-tube/Delayed
fundus of the GB -Study of CBD prior to removal of the T-tube
0
 PP – 15-30 body rotation
-Determine the patency of CBD
Post-motor meal -CM is introduced through the T-tube.

 SS – contracting and emptying power of -Done 10 days after surgery

GB
-RPO
 PP – LAO 200
-Water soluble CM
Supine RPO
-25-30% concentration.
 SS – fills the neck
3. ERCP
 PP – pt is dehydrated
-Examine biliary & pancreatic ducts.
Erect LAO
-ither diagnostic or therapeutic
 SS – floating gallstone
-Endoscope (fiber optic)
 PP – 200 body rotation
*duodenodoscope
Right lateral decubitus
-passed through the mouth to the duodenum.
 SS – stone heavier than bile
Indications:
CHOLANGIOGRAHY (CHOLEDOCOGRAPHY)
1. Assess pathologies either biliary pancreatic
 To demonstrate the hepatic and common
duct.
bile ducts during operation and particular
reference to patency and retained calculi. 2. Provide therapy to alleviate certain
pathologic condition.
Indications:
3. Removal of biliary calculi.
1. Assessment of the non-fixing GB
4. Obstructive jaundice
2. Post cholecyctectomy

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 5. Acute biliary pancreatitis - done when pt with jaundice of unknown cause

6. Evaluation of pancreatic trauma. Indications:

7. Suspected pancreatic cancer. 1. Obstructive jaundice

Contraindication: 2. Stone extraction

1. Acute pancreatitis 3. Biliary drainage

2. Cholangitis Urinary System

3. Pseudocyst Consist of:

Procedures:  2 kidneys

- Topical anesthetic sprayed to the throat  Pair of grand like organs

*To facilitate passage of the endoscope.  Latin word REN

- GA maybe used to:  Renal common term

1. Children  Lying retroperitoneal space

2. Px who are unable to cooperate.  Posteriorly on either side of the vert.

column.
3. When procedure is lengthy
 Upper portion of the abdomen
CM
 Remove waste materials from the blood
 H20 based iodinated CM and eliminate waste in the urine.

- Glucagon  Bean shaped organs

*to reduce spasm in the duodenum.  Excrete 1-2 liters / day.

4. INTRAVENOUS CHOLANGIOGRAPHY Two Ureters

- To investigate the biliary ducts system and  25cm long muscular ducts
particularly in pt whose GB has been removed
 Retroperitoneal and run over the psoas
 If GB is present a fatty meal maybe given muscle, 5cm from midline.

 Cholografin / methylglucamine  Lies anterior to the kidney.

 20-30ml (adult) Bladder

5. PERCUTANEOUS TRANSHEPATIC  Hollow muscular organ ,lies behind the

CHOLANGIOGRAPHY
symphesis pubis.
-demonstareBILIARY DUCT  Acts as reservoir for urine and a
contractile organ to expel urine
- Pre-op radiographic exploration of the biliary
tract &ducts.  Average capacity is 120-320 ml

- Direct puncture of biliary ducts.

 500 ml

- Needle injected in the right side. Urethra

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  Connects bladder to the exterior 3. Tumors

 Infraperitoneal structures 4. Cyst

 Male 18-20 cm 5. Malformation of the UT

 Female 4cm 6. Obstruction

Kidney 7. Strictures

 Measures 4 ½”(11.5 cm) length 8. Trauma

 Measures 2-3” (5 to 8 cm) width 9. Non- functioning kidney

 Left kidney is longer and narrower than Contraindication:

right
1. Renal failure
 150 grams
2. Severe heart disease
 To place ∥ body ↻ 30 °
3. Pregnancy
 Left kidney lies 1cm superior than the
4. Hypersensitivity
right.

 Top of left kidney level of T11&T12 5. DM

UROGRAPHY
 Bottom of right level of upper L3

1. Functional/Descending/Excretory
 When px stands kidney drop 5cm or 2 “
pyelography.
termed as nephroptosis.

2. Instrumental/Retrogade or ascending
Kidney functions:
pyelography.
1. Control water balance.
*directly into the canals.
2. Control blood PH
Preliminary film
3. Control electrolyte balance
AP/PA OBLIQUE AND / OR LATERAL.
4. Excretion of waste product and drugs
 Localize calcerous shadows and tumor
5. Control of blood pressure masses.

6. Activation of vitamin D ERECT

IVP/IVU/Excretion Urography:  Mobility of the kidney.

 Suspected UT pathology Patient preparation:

 Demons. the anatomy and the some extent 1. NPO 6-8 hrs.
physiology and urinary tract.
2. Cleansing enema
INDICATIONS:
3. Laxative
1. Calculi
4. 500-100 ml of CM
2. Infections
5. Refrain from drinking fluids.

