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BARIUM SWALLOW,
BARIUM MEAL,
BARIUM ENEMA
MOHAMAD AFIF B. MOHD RADZI
012011100145
CONTRAST MEDIA
Barium suspension is made up from pure Barium
Sulphate
Advantages of Barium :
excellent coating which allow demonstration of
mucosal pattern
low cost
Disadvantages of Barium :
High morbidity if leaks into peritoneal cavity
Difficult to do CT scan and Ultrasound due to presence of Barium
on musoca ( therefore, CT and US should be done prior to Ba
study)
PHARMACOLOGICAL AGENT :
1. BUSCOPAN ( Hyoscine N Butyl Bromide )
An antimuscarinic agent that inhibits
intestinal motility and gastric secretion
Advantage : immediate onset , short action
duration, cost
DISADVANTAGE
:
Blurring of
vision
Dry mouth
Thacycardia
Urinary
retention
Acute gastric
dilatation
CONTRAINDICATION
S:
Closed angle
glaucoma
Myasthenia
gravis
Paralytic ileus
Pyloric stenosis
Prostatic
enlargement
2. GLUCAGON
A hormone that has hyperglycaemic effect &
causes smooth muscle relaxant
Advantages : more potent than Buscopan
DISADVANTAGES :
Hypersensitivity
reaction
Long onset of
action (1minute)
CONTRAINDICATION
:
Phaechromocyto
ma (glucagon can
cause the tumor to
release
cathecolamine)
Insulinoma
Glucagonoma
BARIUM SWALLOW
AIM : To detect abnormalities of the esophagus
INDICATIONS
1. Dysphagia
2. Anaemia
3. Abdominal pain
4. Assessment of tracheo-esophageal fistulae
5. Assessment of the site of perforation
CONTRAST VOLUME : 100 ml of 250% Barium
CONTRAINDICATION :
* Water soluble contrast agents should be used
instead of Barium in these cases :
Suspected perforation
Risk of aspiration
Suspected tracheo-esophageal OR bronchoesophageal fistula
Post operative assesment for leak
COMPLICATIONS :
1. Leakage of Barium from an unsuspected
perforation
2. Aspiration
BARIUM MEAL
AIM : To detect abnormality of the stomach and
duodenum
METHODS :
1. Double contrast : demonstrate mucosal pattern
2. Single contrast : demonstrate gross pathology
CONTRAST VOLUME :
1. 135 ml of 250% Barium
2. Carbex granules (double contrast)
INDICATIONS :
1. Dyspepsia
2. Weight loss
3. Upper abdominal mass
4. GI hemorrhage / iron deficiency anaemia
5. Partial obstruction
6. Assessment of site of perforation
7. Failed endoscopy
CONTRAINDICATION : Complete large bowel obstruction
PATIENT PREPARATION :
8. Fasting 6 hours before
9. Stop cigarette smoking on the day of procedure
AFTERCARE :
1. Warn patient about white bowel motion
2. Drink adequate water with/without laxatives
3. Wait untill blurring of vision resolves (Buscopan)
COMPLICATIONS :
4. Leakage of barium from unsespected perforation
5. Aspiration of stomach contents
6. Impaction of barium
7. Barium appendicitis
BARIUM ENEMA
INDICATIONS :
Change in bowel habit
Abdominal pain
Abdominal mass
Melena / anaemia
Intestinal obstruction
CONTRAST VOLUME :
1. 500 ml of 115% Barium
2. Air
METHODS :
1. Double contrast : to demonstrate mucosal
pattern
2. Single contrast : to demonstrates gross
pathology in children & reduction of an
intussusception
CONTRAINDICATONS :
.Toxic megacolon
.Pseudomembranous collitis
.Recent rectal biopsy
.Incomplete bowel preparation
.Recent barium meal
PATIENT PREPARATION :
3 days prior to examination :
low residue diet
1 day prior to examination :
Fluids only
Picolax ( a laxative for bowel clearance )
On the day of examination :
antibiotic prophylaxis
( amoxicillin / vancomycin + gentamycin )
AFTERCARE :
White bowel motion
Wait untill blurring of vision resolved (Buscopan)
COMPLICATIONS :
o Bowel perforation :
Infants & elderly
Obstructing neoplasm
Ulceration of bowel wall
Inflation of Foley catheter balloon in colonostomy
Steroid therapy patient
Hypothyroidism
o
o
o
o
Transient bacteraemia
Cardiac arrythmia
Intramural barium
Barium pulmonary embolus
HEPATOBILIARY
SYSTEM
PROCEDURES
ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREATOGRAPHY (ERCP)
Endoscopic retrograde
cholangiopancreatography(ERCP) is a
diagnostic and
interventionalproceduretechnique using
bothendoscopy and fluoroscopy for
examination and intervention of
thebiliary treeandpancreatic ducts.
