RAD 435 PRACTICAL REVIEW Manal al Osaimi Contents

RAD 435 PRACTICAL REVIEW Manal al. Osaimi

Contents 1. 2. 3. 4. 5. 6. 7. 8. Ba Swallow (Esophagogram). Ba Meal. Ba Follow through. Ba Enema. Gall Bladder & Biliary Ducts. Sialography. Hysterosalpingography. Urography procedure.

Marks Total Practical Fluoro = 20 Marks

Ba Swallow

The Normal indentations

Barium Swallow AP view

Barium Swallow LAO view

Barium Swallow Write the name of the procedure RAO The esophagus is seen between the heart and the spine The patient is rotate 3540 degrees with the RT side against the table

Barium Swallow Write the name of the procedure LATERAL

1 Barium Swallow Esophagogastric Junction ( Cardiac Orifice)

Barium Meal

Stomach openings and curvatures Stomach subdivisions: 1 - fundus: upper portion of the stomach. 2 - body. 3 - pylorus When the stomach is empty The internal lining is thrown into numerous longitudinal folds called RUGAE

1 - cardiac orifice (esophagogastric junction): opening between the esophagus and the stomach. 2 -cardiac notch: superior to the cardiac orifice. 3 -distal esophagus. 4 -pyloric valve or sphincter: distal opening of the stomach. 5 - lesser curvature: medial border of the stomach, extends between the cardiac and pyloric openings. 6 -greater curvature: lateral border of the stomach, four or five times longer than the lesser curvature.

Barium Meal A. Distal esophagus B. Esophagogastric junction (cardia orifice) C. Lesser curvature D. Angular notch E. Pylorus of stomach F. Pyloric valve G. Duodenal bulb of the duodenum H. Descending portion of the duodenum I. Body of stomach J. Greater curvature of stomach K. Gastric folds L. Fundus of stomach

Air-Barium Distribution in the Stomach Fundus When the pt is Label: 1, 2 (AP recumbent) Supine position (PA recumbent) Prone position Erect (upright) position Most posterior part Highest part Filled with air Filled with Ba 2 Pylorus filled with Ba The air-fluid level is a straight line

Barium Meal Ba in fundus 2 LPO recumbent SUPINE (AP recumbent)

Air in Fundus Prone (PA recumbent) RAO recumbent Erect Air-fluid level straight

2 Barium Meal Air in fundus Prone RAO

2 Barium Meal Air in fundus Erect

Small Bowel Procedures

Small Bowel Procedures 1 2 3 4 Barium meal follow through. Barium follow through (Small Bowel only Series). Enteroclysis Intubation ( Small bowel enema).

ANATOMY Parts of S. I: Duodenum: 1 st, shortest, widest and most fixed. Jejunum: 2/5 and feathery appearance. Ileum: 3/5, longest, smooth no feathery appearance, and joins large intestine at ileocecal valve

ANATOMY A: duodenum C: jejunum D: ileum E: area of ileocecal valve PA 30 mins

Small Bowel Series

Small Bowel Series 1. Ba Meal Follow through 30 minutes 1 Hour 2 Hour

Small Bowel Series 2. Barium follow through

Small Bowel Series 2. Ba Follow through

Enteroclysis Injection of c/m into the S. B. It is a Double contrast method used to evaluate the S. B. the pt is intubated under flouroscopic control with a special catheter. Stomach → duodenum → duodenojujinal junction. CM 1. Thin Ba. SO 4. ( Coats the mucosa). 2. Air or Methylcellulose, why ? which is Better ? To distend the bowel and provide double contrast Methylcellulose, shows the mucosal details as it adheres to the walls and distends the bowel. It propel the barium from intestine It evacuate barium from the large intestine.

Small Bowel Series 3. Enteroclysis

Intubation ( S. B enema) It is a single contrast method where a nasogastric tube is passed through: pt’s nose→esophagus→stomach→duodenum and into the jejunum. (RAO position is preferred ? ) To help pass the tube from stomach →duodenum by gastric peristalsis. diagnostic Therapeutic C. M: thin Ba. SO 4 or water soluble iodinated c. m.

Small Bowel Series 4. Intubation

BARIUM ENEMA

Technique Preliminary Film to: 1. 2. Bowel preparation. Complete obstruction, Perforation

4 Barium Enema

Splenic flexure Hepatic flexure Transverse colon Aescending colon Descending colon Sigmoid colon single contrast

4 Barium Enema Single Contrast

4 Air Barium Distribution Supine Transverse c. filled with air Prone Transverse c. filled with ba

4 Barium Enema LT LAT Decubitus

4 Barium Enema RT LAT Decubitus

Barium Enema RPO Splenic flexure descending colon appear open

Barium Enema LPO Hepatic flexure ascending colon and rectosigmoid region appear open

4 Barium Enema Hepatic Flexure Splenic Flexure

4 Barium Enema Recto. Segmoid Region

4 Barium Enema Rectum

Gall Bladder and Biliary System Procedures • Definition Performed during surgery, usually During a Cholecystectomy (wherein the surgeon removes the GB). • Indication If the surgeon suspects that residual stones are located in the biliary ducts

Anatomy

Operative (Immediate) Cholangiogram Lt hepatic duct Rt hepatic duct Common bile duct catheter

Gall Bladder and Biliary System Procedures

5 Gall Bladder & Biliary Ducts Catheter T-shape Endoscope

Sialography • Definition radiographic examination of the salivary ducts.

Sialography

6 Sialography Lateral

Hysterosalpingography

Anatomy

8 Hystrosalpingography A = RT fallopian tube. B = Uterine cavity. C = LT fallopian tube. D = Catheter.

Hystrosalpingography

Hystrosalpingography

Urography Procedures

Urography Procedures 1 • Retrograde Cystography (Cystogram) 2 • MCUG Micturating Cystourethrography

Retrograde Cystography (Cystogram) • Definition • • • Is a Non Functional radiographic examination of the urinary bladder after injection of CM via urethral catheter A retrograde cystogram is a radiographic study of the bladder, made after a direct injection of a radiopaque contrast material by means of a urethral catheter CM Urographine

7 Urography Procedures Cystography

MCUG Micturating Cystourethrography • Definition • • • Is a Functional radiographic examination of the urinary bladder and urethra to evaluate the patient’s ability to urinate. micturating cystourethrogram (MCUG), is a technique for watching a person's urethra and urinary bladder while the person urinates (voids). CM Urographine

7 Urography Procedures MCUG

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