B.Sc Radiology procedure questions and answers

1. Question and answers for radiological procedure
By
Iniya sanjana
Melhin hebi
Nithya
Simon
Bharath
Nandha kumar
Mano
Guided by
G yogananthem
Dr.Harshavardhan

2. 1. Enteroclysis
It is a radiological study of small bowel from jejunum to the
ilocaecal junctions by intubation of the jejunum and instillation of
contrast through the tube.
Indication:
1. Partial small bowel obstruction
2. Crohn's disease
3. Suspected meckel's diverticulum
4. Malabsorption
5. Tumors of small intestine
6. GIT bleeding
7. Equivocal barium meal follow thorough (BMFT).
Contra-indication:
1. Complete colonic obstruction
2. Suspected perforation
3. Massive dilatation of the small bowel
4.Duodenal obstruction and gastrojejunostomy
5.Paralytic ileus
Equipment:
Bilbao dotter tube: This is a polythene 22F tube which is 150cm
long. The tube is 5cm longer than the guide wire in order to eliminate
the risk of perforation by the wire protruding beyond the trip. The tip
has multiple side holes with or without an end hole. The guide wire is
Teflon coated to reduce friction.

3. Contrast medium:
Single contrast:
20% w/v suspension of barium sulphate is used.
Double contrast:
High density low viscosity. Barium sulphate suspension is ideal which
is 200-250% W/v . We can use 95% microbar which is diluted to 70%
to decrease the viscosity. Another important constituent is carboxy-
methyl-cellulose (CMC). To prepare this, add 10 gm of c.m.c to 2 litres
of warm water and mix well . Then refrigerate the mixture overnight
shake this well before use.
Patient preparation:
• Follow a clear-liquid diet (such as, water, tea, clear broth) the day
before the enteroclysis.
• Take a laxative the night before.
• Avoid eating or drinking anything after midnight.
• Enema is given to clear stool from the intestines.
Single contrast enteroclysis:
This is performed in a patient with high grade partial small bowel
obstruction, especially if significantly dilated bowel loops are present.
Barium suspension 20% w/v is injected at the rate of 75 to 120 ml.
Care should be taken to ensure that no air goes in during the
injection. An average of one to one and half litres of barium sulfate is
injected without any interruption. The average time taken to reach
the ileocaecal junction is about 15 minutes. Use interrupted

4. fluoroscopy to follow the head of barium column. Stenotic lesions are
best identifiable at the head of the barium column.
Double contrast enteroclysis:
150 to 500 ml of barium suspension (high density and low
viscosity) is injected at the rate of 80-100 ml/minute, till the proximal
ileum is reached. The head of the barium column is followed with
intermittent fluoroscopy and films are exposed whenever necessary.
After this , 0.5% suspension of CMC is injected at a rate of around 75-
120 ml/min using a mechanical injector. Very rapid injection may
result in Atonia. Ileocaecal spot films should be taken initially when
the barium column reaches the ileocaecal junction and the again
when the ileocaecal junction is the double contrast.
2.COMPLICATIONS OF FEMORAL ARTERY
CATHETERIZATION
The risks associated with catheterization include: an allergic
reaction to the contrast material or medications used during the
procedure. bleeding, infection, and bruising at the catheter insertion
site. blood clots, which may trigger a heart attack, stroke, or another
serious problem
Complications:
• It include haematoma, retroperitoneal haemorrhage,
pseudoaneurysm, arteriovenous fistula, arterial occlusion,
femoral neuropathy and infection.

5. • Complications for diagnostic procedures are lower due to the
lack of antiplatelet therapies on board.
• Often, incorrect location of the femoral artery puncture site
results in complications.
• Puncturing below the femoral bifurcation can result in
psedoaneurysm, haematoma and arteriovenous fistulas,
whereas retroperitoneal haemorrhage is caused by high femoral
punctures.
• Identification of bleeding and vascular complications is
paramount as bleeding is associated with adverse events.
To lower complications:
• Techniques to reduce the risk of femoral arterial complications
include the use of ultrasound scan or fluoroscopy guided femoral
punctures.
3.ERCP ( by IniyaSanjana)
This procedure is used to diagnose and treat problems in the
pancreas. These problems may be in the duct or in the pancreas itself.
To examine the pancreatic and bile ducts. A bendable, lighted tube
(endoscope) about the thickness of your index finger is placed
through your mouth and into your stomach and first part of the small
intestine (duodenum). In the duodenum a small opening is identified
(ampulla) and a small plastic tube (cannula) is passed through the
endoscope and into this opening. Dye (contrast material) is injected
and X-rays are taken to study the ducts of the pancreas and liver.
Indications:

6. • Acute recurrent pancreatitis
• Chronic pancreatitis
• Injuries to the duct
• Gallstone disease causing pancreatitis
• Inflammatory disorders affecting the pancreas
• Stones blocking the pancreatic duct
• Narrowing (strictures) within the duct
• Abnormal anatomy of the pancreas or duct
Contraindications:
• Unstable cardiopulmonary, neurologic or cardiovascular status
and existing bowel perforation
• Structural abnormalities of GIT (oesophagus,stomach or small
intestine) •An altered surgical anatomy
• ERCP with Sphintrctrectomy or ampullectomy is relatively
contraindicated in coagulopathic patients
• Acute infective pancreatitis
• Pyloric stenosis Contrast:
Non iconic trio iodinated contrast agent
Iopamidol, Iohexol, iopramide
Pancreatic Duct: low osmolar (1.5mgI/ ml)
Bile duct: low osmolar ( 2.8mgI/ml) .

7. 4. Ascending urethrogram ( by IniyaSanjana)
It is a radiological examination to diagnose pathological conditions
of the urethra. During the test, a contrast medium is infused through
the urethra while X-rays are taken at the same time. X-rays are made
with the use of an external radiation apparatus to produce images of
body organs on a special film When contrast medium is infused
through the urethral orifice with the use of a catheter, the test is
called ‘Ascending Urethrogram’.
In ascending urethrography where contrast to is
injected into the urethra. It is mainly used to demonstrate anterior
urethra.
Indication:
Trauma to urethra
Urethra stricture
Suspected urethral diverticula
UTI
Vesico ureteric reflex.
Voiding difficulties.
Contra indication:
Recent instrumentation
Acute UTI
Uretheritis

8. Technologist duties:
Administer oxygen 10-12 L by face mask, and intravenous isotonic
fluid (eg, 0.9% isotonic sodium chloride solution, Ringer lactate
solution). For severereactions or unresponsive patients, administer
intravenous atropine 0.6-1 mg, repeated every 3-5 minutes as needed
until a total of 3 mg is administered.
Patients are frequently asked about iodine or seafoodallergy before IV
contrast material is administered because of a commonly held belief
among radiologists and others in the medical community of a specific
cross-reactivity between iodinated radiographiccontrast material and
other iodine-rich substances.
• Call for medical assistance
• Emergency assistance protocols
• Know where your crash cart and drug trays are located and how
to capp for help
• Document patient reaction
• Use emergency reactions and according to reactions .

9. 5.Barium swallow
Barium swallow Is a radiological study of pharynx and
oesophagus upto the level of stomach with the help of contrast
Indication:
Dysphasia
Heart burns
Hiatus hernia
Reflex oesophagitis
Foreign body impaction
Motility disorder of oesophagus (eg.achalasia)
Contrast:
It is a medical imaging procedure used to examine upper
gastrointestinal tract with include the oesophagus and to lower
extent the stomach.
The contrast used is barium sulphate.
Contra-indication:
The suspected leakage from oesophagus into the mediasternum
or pleura and peritoneal cavities.
Tracheo-oesophageal fistula.

