Dr.Al-Howaimil- Fluoroscopy
SURFACE ANATOMY OF THE
ABDOMEN Part 1
Clinically, we can devide the
abdomen into a series of regions by
a series of horizontal and vertical
planes. This aids description of the
site of abdominal organs or
symptoms.
These divisions are illustrated on
this picture of the abdomen:
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Dr.Al-Howaimil- Fluoroscopy
The subcostal plane passes
through the lowest parts of the
costal margins (SC). It lies
approximately at the level of the 3rd
lumbar vertebra. It varies with age,
lying higher in children. It also lies
higher in the supine subject, often
level with the 2nd lumbar vertebra.
An alternative plane can be drawn
through a point halfway between
the jugular notch and the pubic
symphysis called the transpyloric
plane. This passes through the
pylorus of the stomach. It should
also correspond to the level of the
lower border of the first lumbar
vertebra. The transtubercular
plane passes through the tubercles
of the iliac crests (TT). It
corresponds with the level of the
spinous process of the 5th lumbar
vertebra.
Another plane often encountered is
the supracristal plane which
represents a line drawn through the
highest part of the iliac crests
(SCR). It lies at the level of the 4th
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Dr.Al-Howaimil- Fluoroscopy
lumbar spinous process. The
umbilicus often lies just below this
plane.
When you examine a patient, you
must be familiar with the different
regions of the abdomen which are
used to describe the location of any
symptoms, pain, lumps or organs
that might be found.
For example, if pain is described as
being in the right iliac fossa, this is
characteristic of appendicitis. If you
then examine the patient and find
they are acutely tender in this
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Dr.Al-Howaimil- Fluoroscopy
region, you could describe the
tenderness as being in the same
region ie right iliac fossa. Taken
with other signs and symptoms, you
arrive at your diagnosis. These
regions are described by surface
anatomy and you should identify
each region on the living subject.
Imagine a pair of vertical lines
drawn through a point which lies
midway between the anterior
superior iliac spine and the
symphysis pubis. This is called the
mid-femoral point. This line also
corresponds to the mid-clavicular
line. These lines have been drawn
in on the illustration of the
abdomen.
Above the transpyloric plane, right
and left hypochondriac regions
(HC) are separated by the
epigastric region located between
them (E).
Below the transpyloric plane, but
above the transtubercular plane, is
the umbilical region (U) in the mid4
Dr.Al-Howaimil- Fluoroscopy
abdomen, with right and left
lumbar regions (L) on either side.
Below the transtubercular plane,
the hypogastric region (HY)
separates the two iliac fossae or
regions. (RIF) - right: (LIF) - left).
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Dr.Al-Howaimil- Fluoroscopy
Dr. Al-Howaimil
L: 1
Digestive system:
Alimentary canal
Accessory organs
Alimentary canal:
Hollow canal
Include:
Mouth, pharynx, esophagus, stomach, small and large
bowel, rectum, anus.
Accessory organs:
Salivary gland, liver, biliry tract, pancreas
Function of digestive system:
1- intake water, vitamins, mineral, digestive food acarbohydrate
b- Lipids
c- Protein
2- absorption of essential digestive food
3- Elimination of any use material as solid west product.
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Dr.Al-Howaimil- Fluoroscopy
Contrast media
Radiolucent (- ve) air, co2, o2
Radio-opaque (+ ve) barium selphate Ba So4
Barium:
Powder, chalk like substance, extremity un-soluble in water.
Ba + water = suspension (not solution)
Types:
A-Thin:
1 part of Ba of 1 part of water
Used for internal GIT
Motility:
Temperature
General condition of patient
Consistency of preparation
B-Thick:
3-4 part of Ba of 1 part of water
Used for esophagus
Descend slowly and coat mucous
Should be consistency of cooked cereal.
Ba- contraindication:
 If any chance to escape into peritoneal cavity
 If surgery followed radiographic procedure
use alternative contrast (water soluble iodinated contrast media
eg. Gastroview or Gastrografin because it is easily removed by
absorption before & during surgery)
Type of Ba:
Double: -ve and +ve
Single: barium only.
Post exam elimination:
On the large bowel absorption of water so Ba may become a
hardened and solidified and difficult to evacuate so patient may
require laxative after exam but if laxative is contraindication, fluid or
mineral oil used until stools are free from all erases of white.
