RAD. CONT (FINALS)

REPRODUCTIVE SYSTEM IMAGING PROCEDURES

1. HYSTEROSALPINGOGRAPHY (HSG)

a. Definition

A fluoroscopic examination of the uterus and fallopian tubes using contrast to evaluate tubal patency and uterine cavity structure.

b. Indications

• Primary or secondary infertility

• Recurrent pregnancy loss

• Suspected tubal blockage

• Uterine anomalies (septate, bicornuate, unicornuate)

• Adhesions or Asherman’s syndrome

• Post-tubal ligation follow-up

c. Contraindications

• Confirmed or suspected pregnancy

• Active pelvic inflammatory disease (PID)

• Active uterine or vaginal bleeding

• Severe contrast allergy

• Recent uterine surgery

d. Equipment Required

• Fluoroscopy unit

• Water-soluble iodinated contrast

• Cannula or balloon catheter

• Speculum, tenaculum

• Sterile gloves, antiseptic solutions

e. Patient Preparation

• Done after menstruation (day 7–10 of the cycle)

• Mild analgesic 1 hour before

• Explain possible cramping

• Empty bladder

f. Technique

1. Lithotomy position

2. Cervix cleaned → catheter inserted

3. Slow injection of contrast

4. Fluoroscopic images taken (AP, oblique)

5. Observe filling of the uterus → fallopian tubes → peritoneal spill

g. Aftercare & Complications

Aftercare:

• Mild cramps expected

• Use pads for contrast leakage

• Advise abstinence for 24 hours

Complications:

• Infection

• Vasovagal syncope

• Contrast reaction

• Uterine perforation (rare)

2. PELVIMETRY

a. Definition

Measurement of the maternal bony pelvis to determine if it is adequate for vaginal delivery.

b. Indications

• Suspected cephalopelvic disproportion

• Large fetus

• Breech presentation

• Previous pelvic trauma or deformity

c. Contraindications

• Pregnancy (radiation risk—rarely done today)

• When ultrasound/MRI is available

d. Equipment

• X-ray or CT scanner

• Lead shielding

e. Patient Preparation

• Remove metallic objects

• Abdominal shielding

f. Technique

• AP, lateral, oblique pelvic views

• CT pelvimetry uses 3D measurements

g. Aftercare & Complications

• None specific

• Minimal fetal exposure risk (why it is mostly obsolete)

3. AMNIOGRAPHY (Historical)

a. Definition

Contrast study of the amniotic cavity by injecting contrast into the uterus—now replaced by ultrasound.

b. Indications

(Historical only)

• Placental localization

• Fetal position

• Congenital abnormalities

c. Contraindications

• Pregnancy (modern practice forbids it)

• Infection

• Coagulopathy

d. Equipment

• Fluoroscopy

• Long spinal needle

• Contrast medium

e. Patient Preparation

• Informed consent (high-risk)

• Mild sedation

f. Technique

• Needle inserted transabdominally

• Contrast injected into the amniotic sac

• Fluoroscopic images taken

g. Aftercare & Complications

• Monitor for contractions

• Risk: fetal injury, infection, miscarriage

• Not used today

4. PELVIC PNEUMOGRAPHY (Historical)

a. Definition

Introduction of gas (CO₂ or O₂) into the peritoneal cavity to outline pelvic organs.

b. Indications

• Pelvic mass differentiation

• Ovarian vs intestinal pathology

c. Contraindications

• Pregnancy

• Peritonitis

• Bowel obstruction

d. Equipment

• CO₂ insufflator

• Needle

• Fluoroscopy

e. Patient Preparation

• Bowel prep

• Fasting

• Consent

f. Technique

• Needle inserted into the peritoneal cavity

• Gas insufflated

• X-ray images taken

g. Aftercare & Complications

• Pain and bloating

• Gas embolism

• Peritoneal irritation

• Now obsolete

5. VAGINOGRAPHY

a. Definition

Contrast radiographic imaging of the vagina to demonstrate structural abnormalities.

b. Indications

• Congenital anomalies

• Fistulas (rectovaginal, vesicovaginal)

