special procedures

PALATOGRAPHY

SRE using positive contrast technique to investigate suspected tumors of the soft palate

Nasopharyngograph

SRE of the nasopharynx using negative and positive CM

Upright lateral projection - Negative cm

Nasopharyngograph

Demonstrate hypertrophy of the pharyngeal tonsil or adenoids

blow thru the nose to evacuate CM

For positive CM nasopharyngography

Pharyngography

Opaque study of the pharynx made with an ingestible contrast medium

Gunson method

A practical technique for synchronizing the exposure with the height of swallowing act in deglutition studies of the pharynx and superior esophagus

Tying a dark colored shoestring around the patient’s throat above the thyroid cartilage

For gunson method we should?

Laryngopharyngography

Stationary or tomographic negative contrast studies of the air-containing laryngopharyneal structures

LARYNGOPHARYNGOGRAPHY

Done on respiratory & stress maneuvers

TOMOLARYNGOGRAPHY

Tomographic studies of the laryngopharyngeal structures either before or after the introduction of radiopaque CM.

Quiet inspiration

test abduction of the vocal cords

Normal ( expiratory ) phonation

Test abduction of the vocal cords

Modified vasalva’s manuever

Test the elacticity of the hypo-pharynx & the piriform recesess

Falciform ligament

Right and Left lobe of the liver is separated by the

800-1,000 ml or 1 quart of bile per day.

Liver secretes?

aid in digestion of fats by emulsifying or breaking down fat globules

The major of function of bile is to

1. Store

2. Concentrate

3. Contract when stimulated

The three primary functions of the GB is:

Bile

is formed in the small lobules in the liver and travels Through the right or left hepatic ducts

Strawberry GB

GB appearance due to the presence of cholesterol/cholesterol gallstone.

Courvoisier GB

Enlarged and palpable GB in patient with carcinomaof the head of the pancreas.

• Associated with jaundicedue to obstruction of the CBD

Sandpaper GB

Roughened condition of the mucous membrane of the GB associated with the presence of gallstones.

Fish scale GB

appearance due to presence of multiple cyst of the mucosa.

Hypersthenic GB

GB moves laterally and superiorly I to 3 inches (2.5 to 7.6 cm) on full expiration.

Asthenic GB

GB moves medially and inferiorly I to 3 inches (2.5 to 7.6 cm) on full inspiration

second or descending portion of the duodenum

The CBD descends behind the superior portion of the duodenum and head of the pancreas to enter the

common hepatic duct

draining the liver joins with the cystic duct to form the common bile duct.

Hepatopancreatic Ampulla or the Ampulla of Vater

The CBD and Pancreatic duct forms into a common passageway called the

Cholegraphy

General term for a radiographic study of the biliary system.

CHOLELITHIASIS

Condition of having gallstones.

Cholecystography

SRE of the galbbladder

Cholangiogram / cholestangiography

Sre of the gallbladder and biliary ducts

Cholecystectomy

Surgical removal of the GB

Cholecystitis

Inflammation of the GB

Gallstones

Choleliths

By mouth

This biliary system administration is absorb thru the intestines and carried to the liver thru portal vein

By injection into a vein ( single bolus or by drip infusion ) intravenous

This biliary system administration is Most commonly injected at the antecubital veins and passes thru the heart. Cm enters via liver

Direct injection into the ducts

This biliary system administration is During biliary tracy surgery or through an indwelling tube

cholesystopaques

The oral cm use for visualization of the GB is called

Oral cholecystogram

The most common SRE to study the GB

Sodium ipodate

6 capsules each containing 500 mg. This is the most widely used agent

Pure cholesterol stones

Appear as negative filling defects

Cholethiasis

most common abnormalities diagnosed during OCG

Choledocholithiasis

Calculi in the CBD

Cholecystitis

Acute or chronic inflammation of the GB, common complication of cholelithiasis

10-12 hours

Preliminary diet for OCG how many hours given the CM prior to the procedure most effective ?

2-3 hours

In OCG Cm is given how many hours after evening meal?

RPO

What patient position is placed so that the GB can best drain?

PA projection

What projection best demonstrate milk calcium bile

Lao position

Which position best demonstrates opacified GB away from vertebral column? The most common basic position of the GB

Rights lateral position

What position used to differentiate gallstones from renal stones or calcified mesentric lymph nodes?

Right lateral decubitus

Which position demonstrate stratification or layering of gallstones?

Intravenous cholangiography

Employed to investigate the biliary ducts of cholecystomized patients

PTC

The performance of this examination has greatly increased because of the availability of the chiba ( skinny ) needle

PTC

More invasive than other forms of cholangiography

OIC

This use to investigate

•patency of the bile duct,

• functional status of the sphincter of the hepatopancreatic ampulla,

•reveal the presence of previously undetected biliary tracy calculi

15-20 degrees

In OIC this degrees RPO is helpful in projecting the biliary ducts away from the spine, especially in hyposthenic patient

Post operative cholongiography

Use to demonstrate the caliber and patency of the ducts; status of the sphincter of the hepato-pancreatic ampulla & presence of residual or previously undetected stones

¾ inch (1.9 cm ) anterior to EAM

What is the CR of nasopharyngograph negative CM

15-20 degrees cephalad

CR for positive CM nasopharyngography

Calcium and magnesium citrate carbonate crystals

In digestive system the most commonly used to produce carbon dioxide gas are?

Esophagogram

Also called barium swallow

Barium or carbon dioxide crystal

In esophagogram if it uses double contrast what is used?

Upright of the esophagus

In esophagogram in single CM , scout film is

End of full inspiration

Barium passed through the esophagus fairly slowly if it is swallowed at the

End of full expiration

Barium is delayed in the lower part for several seconds if it is swallowed at the

Adenocarcinoma

The most common form of cancer of the esophagus

Double contrast media

 A free flowing, high density barium is used.

 A gas producing substance usually carbon dioxide crystal is added to the barium mixture or can be given by mouth immediately before the barium suspension is given

Filling phase

 Use to distend the lumen of the esophagus to demonstrate the entire length.

 2:1 or 3:1 barium preparation

Mucosal Phase

 Use to demonstrate the mucosal pattern of the esophagus.

 4:1 barium preparation

Achalasia

 Motor disorder of the esophagus in which peristalsis is reduced on the distal 2/3 of the esophagus.

 Also called cardiospasm.

Esophagogram and endoscopy

are modality of choice to detect these tumors

Esophageal Varices

 Dilation of the veins in the distal esophagus.

 Has the radiographic appearance of wormlike or cobblestone

Recumbent position

is routinely used for the demonstration of esophageal varices

Breathing exercise, water test, compression paddle, toe touch maneuver

TECHNIQUES FOR THE DEMONSTRATION OF ESOPHAGEAL REFLUX

Vasalva manuever

is the most common breathing exercise.

Toe-touch maneuver

Esophageal reflux and hiatal hernias are demonstrated in this technique

esophagus RAO POSITION

Demonstrate the entire contrast filled esophagus free from superimpositionof the heart and vertebra.

 Best single projectionof barium-filled esophagus

Esophagogram LATERAL position

exposure is made while patient is drinking the CM through a straw in a rapid & continuous swallow

Esophagogram AP/PA projection

Esophagus must be adequately demonstrated through the superimposed thoracic vertebrae

LPO position

Position water test in esophageal reflux