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Dr.Al-Howaimil- Fluoroscopy
Barium swallow
The abdominal viscera can be made visible
on radiographs by the use of a suitable
contrast medium, a radio-opaque dye
which absorbs the x-rays as they pass
through the abdominal structures. Barium
sulphate solution is such a radio-opaque
substance. The patient is given a glass of a
milky white solution (the barium sulphate)
which is swallowed. This creates a bolus of
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Dr.Al-Howaimil- Fluoroscopy
medium
which
passes
down
the
oesophagus into the stomach and then into
the duodenum, small bowel and eventually
through the whole intestine. A thin coating
of barium allows the radiologist and
clinician to identify the surface of the gut
mucosa. The barium meal is widely used to
visualise the oesophagus, stomach,
duodenum and small bowel.
Introducing barium sulphate using
an enema via the anus, a technique
called a barium enema, permits the
examination of the large bowel.
Barium contrast studies can be used to
outline the anatomy of the oesophagus as
the barium passes through the chest.
These examinations are called a barium
swallow
. The barium can be seen in the
oesophagus (1). The oesophagus
has walls which normally have
longitudinal folds within them.
These may be seen as irregular
white lines. Swallowing a glass of
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Dr.Al-Howaimil- Fluoroscopy
barium sulphate suspension
creates a bolus which passes down
the oesophagus in the same way as
food would. This fills the lumen and
appears as a white shadow (2). The
lower end of the oesophagus
passes through the diaphragm and
enters the stomach (3). The
sphincteric action of the
diaphragm occludes or closes the
oesophagus as it pierces the
diaphragm preventing the acidic
stomach contents passing
backwards up into the oesophagus.
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Dr.Al-Howaimil- Fluoroscopy
Dr, Al-Howaimil
L; 2
Barium swallow
Radiographic examination to study the form and function of
pharynx and esophagus by using C\M
Indication:
1. Anatomical anomalies
2. Foreign body obstruction
3. Esophageal reflux
4. Esophageal Artesia
5. Dysphasia.
Contraindication:
Non
Patient preparation:
Non
Procedure:
Patient in erect RAO position, to throw the esophagus clear of
spine. Given cup of Ba and start swallow. Spot films are taken.
After care:
Non
Complication:
1. Aspiration,
2. Unsuspected perforation.
Infants:
To demonstrate a trecho-oesphageal fistula in infants a naso-gastric
tube is introduce to the level of the mid-esophagus, C\M injected
forced to indicate any fistula .Films are taken at the same time.
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Dr.Al-Howaimil- Fluoroscopy
. The barium can be seen in the oesophagus (1). The
oesophagus has walls which normally have longitudinal
folds within them. These may be seen as irregular white
lines. Swallowing a glass of barium sulphate suspension
creates a bolus which passes down the oesophagus in
the same way as food would. This fills the lumen and
appears as a white shadow (2). The lower end of the
oesophagus passes through the diaphragm and enters
the stomach (3). The sphincteric action of the
diaphragm occludes or closes the oesophagus as it
pierces the diaphragm preventing the acidic stomach
contents passing backwards up into the oesophagus.
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Dr.Al-Howaimil- Fluoroscopy
L; 3
Barium meal
Radiographic examination to investigate upper alimentary tract
including esophagus, stomach and duodenum.
To detect any abnormal anatomical or functional conditions.
Indication:
1- Peptic ulcers,
2- hiatus hernia,
3- gastritis,
4- tumor,
5- divertculae,
6- bezoars,
7- dyspepsia,
8- gastro-intestinal hemorrhage,
9- Partial obstruction.
Contraindication:
Perforation
Patient preparation:
Patient must arrive with empty stomach
NPO from midnight until the exam time.
No smoking or chewing during NPO period
Female patient check the LMP & apply 10 day role.
C\M:
Double contrast (Ba + CO2)
Gas producing agents:
1- produce adequate amount of gas i.e 200-400 ml
2- no interference with Ba coating
3- no bubble production
4- rapid dissolution, leaving no residue
5- easily swallow
6- low cost
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Dr.Al-Howaimil- Fluoroscopy
Procedure:
Patient is giving a gas producing agents, Then given Barium to
drink while he is laying on his left side supported by his elbow to
prevent Ba. Not to move quickly to the duodenum and obscuring
the greater curvature of the stomach .
