ORE (Ylaya)

Dacryocystography

Radiographic examination of the lacrimal system following injection of contrast media to detect blockages, narrowing, or injury in the tear drainage ducts

Dacryocystography Indications

• epiphora

• suspected nasolacrimal duct obstruction

• post-dacryocystorhinostomy evaluation

• congenital or traumatic defects

Dacryocystography Contrast Media

Iohexol 300mg/mL

CM injection for dacryocystography

injected through the lacrimal punctum using a lacrimal cannula or a nylon catheter (~0.2 - 0.5 mL per side)

Dacryocystography Patient Position

Upright or supine position with head stabilized and eye region centered to the image receptor

Dacryocystography Waters' View (Occipito-Mental Projection)

Head resting on raised chin, OML is 35 degrees to the IR, and central ray is perpendicular to lower orbital margin

Dacryocystography Lateral Projection

Head in true lateral position, MSP parallel to the IR, and central ray perpendicular to lower orbital margin

Dacryocystography AP Projection

Patient in supine position, MSP centered to midline of table, and central ray perpendicular to nasion

Dacryocystography AP Axial Projection

Patient in supine position, MSP centered to midline of table, and central ray angled 15 - 23° caudad

Dacryocystography Rhese Method

Patient in prone position with chin, nose, and zygoma on the IR, MSP forming a 53° angle from the IR, and AML perpendicular to the IR

Dacryocystography Exposures

• radiographic exposures made before CM injection

• when 1 mL of CM is injected

• after injection is completed

• 7-10 minutes post-injection

Dacryocystography Cannula Technique

• Silver cannula is inserted through the lowerpunctum into the canaliculus

• CM is injected where it remains only for 15-30seconds after injection

• Radiographs must be taken as quickly as possible.

Dacryocystography Catheter Technique

• Uses a nylon catheter attached to a 2 mL syringe

• Radiographs can be taken during the injection of CM

Dacryocystography Normal Findings

Contrast fills canaliculi, flows to lacrimal sac, then to nasolacrimal duct, and enters nasal cavity smoothly[4].

Dacryocystography Abnormal Findings

• Cut-off or non-opacification

• Dilation

• Extravasation

Cut-off or non-opacification

Obstruction

Dilation

Chronic blockage or infection

Extravasation

Canaliculi rupture or trauma

Dacryocystography Aftercare

• Cannula or catheter is removed

• Wash the patient’s eye after theprocedure and ask if the patient has any discomfort

Nasopharyngography

Radiographic examination of the nasopharynx following instillation of a negative or positive contrast media

Nasopharyngography

Used to visualize masses, adenoidal enlargement, or structural abnormalities that may cause breathing or swallowing problems

Nasopharyngography Indications

• Adenoidal hypertrophy

• Nasopharyngeal carcinoma or mass

• Velopharyngeal Insufficiency

• Obstructive Sleep Apnea Studies

Nasopharyngography Premedications

Atropine (Anticholinergic) is given 30 mins before the examination

Nasopharyngography Contrast Media

• Water-soluble iodinated contrast media (thick mixture or aerosol)

• Sometimes uses barium suspension if aspiration risk is minimal

Nasopharyngography Upright Lateral Projection

Patient erect with head in true lateral, CR perpendicular to 3/4 inch anterior to EAM, patient instructed to take deep breath thru the nose

Nasopharyngography Upright Lateral Projection

Best demonstrates hypertrophy of the pharyngeal tonsil or adenoids

Nasopharyngography Positive Contrast Media Projections

Performed to assess extent of nasopharyngeal tumors

Nasopharyngography Postiive Contrast Media

Uses Iodized oil or finely grounded barium sulphate

Preliminary radiographs are taken in …

SMV and Upright Lateral

Upon completion, patient is asked to …

sit up and blow thru the nose to evacuate the CM

Nasopharyngography SMV

Patient supine with shoulders elevated to hyperextend neck, OML 40-45° to horizontal plane, CR angled 15-20° cephalad

Nasopharyngography SMV

1st radiograph taken as well as the most important view of nasopharyngography

Nasopharyngography Upright Lateral

Patient erect with head in true lateral projection and CR horizontally directed towards nasopharynx

Nasopharyngography Procedure

Patient supine or upright with neck hyperextended, topical anesthetic (Lignocaine 4%) sprayed into nostrils, CM introduced via polythene catheter without swallowing, or via gargling

Patient is instructed not to swallow during instillation of CM but to raise the hand when they feel the need to swallow (T/F)

T

Nasopharyngography Aftercare

Inform patient that mild throat or nasal irritation is normal and instruct to drink water to flush out contrast

Laryngography

Radiographic procedure of the larynx (voice box) to assess its structure and motion, especially during speaking or breathing

Laryngography

Used to investigate voice problems, vocal chord paralysis, tumors, or airway narrowing

Laryngography Indications

• Vocal cord paralysis

• Tumors or nodules

• Airway stenosis

• Functional voice disorders

Laryngography Contrast Media

Water-soluble iodinated contrast media (nonionic preferred)

Laryngography AP Projection

Patient erect with head slightly extended and CR directed at C4-C6 laryngeal level

Laryngography Lateral Projection

Patient erect with head in true lateral position with chin slightly raised, CR directed at C4-C6 laryngeal level

Laryngography Procedure

CM introduced via laryngeal catheter or nebulized spray into laryngeal area while fluoroscopic images are taken during phonation or breathing

Laryngography Normal Findings

Symmetrical movement of vocal cords and clear airway passage

Laryngography Abnormal Findings

Fixed vocal cords, irregular margins, and airway narrowing

Laryngography Aftercare

Inform patient mild throat or nasal irritation is normal and instruct to drink water to flush out CM

Fistulogram

Radiographic study of an abnormal connection (fistula) between two body surfaces.

Fistulogram

Helps the physician determine the path, length, and openings of the fistula

Fistulogram Indications

• Post-surgical fistula (e.g. bowel, bladder, biliary)

• Congenital or traumatic fistula

• Infection-related tract formation

Fistulogram Contrast Media Amount

~1.5 mL

Fistulogram Patient Position

Positioning depends on where the fistula is located

Fistulogram Projections

Determined by site

Usual Fistulogram Projections

AP, Right or Left Lateral, RAO, LAO

Fistulogram Technique

CM injected gently into external opening of fistula; radiographs or fluoroscopy used to view tract path

Sinography

Radiographic procedure that examines a sinus

Sinography

Can be used to diagnose sinus thrombosis and to investigate draining tracts in small animals

Sinography Indications

Chronic draining wounds, infected tracts (pilonidal sinus, osteomyelitis tract), and pre-surgical mapping

Sinography Contrast Media Amount

~1-2 mL

Sinography Patient Position

Depends on location

Sinography Projections

Single or multiple views following tract direction

Sinography Procedure

Scout AP radiographs taken, CM injected through fine cannula/catheter into sinus opening under fluoroscopy or x-rays, gauze pad placed over orifice to discourage reflux, and spot films taken

Sinography Aftercare

Clean area, observe for leakage, expect mild soreness, and keep patient in examination room for a few hours to check condition