10. Contrast used:
100%barium sulphate paste
80%barium sulphate suspension
30%barium sulphate suspension for high kv technique.
200-250%high density ,low viscosity for double contrast.
Types of contrast:
Single contrast
Double contrast
Patient preparation:
None in particular but advisable to be in NPO prior to the
procedure. Ensure that no contraindication to the pharmacological
agent used. Check pregnancy test. procedure should be to patient
before undergoing the procedure.
Technique:
Pharynx:
• One mouthful about 10-15 ml of contrast media barium sulphate
paste is given and fluoroscopic observation in frontal and lateral
view with the patient erect.
• To get optimum distension of pharynx expose is triggered at the
time when the hyoid bone is at the highest point during swallow.

11. Oesophagus:
Single contrast:
• Multiple mouthfuls of 80% w/v barium suspension are given.
• Follow the barium bolus down the oesophagus and observe the
peristal is always in supine position.
• RAO, LAO, Frontal and Lateral views are taken in erect position.
• The escape of contrast at the level of the diaphragmatic hitatus
should not be confused for reflex.
Double contrast:
▪ Barium contrast should be high density , low viscosity. ( 200 to 250%)
15-20 ml barium is given the mouth and patient is asked to swallow.
Then effervescent powder is given with another mouthful of barium.
▪ In erect position gas tends to stay up resulting in adequate distension
which stays for longer time as compare to supine position.
▪ Prone position also retains more gas within the oesophagus and gives
adequate distension.
▪ Inj. Buscopan -i.v given before the procedure.
▪ Buscopan keeps the oesophagus distended for longer time
After care:
▪ Ask to consent plenty of water to flush out the barium contrast from
the gastrointestinal tract.
▪ The patient should be warned that fecal matter will be white for few
days after the examination.

12. 6.Single contrast enema: ( by IniyaSanjana)
Single contrast barium enema is a method of imaging the colon with
fluoroscopy and is similar in concept to thedouble contrast barium
enema. "Single contrast" refers to imaging withbariumor water-
soluble contrast only, without addition of air or CO2.
Indications:
• the patient is unable to turn quickly/effectively
• double contrast technique requires rapid changes in patient
position
• when only the position and length of a stricture is required
• evaluation for acute diverticulitis (and CT unavailable for
whatever reason)
• evaluating for a colonic fistula
• evaluation for postoperative leak after colon surgery
• Suspected diverticulitis
Contraindications:
There are few contraindications. If evaluation of the colonic mucosa is
what is clinically desired, then adouble contrast barium enemais
preferred. If screening for colon cancer, thenCT colonographyis
preferred.Water-soluble contrast should be used when evaluating for
postoperative leak.
Contrast media:
• Water-soluble contrast (e.g. Gastrografin) should also be diluted
to approximately 20% iodine.

13. • Barium often comes in 100% w/v solutions, so a way to get to
20% w/v density is
• 400 mL of 100% w/v barium added to 1600 mL of water (2000 ml
total)
• Some radiologists also prefer giving the patient 1 mg
ofglucagon(IV or SQ) before the exam to relax the colon, but this
is not mandatory,
Post patient care:
The patient should be encouraged to stay hydrated and, if using
barium, not to be alarmed if white material comes out in future stool
7.T-tube cholangiography ( by IniyaSanjana)
o A T-tube cholangiography is a fluoroscopic procedure of the
billary duct system.
o These ducts transport bile between liver, gall bladder and small
intestine are seen with the help of a contrast materials.
o The T-tube is most commonly inserted during a cholecystectomy
operation when there is a possibility of residual gall stones within the
biliary tree.
Indication:
1. patient's with possibility of residual small gallstones post
cholecystectomy
2. obstructive jaundice
3. bile duct stricture

14. 4. surgeon unable to explore bile duct during cholecystectomy
surgery .
Contra-indication:
1. non-consent by patient to procedure
2. contrast or iodine allergy
3. pregnancy
4. barium study within last 3 days.
Procedure:
The patient is positioned supine on the X-ray table.A slightly RPO
position can help to ensure the CBD is not superimposed over the
patient's spine.A scout image of the RUQ should be acquired.The tip
of the T-tube is cleaned with antisepticT-tube should be raised and
tapped to ensure there are no air bubbles lurking in the tube.A

15. butterfly needle should be inserted into the T-tubeThe syringe
plunger is withdrawn to remove bile from within the duct.
(optional).The entire biliary tree should be imaged during injection of
contrast medium.Injection should continue until the entire biliary tree
is opacified and there is passage of contrast into the deuodenum.If
the intrahepatic ducts do not fill, the patient can be tilted
trendelenburg and further contrast injected into the T-tube.The
patient may need to lie on their left hand side to fill the left hepatic
duct.At least 2 views of the entire biliary tree should be recorded by
spot film oblique views are often taken.The T-tube is made of very
flexible plastic. The flexibility of the plastic facilitates the
percutaneous remove of the T-tube without surgical intervention.
Ttubes are usually sized between 10 French (10F) and 16 French (16F).
1. BARIUM ENEMA – INDICATION,
CONTRAINDICATION, TECHNIQUE. (by A. Nandhakumar)
A barium enema is an radiographic examinationunder Fluoroscopy
that can detect changes or abnormalities in the large intestine (colon).
An enema is the injection of a liquid into your rectum through a small
tube.
SINGLE CONTRAST BARIUM ENEMA :
INDICATION :
• Evaluation of acute obstruction or volvulus
• Uncooperative, very debilitated or immobile patient

16. • Show configuration of colon
• Where only gross pathology is to be excluded
CONTRAINDICATION :
• Allergy to barium suspension
• Risk of perforation
• Peritonitis
• Suspicion of acute / fulminating ulcerative colitis
• Following a recent beep biopsy
DOUBLE CONTRAST BARIUM ENEMA :
INDICATION :
• High risk patient rectal bleeding, previous H/O
carcinoma or poly family H/O colorectal cancer
or pyloposis
• Demonstration of sinuses or fistula
• Presence of obstruction
• Reduction of an intussusception
CONTRAINDICATION :
• Allergy to barium suspension
• Peritonitis
• Acute or fulminating inflammatory colon disease
• Debilitated, unconscious, inability to co-operate
• History of recent rectal / colon biopsy
CONTRAST MEDIA :

17. • Single contrast barium enema – thin barium
suspension, 15-25% w/v and kilo voltage of 100-110
used.
• Double contrast barium enema – thick barium
suspension, 80-90% w/v and kilo voltage of above
90 is used.
TECHNIQUE :
scout views:
• AP abdomen
• AP pelvis
• left lateral pelvis
• left lateral view of rectum
• left lateral view of the rectosigmoid junction
2.Five high riskfactors and effects of Ionic
contrast media (byNandhakumar)
• Iodinated contrast agents (typically iodine-
substituted benzene derivatives) are bound either
in non-ionic or ionic compounds.
• Ionic contrast agents consist of the negatively
charged anion and the positively charged cation.

18. Used components of the anion are for example
diatrizoate, iodamide, iothalamate or metrizoate
and of the cation the sodium or meglumine ion.
• The osmotic pressure depends on the number of
particles in solution.
• Ionic contrast agents have a greater osmolarity;
double that of non-ionic contrast agents due to
delivering more iodine atoms per molecule.
• Ionic contrast agents were developed first and are
still in use depending on the examination.
• Ionic contrast agents consist of the negatively
charged anion and the positively charged cation.
• Iodine based contrast media are water soluble and
as harmless as possible to the body.
• Ionic agents have more side effects compared to
non-ionic contrast agents due to their high
osmolarity.
SIDE EFFECTS :
• nausea and vomiting.
• headache.
• itching.
• flushing.

