radiological procedures presentation.pptx

Radiological procedures

1. Indications and contraindications with preparation of patients in radiological procedures DR . Prithviraj Jadhav Prof . Department of Radio-diagnosis, DY Patil medical college, hospital & research institute Kolhapur

2. Barium swallow Barium swallow is a dedicated test of the pharynx, oesophagus and GE Junction.

3. indications Dysphagia and obstruction. Pain during swallowing. Assessment of mediastinal masses. Assessment of left atrial enlargement. Pre-op assessment of carcinoma bronchus and oesophagus. Motility disorders of oesophagus, E.g.: Achalasia and diffuse oesophageal spasm, scleroderma. Assessment of site of perforation. Zenker's diverticulum and cricoid webs.

4. RELATIVE CONTRAINDICATIONS Tracheo -oesophageal fistula. Perforation. Complications Leakage of barium from an unsuspected perforation-granuloma formation. Aspiration .

5. Patient preparation Nil orally for 6 h prior to the examination. The patient is advised not to smoke on the day of the examination, as it increases gastric motility. It should be ensured that there are no contraindications to the Preliminary film Technique or pharmacological agents used.

6. Barium meal Barium meal is the radiological study of stomach and duodenum. It is done by oral administration of contrast media (Barium sulphate).

7. indications Dyspepsia Weight loss Upper abdominal mass Gastrointestinal haemorrhage (or unexplained iron-deficiency anaemia) Partial obstruction Assessment of site of perforation - it is essential that a water- soluble contrast medium, e.g. Gastrografin or LOCM, is used .

8. contraindications Complete large bowel obstruction. Patient preparation Nil orally for 6 h prior to the examination. The patient is advised not to smoke on the day of the examination, as it increases gastric motility. It should be ensured that there are no contraindications to the pharmacological agents used.

9. Barium meal follow through It is the radiographic examination of the small bowel up to ileocecal junction by oral administration of contrast media. It is so-called because it is performed following a barium meal examination of the oesophagus , stomach and duodenum.

10. indications Patients who have low suspicion of small bowel disease abdominal pain and diarrhoea . Patients with suspected complete (or) near complete small bowel obstruction. Patients who are suspected of suffering from Crohn's disease. Patients who refuse placement of nasogastric tube/failed intubation. Elderly patients with suspected jejunal diverticulosis who present with malabsorption.

11. contraindications Colonic obstruction. Suspected perforation . Paralytic Ileus.

12. Patient preperation The colon should be cleaned by the administration of a suitable purgative. (Purgative should be avoided in patients with suspected obstruction, acute exacerbation of Crohn's disease or an Ileostomy). A low roughage diet and a high fluid intake is also maintained for 48 hours prior to the investigation No food or fluid should be taken for 12 hours before the investigation. If the patient is taking tranquilizers, antispasmodics and codeine, they should be stopped for 24-48 hours before the examination.

13. Barium enema It is the radiographic study of the large bowel by administration of the contrast medium through the rectum.

14. indications Change in bowel habit Pain Mass Melaena/anaemia Obstruction.

15. contraindicatons suspected  colonic perforation toxic megacolon pseudomembranous colitis imminent rectal biopsy within 7 days of the procedure or within 7-10 days after the rectal biopsy documented history of  anaphylaxis  to barium

16. Patient preparation For 3 days prior to examination Low residue diet On the day prior to examination Fluids only Drink plenty of water to prevent dehydration Magnesium citrate solution or Bisacodyl tablets for 2 days On the day of examination A tap water cleansing enema of 1500 ml

17. Intravenous Urogram It is the radiographic examination of urinary tract including renal parenchyma, calyces and pelvis after intravenous injection of contrast media.

18. INDICATIONS In Adults Screening of the entire urinary tract especially in cases of haematuria or pyuria. Diseases of the renal collecting system and renal pelvis Differentiation of function of both kidneys. Abnormalities of the ureter. Obstructive uropathy- IVU is the gold standard. TB of the urinary tract Calculus disease. Potential Renal Donors. Prior to endo-urological procedures and surgery of urinary tract. Suspected renal injury. Renal colic or flank pain.

19. Indications in Children V ATER anomalies: These patients have vertebral, anal, tracheo ­ oesophageal , and renal anomalies. Renal anomalies are seen in about 90% of patients. Malformation of urinary tract, e.g., polycystic disease, PUJ obstruction etc. Neurological disorders affecting urinary tract. Malformation of genitalia like bilateral cryptorchidism, III degree hypospadias, family history of urinary tract anomalies, urinary tract infection. E nuresis in the presence of bacteriuria,abnormal urinary sediment, adolescents, diurnal/nocturnal incontinence and history of recurrent urinary tract infection. In girls with constant or intermittent dampness which suggests an ectopically inserted ureter, IVU is mandatory. Anorectal anomalies.