INDICATIONS OF ERCP
DIAGNOSTIC
THERAPEUTICS
malignancy
Stent
placement
Investigation
of diffuse biliary disease, e.g. sclerosing
Balloon
dilatation of ductal strictures
cholangitis
Tissue biopsy from biliary or pancreatic ducts
Sphincterotomy
CONTRAINDICATIONS OF
ERCP
Oesophageal obstruction; varices; pyloric
stenosis
COMPLICATIONS OF ERCP
Due to the contrast medium
1. 'Allergic reactions' - rare
2. Acute pancreatitis - more likely with large volumes, high
pressure injections.
Due to the technique
Local
-Damage by the endoscope, e.g. rupture of the oesophagus,
duodenal perforation, damage to the ampulla, proximal
pancreatic duct and distal common duct.
Distant
Bacteraemia,
septicaemia,
aspiration
pneumonitis,
hyperamylasaemia (approx. 70%), acute pancreatitis, postERCP pancreatitis - normally mild
PERCUTANEOUS TRANSHEPATIC
CHOLANGIOGRAPHY (PTC)
Percutaneous transhepatic
cholangiography (PTC) is a radiologic
technique used to visualize the
anatomy of the biliary tract.
A contrast medium is injected into a
bile duct through the liver, after
which X-rays are taken.
INDICATIONS OF PTC
Failed ERCP in treating distal CBD obstruction
ERCP not feasible (e.g. patients with gastrojejunostomy)
Assessment of high biliary obstruction especially at
Hilar region (Porta hepatic)
To identify obstructive cause of jaundice; and
differentiate from medically treatable cause
Introducing stents across the obstruction
CONTRAINDICATIONS OF
PTC
Bleeding tendency: - platelets less
than 100 000 - prothrombin time 2 s
greater than control
Biliary tract sepsis
Non-availability of prompt surgical
facilities, or a patient who is unfit for
surgery
Hydatid disease.
COMPLICATIONS OF
PTC
Due to the contrast medium
Allergic/idiosyncratic reactions - very uncommon.
Due to the technique
Local
1. Puncture of extrahepatic structures
2. Intrathoracic injection
3. Cholangitis
4. Bile leakage - may lead to biliary peritonitis (incidence
0.5%).
5. Subphrenic abscess
6. Haemorrhage
7. Shock - owing to injection into the region of the coeliac
plexus.
. Generalized
Bacteraemia, septicaemia and endotoxic shock. The
likelihood of sepsis is greatest in the presence of
REFERENCES
Chapman S, Nakielny R, A Guide to
Radiological Procedures, 6th edition,
Saunders Ltd. USA, 2013
http://
patient.info/doctor/endoscopic-retro
grade-cholangiopancreatography
http://
radiopaedia.org/articles/percutaneou
s-transhepatic-cholangiography
THANK YOU
ULTRASOUND?
medical test that uses high-frequency sound waves
to capture live images from the inside of your body.
non-invasive test (safe and painless) and nonionizing
usage of a small transducer (probe) and ultrasound
gel placed directly on the skin.
High-frequency sound waves are transmitted from
the probe through the gel into the body.
The transducer collects the sounds that bounce
back and a computer then uses those sound waves
to create an image.
also known as sonography
Used to :
- help physicians evaluate symptoms (pain,
swelling, infection)
- examining body's internal organs
- guide procedures such as needle biopsies
ULTRASOUND FOR
HEPATOBILIARY SYSTEM
Indications:
visualize and assess liver and gallbladder
structure and function
assist in obtaining a biopsy,
diagnose disorders such as gallstones, cancer,
tumors, cysts, and bleeding.
evaluate the effectiveness of therapeutic interventions.
Eg : suspected gallstone
: right upper quadrant pain
: jaundice
: acute pancreatitis
: fever with unknown origin
: guided percutaneous procedures
Contrast
Done without contrast
Patient preparations
Fasting for at least 6 h, preferably overnight.
Water might be allowed.
You may be asked to eat fat-meal in the evening before
the test and then to avoid eating 8 to 12 hours before
the test.
Contraindication
No contraindication
Indications:
Contrast
Done without contrast
Patient preparations
bowel gas must be displaced
filling the urinary bladder to capacity.
The patient should be instructed to drink 1-2
pints of water during the hour prior to scanning
and not to empty their bladder.
