Oral Cholecystography .pptx

Oral cholecystography (OCG) is a diagnostic radiographic examination used to visualize the gallbladder and the biliary system. It involves the use of contrast media to enhance the visualization of these structures.
Detecting and diagnosing gallbladder diseases.
Evaluating gallstone presence and location.
Assessing gallbladder function and motility.

1. Oral Cholecystography(OCG) Presenter: Dr. Dheeraj Kumar MRIT, Ph.D. (Radiology and Imaging) Assistant Professor Medical Radiology and Imaging Technology School of Health Sciences, CSJM University, Kanpur

2. Contents List Introduction to Oral Cholecystography Definition and Purpose Historical Context Indications and Contraindications Why and When OCG is Performed When to Avoid OCG Procedure Overview Patient Preparation Contrast Agent Administration Imaging Process Post-Procedural Care Radiographic Imaging Techniques Positioning Equipment Interpretation of Results Normal vs. Abnormal Findings The Role of Radiologist 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 2

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4. Introduction to Oral Cholecystography Definition: Oral cholecystography (OCG) is a diagnostic radiographic examination used to visualize the gallbladder and the biliary system. It involves the use of contrast media to enhance the visualization of these structures. Purpose: OCG serves several purposes, including: Detecting and diagnosing gallbladder diseases. Evaluating gallstone presence and location. Assessing gallbladder function and motility. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 4

5. Anatomy of Biliary system These ducts ultimately drain into the common hepatic duct. The common hepatic duct then joins with the cystic duct from the gallbladder to form the common bile duct. This runs from the liver to the duodenum (the first section of the small intestine). 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 5

6. Historical Context: The development of OCG in radiology has a rich history, dating back to the early 20th century when pioneers in medical imaging began experimenting with contrast agents and radiography techniques to visualize the gallbladder and biliary system. Key milestones include the refinement of contrast agents and imaging methods over the years, leading to the establishment of OCG as a valuable diagnostic tool in the field of radiology. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 6

7. Indications Suspected Gallbladder Disease: OCG is commonly used when a patient presents with symptoms like abdominal pain, jaundice, or digestive issues, which may be indicative of gallbladder problems. Evaluation of Gallstones: It's an effective method to detect and locate gallstones within the gallbladder. Assessing Gallbladder Function: OCG can evaluate the contraction and emptying of the gallbladder, helping diagnose motility disorders. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 7

8. Contraindications for OCG Allergy to Contrast Media: Individuals with known allergies to iodinated contrast agents should not undergo OCG. Pregnancy: Radiation exposure during OCG can harm the developing fetus, making it unsuitable for pregnant women. Acute Inflammation of the Gallbladder: OCG is avoided in cases of acute inflammation, as it may worsen the condition. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 8

9. Procedure Overview Preparation: Patient Fasting: Before the procedure, patients are typically instructed to fast for a specified duration to ensure that the gallbladder is empty. Explanation to the Patient: It's essential to inform the patient about the procedure, including the use of contrast media and potential sensations during the test. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 9

10. Administration of Contrast Agent An oral iodinated contrast agent is administered to the patient, often in the form of a contrast drink. The amount of contrast media used in Oral Cholecystography (OCG) can vary depending on the specific protocol and the patient's age, weight, and the radiologist's preferences. Typically, for adults, a standard dose of approximately 30 to 50 mL of oral iodinated contrast agent is administered. This contrast agent is often in the form of a contrast drink that the patient ingests prior to the imaging procedure. This contrast agent is absorbed by the digestive system and excreted by the liver into the gallbladder, allowing visualization during imaging. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 10

11. Imaging Process In Oral Cholecystography (OCG), after the administration of the contrast media, images are indeed taken to visualize the gallbladder and biliary system. The contrast media is ingested orally, and it travels through the digestive system, eventually reaching the gallbladder. Radiographic images are then captured at specific time intervals to track the movement and distribution of the contrast material. The timing of these images is critical, as it allows healthcare professionals to observe the filling of the gallbladder, its contraction, and the release of the contrast media into the biliary system. Typically, radiographs (X-rays) or fluoroscopy are used to obtain these images. Fluoroscopy provides real-time, continuous imaging, which is especially useful for monitoring the contrast material's flow and the gallbladder's function. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 11