20. Contraindications (relative) Iodine sensitivity. Pregnancy. Severe history of anaphylaxis previously carries 30% risk of similar reaction on a subsequent occasion. The risk is lower with low osmolar contrast media . Raised serum creatinine levels

21. Ivu patient preparation overnight fasting for 5 hours prior to the date of examination; a laxative may not be necessary for bowel preparation as it does not improve image quality  on the day of the procedure take a scout/pilot film to check patient preparation and also to look for radiopaque calculi check serum creatinine level to be within the normal range (as per hospital guidelines) take a history of the patient for any known drug allergies followed by written informed consent for the procedure emergency medications and emergency equipment must always be available in case the patient has a reaction to contrast

22. Micturating cystourethrogram Voiding cystourethrography also known as a  micturating cystourethrography (MCU),   is a fluoroscopic study of the lower urinary tract in which contrast is introduced into the bladder via a catheter. 

23. Indications in children UTI-Usually done after some weeks after acute stage or may be done under antibiotic coverage. Voiding difficulties like dysuria, thin stream, dribbling, frequency, urgency. Vesico ureteric reflux. Other congenital anomalies : Meningomyelocele, Sacral agenesis, Rectal anomalies. Baseline study prior to lower UT surgery. For post operative evaluation of ureteric abnormalities. Pelvic Trauma.

24. Indications in adults Main indications Trauma to urethra. Urethral stricture. Suspected urethral diverticula. Other indications UTI. Reflux nephropathy prior to renal transplant of one/both kidneys. Follow up of patients with spinal cord injury .

25. Patient preparation The patient micturates prior to the examination. Contraindications Acute urinary tract infection

26. Retrograde urethrography It is the roentgenographic demonstration of urethra by the retrograde injection of radio-opaque material through the urethra.

27. indications Strictures Urethral tears Congenital abnormalities Periurethral or prostatic abscess Fistulae or false passages.

28. Patient preparation Bowel preparation is not required for mcu procedure Contraindications Acute urinary tract infection.

29. CT Contrast procedures CT ENTEROCLYSIS CT UROGRAPHY

30. CT ENTEROCLYSIS It is a hybrid technique that combines the methods of fluoroscopic intubation of duodenum and infusion of fluid for examination of small­ bowel with CT.

31. indications Partial small bowel obstruction. Crohn's disease and Ulcerative colitis. Suspected Meckel's diverticulum. Malabsorption. Small bowel tumours . Unexplained gastrointestinal bleeding. Complete colonic obstruction. Paralytic ileus. Massive small bowel dilatation.

32. contraindications Pregnancy Gastric outlet obstruction Patient preparation Low residue diet and good hydration. Laxatives a day prior to the procedure and no oral dose on the day of procedure. Sedation can be used optionally if required.

33. Ct urography CT urography is temporal and spatial evaluation of the urinary tract involving non contrast phase and post contrast multiphase examination (cortico-medullary, nephrogenic and excretory phases).

34. indications Urinary calculus disease Evaluation of Hematuria Suspected pelvis or ureteral obstruction Inflammatory conditions of the kidney and ureter Congenital anomalies of the kidney and ureter Urinary tract trauma

35. contraindications Allergy to contrast agents. Asthmatic patients. Patients with cardiac diseases. Renal insufficiency. Diabetic patients. Pregnant patients.

36. Patient preparation Patients should be told to avoid food intake 6 hours before the examination. However, they should maintain good hydration prior to the examination.

37. hysterosalpinography It is a fluroscopic procedure in which the contrast is injected into the uterus to study the uterine cavity and fallopian tubes.

38. indications 1. Infertility: • To demonstrate patency of the fallopian tubes and their communication with the peritoneal cavity. • Prior to artificial insemination. 2. Recurrent abortions: To demonstrate congenital abnormalities of the uterus or incompetence of the internal os of the uterus. 3. Following tubal surgery: To monitor the effect of tubal surgery. 4. Migrated IUCD. 5. Uterine and tubal lesions like tuberculosis, submucous fibroids, polyps, and synechiae.

39. Patient preparation The patient should be advised to abstain from intercourse between booking the appointment and the time of examination unless a reliable method of contraception is used to avoid the possibility of irradiating an early pregnancy. The patient should be fasting 4 hours prior to the procedure.

40. contraindications Active Pelvic Sepsis. Sensitivity to contrast media. Recent dilatation and curettage. Pregnancy. The week prior to and the week following onset of menstruation. Severe renal or cardiac disease. Cervicitis/purulent vaginal discharge.

41. thank you !!!