RAD CONTRAST

GROUP 1

1. UGIS (Upper Gastrointestinal Series)

What:

UGIS or Upper Gastrointestinal Series is a fluoroscopic examination of the esophagus, stomach, and duodenum using a radiopaque contrast medium, typically barium sulfate.

Why (Indications):

• Difficulty swallowing (dysphagia)

• Persistent vomiting

• Gastric ulcer or tumor suspicion

• Upper GI bleeding

• Hiatal hernia or reflux study

Who:

Performed on patients with suspected upper digestive tract disorders under a radiologic technologist's and radiologist’s supervision.

When:

Done after a minimum of 8 hours fasting to ensure the stomach and small intestines are empty.

Where:

Conducted in the X-ray or fluoroscopy room equipped with a tilting fluoroscopic table.

How (Procedure):

1. Patient Preparation:

   • Fasting for at least 8 hours before the exam.

   • Remove all metallic items from the chest and abdomen.

   • Explain the taste and texture of the barium.

2. Positioning & Technique:

   • Patient drinks barium sulfate suspension under fluoroscopy.

   • Images are taken in upright, supine, and oblique positions.

   • Spot films of the esophagus, stomach, and duodenal bulb are obtained.

3. Contrast Used:

   • Barium sulfate suspension (thick or thin)

   • Water-soluble contrast (like Gastrografin) if perforation is suspected.

Contraindications:

• Suspected perforation or obstruction (unless using water-soluble contrast)

• Recent GI surgery

💡 Note: Always ensure the patient has no risk of aspiration before drinking barium.

2. SIALOGRAPHY

What:

Sialography is an X-ray examination of the salivary glands and ducts, mainly the parotid and submandibular glands, using a radiopaque contrast medium injected into the duct.

Why (Indications):

• Chronic or recurrent sialadenitis (infection)

• Obstruction or stones (sialolithiasis)

• Ductal dilatation or strictures

• Tumors of the salivary glands

Who:

Performed on patients with salivary gland problems by a radiologic technologist under the radiologist’s direction.

When:

Done after acute infection subsides to avoid contrast spread in inflamed tissues.

Where:

Performed in the X-ray room using fluoroscopic guidance.

How (Procedure):

1. Patient Preparation:

   • Obtain a history of iodine allergy.

   • Patient instructed to avoid eating 2–4 hours before exam.

   • Duct opening identified and dilated gently.

2. Positioning Notes:

   • Parotid gland: Patient’s head turned slightly toward the opposite side.

   • Submandibular gland: Head extended backward.

3. Procedure:

   • Cannulate the duct with a small catheter.

   • Inject iodinated oil-based contrast (e.g., Ethiodol) slowly.

   • Take radiographs in multiple projections (AP, lateral, oblique).

4. Contrast Used:

   • Iodinated oil-based contrast (Ethiodol) or water-soluble medium.

Contraindications:

• Acute infection (risk of spreading infection)

• Iodine allergy

• Recent duct surgery

💡 Note: Always have sour candy ready to stimulate saliva afterward — it helps wash out the contrast.

3. PHARYNGOGRAPHY

What:

Pharyngography is a radiographic study of the pharynx (throat) using the contrast swallow technique under fluoroscopy.

Why (Indications):

• Dysphagia (difficulty swallowing)

• Pharyngeal tumors or diverticula

• Obstruction or narrowing of the pharyngeal lumen

Who:

Patients with swallowing or throat issues performed by a radiologic technologist under ENT or radiologist supervision.

When:

Usually performed together with esophagography or UGIS studies.

Where:

Fluoroscopy suite with tilting table and image intensifier.

How (Procedure):

1. Patient Preparation:

   • Fasting for 4–6 hours.

   • Remove dentures or jewelry.

2. Positioning Notes:

   • Upright lateral position during swallowing.

   • Some images may be taken in AP or oblique views.

3. Procedure:

   • Patient drinks or swallows thick barium paste or liquid.

   • Sequential fluoroscopic images capture swallowing motion and pharyngeal outline.

4. Contrast Used:

   • Barium sulfate suspension (thick consistency)

Contraindications:

• Severe aspiration risk

• Esophageal perforation

💡 Note: Use small amounts first to assess swallowing ability safely.

4. NASOPHARYNGOGRAPHY

What:

Nasopharyngography is an X-ray examination of the nasopharynx, the upper part of the pharynx behind the nose, using contrast or fluoroscopy.

Why (Indications):

• Nasopharyngeal masses (tumors, cysts, hypertrophy)

• Obstructive adenoids

• Eustachian tube dysfunction

• Assessment before surgery

Who:

Patients with nasal blockage, ear problems, or suspected tumors, examined under ENT or radiologic supervision.

When:

Performed when clinical signs of nasopharyngeal obstruction are present.