19. • mild skin rash or hives.
3. CLASSIFICATION OF CONTRAST MEDIA
(by Nandhakumar)
▪ Contrast is a chemical substance which is introduced into the human
body via entral/parentral route to visualize certain structures not seen in
plain radiographic
▪ Radiographic contrast media are divided into positive and negative
contrast agents. The positive contrast media attenuate X-rays more than
do the body soft tissues and can be divided into water-soluble iodine-
based agents and non-water-soluble barium agents.
▪ Contrast materials currently in use are excreted
almost exclusively by glomerular filtration, with subsequent
concentration in the renal tubules and progressive opacification of the
urinary tract
THERE ARE TWO TYPES :
• Ionic (urograffin,angiograffin)
• Non-ionic (Omnipaque, ultravist)

21. 4. USES OF FLUOROSCOPY (by Nandhakumar)
Fluoroscopyis made up of “live” X-ray images that when
they are put together look like a movie. A fluoroscope
allows medical staff to see bones and also helps
physicians to identify soft tissue pathology.
➢A radiologist can use barium to check the functions
of the stomach, the small and large intestines,
colon and rectum. Since X-rays often shoot
completely through these soft tissues, barium adds
density to these anatomies so that they can be
monitored.
➢During a swallow study, a speech language
pathologist can use fluoroscopy to see if food is
going to the right place when swallowed. They can
also check to see if parts of the patients mouth and
throat are working properly.
➢In cardiac procedures, dye can be injected into the
coronary arteries to show blood flow or to
investigate potential blockages. Catheters may be
placed more easily due to fluoroscopic guidance.

22. ➢ Several spine and joint injections can accurately be
made using fluoroscopy after dye is injected. These
injections can be both diagnostic, to see if there is a
greater underlying pathology, or therapeutic,
sometimes providing full relief for an extended
period of time.
5.IODINE IS PERFORMED COMPONENT OF CONTRAST
MEDIA (by Nandhakumar)
• Most of the iv contrast agents contain iodine which as an
atomic number 53 and atomic weight 127
• Total iodine content in the body is 50%
Its performed because :
• High contrast density due to high atomic number
• Allows firm binding to highly variable benzene ring
• Low toxicity
Its not suitable for MRI

23. 5. HYSTEROSALPINGOGRAM
(by Nandhakumar)
Hysterosalpingogram (HSG) is a fluoroscopic examination of the
uterus and the Fallopian tubes, most commonly used in the
investigation of infertility or recurrent spontaneous abortions.
INDICATION :
Infertility to assess uterine morphology and tubal patency.
CONTRAINDICATION :
• pregnancy
• active pelvic infection
• recent uterine or tubal surgery
PROCEDURE :
• The procedure should be performed during the proliferative
phase of the patient’s menstrual cycle (days 6-12), when the
endometrium is thinnest
• This improves visualization of the uterine cavity, and also
minimizes the possibility that the patient may be pregnant 1
• If there is any uncertainty about the patient’s pregnancy
status, a beta hCG is warranted prior to commencing.
• After an antiseptic cleaning of the external genital area, a
vaginal speculum is inserted with the patient in the lithotomy
position; the cervix is cleaned with an aseptic solution.
• catheterization of the cervix is then performed; the type of
device used depends on local practice preferences
e.g. 6 Fr Foley catheter with balloon inflation, or

24. any one of a range of available HSG catheters or metal cannulas 3.
• whatever the device, it should be primed with contrast prior to
commencing to avoid the introduction of gas bubbles which may
provide a false positive appearance of a filling defect.
• water soluble iodinated contrast is subsequently injected slowly
under fluoroscopic guidance.
• A typical fluoroscopic examination includes a preliminary frontal
view of the pelvis, as well as subsequent spot images that
demonstrate uterine endometrial contour, filled Fallopian tubes
and bilateral intraperitoneal spill of contrast, to establish tubal
patency.
7. TOMOGRAPHY ( by Nandhakumar)
Tomography is a radiographic technique that select a level at the body
and blurs out structures below and above the plane leaving a clear
image of the selected anatomy
• This is done by film tube assembly connected by pivot
and moved opposite to each other

25. ADVANTAGES :
• Its advantages are high precision, short exposure times,
and inexpensive equipment.
• Depth localization
DISADVANTAGE :
• A disadvantage isimage blur from out of the plane anatomy
• Only acquires one slice at the time and therefore it would
acquire an excessive dose to acquire a volume

26. 1.Indication, contrast and views for parotid
sialography ( nithya)
Sialography is the radiographic examination under fluoroscopic. its
the study to demonstrate the parotid or submandibular glands by
injecting of contrast medium into the duct system.
Indications
▪ Calculi
▪ Chronic inflammatory disease
▪ Mass lesion
▪ Obstructive lesion
▪ Penetrating trauma
▪ Fistula
▪ strictures
▪ prior to CT evaluation of salivary glands
Contraindication
▪ allergy to iodine
▪ acute sialadenitis
contrast medium -water soluble, ionic contrast media like trivideo 280,
conray 280 or non-ionic contrast media such as omnipaque-350.
Images taken immediately after contrast is injected
Patient may be asked to suck on a lemon or secretory stimulant for 2-3
minutes before sialography.
to make the salivary duct opening conspicuous for cannualtion

27. Film exposure
Parotid- PA, lateral, lateral oblique
▪ Frontal view with face rotated 5-10 degrees towards the side of study
▪ Lateral view with 15-20degree cranial tube tilt
▪ Postioning for submandibular gland
▪ Lateral view is taken with 15-20 degrees cranial tube tilt
▪ Films are taken during injection
.
2.Advantages of double contrast study
( by nithya)
Single contrast study is less sensitivity at detecting small polyps and
early changes of inflammatory bowel disease
The double contrast refers to the use of positive and negative
contrast agents to increase the sensitivity of the examination.

28. Double contrast is high density, low viscosity (200-250%ml)
because of high density exposure technique can be reduced so Less
patient dose
The double contrast study is sensitive to visualize mucosal
irregularities
Positive contrast: barium or barium like agent e.ggastrografin
Negative contrast: air or co2
- Highly accurate in detecting abnormalities
- Bile reflex gastritis
- Marginal ulcerations
- Recurrent Ca
- Mucosal lining is well visualized
- Small lesions are less easily obscured
- Abnormalities of the efferent loop
3.Barium studies for evaluation of GI tract and discuss
in detail about the double contrast barium meal. (by
nithya)
Barium studies in GIT
• Barium swallow
• Barium meal
• Barium meal follow through
• Small bowel enema

29. • Barium enema
Double contrast barium meal
Barium meal is the radiological study of esophagus, stomach,
duodenum and proximal jejunum. It is done by oral administration of
contrast media (barium sulfate)
Contrast media
High density 200-250% low viscosity barium sulfate is essential
Patient preparation
Fasting for 6hours before examination
Avoid smoking
Gas forming agent
To produce gas in the stomach, sodium bicarbonate and citric acid
are given orally.
Smooth muscle relaxants
Hyoscine (buscopan) when given intravenously produces good
distension of the stomach and bowel by smooth muscle relaxation
and produces effacement of the mucosal folds
Dosage of buscopan is 1ml ( 20mg)
I.V buscopan is contraindication in patient with
Glaucoma, tachycardia, cardiac disease, poor general condition,
urinary retention

30. Technique of double contrast
Injection of buscopan IV should be given just before barium to study
the stomach. To study the stomach and duodenum, injection
buscopan is given when barium enters the duodenum.
About 100-150ml of highdensity low viscosity barium is given.
Injection buscopan is given as decribed before, Gas forming agents are
given. Then patient is rotated slowly for mucosal coating, beginning
from supine to right lateral to prone to left lateral and back to supine.
The table may tilted 30degree headup/ head low to attain maximum
distension of the part to be filmed.
After care
Patient should be told that the bowel motion will be white for few
days
Patient should be advised to drink plenty water
Patient must be leave the department until any blurring of vision
produced by buscopan has resolved
4. Intravenous urogram preparation, contrast used,
complication. ( by nithya)

31. It is the radiographic examination of urinary tract renal parenchyma,
calyces and pelvis after intravenous injection of contrast media.
Preparation
• Ask for any history of diabetes mellitus, pheochromocytoma,
renal disease or allergy due to drugs and any specific foods.
• Fasting for 4 hours
• Do not dehydrate the patient.
• Bowel preparation.
Contrast used
Non-ionic contrast media
Iohexol-omnipaque (40-80ml)
Complication
Due to contrast
Minor reaction 5% - nausea, vomiting, mild rash, headache.
Intermediate reaction 1% - extensive urticaria, facial edema,
hypotension, bronchospasm, laryngeal edema, facial edema.
Severe reaction 0.05% - circulatory collapse, pulmonary edema,
myocardial infarction, cardiac or respiratory arrest.