• Trauma

• Tumors

c. Contraindications

• Pregnancy

• Vaginitis or infection

• Contrast allergy

d. Equipment

• Fluoroscopy unit

• Water-soluble contrast

• Vaginal catheter or syringe

e. Patient Preparation

• Explain the procedure clearly

• Empty bladder

f. Technique

• A catheter was inserted into the vagina

• Contrast instilled gently

• AP and lateral radiographs taken

g. Aftercare & Complications

• Mild discomfort

• Rare infection

6. PLACENTOGRAPHY (Obsolete)

a. Definition

Radiographic visualization of the placenta using contrast.

b. Indications (Historical)

• Placenta previa localization

• Placental abruption

c. Contraindications

• Pregnancy (risk to fetus)

d. Equipment

• X-ray

• IV contrast

e. Preparation

• Not used in current practice

f. Technique

• Contrast injected IV → placenta shows as a filling defect

g. Aftercare/Complications

• Fetal radiation risk

• Contrast reaction

• Abandoned due to ultrasound

7. FETOGRAPHY (Historical)

a. Definition

Direct fetal imaging with X-ray.

b. Indications

• Fetal age estimation

• Fetal anomalies

• Multiple gestation

• Presentation

c. Contraindications

• Any viable pregnancy

d. Equipment

• X-ray unit

e. Preparation

• Shielding (old practice)

f. Technique

• Abdominal radiograph performed

g. Complications

• Radiation to the fetus

• Completely replaced by ultrasound

8. PROSTATOGRAPHY

a. Definition

Contrast radiographic study of the prostate gland and prostatic urethra.

b. Indications

• Suspected prostate enlargement

• Urethral obstruction

• Post-traumatic urethral evaluation

c. Contraindications

• Acute prostatitis

• Urethral injury

• Contrast allergy

d. Equipment

• Fluoroscopy

• Foley catheter

• Contrast material

e. Patient Preparation

• Explain procedure

• Local anesthesia if needed

f. Technique

• Contrast injected via the urethra or the suprapubic route

• Fluoroscopic images taken

g. Aftercare & Complications

• Burning sensation during urination

• Hematuria

• Infection

• Contrast reaction

Conclusion

Most of these procedures, except for Hysterography, Prostatography, and Vaginography, are now historical in nature — replaced by safer and clearer modalities like ultrasound, CT, and MRI.
However, understanding them remains important, as they reflect the evolution of reproductive imaging and the foundation upon which modern radiology stands.

OTHER SPECIAL RADIOGRAPHIC PROCEDURES

1. CHOLECYSTOGRAPHY (ORAL / INTRAVENOUS)

a. Definition

Radiographic examination of the gallbladder and biliary system using contrast (orally or IV) to evaluate function and structure.
Note: Now replaced by ultrasound and HIDA scans.

b. Indications

• Gallstones

• Cholecystitis

• Gallbladder dysfunction

• Biliary obstruction

c. Contraindications

• Severe vomiting or diarrhea

• Iodine allergy

• Pregnancy

• Liver failure (won’t concentrate contrast)

d. Equipment

• X-ray unit

• Oral contrast tablets (telepaque) or IV contrast

• Compression band

e. Patient Preparation

• A low-fat meal the night before

• NPO (6–8 hrs)

• No anticholinergics or opioids

f. Technique

• Oral contrast taken 12 hrs before the exam

• X-ray after gallbladder fills

• Fatty meal to test emptying

g. Aftercare & Complications

• Minimal; contrast excreted in stool

• Rare allergy

2.

