Escorts Service Ahmedabad🌹6367187148 🌹 No Need For Advance Payments
X rays in surgery for undergraduates Dr Dev Taneja-06.06.2021
1. X - Rays in Surgery
(for Undergraduates)
Dr Dev Taneja
Asst. Professor of Surgery (Unit 2)
MGM Medical College. Navi Mumbai
2. Why are X rays used in medical diagnosis?
An X-ray is a common imaging test that's been used for decades.
It can help your doctor view the inside of your body without having to
make an incision.
This can help them diagnose, monitor, and treat many medical conditions.
Note: The X – Rays are presented keeping in mind the needs of undergraduate students’ General Surgery examination
3. HISTORY
• Discovered in 1895 by German
physicist named Wilhelm Roentgen
• While studying cathode rays (stream
of electrons) in a gas discharge tube
• He observed that another type of
radiation was produced (presumably
by the interaction of electrons with
the glass walls of the tube) that could
be detected outside the tube
• The radiation could penetrate
opaque substances, produce
fluorescence, blacken a photographic
plate and ionize a gas
• He named his discovery “X rays”
because “X” stands for unknown
8. AP view
•Patient is too ill to stand or non-cooperative or on an ICU or a ward bed
•Heart at a greater distance from film, appears enlarged
9. PA vs AP view
PA view AP view
Clavicle Over lung fields Above lungs apex
Scapulae Away from lung fields Over lung fields
Ribs Posterior ribs distinct Anterior ribs distinct
Heart Actual size Relatively enlarged
12. Exposure
•Adequate exposure: Inter-vertebral spaces barely visible
through the heart shadow
Over-exposed film Under-exposed film
Inter-vertebral spaces clearly
visibile through heart shadow
Inter-vertebral spaces clearly
visibile through heart shadow
14. Good Inspiration - Patient is asked to take deep inspiration & hold
his / her breadth before shooting the X - Ray
• 6 anterior ribs visible
• 10 posterior ribs visible
22. Pleural Effusion
How to detect
minimal pleural
effusion ???
• CXR-PA: 150-175 ml
• CXR-lateral
decubitus: 10-50
ml
• USG thorax: 3-5 ml
Note: The CP angle is obliterated on the Right side
23. Consolidation
Note: The CP angles are clear in Consolidation.
(Here you can appreciate woman Breast shadow as well)
25. Hemithorax
Mediastinum pushed away from the opacified side
• Pleural effusion
• Large lung mass
• Diaphragmatic hernia
Mediastinum pulled toward the opacified side
• Total lung collapse
• Pneumonectomy
• Pulmonary hypoplasia/agenesis
Mediastinum remains central in position
• Consolidation
• Pleural/chest wall mass
• Combination of pathologies
28. Pneumothorax
• Increased translucency
on right side of the
chest.
Absence of lung marking
•
• homogenous
near the
Sharp
opacity
which indicate
hilum
the
•
collapsed lung.
Trachea shifted to
opposite side.
• Dome of diaphragm
flattened.
33. What to Examine ?
• Bone
• Solid organ
• Gas pattern
• Air fluid level
• Soft tissue masses
• Calcifications
• Foreign body
34.
35. Normal Gas Pattern
* Stomach
– Always
* Small Bowel
– Two or three loops of non-distended bowel
* Large Bowel
– In rectum or sigmoid – almost always
36. Gas in
stomach
Gas in a few
loops of
small bowel
Gas in
rectum or
sigmoid
Normal Gas Pattern
37. Free Air in Abdomen
Causes
• Rupture of a hollow viscus
– Perforated ulcer
– Perforated diverticulitis
– Perforated carcinoma
– Trauma
• Post-op 5–7 days
• Instrumentation
42. Differential Diagnosis of Pneumoperitonium
Subphrenic Liver abscess
Note:
In abscess only the right
Diaphragm is raised
In perforation, both the
diaphragms are raised
43. Normal Fluid Levels
Stomach
– Always (except supine film)
Small Bowel
– Two or three levels possible
Large Bowel
– None normally
AIR FLUID LEVELS
45. Large vs. Small Bowel
Large Bowel
– Peripheral
– Haustral markings don't
extend from wall to wall
– Diameter is bigger
Small Bowel
- Central
- Valvulae extend across lumen
- Diameter is smaller
46. • One or two persistently dilated loops of
large or small bowel
• Gas in rectum or sigmoid
Localized Ileus
Key Features
48. • Gas in dilated small bowel and large bowel to rectum
• Long air-fluid levels
• Causes – Post Abdominal Surgery, Exhaustion of Bowel
following Intestinal Obstruction, Peritonitis, Electrolyte
Imbalance etc.
Generalized ILEUS / Paralytic ILEUS
Key Features
52. Volvulus
(an obstruction caused by twisting of the stomach or intestine)
•
Sigmoid volvulus
- Coffee beam appearance
In adults, causes of a sigmoid volvulus include:
• an enlarged colon.
• abdominal adhesions that develop after surgery, injury, or infection.
• diseases of the large intestine, such as Hirschsprung's disease.
• a colon that is not attached to the abdominal wall.
• a narrow connection at the base of the colon.
• chronic constipation.
