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
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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.
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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).
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
BushongPublication Year: 2019Publisher: 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: 2017Journal: The Indian Journal of Radiology
& Imaging
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24. THANK YOU
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