32. 5.Complications of Hysterosalpingography HSG (by nithya)
It is the radiographic procedure under fluoroscopy. In which contrast
is injected into the uterus to study the uterine cavity and fallopian
tubes.
Complication
1. Pain may occur at the following times:
• Using the vulsellum forceps.
• During insertion of cannula.
• With tubal distension and distension of uterus
• Generalized lower abdominal pain due to peritoneal irritation by
the contrast media.
2. Bleeding
3. Venous intravasation
• Excessive injection pressure.
• Traumatization of the endometrium by the tip of the cannula.
• The examination performed when the endometrium is deficient
as after curettage or menstruation.
4. Trauma to the uterus due to cannula causing perforation.
5. Exacerbation of pelvic infection.

33. 6.Filming Technique of I.V.U( by nithya)
Intravenous Urogram I.V.U is the radiographic examination of urinary
tract including renal parenchyma, calyces and pelvis after intravenous
injection of contrast media.
Filming technique
Short exposure should be used to get optimum image contrast
• Plain x-ray KUB/scout film
• 1 minute film
• 5 minutes film
• 10 minutes film
• 15 minutes film
• 35 minutes film
• Post void film
Plain x-ray KUB/scout film provides valuable information and
sometimes indicates probable diagnosis. Useful in assessing
• Calculus
• Intestinal abnormalities
• Intestinal gas pattern
• Calcification
• Abdominal mass
• Foreign body
1minute filmshows nephrogram. This radiograph is often omitted
as the renal outlines are usually adequately visualized on 5minutes
film.

34. 5 minutesfilm shows nephrogram. renal pelvis, upper part of
ureter.
Compression band is now applied on patient abdomen and the
balloon is positioned on anterior superior iliac spine where ureters
cross pelvic brim.
Compression contraindicated in;
• Renal trauma
• Large abdominal mass
• Abdominal aneurysm
• After abdominal surgery
• If 5 minutes film shows dilated calyces or if calyces and pelvis
are not adequately opacified, obstruction exists and
compression band should not be applied.
If compression is applied, a film is taken after 5minutes of
compression.10 minutes film, centred on kidneys to demonstrate
distended collecting system and proximal ureters.
15 minutes film:visualization of ureter is better in prone position
they fill better.
35 minutes film:it gives complete overview of the urinary tract
kidney, ureter, bladder. Bladder distension can be evaluated
Post voiding film:taken immediately after voiding. It is used to
assess for
Residual urine, bladder mucosal lesion, diverticula, bladder tumour,
outlet obstruction.
Note :all films are taken in full expiratory phase

35. 7.Micturating cystourethrogram procedure, contrast
used, radiographic technique (by nithya)
Urethrography is of 2 types:
Ascending – where contrast is injected into the urethra. It is mainly
used to demonstrate anterior urethra.
Descending – used to demonstrate posterior urethra
Voiding cystourethrogram demonstrates the lower urinary tract and
helps to detect the existence of any vesico- ureteral reflux, bladder
pathology and congential or acquired anomalies of bladder outflow
tract.
Contrast media
Water soluble contrast media like conray 280, trivideo 400mg,
urograffin 60% are used which is diluted with normal saline in1:3
ratio.
Procedure
Consent form must be signed by patient
Using sterile technique a catheter is introduced into the bladder. A 5f
feeding tube with side holes are used for children and in older

36. children 8f or 10f polyethylene or soft rubber tube catheters with
holes are suitable.
In girls- 10 day rule must be followed , and after an initial inspection
of the perineum to identity any local genital abnormalities like
cystoceles or labial fusion etc., the urethral catheter is inserted. When
it enters the bladder a varying amount of urine will flow through it. If
there is no flow the catheter is advanced until urine is obtained.
Suprapubic pressure is sometimes helpful in expressing a small
amount of urine in the near empty bladder. If no urine is obtained the
catheter may have been inserted into the vagina.
In males – the foreskin is retracted and catheter is introduced the
catheter should be lubricated with an anaesthetic jelly and inserted
slowly and gently into the urethra holding the penis in a vertical
position.
technique
The following projection should be acquired keeping within the
ALARA principle
• AP with full bladder
• Both oblique to demonstrate bilateral vesicoureteric junctions.
• Post void film to check for a ureterocoele.
8.Lower limb arteriography( by nithya)

37. It is the radiographic examination under DSA digital subtracton
angiography. It is study of blood vessels by injection of a contrast
medium into the vessels. This can be done in two ways
• Direct injection of contrast with needle
• Injection of contrast with catheter
Indication :
Narrowed or blocked blood vessel
Contraindication
Bleeding tendencies
Thrombogenic tendency
Abnormal renal function
Hepatic failure
Pregnancy
Patient preparation and precautions
Careful history and clinical examination
Informed consent
Patient should be well hydrated
Fasting for 4 hours prior to procedure
Shave and clean arterial puncture site
Following investigation to be done
Hb%, ESR, PT, PTT, BT, CT, HBsAg , HIV, and Pulse chart
Heparin should be stopped 4-6 hours before procedure
Any history of drug intake

38. History of diabetes mellitus
History of coronary heart disease
Local anaesthesia – 1%-2% xylocaine without adrenaline is used
The following procedure is done by radiologist
Direct needle puncture+ injection of contrast with needle in SITU
For the femoral artery
Feel the inguinal ligament
Feel the artery and fix it with three fingers of left hand below the
inguinal ligament
Inject local anaesthetic agent at the site of the puncture. Make a hole
in skin using a thick needle 2 cm 1inch thick below the inguninal
ligament.
Introduce the needle through skin hole maintain an angle 45degree to
the skin surface
Connect the tubing to the hub of the needle through a 2way stop cock
making sure that there is no air inside it
Suck and withdraw blood in syringe and discard it and flush with
another syringe
Then contrast is injected and do filming
Flush the system once every minutes. The stopcock should be closed
during flusing and not after stopping the injection.
Volume of contrast media
Femorals 20-40ml
Contrast used for angiography

39. Low density contrast material can be used wherever DSA is available
Low density 30% dilute medium contrast by 50%
9. DEFECOGRAPHY( by nithya)
Defecography is the radiographic study under fluoroscopy. It shows
the rectum and anal canal as the change during defecation (having a
bowel movement). This test is used to evaluate for disorder of the
lower bowel.
Defecography is a technique in which a barium contrast medium is
introduced into your rectum after the radiologist performs a rectal
examination. The barium is visible within the rectum on x-rays. During
the test patient is instructed to defecate empty the rectum. This x-
rays are taken while the person is sitting at rest, straining, squeezing
and during defecation.
INDICATION
• Chronic constipation
• Rectal prolape
• Rectocele
• Fecal incontinence
• Anismus

40. 1. CONTRASTS AGENTS USED IN MRI
( by mano)