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No fluid restriction to:  To open out the calyces or remove
overlying opacities.
1. Diabetic
8. Tomography
2. Renal failure
 To remove overlying gas shadow or
3. Children identify the extent of filling defects.

Scout film 9. Compression

1. Verify patient prep.  Slow the drainage of urine from the
calyceal system and fill out the calyces to
2. Determine exposure
give clearer image.
3. Verify positioning
 Positive midline b/w the lower CM and
4. Detect abnormal calcifications iliac crest.

5. Demons. the nephrogram/renal Compression band should not applied to:

parenchyma / renal tubules.
1. Renal failure
PROCEDURES:
2. Obstruction
1. Immediate
3. Children
 10- 14s after injection to show the
4. Patient who had a recent abdominal
nephrogram (renal parenchyma renal
surgery.
tubules).

2. 1min (renal area) 10. Post micturition

 Show the quality of emptying any

 To see the nephrogram
abdominal bladder shapes or reflux.
 Enables to see any filling defect
 15 ° caudad
 Renal parenchyma
 Assess bladder emptying
3. 5min.(renal area)
 To aid the diagnosis of bladder tumors
 Enables to see early calyceal filling or
 To confirm uterovesical junction calculi.
filling defects.

 Demonstrate urethral diverticulum in

4. 10 mins (renal area)
females.
 To show the filled calyces.
11. Delayed 24 hours in cases of obstructive
5. 15mins. uropathy.

 To demonstrate the ureters. DOSAGE PROTOCOL FOR CHILDREN

6. 20 minutes 0-1year – 3ml / kg

 Show the drainage of the kidneys, ureters , 1-2 years – 30 ml/kg

and bladder filling.
2-8 years - 40ml/kg
7. 30 minutes and 45 minutes
8-18 years – 50 ml/kg.

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HYPERTENSIVE IVP 2. Previous examination show an obstruction
but the cause cannot be identified.
-Increased of blood pressure caused an increase
of excretion rate. Contraindications:

1. Control/scout 1. Current UTI / strictures

2. 1, 2, & 5 mins. PROCEDURE:

3. 15mins. 1. Control

4. After micturition/post void - Identify the position of the calculus

- Identify the tip of any catheters

TRAUMA IVU 2. 35 ° (RPO)

-To confirm injury to the kidney or renal tract or - Full length

to see if there is one normal kidney when the
CYTOSCOPE – is passed per urethra and bladder
other must be due to drainage.

NEEDLE NEPHROSTOMY
1. Control

2. 20mins. -Interventional examination of the

PELVICALYCEAL SYSTEM.
*show leaking contrast or extravasation.
Indication:
URETHROGRAMS
- Relief of obstruction of the kidney
- Examination of the urethra to see the caliber of
Contraindication:
the urethra.

Indications: 1. Bleeding

 Higher than average tendency to acquire

1. Strictures
certain disease
2. Tears
 20mL Urografin
3. Congenital abnormalities
PERCUTANEOUS NEPHROLITHOTOMY
4. Fistula
-Interventional procedure for removing renal
5. After surgery calculi

6. Diverticulae Indications :

7. Urethral valves 1. Rebulking of large calculi / disintegration

Contraindications: 1. UTI 2. Inability to use ESWL

RETROGRADE URETHROGRAPHY 3. Ureteric fistulae

 Examination of the full length of the Contraindication:

urethra.
1. Bleeding
Indications:
Procedures:
1. Identify if an opacification is in the ureter.
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 1. Control - CR 5 ° caudad, RP: superior border of
symp.pubis
2. Full length (residual calculus)
CYSTOURETEROGRAPH
RETROGRADE PYELOGRAPHY
- Inspection of the lower ureters
- Non-functional examination of the urinary
system directly into the pelvicalyceal system PYELOGRAPHY

- To demons. The kidneys and ureters in cases of - Demonstrate of the renal pelvis and calyces
doubtful lesion.
RETROGRADE UROGRAPHY
- Ureteric catheter is introduced via urethra and
bladder into ureteric orifice. - Examination of proximal urinary tracts and
catherization of the urinary canals.
- 5-10ml
MALE REPRODUCTIVE SYSTEM
- 35cc of cm
EPIDIDYMOGRAHY/
Contraindications : EPIDIDYMOVESICULOGRAPHY

1.UTI AP PROJECTION

VCUG (VOID CYSTOURETHROGRAM) - CR: superior border of symp.pubis.

- Study of the urethra and evaluate the patients PROSTATOGRAPHY

ability to urinate.
-investigation of the prostate by radiographic,
- Functional study of bladder and urethra. cystographic, or vesiculographic procedures

Indications : -pt is instructed to empty his bladder.