12. Post-Procedural Care and Monitoring After OCG, patients may be monitored for any adverse reactions to the contrast media. Radiologists and medical staff should be prepared to address any immediate concerns or discomfort experienced by the patient. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 12

13. Radiographic Imaging Techniques: Standard Two-View Technique: OCG typically involves obtaining two sets of images: one in the supine and another in the upright position. This helps assess gallbladder function and mobility. Serial Images at Timed Intervals: Radiographic images are taken at specific time intervals after the ingestion of the contrast agent, allowing visualization of the contrast's movement through the biliary system. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 13

14. Positioning Supine and Upright Positions: Patients are positioned both supine (lying down) and upright during the procedure to observe changes in the location and shape of the gallbladder. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 14

15. Equipment Fluoroscopy or X-ray Machine: Radiographic imaging is typically performed using fluoroscopy or X-ray machines, which provide real-time visualization of the contrast flow and gallbladder movement. Radiopaque Markers: Radiopaque markers may be used to indicate anatomical landmarks and aid in precise positioning for imaging. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 15

16. Interpretation of Results Normal Findings: Visualization of Gallbladder: In a normal OCG, the gallbladder is visualized as a well-defined structure filled with contrast. Timely Emptying: The gallbladder should contract and empty efficiently, ensuring proper flow of the contrast material into the biliary system. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 16

17. Abnormal Findings Gallstones: The presence and location of gallstones can be detected through OCG, helping diagnose cholelithiasis . Non-filling of the Gallbladder: If the gallbladder fails to fill with contrast or exhibits delayed emptying, it may indicate gallbladder dysfunction. Abnormal Contraction Patterns: Irregular or spasmodic contractions of the gallbladder can suggest motility disorders. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 17

18. Advantages Non-Invasive: OCG is a non-invasive procedure, avoiding the need for surgical intervention. Gallstone Detection: It is effective in detecting and locating gallstones. Evaluation of Gallbladder Function: OCG assesses gallbladder contraction and emptying, aiding in motility disorder diagnosis. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 18

19. Disadvantages Radiation Exposure: Patients are exposed to ionizing radiation during OCG, which carries a minimal risk. Limited Diagnostic Value: OCG may have limited diagnostic value for certain conditions like acute inflammation, which can be better assessed through other imaging modalities. Contraindications and Side Effects: Contraindications, such as allergies to contrast media, and potential side effects should be considered. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 19

20. Case Studies Case 1: Normal OCG Presentation of a case with normal OCG findings. Describe the patient's symptoms, contrast flow, and gallbladder function. Explain the diagnosis and potential treatment options. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 20

21. Case 2:Gallstones Detected Gallstones Detected Present a case where gallstones are detected in the OCG. Discuss the significance of gallstone location and size. Describe the diagnostic implications and possible interventions. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 21

22. Case 3:Non-Filling of Gallbladder Non-Filling of Gallbladder Illustrate a case where the gallbladder does not fill with contrast or exhibits delayed emptying. Discuss the potential causes of non-filling and its clinical relevance. Highlight the importance of motility assessment. 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 22

23. References "Radiology 101: The Basics and Fundamentals of Imaging" Authors : Wilbur L. Smith, Charles S. Odwin Publication Year: 2013 Publisher: Lippincott Williams & Wilkins "Radiologic Science for Technologists: Physics, Biology, and Protection" Authors : Stewart C. Bushong Publication Year: 2019 Publisher: Elsevier "Oral Cholecystography: An Overview of Technique and Clinical Applications" Authors : A. Y. Patel, J. T. Lamb, M. K. Greenawald Publication Year: 2020 Journal: Radiologic Technology "Oral Cholecystography: Historical Perspective and Current Clinical Applications" Authors : H. K. Bhatia, A. K. Anand, A. Bhatia Publication Year: 2017 Journal: The Indian Journal of Radiology & Imaging 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 23

24. THANK YOU 13/09/2023 Oral Cholecystography By- Dr. Dheeraj Kumar 24