Then the patient is asked to lay supine with slightly to his right
side to bring up the Ba. To the gastro-esophageal junction and
the patient screened to check the reflux by asking the patient to
cough or swallow water
Then injected with bascopan 20 ml or glucagons 0.3 ml to relax
the smooth muscle
Then asked to roll in Rt side to complete circle and finish in RAO
position for good coating .
Films are taken.
After care:
1- patient is warned about white bowel
2- patient is asked not to leave department until blurred vision
is resolved
Complication:
1- unsuspected perforation,
2- aspiration ,
3- partial obstruction may lead to complete obstruction,
4- Side affect of pharmacological agents.
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Dr.Al-Howaimil- Fluoroscopy
L; 4
Barium follows through or small bowel serious (SBS)
Radiographic examination of the small intestine to study the form
and function of the 3 components of small bowel.
Indication:
1. Pain,
2. Enteritis,
3. Neoplasm,
4. Hemorrhage,
5. Ileus,
6. Malabsorpation.
Contraindication:
1. Perforation,
2. Large bowel obstruction
Patient preparation:
Laxative on evening
Metoclopramide 20 min oral before exam to enhance the rate of
gastric emptying.
Preliminary film:
Plain ABD film
Procedure:
4 techniques:
1-upper GI- small bowel comp.:
Routine upper GI + routine stomach study
During upper GI study, patient should ingest 1 full cup of Ba &
exact time is recorded.
When flouro. of stomach is finished time is recorded
30 min after ingest 1 full cup of Ba PA film of proximal small
bowel (around 15 min after finishing upper GI)
1\2 hrs interval films (with centering to iliac crest) until Ba reach
large bowel usually 2 hrs
1 hr interval until Ba passes through the ileo-ceacal valve
Spot films of ileo-ceacal valve & terminal ileum are taken.
Radiologist may need delayed films are order to follow though
large bowel usually after 24 hr.
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Dr.Al-Howaimil- Fluoroscopy
2- Small bowel serious only:
Plain ABD film
2 cup of Ba ingested, record the time
After 30 min take film high centering to include proximal small
bowel
1\2 hrs interval films (with centering to iliac crest) until Ba reach
large bowel usually 2 hrs
1 hr interval until Ba is well into ascending colon.
3- Intubations:
Nasogastric tube is passed though the patient nose, esophagus,
stomach, duodenum, and into jejunum,
CM ingested in RAO position and that will help in passing the tube
by peristalsis movement and record the time
After 15- 30 min films are taken.
1 hr interval when required.
4- Enteroclysis:
Patient is intubated under fluoroscopy
C\M with special Enteroclysis catheter which pass into the region
of duodenal-jejunum junction
Ba sulphate is instilled air or methyl cellulose is injected into the
bowel to distend it and provide double DC
DC dilated the loops of small bowel while increase visible of
mucosa.
Films are taken.
Disadvantage:
1- increase patient discomfort
2- long exam time
3- possible perforation
Advantage:
Ideal for patient with bowel obstruction and malabsorption
After care:
Complication:
the same as the Ba. Meal
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Dr.Al-Howaimil- Fluoroscopy
L; 5
Barium enema
A method of investigation of colon by using C\M to study the form
and function of large intestine.
Indication:
1. colitis,
2. neoplasm,
3. divertcullum,
4. Volvus.
Contraindication:
1. rectal biopsy,
2. colonscopy, or sigmoidscopy
3. sever diarrhea,
4. Inflammation lesions e..g. appendicitis .
5. obstruction
Patient preparation:
The patient must arrive with empty colon
1. Patient kept to low residue diet for 4 days
2. laxative agent 48 hrs before exam.
3. colon washout
4. NPO 4-6 hrs before exam.
5. Patients undress copletly &wear gown.
Procedure:
Patient on lat. position with opposite knee flexed,
Well lubricated catheter is inserted 10 cm into rectum
Patient may injected with with Bascopan,
Then patient is Positioned in prone,
Enema reservoir is 100 cm over the table and table tilted so head is
at an angel 100
Ba runs until reach splenic flexure
Air pumped to produce DC
Patient rotated, films are taken.