1. Trauma or involuntary loss of urine -Exposure is made at the end of exhalation.

MALE VCUG UTERUS AND FALLOPIAN TUBES

- To demons. The urethra and bladder neck HYSTEROSALPINGOGRAPHY

150ml + 20ml of oily medium - introduction of a radiopaque contrast

medium through a uterine cannula
- RP. Superior border of symphysis pubis
- determine the size, shape, and position of
- FS 10x12 the uterus and uterine tubes

- RPO and LPO positions - aplporpolat

FEMALE VCUG - RP: 2” superior to symp.pubis

- 150ml of CM + 20ml of more dense oily Indications:

- To outline the base of the bladder and urethral - to delineate lesions such as polyps,
catheter in site.
submucous tumor masses, or fistulous
tracts
- Demonstrate defects in bladder mechanism

 to investigate the patency of the uterine

AP position
tubes in case of sterility

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Contraindications: -is performed to investigate congenital
abnormalities, vaginal fistulae, and other
- Acute/subacutepelvic inflammation pathologic conditions involving the vagina.

- Vaginal or cervical infection w/ purulent -CM is introduced to vaginal canal.

DC
Vaginography ⊥
- Immediate premenstrual or postmenstrual
phase  Lambie, Rubin &Dann

- Acute uterine bleeding  use of a thin barium sulfate mixture for the
investigation of fistulous communications with
- Pregnancy the intestine.

Patient preparation: COE - advocated the use of an iodinated organic

compound.
- proper bowel prep including mild laxatives,
suppositories & cleansing enema - CR: ⊥

- ptis instructed to take mild pain - Localized studies, 2 “

relieverbefore examination to alleviate
some discomfort - RP: superior border of symp.pubis

th
- Examination should be scheduled b/n4 - FETOGRAPHY
10thday following the onset of
- Demons. Fetus in uterus.
menstruation

- This taken 18weeks after gestation.

Procedures:

- Scout film - Detect suspected abnormalities of

development
- Adjust the ptin the lithotomy position after
- Confirm suspected fetal death
scout

- Determine presentation and position of

- Gynecologist then introduced a vaginal
speculum and clean the cervix and then fetus
inserts the cannula into the cavity through - Determine whether the pregnancy is single
the cervical canal fiiting the cone shaped or multiple.
rubber plug to prevent reflux of the CM.
AP or PA and lateral projections - to demons.
- Introduced the CM the maternal pelvis and developing fetus.

- ⊥ central ray to the abdomen.

PELVIC PNEUMOGRAPHY PA & LATERAL PROJECTION for early

- Pelvic pneumography, gynecography, and pregnancy.

pangynecography are the terms used to denote - CR: 25-30 °s cephalad passing through
radiologic examinations of the female pelvic region of anus.
organs by means of intraperitoneal gas
insufflation.

VAGINOGRAPHY PELVIMETRY

- Demonstrate the architecture of the

maternal pelvis and to compare the size of
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 the fetal head with the size of the maternal THOMS METHOD– suggest both lateral
bony pelvic outlet. &inlet position are made w/ at 36” FFD.

- Deter. whether the pelvic diameters are - Thoms&Wilson same fixed distance be
adequate for normal parturition. used to maintain relative size values to
minimize error caused by divergence of
xray beam.

AP PROJECTION - Position: seated upright

- Supine, MSP midline of the table. - ⊥ to MSP. 2 1/2” (6cm) posterior to

symp.pubis.
- Flex the patient's knees to elevate the
forepelvis. - Inlet imagesequiresadjustable Back-rest
apparatus (Torpin-Thomas appartus)
- separate the thighs enough to permit
correct placement of the pelvimeter.

- Place the scale of pelvimeteragainstgluteal  BALL METHOD – requires no special

fold/buttocks at the level of the ischial apparatus.
tuberosities.
- Position: AP & LATERAL ERECT
- CR: ⊥RP: superior margin of symp.pubis
- ⊥ to MSP. 2 1/2” (6cm) posterior to
symp.pubis

COLCHER-SUSSMAN METHOD (AP  BALL & GOLDEN –advocate the

PROJ.) comparison of fetal head.

- Uses of the Colcher-Sussmanpelvimeter.

- device consists of a metal ruler ii at PLACENTOGRAPHY

centimeter intervals and mounted on a
small stand in such a way that it is always walls of the uterus are investigated to
∥ to the plane of the JR. This ruler can be locate the placenta in cases of suspected placenta
↻ in a complete circle and adjusted for previa.
height.
ANTHROGRAHY
- Supine, MSP midline of grid
ARTHROGRAPHY

-Arthrography is a radiographic examination of

COLCHER-SUSSMAN METHOD joints. This is used to denote radiologic
(LATERAL PROJ.) examinations of the soft tissue structures of joints
(meniscu. ligaments, articular cartilages, bursae)
- R&L lateral posi. MCP of the midline of the
following injection of one or more contrast into
table. the capsular space.