Contraindication
No contraindication
Referrences
A GUIDE TO RADIOLOGICAL PROCEDURE by
chapman & nakielny
http://www.radiologyinfo.org/en/info.cfm?pg=
genus
http://www.labdxtest.com/labdxtest/view/Dav
is-Lab-and-Diagnostic-Tests/425161/all/Ultr
asound_Kidney?q=ultrasound%2C%20renal%20sys
tem&ti=0
http://www.labdxtest.com/labdxtest/view/Davi
s-Lab-and-Diagnostic-Tests/425315/all/Ultras
RENAL AND
REPRODUCTIVE SYSTEM
Indications
Check for anatomical
variants or congenital
anomalies
Check the course of
the ureters
Detect and localise a
ureteric obstruction
Assess for
synchronous upper
tract disease in those
with bladder
transitional cell
carcinoma
Contraindication
A previous severe
adverse reaction to
contrast medium
Asthma or severe allergy
Hypersensitivity to
iodine
Infancy, thyrotoxicosis
Using B-blocker, heart
disease
Hepatic failure and renal
impairment
Poor hydration
Sickle-cell anaemia
Normal examination
Bladder calculi
Left Staghorn
kidney
Patient Preparation
No food 5 hours prior to the
examination.
Patient should be ambulant 2 hour
prior to the examination to reduce
bowel gas
Complications
Due to contrast medium
Due to technique
Incorrectly applied
abdominal
compression may
produce intolerable
discomfort or
hypotension
Contrast Medium
(HOCM OR LOCM 370)
LOCM
Infants and small
children
Elderly
Poor hydrated patient
Patient with diabetes,
myelomatosis, sickle-cell
anaemia
Patient who had a
previous severe contrast
medium reaction with
LOCM or allergic history
Dosage
Adult - 50 ml
Paediatric - 1ml per
kg
MICTURATING
CYSTOURETHROGRAPH
Y
(MCU)
Indications
Vesicouretric reflux
Study of the urethra during
mictuirition
Abnormalities of the bladder
Stress incontinence
UTI, dysuria, hydronephrosis
Hematuria
Trauma
Congenital anomalies of
GUT
Contraindications
Partial ureteral
duplication
Normal MCU
Vesicoureteric
Equipments
Contrast medium of
HOCM or LOCM 150
Fluoroscopy unit with
spot film device and
tilting table
Video recorder
Jaques or foley`s
catheter
Patient
preparation
The patient
mictuirates prior to
the examination
Film
Aftercare
Complications
Due to contrast medium
Due to technique
Acute UTI
Catheter trauma
Perforation from over
distension
Catheterization of
vagina or an ectopic
ureteral orifice
Retention of Foley`s
catheter
HYSTEROSALPINGOGRAPHY (HSG)
This is a special x-ray using dye to
look at the uterus and fallopian tube.
Indications
Infertility
Recurrent miscarriage
Following tubal
surgery
Assessment of the
integrity of a
caesarean uterine scar
Contraindications
Pregnancy
A purulent discharge
of the vulva or cervix
or diagnosed as PID
patient
Recent dilatation
&curettage or
abortion, immediately
post menstruation
Contrast sensitivity
Normal finding on
HSG
Blockage of fallopian
tube
Equipments
Fluoroscopy unit with
spot film device
Vaginal speculum
Vulsellum forceps
Uterine cannula,
Leech-Wilkinson
canula, olive or 8-F
paediatric Foley
catheter
Contrast medium
Complications
Due to contrast
medium
Allergic phenomena
Due to technique
Pain.
Bleeding
Transient nausea,
vomitting and
headache
Intravasation of
contrast medium into
the venous system
Infection
abortion
Preparation
This procedure is best
performed one week
after menstruation but
before ovulation
On the night before the
procedure, patient
given laxative or an
enema to empty bowel
Make sure patient is
not pregnant, allergy
Patient may be given
sedative to minimize
the discomfort
Film
Preliminary film by
coned PA view of the
pelvic cavity
Using undercouch tube
1. As the tubes begin
to fill
2. When peritoneal
spill has
occurred and with
all the
instrument
removed
After care
It must be ensured that the patient is
in no serious discomfort nor has
significant bleeding before she
leaves
The patient must be advised that she
may have bleeding per vagina for 1-2
days and pain may persist up to 2
weeks.