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Dr.Al-Howaimil- Fluoroscopy
After care:
1. patient is warned about white bowel
2. patient is asked not to leave department until blurred vision is
resolved
3. Patient must be fit enough to leave department.
Safety concerns during Ba enema;
1- review patient’s chart
2- never force an enema tip into rectum
3- the height of enema bag should not exceed 100 cm
4- verify the water temperature of C\M
5- Escort the patient to rest room.
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Dr.Al-Howaimil- Fluoroscopy
BARIUM STUDIES: LARGE BOWEL
You should be able to identify the various components of
the bowel on these films. Note the caecum (1), ascending
colon (2), transverse colon (3), descending colon (4) and
the rectum (5). On the right, the ascending colon turns
towards the midline. This is called the right colic flexure
(6) (also known as the hepatic flexure - so called as it is
adjacent to the liver). On the left, the transverse colon turns
downwards, creating the left colic flexure (7) (or splenic
flexure - so called as it is adjacent to the spleen).
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Dr.Al-Howaimil- Fluoroscopy
BARIUM STUDIES: LARGE BOWEL 2
The sigmoid colon and the rectum can also be examined in
the barium enema studies. Views may be taken in the
prone postero-anterior position or in lateral or oblique
positions. Make sure you understand what these terms
mean.
The rectum appears well filled with barium (10). Superior
to the rectum and hidden by its outline can be seen the
sigmoid colon (11). The lower part of the descending
colon can also be identified (12).
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Dr.Al-Howaimil- Fluoroscopy
L: 6
Sialography
Definition:
A radiographic visualization of salivary glands and its ducts
*
provides both diagnostic and preoperative information in case of
salivary glands pathology).
Indication:
1- Pain
2- Calculi
3- strictures of ducts ‫ا‬
4- sialctasis
5- tumor
Contraindication:
Sever inflammatory of salivary glands ducts
History of sensitivity of iodinated contrast media
Contrast media:
1- oily: Ethiodol (have slow excretion rate, give a greatest
density, but may cause granulomatus tissue.
2- W.S.I .: Renografin (good for routine sialography)
Patient preparation:
None but check history of allergies
Procedure:
In case of suspected sialothiasis scout films are required.
Determination of salivary ducts by: palpation ducts or sucking
on a lemon slice.
Ducts are dilated by standard double-ended blunt dilators or
lacrimal probes
Then ducts canulated (the most preferred; Abbott butterfly set)
Wing is secured with hemostat
cannula should be refilled with CM to avoid Injection of air
bubbles and immobilized The tubing with syringe are taped to
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Dr.Al-Howaimil- Fluoroscopy
shoulder or chest Then CM injection slowly under fluoroscopy -----then Spot films are taken
Views:
Delayed films are taken to study the function emptying of gland
Films:
Preliminary films:
Parotid gland:
1- AP with head rotated 5 away from the side under
investigation
2- Lat
3- Lat-oblique
Submandibular gland:
1- infer superior using occulusal
2- lat
3- lat-oblique
After injection of CM:
1- infer superior using occulusal
2- lat
3- lat-oblique
Post secretary:
1. infer superior using occulusal
2. lat
3. lat-oblique
After care: -----None
Complication:
Pain
Damage to duct orifice
Rupture of duct
Infection
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Dr.Al-Howaimil- Fluoroscopy
L: 7
Maylography
A radiographic study of spinal cord and its nerve root
branches
Indication:
Detect any lesion may be presented within spinal
canal
For example:
Space occupying lesions
Degenerative disease of central nervous system(CNS)
Malformation of the spinal cord.
Contraindication:
Blood in CSF
Arachnoiditis
Increase intracranial pressure
Lumber puncture performed 2 weeks of current
examination
Patient preparation:
 Patient encouraged drinking fluids before exam
to decrease incidence of lumber puncture
headache
 Patient maturate before exam
 To decrease anxiety and to relax patient,
sedative relaxant agent may be given 1 hr
before exam
 NPO 4hr before exam.