Where:

Fluoroscopy or CT suite, depending on the needed detail.

How (Procedure):

1. Patient Preparation:

   • Remove dentures or nasal prosthesis.

   • Explain the procedure (may cause mild discomfort).

2. Positioning:

   • Lateral and oblique projections are commonly used.

3. Procedure:

   • Patient may swallow contrast material, or a contrast-soaked swab may be placed near the nasopharyngeal area.

   • Fluoroscopic observation and radiographs taken during swallowing or phonation.

4. Contrast Used:

   • Barium suspension (thin), sometimes water-soluble contrast for soft tissue study.

Contraindications:

• Severe gag reflex

• Suspected perforation or trauma

💡 Note: Today, CT and MRI have largely replaced this test, but it remains educational in understanding nasopharyngeal imaging.

5. LARYNGOGRAPHY

What:

Laryngography is a radiographic visualization of the larynx (voice box) using contrast medium to outline its shape and function.

Why (Indications):

• Vocal cord paralysis

• Laryngeal tumors

• Functional disorders of phonation

• Assessment after laryngeal trauma or surgery

Who:

Performed for patients with voice changes, hoarseness, or suspected laryngeal lesions.

When:

Scheduled after clinical evaluation by an ENT specialist.

Where:

In a fluoroscopic room equipped for motion studies.

How (Procedure):

1. Patient Preparation:

   • Explain procedure (may cause throat irritation).

   • The patient should not eat for 4–6 hours before.

2. Positioning:

   • Upright lateral and AP positions were used.

3. Procedure:

   • A small amount of water-soluble contrast is introduced through the nose or mouth into the larynx.

   • The patient is asked to phonate (“ee” sound) during fluoroscopy to assess vocal cord movement.

   • Sequential images are captured.

4. Contrast Used:

   • Water-soluble iodinated contrast medium (e.g., Gastrografin).

Contraindications:

• Acute laryngeal inflammation

• Severe respiratory distress

• Known contrast allergy

💡 Note: This study helps visualize dynamic movement of vocal cords — very useful in paralysis or structural defects.

🧓 Summary (by the Old Pro)

Each of these exams plays a unique role in diagnosing head, neck, and digestive tract conditions.

GROUP 2

I. LGIS (Lower Gastrointestinal Series)

Definition / What

The Lower Gastrointestinal Series (LGIS), also called a Barium Enema, is a radiographic study of the large intestine (colon and rectum) using a contrast medium, usually barium sulfate, to visualize the mucosal lining and detect abnormalities.

5Ws & 1H

Indications

• Chronic diarrhea or constipation

• Rectal bleeding

• Unexplained weight loss or abdominal pain

• Suspected colorectal cancer, polyps, or diverticulosis

Contraindications

• Suspected bowel perforation

• Severe ulcerative colitis (risk of perforation)

• Toxic megacolon

• Immediately after a colon biopsy

Patient Preparation

• Low-residue diet for 2 days before the exam

• Laxative night before; cleansing enema morning of exam

• NPO (nothing by mouth) for at least 8 hours

Positioning Notes

• Patient lies on fluoroscopic table; multiple position changes (supine, prone, lateral, oblique) to coat the entire colon wall.

Procedure

1. Explain the procedure and obtain consent.

2. Insert the rectal enema tip gently.

3. Instill barium sulfate suspension to fill the colon.

4. Use fluoroscopy to watch the contrast flow.

5. Take radiographs in various positions.

6. After filling, the patient evacuates the barium, and then a post-evacuation image is taken.

Contrast Media

• Barium sulfate suspension (80–100% w/v) for typical cases.

• Water-soluble iodinated contrast (e.g., Gastrografin) if perforation or surgery is suspected.

Normal Findings

• Uniform filling of the colon with a smooth mucosal pattern and haustral folds visible.

Abnormal Findings

• Filling defects (polyps), “apple-core” lesions (cancer), or diverticular outpouchings.

II. SMALL BOWEL SERIES (SBS)

Definition / What

A Small Bowel Series evaluates the small intestine (duodenum, jejunum, ileum) after oral ingestion of contrast.
It is often done following an upper GI series.

5Ws & 1H

Indications

• Crohn’s disease

• Malabsorption syndrome

• Intestinal obstruction

• Unexplained abdominal pain

Contraindications

• Complete bowel obstruction

• Suspected perforation (use water-soluble contrast instead)

Patient Preparation

• Fasting for 8 hours

• Avoid smoking or chewing gum before the procedure

Positioning & Procedure

1. Patient drinks 300–600 mL of barium.

2. Initial film taken of the stomach and duodenum.

3. Subsequent films every 15–30 minutes until contrast reaches the ileocecal valve.

4. The patient may walk between films to hasten transit.

Contrast Media

• Barium sulfate suspension (low density)

• Water-soluble contrast if perforation is suspected.

