RAD 435 PRACTICAL REVIEW

Manal alOsaimi

Contents

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

Marks

Total Practical Fluoro = 20 Marks

Ba Swallow

The Normal indentations

Barium Swallow

AP view

Barium Swallow

LAO view

Write the name of the procedure

Barium Swallow

RAO

The esophagus is seen between the heart and the spine

The patient is rotate 35- 40 degrees with the RT side against the table

Write the name of the procedure

Barium Swallow

LATERAL

Barium Swallow

Esophagogastric Junction( Cardiac Orifice)

1

Barium Meal

Stomach subdivisions:1- fundus: upper portion of the stomach.2- body.3- pylorusWhen the stomach is emptyThe internal lining is thrown into numerous

longitudinal folds called RUGAE

Stomach openings and curvatures

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 esophagusB. Esophagogastric junction

(cardia orifice)C. Lesser curvatureD. Angular notchE. Pylorus of stomachF. Pyloric valveG. Duodenal bulb of the

duodenumH. Descending portion of

the duodenumI. Body of stomachJ. Greater curvature of

stomachK. Gastric foldsL. Fundus of stomach

Label: 1, 2

Air-Barium Distribution in the Stomach

2

FundusWhen the pt is

(AP recumbent )Supine position

Most posterior part

Filled with Ba

(PA recumbent)Prone position

Highest part

Filled with air

Erect (upright) position

Highest partFilled with air Pylorus filled with Ba

The air-fluid level is a straight line

Ba in fundus

Barium Meal

2

LPO recumbent

SUPINE (AP

recumbent)

Air in Fundus

Prone (PA recumbent)

ErectAir-fluid level

straight

Barium Meal 2Air in fundus

Prone RAO

Barium Meal 2 Air in fundus

Erect

Small Bowel Procedures

Small Bowel Procedures

Barium meal follow through.

Barium follow through (Small Bowel only Series).

Enteroclysis

Intubation ( Small bowel enema).

1

2

3

4

Parts of S.I:Duodenum: 1st,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: duodenumC: jejunumD:ileumE: area of ileocecal

valve

PA 30 mins

ANATOMY

Small Bowel Series

Small Bowel Series

30 minutes 1 Hour 2 Hour

1.Ba Meal Follow through

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 BaSO4. ( 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 intestineIt 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.

C.M: thin BaSO4 or water soluble iodinated c.m.

diagnostic

Therapeutic

Small Bowel Series

4.Intubation

BARIUM ENEMA

Preliminary Film to:1. Bowel

preparation.2. Complete

obstruction, Perforation

Technique

Barium Enema4

Hepatic flexure

Splenic flexure

Transverse colon

Aescending colon Descending colon

Sigmoid colon

single contrast

Barium Enema4

Single Contrast

Air Barium Distribution 4

Supine

Transverse c. filled with air

Prone

Transverse c. filled with ba

Barium Enema4

LT LAT Decubitus

Barium Enema4

RT LAT Decubitus

Barium Enema

RPO

Splenic flexure descending colon appear

open

Barium Enema

LPO

Hepatic flexure ascending colon and rectosigmoid region

appear open

Barium Enema4

Hepatic Flexure Splenic Flexure

Barium Enema4

RectoSegmoid Region

Barium Enema4

Rectum

• DefinitionPerformed during surgery, usually During a

Cholecystectomy (wherein the surgeon removes the GB).

• IndicationIf the surgeon suspects that residual stones are

located in the biliary ducts

Gall Bladder and Biliary System Procedures

Anatomy

Operative (Immediate) Cholangiogram

Rt hepatic ductLt hepatic duct

Common hepatic duct

Common bile duct

catheter

Gall Bladder and Biliary System Procedures

Gall Bladder & Biliary Ducts5

Catheter

T-shape

Endoscope

• Definitionradiographic examination of the salivary

ducts.

Sialography

Sialography

Sialography6

Lateral

Hysterosalpingography

Anatomy

Hystrosalpingography

A = RT fallopian tube.

B = Uterine cavity .

C = LT fallopian tube.

D = Catheter.

8

Hystrosalpingography

Hystrosalpingography

Urography Procedures

Urography Procedures

1• Retrograde

Cystography (Cystogram)

2• MCUG Micturating

Cystourethrography

• 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

• CMUrographine

Retrograde Cystography (Cystogram)

Urography Procedures 7

Cystography

• 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).

• CMUrographine

MCUG Micturating Cystourethrography

Urography Procedures 7

MCUG

Wish you Best of Luck