Contrast media:
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Dr.Al-Howaimil- Fluoroscopy
must meet the following requirements:
1- miscible (mixed well with CSF)
2- has good radopacity
3- easily absorbed
4- non toxic
5- inert(non reactive)
----------------------------------------------------------1- oily contrast media 5-6 ml of myodil
Advantage:
Provides good radiopacity
Little complication
Disadvantage:
Not demonstrate root broches adequately
Not absorbed by the body, so must be removed
Needle is placed in place, so positioning of patient
is difficult
Residual oil-based CM is absorbed by the body
---------------------------------------------------------2- WSI c/m 8-10 ml
Provides good visualization of nerve root
Absorbed quickly
Spinal needle can be removed so patient can be
positioned
Absorption begins 30 min post injection.
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Dr.Al-Howaimil- Fluoroscopy
Procedure:
Lumbar puncture method:
By injection of CM into subrachnoid space
Patient placed in seated or lat-decubitus for
injection.
Skin is prepared and infiltrated with anesthetic
agent
Stylist needle inserted into subrachnoid space
Stylet removed spinal fluid flows from the needle
Site of injection is lower lumbar region, this area
reduce the possibility of trauma to the spinal cord
Between 2nd -3rd lumber vertebrae
(For cervical c3 – c4 or c4-c5 )
Small sample of spinal fluid is collected for
laboratory
At the same time Blood pressure can be taken
after CM is injected
(Withdrawing a small amount of spinal fluid and
replacing it with equal amount of CM)
Patient rotated into prone position and head kept
straight i.e. with chine resting on pad and table is
tilted so CM move upward and not entering the
head)
Views:
Patient porn position usually 2-3 exposures on 24 * 30 or
35 * 35 and L or R markers should be used
Lat view are taken in porn and anterior oblique
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Dr.Al-Howaimil- Fluoroscopy
After care:
Patient returned to the word on stretcher
Patient lies flat for at least 8 hr
Patient trunk raised and supported by billows at an
angle of 45 to prevent residue CM from entering
the head
Pulse and blood pressure are checked and
recorded Every ½ hr for next 4 hr then 4 hourly
for 24 hr.
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Dr.Al-Howaimil- Fluoroscopy
L: 8
Micturating CystoUrethroGraphy (MCUG)
Indication:
1- Vesico-ureteric reflux.
2- Study of the urethra during minctrution.
3- Abnormalities of the bladder.
4- Stress incontinence.
Contraindication:
1- Acute urinary tract infection.
CM:
HOCM or LOCM 150.
Equipment:
1- Fluoroscopy unites with spot film.
2- Video recorder.
3- Foley catheter.
Patient preparation:
The patient micturate prior the examination to empty the bladder.
The purpose of MCUG:
1- To demonstrate Vesico-ureteric reflux.
2- To demonstrate Vesico-vaginal or recto-vesical fistula.
3- To demonstrate stress incontinence.
Preliminary film:
Coned view to bladder.
Procedure:
1- TO DEMONSTRATE VESICO-URETERIC REFLUX
1- Patient lies supine on the x-ray table.
2- Using aseptic technique.
3- Insert catheter in to bladder.
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Dr.Al-Howaimil- Fluoroscopy
4- Residual urine is drained.
5- CM is slowly dripped in and the bladder filling.
6- The catheter should not be removed until no more CM will
be drip into the bladder.
7-sopt films are taken during micturation and any reflux
recorded. The lower ureter is best seen in to AO position. Boys
should micturate with AO position with opposite knee flexed.
8- A full-length view of the Abd. Is taken to demonstrate any
reflex of CM that might have occurred unnoticed into the
kidneys and to record the post-micturation residue.
2- TO DEMONSTRATE VESICO-VAGINAL OR RECTOVESICAL FISTULA
As above, but films are taken in lat position.
3- TO DEMONSTRATE STRESS INCONTINENCE
As above, but the catheter is left in situ until the patient is in the
erect position.
Films should include sacrum and symphysis pubis because
bony land marks are used to assess bladder neck descent.
Views:
1- Lat bladder.
2- Lat bladder, straining.
3- Lat bladder during micturation.
After care:
Patient should be warned about dysuria.
Complication:
DUE TO CM:
1- Adverse reaction may result from obstruction of CM BY the
bladder mucosa.
2- CM induced cystitis.
DUE TO TECHNIQUE:
1- Acute urinary tract infection.
2- Catheter trauma- may produce dysuria, frequency,
haematuria and urinary retention.
3- Retention of a Foley catheter.