- Place the pelvimeter against the * Gaseous Medium - Pneumoarthrography

midsacrum.
*water soluble iodinated medium - contrast
- CR: ⊥ RP: most prominent point of the arthrography
greater trochanter.
* combination of both - double contrast
angiography

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BRONCHOGRAPHY - Contrast is introduced into the
subarachnoid space by spinai puncture at
Term aplied to the specialized radiologic the L3-L4 interspace
examination of the lungs and bronchiail tree by - Demonstrate the site and extent of spinal
means of introducing an opaque contrast medium cord lesions, tumors and encroachment by
into the bronchi. posterior protrusion of herniated
intervertebral disks
(1) AP Supine
1. Dimer X
(2) PA Upright
- water soluble cm
(3) R&L Obiiques
-used lumbar region only to give better definition
(4) Lateral of nerve roots

lNDICATIONS: 2. Amepaque used in the thoracic and cervical

regions non-toxic
1.Hemoptysis
- CM water soluble non-ionic iodinated CM
2. Bronchiectasis
- the 1st non-ionic METREZAWDE less viscous,
3. Chronic Pneumonia good visualization

4. Bronchial Obstruction
Metrezamide

5. Pulmonaty tumors, cysts and cavities - used in thoracic and lumbat areas

6. Bronchopleural cutaneous fistula - 2nd generation non-ionic = lohexol, Iopamidol,

and Ioversol
METHODS OF CONTRAST INSTILLATION:
Pantopaque = the oldest C M
1.Supraglottic medium is rapidly dropped from the
cannula onto the base of the tongue from where it *disadvantage poor visualization of the name
flows into the glottis. roots

lntraglottic catheter is advanced into the glottis for DISKOGRAPHY

the introduction of contrast
- Term used to denote radiographic
2.Trans-glotticintratracheal intubation a rubber examination of individual intervertebral
intratracheal catheter is passed trans-orally or disk by means of injection of small
transnasally through the glottis and trachea into quantity of one of the water soluble
the main stem bronchus of the side under iodinated media into the center of the disk
investigation. by way of a double entry needle.

3.Percutaneous Cricothyroid or Percutaneous INDICATIONS:

Transtracheal a puncture needle is inserted into
the subglottic tracheal space through the - internal disks lesions such as rupture of
cricothyroid membrane or slightly lower at an nucleus pulposus that cannot be
intercartrlaginous tracheal space. demonstrated by myelography

MYELOGRAPHY LUMBAR DISKOGRAPHY

- Exam. of CNS structures situated within - The patient is placed in lateral position for
the spinal canal thei introduction of the needle and
contrast.

22
AFTER INJECTION CM = Direct lateral radiograph - demonstrate the ventricles of the brain by
the direct injection of air or a positive cm
- PATIENT IN SUPINE with the THIGH 1-2 ml.
FLEXED to place the back in close contact
with the table PULMONARY ANGIOGRAPHY

- For FRONTAL PROJECTIONS of the - investigate suspected vascular

LATERAL 2 disk spaces, the THIGH is abnormalities in the mediastinum of lungs
FLEXED in LITHOTOMY with CR 10-20 °s for acute pulmonary embolism
cephalad
ENCEPHALOGRAPHY
- UPRIGHT: Flexion ,Extension, Weight
- demonstrate the ventricular and cistemal
bearing Lateral studies of the disk or disks
system of the brain by injection of a gas or
CERVICAL DISKOGRAPHY air into the lumbar subarachnoid space or
directly into the cistema magna.
- This requires the use of vertical table to a
grid device to hold a vertically placed hlm ERCP
and portable for crosstable lateral images.
- a method where the pancreatic duct is
- CR 10 °s cephalic for AP directly catheterized from the ascending
duodenum via fiexi . le iiber optic
VERTEBRAL ANGIOGRAPHY
endoscope examine biliary and pancreatic
ducts passed through the mouth to the
- to outline the posterior cerebral and
duodenum
cerebellar circulation into the vertebral
arteries INDICATIONS:

CAROTID ANGIOGRAPHY - assess pathologies either in biliary or

pancreatic duct provide therapy to
- to outline the circulation in the cerebral
alleviate certain pathologic conditions
hemispheres especially the anterior and middle
cerebral vessels by injecting cm
CONTRAINDICATIONS:
e.g aneurysm displacement of vessels caused by
Acute pancreatitis Cholangitis Pseudocyst
tumors or abscess
ERCP PROCEDURES: Topical anesthetic sprayed
SPINAL VENOGRAPHY
to the throat to facilitate passage of the
endoscope
- demonstrate a prolapsed intervertebral
disks, especially a lateral protrusion

VENOGRAPHY

- demonstrate the patency in the deep veins

of the legs. pelvis or axilla

- Leg 20 ml = vein in the dorsum of the foot

Pelvis into the femoral vein Axilla median
cubital vein

VENTRICULOGRAPHY

23
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