PTC.pptx

Percutaneous Transhepatic Cholangiography (PTC) is a radiographic procedure used to visualize and assess the biliary system, including the bile ducts within the liver and those leading to the small intestine.

1. Percutaneous Transhepatic Cholangiography 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 Introduction to Percutaneous Transhepatic Cholangiography (PTC) Indications and Contraindications Procedure Overview Imaging Technique Interpretation of Results Advantages and Disadvantages Complications and Safety Measures Case Studies Conclusion Questions and Discussion 16/09/2023 PTC By- Dr. Dheeraj Kumar 2

3. Introduction to Percutaneous Transhepatic Cholangiography (PTC) Definition: Percutaneous Transhepatic Cholangiography (PTC) is a radiographic procedure used to visualize and assess the biliary system, including the bile ducts within the liver and those leading to the small intestine. 16/09/2023 PTC By- Dr. Dheeraj Kumar 3

4. Anatomy 16/09/2023 PTC By- Dr. Dheeraj Kumar 4

5. Purpose PTC serves several essential purposes in radiography and healthcare: Diagnosis and assessment of biliary system disorders. Evaluation of bile duct blockages, strictures, or leaks. Preoperative planning for biliary surgery. 16/09/2023 PTC By- Dr. Dheeraj Kumar 5

6. History History of PTC reflects the ongoing commitment of radiologists and medical researchers to refine and expand the capabilities of diagnostic radiology. From early experiments with contrast agents to the development of sophisticated percutaneous techniques, PTC has made a lasting impact on the field of medical imaging and the diagnosis and treatment of biliary system disorders. In recent years, the field of interventional radiology has continued to evolve with the development of less invasive alternatives like magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). 16/09/2023 PTC By- Dr. Dheeraj Kumar 6

7. Pioneer Radiologists and Key Milestones Dr. Felix Berci : A pioneer in interventional radiology, Dr. Felix Berci played a pivotal role in advancing PTC techniques in the 1960s and 1970s. He introduced safer contrast agents and refined percutaneous puncture methods. Dr. Jean-François Gigot: Dr. Gigot further advanced the field by contributing to the understanding of PTC's diagnostic capabilities and its role in guiding biliary surgery. 16/09/2023 PTC By- Dr. Dheeraj Kumar 7

8. Indications Suspected Biliary Obstruction: PTC is frequently performed when a patient presents with symptoms such as jaundice, abdominal pain, or abnormal liver function tests that may suggest biliary obstruction. Evaluation of Biliary Anatomy: It is utilized to obtain detailed information about the biliary system's anatomy and any associated abnormalities. Preoperative Planning: Surgeons may request PTC images to plan surgical interventions involving the biliary tract. 16/09/2023 PTC By- Dr. Dheeraj Kumar 8

9. Contraindications Allergy to Contrast Media: Individuals with known allergies to iodinated contrast agents used in PTC should not undergo the procedure. Uncontrolled Bleeding Disorders: Patients with severe bleeding disorders may not be suitable candidates for PTC due to the risk of hemorrhage . Severe Coagulopathy: Patients with coagulation disorders or anticoagulant therapy may require careful consideration and potential adjustment of their medications. 16/09/2023 PTC By- Dr. Dheeraj Kumar 9

10. Procedure Overview Patient Preparation: Consent and Explanation: Informed consent is obtained from the patient, and a detailed explanation of the procedure is provided. Fasting Requirements: Patients are typically instructed to fast for several hours before the procedure to reduce the risk of aspiration and ensure optimal imaging conditions. 16/09/2023 PTC By- Dr. Dheeraj Kumar 10

11. Localization and Skin Marking Identifying the Puncture Site: Imaging guidance, such as ultrasound or fluoroscopy, is used to identify the optimal puncture site on the patient's abdomen. Skin Marking: The chosen puncture site is marked on the patient's skin for precise needle placement. 16/09/2023 PTC By- Dr. Dheeraj Kumar 11

12. Needle Puncture Accessing the Biliary System: A thin, hollow needle is inserted through the marked site, through the liver tissue, and into the biliary system under sterile conditions and imaging guidance. 16/09/2023 PTC By- Dr. Dheeraj Kumar 12

13. Contrast Media Injection Visualization of the Biliary System: A radiopaque contrast material is injected through the needle into the biliary system. Opacification of Ducts: The contrast material opacifies the bile ducts, allowing them to be visualized on X-ray images. 16/09/2023 PTC By- Dr. Dheeraj Kumar 13

14. Imaging and Documentation X-ray or Fluoroscopy: Real-time X-ray images or fluoroscopic images are captured to visualize the contrast's flow within the bile ducts. Static Images: Static images may be taken to document specific findings or abnormalities. 16/09/2023 PTC By- Dr. Dheeraj Kumar 14

15. Catheter Placement Extended Contrast Injection or Drainage: In some cases, a catheter may be left in place to facilitate extended contrast injection, drainage of bile, or therapeutic interventions. 16/09/2023 PTC By- Dr. Dheeraj Kumar 15

16. Imaging Technique Radiographic Equipment: Fluoroscopy or X-ray Machine: PTC is typically performed using fluoroscopy or X-ray equipment to capture real-time and static images. Image Intensifier: Fluoroscopy often employs an image intensifier to enhance image quality and reduce radiation exposure. 16/09/2023 PTC By- Dr. Dheeraj Kumar 16