66. Renal Staghorn Calculi
Staghorn calculi are most frequently
composed of mixtures of
magnesium ammonium phosphate
(struvite) and calcium carbonate apatite
Staghorn calculi, also sometimes called
coral calculi, are renal calculi that obtain
their characteristic shape by forming a
cast of the renal pelvis and calyces,
thus resembling the horns of a stag.
They refers to struvite calculus involving
the renal pelvis and extending into atleast
two calyces
67. Ureteric Calculi
Note: The Abdominal Ureter Corresponds to Vertical Line along tips of Lumber Vertebrae Transverse process
68. Ureteric Calculi - 2nd X - ray Plate is important,
else you may miss Pelvic Ureteric Calculi
69. Double-J Stent
A JJ stent is a tube that is temporarily placed in the ureter to
make sure urine can flow from the kidney to the bladder
70. Intra Venous Pyelogram (IVP)
In an IVP exam, an iodine-containing
contrast material is injected through a
vein in the arm.
The contrast material then collects in
the kidneys, ureters and bladder,
sharply defining their appearance in
bright white on the x-ray images
77. X – Ray Skull Fracture
Skull Fracture - Linear Skull Fracture - Depressed
78. X - Ray Para Nasal Sinus (PNS)
Maxillary Sinusitis
Note: The Left Maxillary Sinus is Opaque due to Sinusitis
79. Indications:
1) Evaluation of Trauma
2) Third Molars
3) Large Lesions
4) Tooth Development
5) Development Anomalies
6) Intolerant to intraoral procedures
OPG
Orthopantomography
81. Parotid Gland Silography - Sjogren’s Syndrome
Parotid sialography provides visualization of the ducts (including a punctate sialadenitis)
through retrograde cannulation of the major salivary gland ducts followed by injection of
contrast material and X-ray examination.
Presence of diffuse sialectasias (punctate, cavitary, or destructive pattern) without
evidence of obstruction in major ducts is considered diagnostic of SS
Each gland's major duct
(Stensen's duct) opens in
the rear of the mouth cavity
near the second upper molar
82. Submandibular Gland
Submandibular Duct Calculus Submandibular Gland - Sialography
The Submandibular duct passes between the sublingual gland and the genioglossus and opens by a narrow opening
on the summit of a small papilla (the "sublingual caruncle") at the side of the frenulum of the tongue.
83. GI - Contrast examination
Barium sulphate is the best CM for demonstrating the GI-tract.
- Single CM is used to outline the structure.
- Double CM is used for detail viewing of the mucosal
pattern.
Water soluble CM is used in some cases such as perforation, small
bowel obstruction, pediatric patient.
Double contrast" refers to imaging with the
positive contrast of barium sulfate contrast medium (rarely water-soluble
iodinated contrast) as well as with the negative contrast of gas
(CO2 preferable).
84. Characteristic of Barium
High density with low viscosity.
Particles size 0.1 to 0.3 µm
pH = 5.3
Inert compound with no adverse reaction
Route: Orally & Rectally
Method: Single contrast & double contrast
85. Difference?
Single contrast
medium
Double contrast
medium
Only barium is given. 60-
100% w/v
Barium with gas producing
agent is given. 200-250% w/v
To outline the structures,
lumen and large
abnormalities.
For detail viewing of the
mucosal pattern, making it
easier to see narrowed areas
(strictures), diverticula or
inflammation.
86. Barium Swallow
Indication:-
1. dysphagia
2. anaemia
3. pain
4. assessment of tracheo-oesophageal fistula
5. assessment of site of perforation
Patient preparation:-
-NPO for 6 hours prior to the examination.
-Smoking should be avoided on the day of examination.
- Muscle relaxants before the procedure
Contrast medium:-
-Double contrast 200-250%w/v, 100ml/ more according to need.
-Water soluble contrast agent if perforation is suspected
(Gastrograffin).
-LOCM(approx 300 mgI /ml) in case of aspiration.
89. Barium Meal
Indications:-
-dyspepsia
-weight loss
-upper abdominal mass
-partial obstruction
-GI hemorrhage
Contraindication:-
-complete large bowel obstruction
Patient preparation;-
-Pt. should follow a low residue diet for 2 days prior to exam
-NPO for 6 hours prior to the examination.
Contrast medium:-
-E-Z HD 250%w/v, 135ml
92. Barium follow-through
Methods:-
- single contrast.
- with the addition of an effervescent agent.
- with the addition of a pneumocolon technique.
Indications:-
- Diarrhoea
- Anaemia
- Partial obstruction
- Malabsorption
- Abdominal mass
Contraindication:-
- Complete obstruction
- Suspected perforation
93. Technique
Prone PAfilm of the
abdomen are taken every
15-20min during the first
hour.
And subsequently every
20-30 min until the colon is
reached.
Spot film of the terminal
ileum
are taken in supine.
96. Barium Meal – ILEOCAECAL Region
Important: Multiple filling defects in Appendix with Deep Tenderness at McBurney’s point
and history of pain off & on in RIF are suggestive of Chronic Appendicitis
97. X - Ray Foot
Erosive bone lesions due to Ulcerative pathology
102. Foreign Bodies
Objects that may be seen include ingested and rectal
foreign bodies, such as coins, dress buttons and jewelry.
Other objects may have been operatively placed for
example an aortic stent, an inferior vena cava filter or a
suprapubic urinary catheter.
Sterilization clips and an intra- uterine device are
common findings in women.