41. 2. NON IONIC MONOMERS AND DIMER. ( by mano)
NON IONIC :
Non ionic form decreases this risk, but is much more expensive
.non ionic contrast media is much more widely and today.
TYPES OF NON IONIC CONTRAST MEDIA
➢ Non ionic monomers
➢ Non ionic diners
NON IONIC MONOMERS;
single tri-iodinated benzene ring without a carboxylate
containing benzene constituent
1.these contrast have one organic molecule at molecular level.
2.they are less toxic that can be used in blood stream.
3.some non ionic monomers
➢ Iohaxol (umnipaque)
➢ Iopamidol(nipam)
➢ Iopramide (ultravist)
➢ Iopentol(imagopaque)
➢ Ioversal (optoray)

42. NON IONIC DIMERS:
Tri-iodinated benzene rings that do not contain a carboxylate
function group with in any benzene substituent .
1.they contain two organic compounds at molecular level.
2.they are less toxic so are called iso-osmolar contrast media.
3.some non ionic diners
➢ Iotral
➢ Iotrolan(isovist)
➢ Iodixanol

44. WHAT ARE THE COMPLICATIONS OF THE BARIUM
ENEMA. ( by mano)
COMPLICATIONS;
✓ Preparation of the patient
✓ Pharmacology agents
✓ Procedure
PERFORATION ;
❖ Balloon catheters may cause local trauma to rectum.
❖ Patient with colitis, radiation therapy and where
there is low anastomosis more prone for
perforation.
❖ Perforation may be intra peritoneal or extra
peritoneal.
❖ In intraperitoneal – massive serosal fluid exudate
with hypovolaemia will occur which may be
compounded by gram negative endoscopic shock.
❖ Barium sulphate particle in peritoneal cavity will
cause foreign body reaction with formation of
dense adhesions.
❖ Barium granules – due to barium retention within
bowel wall from intramural perforation.
❖ Rarely venous intravasation.
❖ If barium enters systemic circulation, pulmonary
embolism will result.
❖ Treatment: antibiotics, fluid replacement and
peritoneal salvage.

45. INSPIRATION OF BARIUM;
❖ Causing severe constipation to the patient.
❖ It is seen in elderly patients with obstructive lesion
or if barium is given in large amount and infused
beyond the lesion.
❖ Usually results form residue impacting in a
structure and high intra colonic pressure generated
by the purgative exceeding the integrity of the
bowel wall .
WATER INTOXICATION AND ELECTROLYTE IMBALANE :
❖ Due to preparation with cleansing water enema.
PHARMACOLOGICAL AGENTS CAUSING
COMPLICATIONS:
❖ Buscopan: dry mouth and in 10% of patient there is
blurring of near vision, which lasts for about 20
mints
❖ Sensitively to barium suspension is very rate.
❖ Anaphylactic reaction to latex balloon catheter
have been reported.

46. 4.T TUBE CHOLANGIOGRAPHY PROCEDURE. ( by
mano)
A T-tube cholangiogram is examination radiological study under the
fluoroscopic procedure in which contrast medium is injected through
a T-tube into the patient's biliary tree. The T-tube is most commonly
inserted during a cholecystectomy operation when there is a
possibility of residual gall stones within the biliary tree.
INDICATIONS:
➢ Stones smaller than 9 mm
➢ Filling effect of cholangiography
➢ Fewer than 9 stones
CONTRAINDICATIONS:
➢ Stone lager then 1 cm
➢ Stones proximal to the cystic duct entrance into the
CBD.
➢ Small friable cystic duct, <3 mm in diameter
➢ tortuous cystic duct
➢ 10 or more stones
➢ Iodine sensitivity
➢ Non consent by patient to procedure
CONTRAST MEDIA;

47. Contrast - ionic contrast ,20-30 ml
PREPARATION:
1. patient identification (3 Cs- correct patient, correct side, correct
procedure).
• Patient should be wearing a hospital gown.
• consent form.
• no diet restrictions (some centres suggest fast from solids for 4
hours prior to procedure)
• collect relevant previous imaging for ease of access prior to
procedure.
• prophylactic dose of broad spectrum antibiotic prior to
procedur.
• Some operators prefer the T-tube to be clamped prior to the
procedure to allow the bile duct to fill with bile. Air in the bile
duct can give a false impression of a gallstone.
PROCEDURE:
• the patient is positioned supine on the X-ray table
• A slightly RPO position can help to ensure the CBD is not
superimposed over the patient's spine.
• a preliminary/scout image of the RUQ should be acquired.
• The tip of the T-tube is cleaned with antiseptic
• the T-tube should be raised and tapped to ensure there are no
air bubbles lurking in the tube.
• A butterfly needle should be inserted into the T-tube

48. • The syringe plunger is withdrawn to remove bile from within the
duct. (optional)
• An early filling image should be obtained.
• The entire biliary tree should be imaged during injection of
contrast medium.
• Injection should continue until the entire biliary tree is opacified
and there is passage of contrast into the deuodenum.
• If the intrahepatic ducts do not fill, the patient can be tilted
trendelenburg and further contrast injected into the T-tube.
• The patient may need to lie on their left hand side to fill the left
hepatic duct.
• At least 2 views of the entire biliary tree should be recorded by
spot film (DSI)
• oblique views are often taken
The T-tube is made of very flexible plastic. The flexibility of the plastic
facilitates the percutaneous remove of the T-tube without surgical
intervention. T-tubes are usually sized between 10 French (10F) and
16 French (16F).
TECHNIQUE;
• Contrast media should be diluted with saline so that small biliary
stones are not obscured by an overly dense contrast media
• Preliminary/scout images are important. Failure to take a
preliminary/scout image is one of the most frequently made
errors by Radiology Registrars performing fluoroscopy
procedures
• air-bubbles can often be distinguished from stones by their
behaviour- air bubbles tend to float 'up hill' and can change
shape and may separate into two smaller bubbles.

49. • If the examination is marred by air bubbles, the biliary system
can be flushed with saline and the study repeated.
• If there is any question of distal obstruction, a delayed drainage
image should be obtained
POST PROCEDURE CARE:
• patient can eat and drink normally
• warn patient to advise of any itching or rash post procedure
• patient should remain in hospital for observation for at least 24
hours post procedure
• If the T-tube is removed at the end of the procedure, the wound
should be checked for bile leakage for 24 hours
5.WHAT IS IMAGE INTERSIFIER OF ITS USAGE WITH
ADVANTAGES AND DISADVANTAGES. (by mano)
Fluoroscopy was performed by viewing the live ,produced by x-ray on
a thick intensifying screen.
The patient side of the vacuum bottle has the Al window
(1 mm) which is a curved one to withstand air pressure.
The evacuated glass envelope limits the size of the level
and diameter ranges from 23 to 57 cm .
The field size can be reduced electronically using
electrostatic focusing.

50. The glass envelope is mounted inside a metal container, which will
avoid damage and rough handling.
The image intensified is an evacuated glass envelope,
which contains four basic elements.
They are 1.input screen
2.focusing electrodes
3.anode
4.output screen
ADVANTAGES AND DISADVANTAGES:

51. 6.BRAIUM ENEMA ( by mano)
Barium enema examination is radiological study
under the fluoroscopy imaging. The large bowls by
administration barium through the rectum.
The major advantage of barium enema is its
ability to examine the entire colon.