17. Contrast Media Characteristics Radiopaque Properties: The contrast media used in PTC has radiopaque properties, making it visible on X-ray images. Opacification of Bile Ducts: It selectively opacifies the bile ducts, enhancing their visibility. 16/09/2023 PTC By- Dr. Dheeraj Kumar 17

18. Timing and Image Sequence Real-time Imaging: Real-time fluoroscopy allows continuous monitoring of the contrast flow during injection. Static Images: Static X-ray images are taken at specific points to document findings and provide detailed anatomical information. 16/09/2023 PTC By- Dr. Dheeraj Kumar 18

19. Interpretation of Results Normal vs. Abnormal Findings: Normal Bile Duct Anatomy: In a normal PTC, the radiologist observes well-defined bile ducts with a characteristic branching pattern. Identification of Abnormalities: PTC is invaluable for identifying various abnormalities, including: Bile Duct Blockages: The procedure can pinpoint the location and extent of blockages caused by factors like gallstones or tumors. Biliary Strictures: Narrowing or strictures in the bile ducts can be precisely identified. Biliary Leaks: PTC can detect leaks in the biliary system, often as a result of injury or surgery. 16/09/2023 PTC By- Dr. Dheeraj Kumar 19

20. Radiologist's Role Image Analysis: Radiologists play a central role in interpreting PTC results. They analyze the images, identify abnormalities, and provide detailed reports. Collaboration with Healthcare Team: Radiologists collaborate closely with surgeons, gastroenterologists, and other healthcare professionals to determine the best course of treatment based on the PTC findings. 16/09/2023 PTC By- Dr. Dheeraj Kumar 20

21. Advantages Direct Visualization: PTC provides direct visualization of the biliary system, offering precise anatomical information. Diagnostic Precision: It is highly effective in diagnosing a wide range of biliary conditions, guiding treatment decisions. Minimally Invasive: PTC is less invasive than surgical exploration and can often replace more invasive procedures. 16/09/2023 PTC By- Dr. Dheeraj Kumar 21

22. Disadvantages Invasive Nature: PTC is an invasive procedure, involving percutaneous access to the liver, which carries inherent risks. Risk of Complications: There is a risk of complications such as bleeding, infection, or bile leakage, although these are relatively uncommon. Limited Therapeutic Role: While PTC is primarily diagnostic, it may also guide some therapeutic interventions. However, it may not be suitable for all cases or therapeutic purposes. 16/09/2023 PTC By- Dr. Dheeraj Kumar 22

23. Potential Complications Bleeding: PTC may lead to bleeding at the puncture site or within the liver. Infection: Infection is a possible complication, although strict sterile techniques are employed to minimize this risk. Perforation: Rarely, there may be unintended perforation of structures within the liver or bile ducts. 16/09/2023 PTC By- Dr. Dheeraj Kumar 23

24. Safety Measures Sterile Technique: PTC is performed under strict sterile conditions to reduce the risk of infection. Monitoring: Patients are closely monitored during and after the procedure to detect and manage complications promptly. Preventive Measures: Care is taken to minimize bleeding risks, including assessment of coagulation status, and correction of coagulopathies when necessary. 16/09/2023 PTC By- Dr. Dheeraj Kumar 24

25. Case Studies Case 1: Biliary Obstruction: Detail a case where PTC identified a biliary obstruction, leading to a diagnosis and treatment plan. 16/09/2023 PTC By- Dr. Dheeraj Kumar 25

26. Case 2: Biliary Stricture Present a scenario involving a biliary stricture, demonstrating how PTC can precisely locate and characterize the stricture. 16/09/2023 PTC By- Dr. Dheeraj Kumar 26

27. Case 3: Complications and Management Discuss a case where complications arose during PTC and describe the appropriate management and intervention. 16/09/2023 PTC By- Dr. Dheeraj Kumar 27

28. Conclusion The diagnostic significance of PTC in evaluating biliary system disorders. Indications and contraindications for the procedure. The procedure overview, including patient preparation, needle puncture, contrast media injection, and imaging techniques. The role of radiologists in interpreting PTC results. Advantages, disadvantages, and safety considerations. Potential complications and safety measures. Real-world case studies showcasing the diagnostic and therapeutic utility of PTC. 16/09/2023 PTC By- Dr. Dheeraj Kumar 28

29. Questions and Discussion Open the Floor for Questions? and Discussion @@ 16/09/2023 PTC By- Dr. Dheeraj Kumar 29

30. Thank You Express gratitude to the Students for their active participation, attention, and contributions during the presentation. 16/09/2023 PTC By- Dr. Dheeraj Kumar 30

31. References "Radiologic Science for Technologists: Physics, Biology, and Protection" Authors : Stewart C. Bushong, Publication Year: 2019, Publisher: Elsevier "Interventional Radiology Procedures in Biopsy and Drainage“, Authors: Ronald S. Arellano, Aldo A. Maksoud, Publication Year: 2020, Publisher: Springer "Percutaneous Transhepatic Cholangiography: Techniques and Applications“, Authors : C. Christian, H. Weismann, S. Dengler , et al., Publication Year: 2021 "Complications of Percutaneous Transhepatic Cholangiography in the Management of Postsurgical Biliary Leaks and Strictures“, Authors: Arno NK Joseph, Peter Thuluvath , Publication Year: 2020 16/09/2023 PTC By- Dr. Dheeraj Kumar 31