Findings

• Normal: even, feathery mucosal pattern.

• Abnormal: strictures, dilated loops, “string sign” in Crohn’s disease, or mass lesions.

III. ENTEROCLYSIS

Definition / What

Enteroclysis (small bowel enema) is a detailed radiographic study of the small intestine performed by direct instillation of contrast through a nasojejunal tube, rather than oral ingestion.
It provides a more precise view of small bowel abnormalities.

5Ws & 1H

Indications

• Inconclusive small bowel series

• Detect subtle mucosal or motility disorders

• Evaluate strictures, Crohn’s disease, or tumors

Contraindications

• Bowel perforation

• High-grade obstruction

• Severe patient intolerance or aspiration risk

Patient Preparation

• NPO for 8–12 hours

• A cleansing enema may be required

• Explain procedure (discomfort possible due to the tube)

Procedure

1. Insert nasojejunal catheter under fluoroscopic guidance.

2. Infuse barium sulfate (low-density) to coat the mucosa.

3. Follow with methylcellulose to distend loops.

4. Take spot and overhead images of the entire small intestine.

Contrast Media

• Barium sulfate (low density) + methylcellulose (double-contrast method).

• If perforation is suspected → water-soluble contrast (Gastrografin).

Findings

• Excellent visualization of mucosal pattern and fold spacing.

• Detects early Crohn’s disease, strictures, tumors, or adhesions.

IV. BARIUM ENEMA

(Although part of LGIS, presented here separately for clarity)

Definition / What

A Barium Enema (BE) is a fluoroscopic examination of the colon using barium sulfate introduced through the rectum, with or without air (double-contrast).

5Ws & 1H

Indications

• Colonic obstruction (partial)

• Diverticulosis

• Polyps or carcinoma

• Chronic bowel habit changes

Contraindications

• Acute colitis or diverticulitis

• Suspected perforation

• Recent biopsy or surgery

Patient Preparation

• Low-residue diet for 2 days

• Laxative the night before

• Cleansing enema before exam

• NPO 8 hours

Positioning

• Sim’s position for tip insertion

• Radiographs taken in supine, prone, oblique, and lateral positions

Procedure

1. Insert the lubricated enema tip into the rectum.

2. Instill barium slowly under fluoroscopic control.

3. Obtain images during filling and emptying.

4. Air may be introduced for the double-contrast technique.

5. Patient evacuates contrast; take post-evacuation film.

Contrast Media

• Single Contrast: Barium sulfate suspension (100% w/v)

• Double Contrast: Barium sulfate + Air (for fine mucosal detail)

• Water-soluble contrast (Gastrografin) if perforation is suspected

Normal Findings

Smooth colonic contour with visible haustral markings.

Abnormal Findings

• Polyps: Rounded filling defects

• Cancer: “Apple-core” or annular constriction

• Diverticula: Outpouchings of the bowel wall

• Inflammation: Irregular mucosal pattern

🧠 SUMMARY TABLE

GROUP 3

I. INTRAVENOUS PYELOGRAPHY (IVP) / INTRAVENOUS UROGRAPHY (IVU)

Definition / What

Intravenous Pyelography (IVP) is a radiographic procedure that evaluates the kidneys, ureters, and urinary bladder after intravenous injection of an iodinated contrast medium, which is filtered and excreted by the kidneys.
It outlines the entire urinary tract to detect pathology.

5Ws & 1H

Indications

• Evaluation of renal pelvis, ureters, and bladder

• Detection of stones, tumors, obstruction, or congenital anomalies

• Investigation of hematuria

Contraindications

• Iodine contrast allergy

• Renal failure (creatinine >1.5 mg/dL)

• Multiple myeloma or dehydration

• Pregnancy

Patient Preparation

• NPO for 8 hours before procedure

• Laxative the night before clear bowel gas and feces

• Hydration before and after the exam

• Allergy check for iodine or seafood

Positioning

• Supine on X-ray table; may be tilted slightly (Trendelenburg)

• Compression device applied to ureters (optional)

Procedure

1. Preliminary (scout) KUB film taken.

2. Inject iodinated contrast (50–100 mL) intravenously.

3. Take films at 1, 3, 5, 10, and 15 minutes.

4. Delayed films for slow drainage.

5. Post-void image to assess bladder emptying.

Contrast Used

• Water-soluble iodinated contrast (e.g., Iohexol [Omnipaque], Iopamidol [Isovue])

Normal Findings

• Symmetrical kidneys with proper function and excretion; contrast-filled calyces, pelvis, ureters, and bladder.

Abnormal Findings

• Hydronephrosis, calculi, masses, delayed excretion, or non-visualization of the kidney (non-functioning).