3. HYPOTONIC DUODENOGRAPHY

a. Definition

Specialized contrast exam of the duodenum performed after relaxing the bowel with glucagon to improve visualization.

b. Indications

• Suspicion of duodenal tumors

• Early pancreatitis

• Duodenal diverticula

• Partial obstruction

• Superior mesenteric artery syndrome

c. Contraindications

• Glucagon allergy

• Severe ileus

• Diabetes (glucagon raises blood sugar)

d. Equipment

• Fluoroscopy

• Thin barium

• Glucagon injection

e. Patient Preparation

• NPO for 8 hrs

• Remove metallic objects

• Explain possible flushing after glucagon

f. Technique

• Glucagon given → duodenum relaxes

• Barium is injected through a tube or swallowed

• Detailed spot films of the duodenal loop

g. Aftercare & Complications

• Nausea, transient vomiting

• Rare allergic reaction

• Hyperglycemia (monitor diabetics)

4. ARTHROGRAPHY

a. Definition

Contrast study of a joint (shoulder, knee, hip, wrist) using iodinated contrast, sometimes with air (double contrast).

b. Indications

• Ligament tears

• Meniscal injuries

• Joint capsule abnormalities

• Chronic joint pain

• Prosthesis evaluation

c. Contraindications

• Infection at the needle site

• Hypersensitivity to contrast

• Severe bleeding disorders

d. Equipment

• Fluoroscopy or CT/MRI

• Iodinated contrast

• Sterile needles

• Local anesthetic

e. Patient Preparation

• Explain the mild pain expected

• No heavy activity 24 hours before

• Consent

f. Technique

• Joint sterilized

• Needle inserted into joint space

• Contrast injected

• Fluoroscopic or CT images taken in various positions

g. Aftercare & Complications

• Ice pack for joint pain

• Avoid strenuous activity for 24 hrs
  Complications:

• Pain

• Infection

• Bleeding

5. BRONCHOGRAPHY (Historical)

a. Definition

Imaging of the bronchial tree using contrast injected into the airways. Now replaced by CT.

b. Indications

• Bronchiectasis

• Chronic infections

• Congenital bronchial anomalies

c. Contraindications

• Severe respiratory disease

• Bronchospasm

• Allergy

d. Equipment

• Fluoroscopy

• Catheter

• Iodinated contrast

e. Patient Preparation

• Sedation

• Local anesthesia in the throat

• Fasting for 6 hrs

f. Technique

• A catheter was inserted into the trachea

• Contrast injected into the bronchi

• AP, lateral, oblique chest views

g. Complications

• Coughing

• Dyspnea

• Aspiration

• Rare pneumothorax

6. MYELOGRAPHY

a. Definition

Contrast study of the spinal canal to visualize the spinal cord, nerve roots, and dural sac using intrathecal contrast.

b. Indications

• Disc herniation

• Spinal stenosis

• Tumors

• Arachnoiditis

• CSF leak

c. Contraindications

• Infection at the puncture site

• Increased intracranial pressure

• Contrast allergy

• Clotting disorders

d. Equipment

• Fluoroscopy

• Nonionic contrast (intrathecal)

• Lumbar puncture tray

e. Patient Preparation

• NPO 6–8 hrs

• Hydrate

• Explain post-procedure headache risk

f. Technique

• Lumbar puncture (L3–L4)

• Contrast injected into CSF

• Trendelenburg to guide flow upward

• Imaging with fluoroscopy or CT

g. Aftercare & Complications

• Lie flat for 24 hrs

• Increase hydration
  Complications:

• Headache

• Nausea

• Seizures (rare)

• CSF leak

• Infection

7. DACRYOCYSTOGRAPHY

a. Definition

Contrast imaging of the lacrimal drainage system (tear ducts).

b. Indications

• Nasolacrimal duct obstruction

• Chronic tearing (epiphora)

• Congenital lacrimal anomalies

• Trauma

c. Contraindications

• Acute infection

• Allergy to contrast

d. Equipment

• Fluoroscopy

• Microcatheter

• Nonionic iodinated contrast

e. Patient Preparation

• Topical anesthesia

• Clean periocular skin

f. Technique

• Catheter inserted into the lacrimal punctum 

• Contrast gently injected

• Imaging in AP and lateral views

g. Aftercare & Complications

• Mild discomfort

• Small risk of infection

• Tearing for a few hours

Conclusion

Radiology has evolved, but understanding these classic procedures enables us to appreciate the significant advancements in diagnostic imaging. Modern CT, MRI, and ultrasound have largely replaced many older techniques, yet the principles underlying these technologies remain vital.