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Dr.Al-Howaimil- Fluoroscopy
L. 8
Micturating Cystourethrogram (MCUG)
Indications for imaging
Vesicoureteric reflux in children - in recurrent UTI
Stress incontinence
Urethral stricture
Bladder dysfunctions
Contra Indications
Current - urinary tract infection
Contrast media allergies - cautionsAnatomy Demonstrated
Technique (typical for demonstration of reflux in a child)
This is normally a paediatric procedure, therefore all normal paediatric imaging considerations
are vitally important in this embarrassing and invasive procedure
Some centres give prophylactic antibiotic cover.
The patient lies supine on the examination table for catheterisation if not already catheterised
outside the department, the patient is catheterised. Bladder catheterisation is an aseptic
procedure undertaken by a suitable trained and qualified person.
The contrast media warmed to body temperature is slowly infused through the catheter using a
"giving set" into the bladder, intermittent pulsed fluoroscopy is used to check the filling and for
reflux up the ureters. The contrast media reservoir should be no more than 1 metre above the
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Dr.Al-Howaimil- Fluoroscopy
table to limit the pressure.
An alternative to spot films is to video tape the fluoroscopy.
1) Spot films are taken of the bladder, kidneys and ureters to record the normal or abnormal
anatomy.
2) When the bladder is considered full or the contrast leaks round the catheter the balloon is
deflated and the catheter withdrawn. depending on the age of the patient the patient is asked to
micturate into a receiver either erect or supine, suitable privacy and sympathy may be required.
3) Spot films are taken during micturition and any reflux recorded,
The patient is rotated into the 30 degree left and right anterior obliques to demonstrate the
bladder ureteric junctions, to demonstrate the male urethra the left anterior oblique position is
adopted with flexion of the right hip and knee to visualise the whole of the male urethra.
4) A final full length abdominal film is taken to visualise the kidneys.
Variations
For stress incontinence the film series is taken to include , at rest, straining and micturating in
the lateral position, some centres have special sitting fluoro arrangements.
For fistulae and bladder tract abnormalities a series of films in AP. lateral and oblique positions
may be required.
Contrast Media
Low strength (approx 25% weight/volume) contrast agent i.e. Hypaque 25% urografin 150,
suitable volume to fill the bladder, typical 20 ml in an infant to 500 ml in an adult, the contrast
media should be warmed to body temperature.
Radiation protection
General fluoroscopic dose limiting precautions should be employed.
Equipment
NursingCatheterisation pack - and aseptic procedure pack..
Sterile towels
Skin prep./ wash
Sterile lubricant
Giving setSelection of Foley catheters 5 -7 gauge French in infants larger in adults.
Drip stand
Radiographic
Fluoroscopy set with spot film or video recording devices.
Complications
Temporary Dysuria
Transient Haematuria from catheterisation.
Cystitis
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Dr.Al-Howaimil- Fluoroscopy
Aftercare
Non specific, general patient post procedure care.
Evaluation of the Image
ID and anatomical markers must be present and correct in the appropriate area of the film.
Optimal exposure should penetrate all the bone structures and contrast should be low enough to
visualise fully the bone and soft tissue structures. Images should be marked with contrast
volume and indications of voiding or straining.
Radiographs
Full length voiding film showing reflux into the right kidney
Additional modalities
Ultrasound is a useful adjunct
RNI may be used to assess renal scarring in cases of proven reflux.
Useful Text: A Guide to Radiological Procedures, Chapman & Nakielny
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Dr.Al-Howaimil- Fluoroscopy
L: 8
Arthrography
A contrast media study of synovial joints & related soft structures
including hip, shoulder, elbow, ankle, wrist, TMJ and knee
Knee tech. mostly similar for all joints.
Knee arthrography
Performed to demonstrate & assess the knee joint & associated soft
tissue structures for pathology including joint capsule, menisci,
(Collateral, cruciate, minor)ligaments
Indication:
 Traumatic:
Tears of joint soft structures capsule
 Non-traumatic: pathology (Baker’s cyst)
Contraindication:
Allergy to C\M
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Dr.Al-Howaimil- Fluoroscopy
Contrast media :Double contrast
5 ml of low density CM e.g. Renografin
80-100 cc of CO2, O2 , or air
Preliminary film:
AP + Lat
AP
Lat.
