Fluoroscopy (Pandya)

Question 1

Definition of fluoroscopy?

Answer 1

REAL TIME X-ray

Question 2

Types of contrast used in fluoroscopy?

Answer 2

• barium
• iodinated contrast
• gastrografin (for small bowel and upper GI series)

Question 3

Which of the following is not a use of fluoroscopy?
A) Barium X-rays and Enemas (for seeing GI tract)
B) Catheter Insertion & manipulation (to visualize and direct movement of a catheter through blood vessels)
C) Placement of devices (ex: stents)
D) For Angiograms (to visualize blood vessels and organs)
E) Ortho Surgery (to guide joint replacement and fracture treatment)

Answer 3

none; all are uses!

Question 4

Does fluoroscopy have the same color rules as X-ray and CT?

Answer 4

YES; 
metal/calcium/barium- white
water/soft tissue- gray
fat- dark gray 
air- black

Question 5

What needs to be done for the pt prep?

Answer 5

• NPO after midnight prior to exam for ALL fluoroscopic exams
• for barium enema: prep pt w/ laxatives
• Screen pts for allergies to contrast

Question 6

What is the technique for fluoroscopy?

Answer 6

Fluoroscope sends x-rays into pt–> fluoroscope is manipulated to get images of pt in variety of positions

Question 7

What contrast is used in single contrast vs double?

Answer 7

single: barium ONLY

Double contrast: barium + gas (i.e: air, CO2)

Question 8

Single contrast is used to outline structures, lumen, & large abnormalities. What is double contrast used for?

Answer 8

used to get a detailed view of mucosal patterns, easier to see obvious pathology (i.e: strictures, diverticula, inflammation)

Question 9

Single contrast has few CIs, what is double contrast CI in?

Answer 9

1. toxic megacolon

2. pseudomembranous colitis

Question 10

Single contrast evaluates the ___, while double contrast evaluates the ___

Answer 10

Lumen; mucosa

Question 11

In single contrast, what can you visualize?

Answer 11

• strictures, obstruction, Diverticula, masses

Question 12

in double contrast, what can you visualize?

Answer 12

• ulceration, inflammation, & polyps/masses

Question 13

What’s a filling defect?

Answer 13

a space occupying stricture, barium will track around it

Question 14

important examples of filling defects include:

Answer 14

• polypoids
• sessiles
• apple cores

Question 15

How does ulceration look on fluoroscopy?

Answer 15

a small pit of barium in the ulcer cavity (small bright spot in pit)

Question 16

What do diverticula look like on fluoroscopy?

Answer 16

Little outpouchings

Question 17

Define extravasation:

Answer 17

leaking from the lumen

(i.e: fluid leaking out of a stomach post-op

Question 18

Define fistula:

Answer 18

an abnormal connection b/w 2 structures

Question 19

Define sinus tract:

Answer 19

blind ending

Question 20

What is an upper GI used for and what does it include?

Answer 20

used to visualize upper GI via esophagram or stomach and duodenum in single/double contrast

Question 21

Indications for an upper GI series?

Answer 21

Ulcers
GERD
Inflammation (of esophagus, stomach, and duodenum)
Tumors
Evaluate structural abnormalities
Hiatal hernia
Dysphagia
Epigastric pain
Gastric outlet obstruction

Question 22

Contrast agents used in a small bowel series

Answer 22

barium and gastrografin

Question 23

how is imaging done in a small bowel series?

Answer 23

X-rays taken every 15 min for 1 hour, and then every 30 minutes thereafter until barium reaches end of small intestine

Question 24

Indications for a small bowel series?

Answer 24

Crohn's disease
Small bowel obstruction 
IBS
Abnormal masses/polyps
Cancers
Post-surgical eval
Abdominal pain
Malabsorption
Lack of absorption of fat, Vit B12, Xylose
GI bleed

Question 25

Celiac disease can be seen by a small bowel series, what would you see?

Answer 25

- DILATED loops of small bowel - Excess intestinal fluid - Edema of mucosa

Question 26

Use for a video esophagram?

Answer 26

evaluates swallowing ability

Question 27

How is imaging done via a video esophagram?

Answer 27

- give pt contrast of varying thickness under fluoroscopic imaging - generally done w/ a speech pathologist present

Question 28

Pt prep for a video esophagram?

Answer 28

NPO 2 hrs before procedure (apparently)

Question 29

Indications for a video esophagram?

Answer 29

``` Hiatal hernia Zenker’s Diverticulum Esophageal stricture Esophageal dysmotility Mass Laryngopharyngeal reflux ```

Question 30

Use for a contrast enema (barium enema)?

Answer 30

evaluate for abnormalities of the large colon

Question 31

Pt bowel prep:

Answer 31

- cathartic - laxative - enema/suppository in AM

Question 32

How is a contrast enema imaging done?

Answer 32

barium is injected through the rectum (if single contrast)

Question 33

Indications for a contrast enema:

Answer 33

``` Ulcerative colitis Obstruction/Polyp Cancer IBS Post-surgical eval (esp. after a sigmoidectomy) ```

Question 34

Use for a ECRP?

Answer 34

to evaluate pancreatic and bile ducts

Question 35

how imaging is done in an ECRP?

Answer 35

endoscope is inserted into mouth and enters duodenum--> catheter is passed through the ampulla of vater and contrast is injected to examine the bile ducts + pancreas

Question 36

How can an ERCP be therapeutic?

Answer 36

- biliary stenting for strictures | - bile duct stone removal

Question 37

Indications for an ECRP:

Answer 37

- obstructive jaundice - biliary or pancreatic ductal system disease - tissue sampling of pancreas/biliary system

Question 38

what is a t-tube cholangiogram used for?

Answer 38

used to check for gallstones in the ducts after surgery has been performed - is more aggressive than ERCP

Question 39

Use for esophagram and indications:

Answer 39

``` evaluate esophagus; indications: - dysphagia -odynophagia (painful swallowing) -reflux ```