Positioning and Imaging of the Biliary System (RADS 320)

Reasons for checking the gallbladder and biliary system

to see condition of the biliary ducts (patency) and check for gallstones

Types of gallstones

Pure Cholesterol Stones & Calcium

Pure Cholesterol Stones

appear as negative filling defects within the bile and cannot be visualized on plain radiographs without contrast media (radiolucent)

Calcium Stones

contain deposits that asorb x-rays and appear as white dots on radiographs (radiopaque)

kVp for Gallbladder exams

70-80 kVp because we use iodinated contrast

CR for gallbladder exams

L2 or 9th costal cartilage

Breathing for gallbladder projections

exposure made of expiration

Cholegraphy

General term for a radiographic study of the biliary system

Cholecystocholangiography

radiography of the gallbladder and bile ducts

cholecystography

radiography for investigation of the gallbladder

cholangiography

radiography of bile ducts

Cholelithiasis

gallstones

Cholecystitis

acute or chronic inflammation of the gallbladder

Pathologies demonstrated for gallbladder exams

-biliary calculi

-neoplasm

-biliary duct stenosis

-lesions of head of pancreas

Methods for checking gallbladder and biliary system

-Endoscopic Retrograde Cholangiopancreatogram (ERCP)

-Operative Cholangiogram

-Postoperative (T-tube) cholangiogram

Purpose of Endoscopic Retrograde Cholangiopancreatogram (ERCP)

investigates patency of biliary/pancreatic duct, reveal choleliths, and demonstates small lesions

Degree if obliquity for Endoscopic Retrograde Cholangiopancreatogram (ERCP), RPO position

15-40 degrees

Endoscopic Retrograde Cholangiopancreatogram (ERCP), RPO position: CR

center to RUQ; T12

Indications for Operative Cholangiogram

-investigate patency of biliary tract

-determine status of hepatopancreatic ampulla (ampulla of vater)

-reveals gallstones not previously detected in biliary ducts

-demonstrates small lesions, strictures, or dilation

The postoperative cholangiogram (T-Tube) is done...

after the gallbladder is removed

The T-tube of the postoperative cholangiogram is left in the...

common bile duct and common hepatic duct for post operative drainage of excess bile

Indications for Postoperative (T-Tube) Cholangiogram

-demonstrates caliber and patency of ducts

-status of the sphincter of hepatopancreatic ampulla

-precense of stones