52. INDICATIONS:
✓Colon cancer
✓Inflammatory bowl disease
✓Diverticular disease
✓Inconclusive colonoscopy
CONTRAINDICATIONS:
✓Toxic megacolon
✓Recent biopsy
✓Pregnancy
CONTRAST MEDIUM:
➢Contrast – barium
➢Single contrast barium enema – thin
barium suspension, 15-25% w/v and kilo
voltage of 100-110 used.
➢Double contrast barium enema – thick
barium suspension, 80-90% w/v and kilo
voltage of above 90 is used.
EQUIPMENT:
1. rectal tube (e.g. Miller) for
administration of contrast
tape is often useful to tape the tube to

53. the patient and prevent it from backing out
2. enema bag and IV pole
PATIENT PREPARATION:
For 3 day prior to examination
1. Low residual diet
On the day prior to examination
1.fluid only
2. Patient not dehydrate
3. Magnesium citrate solution or
bisacod tablets for 2 days.
TECHNIQUE:
The following technique is for a standard
single contrast exam. If the exam is for postoperative
leak or for evaluation of a known lesion, it can be
modified.
• scout views
o AP abdomen
o AP pelvis
o left lateral pelvis

54. Then bring the enema bag on the IV pole up and let
the contrast flow in under gravity.
• left lateral view of rectum
• left lateral view of the rectosigmoid junction
• LPO of mid sigmoid
• RPO of rectosigmoid junction
• (optional R lateral rectum)
• RPO of descending colon and splenic flexure
• barium flows through the transverse colon and into
the ascending colon, LPO of hepatic flexure
• AP views of transverse colon
• the contrast should continue to flow until it reaches
the cecum and the ileocecal valve (and possibly the
appendix) can be seen
o AP and/or oblique views of the ascending colon,
cecum, and possibly the terminal ileum
During the exam, palpation should be performed to
press out the contrast at the head of the contrast
column. This allows for some evaluation of the
mucosa. This is harder to do when the colon is
completely full of contrast. It may be impossible to
compress the colonic flexures underneath the ribs.

55. The sequence above is a suggestion. When
performing the exam, the key points are to
1. ensure you image the entire colon
2. ensure you adequately evaluate any suspicious areas Don't
slavishly follow a protocol sequence. If you need to break out of an
imaging sequence to accomplish either of these goals...then do it!
At the end of the exam, empty the contrast out of the
colon and then obtain
• post evacuation radiograph consider post evacuation compression
and spot radiographs of suspicious areas
1.SIALOGRAPHY (by melhin)
Sialography is the x ray fluoroscopic study of salivary glands. It usually
involves the injection of a small amount of contrast medium into the
salivary duct of a single gland. A small flexible tube called a catheter is
introduced in to the opening of the duct. Then the contrast medium is
injected into the duct.
Contrast agents are classified into two groups : fat soluble and
water soluble contrast agents.

56. • Water soluble contrast agents can fill the finer
elements of the ductal system.
• Fat soluble contrast agents are viscous and can cause
allergic reactions. These can also cause discomfort to
the patient .fat soluble contrast agents do not fill finer
elements of the duct.
Images are taken in lateral oblique view of the face.
2.DOUBLE CONTRAST ENTEROCLYSIS (by melhin)
INTRODUCTION:
Enteroclysis is an fluorouscopic imaging of the small intestine. The
test looks how a liquid called contrast material moves through the
small intestine.
CONTRAST MEDIUM:
• Single contrast electroclysis—20% w/v suspension of barium
sulphate is used.
• Double contrast electrolysis — 200 – 250% w/v suspension of
barium sulphate is used.
EQUIPMENT REQUIRE:
Bilbao dotter tube

57. • 22 F polyethylene tube
• 150 cm long
• Multiple side (8) holes at the tip with or without end
hole.
INDICATIONS:
• Partial small bowel obstruction Crohns disease
• Suspected meckels diverticulum
• Malabsorption
• Tumors of small intestine
• Equivocal BMFT but strong clinical suspension
CONTRA INDICATIONS:
• Suspected perforation
• Complete colonic obstruction
• Massive dilatation of small bowel
• Paralytic ileus
TECHNIQUE:
• Patient neck is hyperextended. Bilbao dotter tube
without guide wire is introduced is inserted through one
of the nostrils and advanced with swallowing action till
it reaches the stomach. Guide wire may be used stiffen
the tube. Then, with the guide wire the tube is reached
to the duodenal cap.
• Finally the tube tip should be approximately 4-5 cm
distal to trietz ligament.
DOUBLE CONTRAST ENTEROCLYSIS:
• A volume of 300 -600 ml of contrast is suggested.

58. Room air or CO2 is introduced via a pump when the barium reaches
the distal small bowel .This can be quite uncomfortable for the
patient and should be done carefully and likely with sedation. Then
abdomen AP views are taken.
3.Methods of minimizing radiation exposure during
fluoroscopy. ( by melhin)
Basics of fluoroscopy :
• Fluoroscopy involves the use of X-ray imaging in real
time for diagnostic and therapeutic purposes .
• Radiation dose that is delivered to the patient is
dependent on the fluoroscopic procedure time, mA,
kVp, collimation, magnification and additional factors.
• Fluoroscopy is performed at lower X-ray tube
current(~3mA) for continuous operation.
Ways to reduce radiation does:
• Reducing fluoroscopy time
--- last image hold (LIH)
--- fluoroscopy store
• Dose reduction during fluoroscopy
--- minimize image magnification
---collimation
--- removal of grid

59. --- using continuous vs pulse fluoroscopy
--- use automatic brightness control system (ABC).
--- adjusting the X-ray tube current and voltage
(kVp and mA).
Protective equipments:
• Wear lead apron of at least 0.5mm lead (pb) or lead
equivalent thickness to provide 90% exposure dose
reduction to the operator and staff.
Use thyroid collars and lead lined glasses.
3. EVACUATION PROCTOGRAPHY ( by melhin)
INTRODUCTION:
Evacuation proctography (defecography) is a fluorouscopic
study to evaluate pelvic floor disorders.
CONTRAST:
Barium is used as a contrast. Contrast is inserted into the
rectum.
INDICATION:
• Incomplete or obstructed defecation /constipation.
• Pelvic floor disorder
• Rectal prolapse
• Fecal incontinence

60. CONTRA INDICATIONS:
• Post operative rectum(e.g:coloanal anastomosis)
• Caution should be exercised before loading and
stressing an anastomosed rectum.
PATIENT PREPARATION:
Bowel preparation is must. Patient should not eat anything
during 2 hours prior to the procedure.
Vagina
• Amount of contrast varies between institutions ,but 5 ml is
used at some. (Urographin)
Water soluble contrast.
• Not performed if the patient has never been sexually active.
TECHNIQUE:
• Patient is first in lateral decubitus position .
Barium thick paste is introduced into the rectum with a
large bore soft catheter and the 60ml syringe.
• Barium may be mixed with breadcrumbs or cornflour to
form a solution with stool like consistency( neostool)
• Patient is positioned on the defecography chair and a
right lateral view of the seated patient is readied.
1. Spot image of the patient at rest.
2. Optional cine and spot images of the patient
straining as if they were defecate ,but actually
defecating.

61. Then final the patient should “go like they would go at home “ and
spot and cine images are taken while the patient evacuates their
rectum
5.RETROGRADE PYELOGRAM (by melhin)
Retrograde pyelogram is a urologic procedure where the physician
injects a radiocontrast agent into the ureter in order to visualize the
ureter and kidney with fluoroscopy. The flow of contrast is opposite
the usual out bond flow of urine ,hence the retrograde (“moving
backwards “)name.
Contrast media:
Ionic contrast media can be used. The strength of contrast
media should be 150-200mg/ml. Contrast media should not be too
dense.
Indications:
having an obstruction ,such as a tumor, stone, blood clot, stricture in
the kidney or ureter.
Contra indication :
• Acute urinary tract infection
• Hypersensitivity to iodinated contrast medium
• Hepato renal syndrome
• Pregnancy
Procedure :

62. • Bowel preparation is must. The procedure is done
under anesthesia.
The urologist inserts a long, thin telescope with a light at the end
(Cystoscopy) through the urethra. Then place a catheter up into the
ureter .A contrast is injected into the ureter through the catheter. X-
rays are taken of the ureters and kidneys. The test can take 15 -30
minutes.
Images are taken in supine AP view.
6.Write about indications and techniques of CT
MYELOGRAM. ( by melhin)
Myelography is a type of X-ray / CT examination that uses a contrast
medium to detect pathology of the spinal cord ,including the location
of a spinal cord injury ,cysts and tumors.
INDICATIONS:
• Spinal cord tumors
• Cysts
• Spinal nerve root injury
• Compression of the spinal cord by a herniated disc.
PREPARATIONS FOR CT:
• Fasting for 4-6 hours.