Procedure:
Patient lies supine and pad is placed under popliteal fosse and knee
slightly flexed.
Skin is cleaned and sterile towel is dropped around the knee
Skin infiltrated with local anesthetic and thin walled
(19 – 21 gage) needle is inserted into the joint.
Fluid from joint is aspirated and 3 ml of 1\1000 adrenaline is injected
to reduce the rate of absorption of CM Which is useful in case of
sinovitis
The CM is injected under fluoroscopic control ,followed by 40 ml of
air until supra-patellar pouch is tense (like balloon) then needle is
removed
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Dr.Al-Howaimil- Fluoroscopy
Knee extends & flexed several time to distribute the CM
Patient turned in prone position and (varus and valgus) being applied
until each meniscus is separated by gas
Views:
Usually 4 views of each quadrate of knee
AP + lat with knee flexed to demonstrate cruciatel
After care:
No special after care but patient should be warned that he may
experience discomfort for several days
Knee will sequelsh when flexed or straightened.
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Dr.Al-Howaimil- Fluoroscopy
L: 9
T-tube postoperative [delayed]
Cholangiography
Performed in the radiology department following a cholecystectomy
where the surgeon concerns about residual stones in the biliary duct,
so he will place a special T tube catheter into CBD (commune bile
duct) and extend outside the body.
The purpose:
1. Visualize any residual undetected stones
2. Evaluate the status of the biliary duct system
3- Demonstrate the small lesions, strictures or dilatation
Contraindication:
None
C\M:
Hypaque
Preliminary film:
Coned PA of Rt. side of abdomen.
Procedure:
This Procedure performed between 3rd 10th days following a
cholecystectomy
Patient lies supine and drainage tube clamped near the patient and
cleaned with antiseptic
23 G needle , extension tubing
and 20 ml syringe are assembled and filled with CM
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Dr.Al-Howaimil- Fluoroscopy
after removing air bubbles , needle is inserted into tubing between
the patient and clamp
Films & views:
PA
RAO
LAO
After care:
Non
Complication:
Adverse reaction
Septicemia
37
Dr.Al-Howaimil- Fluoroscopy
Hysterosalpingography:
Examination of the female reproductive system using
contrast media.
Indication:
1. Infertility.
2. Recurrent miscarriages.
3. Following tubule surgery.
Contraindication:
1. Pregnancy.
2. Acute pelvic inflammatory disease.
3. Active uterine bleeding.
Contrast media:
Omnipaque300
Equipments:
They are inside a closed sterilized box.
1. Speculum vaginal: 2pices.
They come two sizes: large35cm. /medume20cm.
2. Tenaculums: 2pices.
Toothed 25cm
3.foceps: 2pices.
Sponge 25cm.
4.bowls: 2
25cc
5.towels: 2
6.sterilized pair of
gloves.
38
Dr.Al-Howaimil- Fluoroscopy
Set of salpingograph:
1.OB-Gyneleechcannula with 2 stylets: sml. /med./large.
2.Cones: small/med./large.
3.three-way stopcock
4.labrcating jell.
5.tray
Position:
Patient is supine with knees flexed and legs abducted.
Procedure:
 Patient lie supine with knee flexed and places her
feet at the end of the table.
 With sterile towels and technique a vaginal
speculum is inserted into the vagina.
 The vaginal walls and cervix are cleansed with an
antiseptic solution.
 A cannula or ballon catheter is then inserted into
the cervical canal. Dilation with a balloon
catheter helps to occlude the cervix preventing
c/m from flowing out of the uterine cavity during
the injection phase.
 A tenaculum may be necessary to aid in the
insertion and fixation of the cannula or catheter.
 Once cervical placement of cannula or catheter is
obtained ,a syringe filled with c/m is attached to
the cannula or balloon catheter.
 Using fluoroscopy the physician slowly injects
the c/m into the uterine cavity.
 If the uterine tubes are open c/m will flow from
the distal ends of the tubes into the peritoneal
cavity.
39
Dr.Al-Howaimil- Fluoroscopy
Films:
1.preliminary film for the pelvic.
2.when the c/m is injected.
3. When it reaches the tubes
4. When c/m reaches the uterus.
After care:
The patient is tolled that she may have bleeding for1or 2
days and pain.
40