Preparation
Consent
Stop blood thinners
Investigations (coagulation factors, FBC)
Aftercare
Apply pressure to the site of puncture to
prevent or minimize bleeding
May experience soreness at the site
No heavy lifting or strenuous activity in
24 hour
Complication
Bruising and bleeding
A hematoma or collection of blood
may form at the biopsy site
Infection or abscess
Chest Biopsy: pneumothorax, local
pulmonary hemorrhage and
haemoptysis
Percutaneous Nephrostomy
Drainage
catheter is place
into the kidney
done under
radiological
guidance (x ray
or ultrasound)
Indication:
Obstructive uropathy
Access for percutaneous procedure
( e.g: prior to percutaneous
nephrolitotomy)
Ureteric fistulae
Urinary diversion
Contraindications:
Uncontrolled bleeding diathesis
Preparation
Consent
Investigations
Fasting for at least 4 hour
Premedication (Analgesia, sedation)
Prophylactic antibiotic
Patient should empty the bladder prior
to the procedure
Aftercare
Bed rest for 12 hour
Monitor blood pressure and temperature
half hourly for 6 hour
Monitor input and output chart
Urine cultures and sensitivity
Complication
Unsuccessful drainage
Hemorrhage
Perforation of collecting system
Septicemia
References
Chapman S, Nakielny R, A Guide
to Radiological Procedures, 6th
edition, Saunders Ltd. USA, 2013
http://www.radiologyinfo.org/en/inf
o.cfm?pg=biopgen
http://www.riainvision.com/exams/im
age_guided_biopsy.aspx
http://radiopaedia.org/articles/perc
utaneous-nephrostomy
ANGIOGRAPHY
INDICATION
Determining the severity and the location of
the narrowing/blockage of blood vessel
causing the symptoms.
Locating a bleeding site and often combined
with embolization.
Locating the aneurysm site and putting the
stent.
Locating and removing a blood clot in a
blocked blood vessel and restoring blood flow.
Treating certain type of tumours by blocking
CONTRAINDICATION
Relative contraindications
Blood disorders
Pregnancy
Allergy to contrast medium
Renal impairment
PATIENT PREPARATION
The patient may need admission to hospital as
careful preparation before and observation after
the procedure will be required.
Explain to patient regarding the procedure.
Take consent from patient.
Ask some relevant history from patient; medical
history, medication, allergy and pregnancy.
Examine the patient together with vital sign.
Check for urea and creatinine level.
TECHNIQUE
The area around the artery to be assessed is
covered with antiseptic.
Give local anaesthetic to numb the area where a
catheter will be inserted into the blood vessel.
(femoral, brachial and axillary artery)
Seldinger Technique step by step.
Inject the contrast dye.
The procedurewill usually take less than an hour to
carryout. If it is combined with another procedure,
such as angioplasty or embolization, the time will
be longer.
Seldinger Technique
AFTERCARE
Remove the catheter.
Press the insertion site for 10
minutes to help stop the bleeding.
Stay in a recovery room for up to
4hours after the procedure.
Allow patient to eat and drink after
the procedure.
COMPLICATION
- Allergic reaction
- Bleeding and bruising at the
puncture site
- Infection at the puncture site
- Damage to blood vessel
- Thrombosis or embolus formation
- Septicemia
COMPUTERIZED
TOMOGRAPHY
(CT) SCAN
PATIENT PREPARATION
Explain on the procedure:
How it is done briefly, the purpose, its duration, the
contrast medium, the necessity for immobility, the
necessity for breath-holding whilst scanning chest
and abdomen, the risks and side effects, the
release of results, etc.
SIDE EFFECTS
DUE TO CONTRAST:
A feeling of warmth,
Nausea and vomiting,
Local irritation at the site
of injection,
Itchiness, allergic reaction,
Nephrotoxic effect in renal
compromised patient,
Unpleasant metallic taste
DUE TO RADIATION
CONTRAINDICATIONS
Patient weight>150kg
Pregnancy
Allergic reaction to
contrast medium
Renal impairment or
dehydration
MAGNETIC RESONANCE
IMAGING (MRI)
INDICATIONS
PATIENT PREPARATION
Explain on the procedure:
How it is done briefly, the purpose, its duration, the
contrast medium, the , the necessity for immobility,
the risks and side effects, the release of results,
etc.
SAFETY IN MRI
Potential hazards associated with
magnetic resonance imaging which may
affect patients and staff are due to:
Magnetic fields
Auditory effects of noise
Inert gas quench
Claustrophobia
Intravenous contrast agents
CONTRAINDICATIONS
Ferromagnetic objects
These objects include medically inserted items
such as cerebral aneurysm repair clips, vascular
clips, and surgical staples.
It can be moved by the magnetic field and could
damage adjacent tissues.
Potential to be heated and cause burns to
surrounding tissues.
Some foreign bodies, such as bullets,
shrapnel, and metal in the eyes (as can be
seen in metal workers) can also be ferromagnetic.
THANK YOU!