63. • Contrast material Urographin, telebrix 1-2 mg/kg.
CT myelogram :
• Usual scanning
• Axial slides 2-4 mm.
2mm in cervical spine /4 mm in lumbar spine.
• CT myelography is considered as intrathecal contrast
injection with L puncture needle.
• We have 2 windows,
Soft tissue and bone window.
1. disc lesions are detected in soft tissue window .
2. The normal posterior border of the disc is concave. The
abnormal is straight or convex.
PROCEDURE:
• Patient lies prone on the CT couch.
• The radiologist will numb the skin by injecting a local
anesthetic drug using a thin needle.
• A needle will be inserted through the numbed skin and into
the space where the spinal fluid is located. Patient feel some
pressure while the needle goes in.
• The radiologist will remove some of the spinal fluid from the
spinal canal. A small amount of contrast will be injected into
the spinal canal through the needle. Patient feel a warming
sensation ,when the contrast is injected.
• The needle is then removed and the CT scan pictures are
taken.

64. 7. BARIUM MEAL FOLLOW THROUGH PROCEDURE,
techniques to image ileocaecal junction . ( bymelhin)
Barium follow through is designed to demonstrate the
small bowel from the duodenum to the ileocaecal region
encompassing the duodenum, jejunum and ileum including the
junctions superiorly with the stomach and inferiorly with the
ascending colon.
Also known as barium meal follow through (BMFT) &
small bowel follow through (SBFT).
CONTRAST MEDIUM:
• 300 ml of 100% w/v barium suspension.
METHODS:
• Single contrast
• With addition of effervescent agent
INDICATIONS:
• Diarrhea
• Pain
• Gastrointestinal bleeding
• Malabsorption
• Abdominal mass
CONTRA INDICATIONS:
• Complete obstruction

65. • Suspected perforation
PATIENT PREPARATION:
• NPO over night
• A prokinetic agent metoclopramide (20mg) is given orally,
at least 30 minutes before the study starts.
PROCEDURE:
• However, instead of drinking the barium liquid ,a thin tube
is passed down the gullet, through the stomach and into
the first part of the small intestine. Barium liquid is then
poured down the tube.
Compression is mandatory
1. to separate the bowel loops
2. Assess mobility
3. Define mucosal pattern
Done by prone inflatable paddle .
8. Endoscopic Retrograde CholangioPancreatography
(ERCP)(by melhin)
ERCP is a procedure to examine the pancreatic and bile duct. It
combines the use of endoscopy and fluoroscopy to diagnose and treat
certain problems of
• the duodenum
• the bile ducts
• the gall bladder and the pancreatic duct

66. Water soluble iodine based contrast is used. The upper GI tract must
be empty. Generally, no eating or drinking is allowed 8 hours before
ERCP.
A flexible, lighted tube (endoscope) about the thickness of our index
finger is placed through the mouth and into the stomach and first part
of the small intestine (duodenum). The region can be directly
visualized with the endoscopic camera.
1.BARIUM SWALLOW: ( by bharath)
A barium swallow is a special type of X-ray test that helps your doctor
take a close look at the back of your mouth and throat, known as the
pharynx, and the tube that extends from the back of the tongue down
to the stomach, known as the esophagus.Your doctor may ask you to
do a barium swallow to help diagnose any conditions that make it
difficult for you to swallow or if they suspect that you have a disorder
of the upper gastrointestinal (GI) tract. Your upper GI tract includes:
* the esophagus
* the stomach
* the first part of the small intestine, called the duodenum.
INDICATIONS FOR BARIUM SWALLOW:
* Hiatal hernia

67. * inflammation
* blockages in the esophagus
* gastroesophagal reflex disease
* ulcers.
CONTRAINDICATIONS FOR BARIUM ENEMA:
* an esophageal or bowel perforation.
* bowel obstruction.
* difficulty swallowing.
* severe constipation.
2.SINGLE CONTRAST BARIUM ENEMA ( by bharath)
Single contrast barium enema is a method of imaging the colon with a
fluoroscopy and is similar to double contrast barium enema. Single

68. contrast refers to imaging with barium or water soluble contrast only,
without addition of air or co2.
INDICATION FOR SINGLE CONTRAST BARIUM ENEMA:
* The single contrast preferred over the double contrast technique
when
† when the patient is unable to turn quickly or effectively, in
double contrast technique patient has to rapidly change the position.
* when only the position and length of stricture is required
* evaluating for colonic fistula.
* evaluation for post operative leak after colon surgery.
CONTRADICTION FOR SINGLE CONTRAST BARIUM
ENEMA:
* patient having the acute attack of diverticulitis becuz of increased
risk of perforation
* severe ulcerative colitis
* pregnancy
* toxic megacolon
* acute abdominal pain.
SINGLE CONTRAST BARIUM ENEMA

69. 3. ADVANTAGES OF ENTEROCLYSIS: ( by bharath)
*Enteroclysyis is a quick procedure
* Tube may be left in place in patient with obstruction
for decompression
* better delineation of smal bowel than BMFT
* sinuses and fistulas are better demonstrated in enteroclysyis
* contrast administration is not influenced by the
pyloric sphincter.

70. DISADVANTAGES OF ENTEROCLYSYIS:
* Discomfort by placement of tube
* rapid clonic emptying is caused
* failure to depict extra intestinal changes
* nausea and vomiting due to inadequate tube placement
during the procedure.
4.PATIENT PREPARATION FOR BARIUM MEAL: ( by
bharath)
you will be advised to have no food or drink for several hours before
the test. Often this means no food or drink from midnight on the day
before a morning test. (Fasting instructions may vary slightly among
X-ray centres, so remember to follow exactly the particular
instructions that you are given.) If you have diabetes, contact the
centre performing the test, or your doctor, about how to prepare for
the test.You may be asked not to smoke for several hours before the
test, as smoking causes extra secretions to flow into your digestive
tract.Your doctor will usually advise you not to take your regular oral
medicines on the day of the test, until after the test is finished.
However, check with your doctor whether this applies to all your
regular medicines. It is especially important not to take antacids
before the test.

71. 5.LUMBAR MYELOGRAPHY: (by bharath)
A myelogram is a diagnostic imaging test generally done by a
radiologist. It uses a contrast dye and X-rays or computed tomography
(CT) to look for problems in the spinal canal. Problems can develop in
the spinal cord, nerve roots, and other tissues. This test is also called
myelography.
INDICATION:
* Herniated discs (discs that bulge and press on nerves and/or the
spinal cord).
* Spinal cord or brain tumors.
* Infection and/or inflammation of tissues around the spinal cord and
brain.
* Spinal stenosis (degeneration and swelling of the bones and tissues
around the spinal cord that make the canal narrow).
* Ankylosing spondylitis (a disease that affects the spine, causing the
bones to grow together).
* Bone spurs.
* Arthritic discs.
CONTRAINDICATIONS:
* A history of seizures
* Allergic to any local anesthetics (lidocaine) or IV contrast
* There is any chance that you could be pregnant

