Rad Contrast Midterms

Question 1

Sialography

Answer 1

CM: iodinated, non-ionic, barium sulfate

PX PREP: 2 – 3 minutes before the procedure; patient is given a secretory stimulant to open the duct for ready identification of its orifice & for easier passage of a cannula or catheter
- Suck a wedge of fresh lemon

IND: demonstrate inflammatory lesions & tumor to determine the extent of salivary fistulae & to localize diverticulae, strictures and calculi

Question 2

Palatography

Answer 2

CM: Barium sulfate

PX PREP: sitting lateral position with the nasopharynx centered to IR.

PROCEDURE: swallow small amount of thick creamy barium sulfate to coat inferior surface of the soft palate and uvula.
- 0.5ml creamy barium is injected in each nasal cavity

IND: investigate suspected tumors of the soft palate

CR: midline of hard palate

Question 3

Nasopharyngography

Answer 3

CM: positive/negative

PX PREP: intake of deep breath thru the nose

IND: demonstrate HYPERTROPHY of pharyngeal tonsil/adenoids

CR: directed to 3/4 inch (1.9 cm) anterior to EAM

Question 4

Pharyngography

Answer 4

CM: Ingestible CM, Barium Sulfate, Bolus

PX PREP: Gunson method -tying dark colored shoestring around px throat above thyroid cartilage
-Deglutition (act of swallowing)
-Mucosal phase px is refrain from swallowing again the Barium sulfate

IND: aspiration, nasal regurgitation, fistula formation, cancer

CR: directed to pharynx/area of interest

Question 5

Laryngopharyngography

Answer 5

CM: Barium Sulfate, Water soluble iodinated contrast

PX PREP: 5 Maneuvers:
Quiet inspiration
Normal (expiratory)phonation
Inspiratory phonation
Valsalva maneuver
Modified Valsalva maneuver

IND: evaluate the structures of the larynx (voice box) and pharynx (throat)

CR: visualizing larynx & pharynx

Question 6

Modified Valsalva’s Maneuver

Answer 6

CM:

PX PREP: pitch the nostril together with the thumb & forefinger of one hand & the mouth closed

IND:

CR:

Question 7

GALLBLADDER

Answer 7

Fish scale GB
Strawberry GB
Sandpaper GB
Courvoisier GB

Question 8

BILIARY SYSTEM

Answer 8

ADMIN:
- By mouth
-By injection into vein
- Direct injection into the ducts

Question 9

ORAL CHOLECYSTOGRAM (OCG)

Answer 9

• most common SRE to study GB

CM: Sodium ipodate (Biloptin)
Iopanoic acid (Telepaque) -6 capsules (500 mg)

PX PREP: Ingestion of 4-6 tablets or
capsules during the
evening before the examination.

Preliminary Diet:
-CM is given 2-3 hours after evening meal.
-Absorption time is 10-12 hours.
Fatty meal -Post motor meal

IND: function of liver, patency & condition of biliary ducts, pure cholesterol stones
-Cholelithiasis
- Cholecystitis

Contraindications:
1.Advanced hepatorenal disease
2. Active gastrointestinal disease
3. Hypersensitivity to iodinated CM
4. Pregnancy

POSI:
-PA Proj Scout
-LAO (left anterior oblique)
- Right Lateral
- Upright projection

Question 10

CHOLELITHIASIS

Answer 10

most common abnormalities diagnosed during OCG
-stones/calculi in GB

Question 11

CHOLECYSTITIS

Answer 11

acute or chronic inflammation of the GB

Question 12

INTRAVENEOUS CHOLANGIOGRAPHY

Answer 12

CM: iodinated, water soluble

PX PREP:
-px in supine posi for preliminary radiograph of abdomen\
-px in RPO posi (15-40) for AP oblique proj of biliary ducts

IND: Evaluation of Biliary Obstruction
- obstructive jaundice and post-cholecystectomy

CR: region of biliary system

Question 12

PERCUTANEUS TRANSHEPATIC CHOLANGIOGRAPHY (PTC)

Answer 12

CM: Iodinated (Iopromide)

PX PREP: performed by placing the patient in supine position on radiographic table
-local anesthesia, skinny needle is held parallel to the floor & inserted through the right lateral intercostal space & advanced towards the liver hilum

IND: obstructive jaundice, stone extraction & biliary drainage.

CR: midline of abdomen

Question 13

OPERATIVE – IMMEDIATE CHOLANGIOGRAPHY

Answer 13

CM: Iodinated (6-8 cc) is introduced into the CBD

PX PREP: NPO (6-8 hrs)

IND:
1.patency of the bile ducts
functional status of the
2.sphincter of the hepatopancreatic ampulla

CR: mid abdomen, L1-L2

Question 14

POST OPERATIVE CHOLANGIOGRAPHY

Answer 14

CM: Water soluble (25-30%) concentration

PX PREP: px is lateral
-fluoro guided
-Clamped is not removed from the t-tube before completion of the examination

IND: demonstrate the caliber & patency of the ducts

CR: 15-20 RPO

Question 15

ERCP (Endoscopic Retrograde Cholangiopancreotography)

Answer 15

CM: Iodinated Water-Soluble contrast, Non-ionic, Gadolinum based

• injected CM must be drain from the normal ducts within approximately 5 minutes.

PROCEDURE: performed by passing a fiberoptic endoscope through the mouth into the duodenum under fluoroscopic control.

PX PREP: 1 hr prohibited of food & drink after examination

IND: biliary obstruction, pancreatitis

CR:
POSI: Trendelenburg posi
-semi-erect

Question 16

PAROTID GLAND

Answer 16

1. Tangential projection -supine
2. Tangential projection -prone
3. Lateral projection parotid & submandibular gland
4. Axial projection intraoral method