RADCON - Sialography

SIALOGRAPHY

Radiologic exam of salivary glands and ducts using contrast (usually water-soluble iodinated media).

• Inflammatory lesions

• Tumors

• Extent of salivary fistulae

• Diverticulae

• Strictures

• Calculi (stones)

Indications for Sialography

🔹 Only one gland at a time can be examined due to proximity of paired glands.

• Parotid

• Submandibular

• Sublingual

Salivary Glands

Parotid

"Near the ear", largest, anterior to external ear

Submandibular

• also called submaxillary

• below mandible or maxilla

Sublingual

below the tongue

SIALOGRAPHY

1. Inject contrast into the main duct → flows into ductules and gland

2. Scout film to assess gland before contrast

3. 2–3 mins before exam: give lemon wedge (secretory stimulant)

4. After exam: another lemon wedge → stimulate contrast evacuation

5. 10 mins post-procedure: radiograph may be taken to check clearance

• Tangential

• Lateral

PROJECTIONS FOR SIALOGRAPHY

Tangential Projection

• IR: 8×10"

• Position:

  • Supine: Rotate head slightly toward side examined

  • Prone: Rotate head so parotid area is perpendicular

• Mandibular ramus parallel to IR

• Breathing: Puff cheeks or suspend respiration

• CR: Perpendicular along lateral mandibular ramus

• Shows: Parotid gland and duct

Lateral Projection

• Parotid and Submandibular Glands

• IR: 8×10"

• Parotid:

  • Semi-prone or upright

  • Rotate head 15° toward IR

  • Center IR ~1" superior to mandibular angle

• Submandibular:

  • True lateral

  • Center IR at inferior margin of mandibular angle

  • Iglauer's method: depress mouth floor with index finger to displace gland

• Respiration: Suspend

• Shows: Bony structure, calcifications, swelling, ducts

PHARYNGOGRAPHY

• Uses thick barium + fluoroscopy during swallowing (deglutition)

• Commonly spot-filmed

• Gunson Method

• Valsalva's Maneuver

• Modified Valsalva's Maneuver

Special Techniques in PHARYNGOGRAPHY

Gunson Method

• Tie dark shoestring above thyroid cartilage

• Watch for string elevation during swallowing

Valsalva's Maneuver

• Deep breath → bear down as if to poop

• Tests closure of glottis; increases thoracic/abdominal pressure

Modified Valsalva's Maneuver

• Pinch nose, close mouth → try to blow nose or cheeks

• Distends hypopharynx and piriform recesses

POSITIVE-CONTRAST LARYNGOPHARYNGOGRAPHY

• Purpose: Locate size and site of tumors

• Prep: May give sedative, apply topical anesthetic

• Contrast: Iodized oil (via metal cannula)

• Process:

  • Slowly drip contrast over back of tongue or into larynx

  • Use fluoroscopy, spot images, or cineradiography

  • Tell patient: Don’t swallow/cough after contrast

• AP

• Lateral

PHARYNX AND LARYNX PROJECTIONS

AP Projection

• IR size: 8 x 10 inches

• Patient position: Upright (seated or standing), midsagittal plane centered

• Head position: Slight extension to avoid mandibular shadow over larynx

• Respiration: Image during inspiratory phase of quiet nasal breathing

• Central ray: Perpendicular to laryngeal prominence

• Structures shown: Soft palate, pharynx, and larynx; use grid for improved contrast.

Lateral Projection

• IR: 8×10"

• Position: Upright lateral

• Centering depends on target:

  1. 1" below EAM → nasopharynx / cleft palate

  2. Mandibular angle → oropharynx

  3. Laryngeal prominence → larynx, laryngopharynx, upper esophagus

• Head: Slight extension

• Shoulders depressed, hands clasped behind if needed

• Respiration: Quiet nasal inspiration

ESOPHAGOGRAM (BARIUM SWALLOW)

• Visualize form and function of pharynx and esophagus

  • Radiopaque contrast (usually barium sulfate)

  ⚠ Contraindications

  • Sensitivity to barium or water-soluble CM

• No prep if not followed by UGI series

• Remove metal from mouth to waist

• Take clinical history

• Use thin and thick barium

• May also use:

  1. Barium-soaked cotton balls

  2. Barium pills/capsules

  3. Marshmallows

Patient Preparation for ESOPHAGOGRAM

• Patient upright with thin barium in left hand

• Radiologist directs swallowing and observes via fluoroscopy

• Observe both thin and thick barium

• Followed by supine, horizontal, or Trendelenburg views

• RAO view common

ESOPHAGOGRAM Procedure

• Breathing Exercises

• Water Test

• Compression Technique

• Toe-Touch Maneuver

ESOPHAGEAL REFLUX DEMONSTRATION

Breathing Exercises

• Valsalva maneuver: breath + bear down

• Modified Valsalva: pinch nose + blow

• Mueller maneuver: exhale then try to inhale against closed glottis

Water Test

• LPO position (fills fundus with barium)

• Swallow water through straw

• Positive = reflux of barium into esophagus

Compression Paddle Technique

• Compression paddle → pressure on stomach

• Demonstrates EG junction

Toe-Touch Maneuver

• Patient bends to touch toes

• May demonstrate reflux or hiatal hernia