72. * You are on anticoagulant therapy (blood thinners)
PROCEDURE:
* You will be reminded to empty your bladder prior to the start of the
procedure.
* During the procedure, you will lie on your stomach on a padded
table.
* Your back will be cleaned with an antiseptic solution and draped
with sterile towels.
* The radiologist will numb the skin by injecting a local anesthetic
(numbing) drug using a thin needle. This injection may sting for a few
seconds, but it makes the procedure less painful.
* A needle will be inserted through the numbed skin and into the
space where the spinal fluid is located. You will feel some pressure
while the needle goes in, but you must remain still.
* The radiologist will remove some of the spinal fluid from the spinal
canal. Next, a small amount of contrast dye will be injected into the
spinal canal through the needle. You may feel a warming sensation
when the contrast dye is injected.
* The X-ray table will be tilted in various directions to allow gravity to
help move the contrast dye to different areas of your spinal cord. You
will be held in place by a special brace or harness. More contrast dye
may be given during this process through the secured lumbar
puncture needle.
* The needle is then removed and the X-rays and/or CT scan pictures
are taken
COMPLICATIONS:

73. * Numbness and tingling of the legs
* Blood or other drainage from the injection site
* Pain at or near the injection site
* Nausea or vomiting
* Inability to urinate
1.ERCP (by,SIMON.I)
ERCP is a procedure that examine the pancreatic and bile ducts. A
bendable, lighted tube (endoscope) about the thickness of your index
finger is placed through your mouth and into your stomach and first
part of the small intestine (duodenum).
• Sphincterotomy. This involves making a small incision (cut) in
the opening of the pancreatic duct or the bile duct, which can
help smallgallstones, bile, and pancreatic juice to drain
appropriately.
• Stentplacement. A stent is a drainage tube that is placed in the
bile duct or the pancreatic duct to hold the duct open and allow
it to drain.
• Gallstone(s) removal. ERCP can remove gallstones from the bile
duct, but not from the gallbladder itself.
Indications:

74. • Obstructivejaundice
• bileducttumors
• SphincterofOddidysfunction
• Choleolithiasis
• Pancreatitis or cholangitis.
Contraindications:
• Hypersensitivity to iodinated contrast medium
• History of iodinated contrast dyeanaphylaxis(although iodine-
free contrast is now available)
• Acute pancreatitis (unless persistently elevated or rising bilirubin
suggests ongoing obstruction)
• (Irreversible) coagulation disorder if sphincterotomy planned
• Recentmyocardialinfarctionor pulmonary embolism
• Severecardiopulmonarydisease or other serious morbidity
2.Indications and contraindications for AUG ( by simon)
In Ascending Urethrography, a radiological procedure that done by
infusing contrast medium into your bladder through a special catheter
that will be placed to the outer urethral orifice During this phase, X-
rays will be taken at regular time intervals.
Indications
• pelvic trauma in the emergency department (retrograde only)
• diminished urinary stream
• urethral strictures
• urethral diverticula

75. • urethral obstruction
• suspected urethral foreign bodies
• urethral mucosal tumors
• suspected urethral fistula
Contraindications:
• UTI(Acute)
• Recent instrumentation
• Urithritis
3.VENOGRAPHY ( by Simon)
Venography is an x-ray examination that uses an injection of contrast
material to show how blood flows through your veins. to find blood
clots, identify a vein for use in a bypass procedure or dialysis access,
or to assess varicose veins before surgery.
• Infecting the contrast low/isoosomalar contrast media 240
mgI/ml constantly through tha catheter.
• Volume about 50 - 150ml.
Venography can be divided into following types
Pheripheral venography:
• Lower limb venography
• Upper limb venography
• Pheripheral venography
Central venography:

76. • Inferior vena cavography
• Superior vena cavography
Selective visceral venography:
• Renal venography
• Hepatic venography
• Portal venography
Indications:
• Oedema
• To demonstrate the site of venous obstruction
• Svs obstruction
• Congenital abnormality of the venous system
• To detect caval and renal abnormalities
• Thrombus or stenosis or occlusion of superior vena cava
• Preliminary examination in trans venal interventional
techniques
Contra indications:
• Contrast media allergy
• Impaired renal functions
• Blood clotting disorders
• Anticoagulants medication
• Unstable cardiopulmonary or neurologic status
• Non – consent by patient to procedure.

77. 4.Contrast enema in neonates ( by Simon)
contrast enema is used to help find the cause of your child's
symptoms and diagnose diseases and other problems that affect the
large intestine.
child will be taken to the procedure room, where the fluoroscope is
used to take x-rays. child will be awake at all times during the contrast
enema study.
Indications:
• Change in bowel habits
• Chronic diarrhoea
• Detecting problems with the structure of the large intestine
• Irritable bowel syndrome
• Rectal bleeding
• Severe constipation
• Unexplained weight loss
Patient preparations:
• no preparation is necessary.
• child may eat or drink before the study.
• Some contrast enemas require that the child not eat or drink for
a period of time prior to the study
• Child will given his or her medications as usual.

78. Technique:
In this contrast enema study, a small tube is inserted into
child's rectum and the colon child's large intestine are filled with
contrast material.
Once the contrast fills the colon and large intestine,x Ray’s or
fluoroscopic images are taken.
5.PTC ( by Simon)
Percutaneous transhepatic cholangiography (PTHCor PTC)
or percutaneous hepatic cholangiogram is a radiological technique
used to visualize the anatomyof the biliary tract. A contrast medium is
injected into a bile duct in the liver, after which X-rays are taken. It
allows access to the biliary tree in cases where endoscopic retrograde
cholangiopancreatography
Contrast:iodinated water soluble contrast.
Indications:
Cholestatic jaundice, to exclude extra hepatic bile duct obstruction,
prior to biliary drainage procedure.
If ERCP is failed and/or there is an obstruction in the proximal billiary
tree
Contraindications
• Bleeding tendency
• Biliary tract sepsis

79. • Being unfit for surgery
• Hydatid cysts
• Ascites
• CLD (Chronic liver disease
6.TYPES OF CONTRAST REACTION ( by simon)
Barium Sulfate Contrast Materials
You should tell your doctor if these mild side effects of barium-sulfate
contrast materials become severe or do not go away:
• stomach cramps
• diarrhoea
• nausea
• vomiting
• constipation
Tell your doctor immediately about any of these symptoms:

80. • hives
• itching
• red skin
• swelling of the throat
• difficulty breathing or swallowing
• hoarseness
• agitation
• confusion
• fast heartbeat
• bluish skin color
You are at greater risk of an adverse reaction to barium-sulfate
contrast materials if:
• you have a history of asthma, hay fever, or other allergies, which
will increase your risk of an allergic reaction to the additives in
the barium-sulfate agent.
• you have cystic fibrosis, which will increase the risk of blockage in
the small bowel.
Iodine-based Contrast Materials
Mild reactions include:
• nausea and vomiting
• headache
• itching
• flushing
• mild skin rash or hives
Moderate reactions include:

81. • severe skin rash or hives
• wheezing
• abnormal heart rhythms
• high or low blood pressure
• shortness of breath or difficulty breathing
Severe reactions include:
• difficulty breathing
• cardiac arrest
• swelling of the throat or other parts of the body
• convulsions
• profound low blood pressure
A very small percentage of patients may develop a delayed reaction
with a rash which can occur hours to days after an imaging exam with
an iodine-based contrast material. Most are mild, but severe rashes
may require medication after discussion with your physician.
7.ULTRASOUND CONTRAST AGENTS ( by
Simon)
• It also called as echo enhancing agents
• These agents increase the echogenity of of blood which
heightens the tissue contrast & allow better delineation of body
cavities
• Consist of microscopic gas filled bubbles.
• Their extremely high reflectivity (backscatter) arises from the
fact that microbubble easily change their size contracting in

82. compression part of the ultrasonic cycle & expanding in the
refraction part.
• They resonate in the ultrasound beam when there is mismatch
between their diameter and ultrasonic wavelength which occurs
for microtubules in 2 – 7 um at ultrasound frequency of 2 – 10-
MHz.
Ideal ultrasound contrast agent:
• Be injectable by pheripheral vein
• Be non toxic
• Small enough to pass through pulmonary , cardiac & capillary
systems

83. • Half life should be sufficient to allow complete examination
• Should require little preparation
THE END
Thank you