II. NEPHROTOMOGRAPHY (TOMOGRAPHIC UROGRAPHY)

Definition / What

Nephrotomography is a tomographic (layered) X-ray study performed immediately after IV contrast injection during an IVP.
It produces sectional images of the kidneys, helping to visualize renal parenchyma clearly without superimposed structures.

5Ws & 1H

Indications

• Renal cysts vs. solid tumors

• Evaluation of renal parenchyma or trauma

Contraindications

• Same as IVP (iodine allergy, renal failure, pregnancy).

Patient Preparation

• Same as IVP (fasting, hydration, bowel prep).

Positioning

• Supine, centered to the kidneys (L2 level).

Procedure

1. Inject contrast intravenously.

2. Wait 30–60 seconds (nephrogram phase).

3. Perform tomographic exposures at multiple levels (usually 3–5 slices).

Contrast Used

• Same iodinated contrast as IVP.

Findings

• Normal: Uniform enhancement of renal cortex.

• Abnormal: Cyst (non-enhancing), solid mass (enhancing), or distortion of the collecting system.

III. PERCUTANEOUS RENAL PUNCTURE (NEPHROSTOMY)

Definition / What

Percutaneous Renal Puncture is a direct puncture of the renal pelvis through the skin using a needle, performed under imaging guidance to drain urine, obtain samples, or inject contrast for diagnostic or therapeutic purposes.

5Ws & 1H

Indications

• Urinary obstruction (hydronephrosis)

• Renal abscess drainage

• Contrast injection for pyelography

Contraindications

• Bleeding disorders

• Severe infection

• Uncooperative patient

Patient Preparation

• NPO 6–8 hours

• Consent form signed

• Local anesthesia administered

• Ultrasound/fluoroscopic guidance planned

Procedure

1. Under aseptic technique, the patient is in a prone or oblique position.

2. Needle inserted into renal pelvis (under image guidance).

3. Contrast injected for visualization.

4. A catheter may be placed for drainage (nephrostomy tube).

Contrast Used

• Non-ionic iodinated contrast (e.g., Iohexol).

IV. HYPERTENSIVE PYELOGRAPHY

Definition / What

Hypertensive Pyelography is a specialized IVP performed in patients with hypertension suspected to be of renal origin, particularly to assess renal artery stenosis or ischemic nephropathy.

5Ws & 1H

Indications

• Renovascular hypertension

• Asymmetrical renal function

Contraindications

• Same as IVP

Preparation & Procedure

• NPO 8 hours

• Baseline BP and renal tests done

• Contrast injected IV

• Observe for a delayed nephrogram on the affected side

Contrast Used

• Water-soluble iodinated contrast

Findings

• The affected kidney shows delayed opacification and drainage, suggesting renal artery stenosis.

V. RETROGRADE PYELOGRAPHY

Definition / What

Retrograde Pyelography is a non-functional study where contrast medium is introduced directly into the ureters through a cystoscope to visualize the renal pelvis and ureters.

5Ws & 1H

Indications

• Non-functioning kidney (IVP inconclusive)

• Ureteral obstruction or tumor

• Hematuria investigation

Contraindications

• Acute urinary infection

• Recent surgery or trauma

Preparation

• NPO 8 hours

• Bowel cleansing, if necessary

• Antibiotic prophylaxis

Procedure

1. Patient in lithotomy position.

2. Cystoscope inserted into the bladder.

3. The ureteral catheter was advanced into the ureter.

4. Contrast was injected retrograde into the renal pelvis.

5. Fluoroscopic images taken.

Contrast Used

• Water-soluble iodinated contrast (non-ionic).

Findings

• Normal: Uniform filling of the ureter and pelvis.

• Abnormal: Obstruction, stones, or mass indentations.

VI. CYSTOGRAPHY

Definition / What

Cystography is a radiographic study of the urinary bladder following retrograde filling with contrast via a Foley catheter to evaluate bladder structure and function.

5Ws & 1H

Indications

• Bladder rupture or trauma

• Vesicoureteral reflux

• Diverticula or bladder tumor

Contraindications

• Acute UTI

• Recent bladder surgery

Patient Preparation

• Bladder emptied prior

• Aseptic catheterization

• Inform the patient of mild discomfort during filling

Procedure

1. Insert a Foley catheter aseptically.

2. Fill bladder with contrast (150–300 mL) until patient feels urge to void.

3. Take fluoroscopic and spot films.

4. Obtain voiding film for reflux detection.

Contrast Used

• Water-soluble iodinated contrast (Iohexol, Iopamidol)

• In children, low-osmolar non-ionic contrast is preferred.

Findings

• Normal: Smooth bladder outline with no reflux.

• Abnormal: Diverticulum, reflux, trauma, or mass.

🧠 SUMMARY TABLE

GROUP 4

GROUP 5

GROUP 6