Radio graphic technique 3

1. Radiographic Technique 3
May, 2014
Prepared by:
Behzad Ommani
Bachelor of Radiology
Master of Medical Engineering

2. Pharyography

3. Pharynx
Pharynx has 3 Parts:
1. Nasopharynx
2. Oropharynx
3. Laryngopharynx

4. Pharynx
 Nasopharynx
The Nasopharynx (nasal part of the pharynx) is the uppermost
part of the pharynx. It extends from the base of the skull to
the upper surface of the soft palate.
Radiography:
1. Lateral with open mouth
2. Lateral with Valsalva's manuver

5. Pharynx
Why does the adenoid enlarge?
Increase in size of the adenoid can occur on its own or due
to inflammation [infection, allergy]

6. Pharynx
Radiography:
1. Lateral with open mouth

7. 2. Lateral with Valsalva's manuver
The Valsalva maneuver or Valsalva manoeuvre is performed
by moderately forceful attempted exhalation against a
closed airway, usually done by closing one's mouth,
pinching one's nose shut while pressing out as if blowing
up a balloon.
Pharynx

8.  Oropharynx
Radiography with Thick Barium :
1. AP
2. Lateral
 Laryngopharynx
1. AP
2. Lateral
3. Oblique
Pharynx

9. Pharynx

10. Pharynx

11. Esophagography

12. Esophagus
• The esophagus (oesophagus) is an organ in vertebrates which
consists of a muscular tube through which food passes from the
pharynx to the stomach. During swallowing, food passes from the
mouth through the pharynx into the esophagus and travels via
peristalsis to the stomach.
• The word esophagus is derived from the Latin œsophagus, which
derives from the Greek word oisophagos, lit. "entrance for
eating.“
• In humans the esophagus is continuous with the laryngeal part of
the pharynx at the level of the C6 vertebra. The esophagus passes
through posterior mediastinum in thorax and enters abdomen
through a hole in the diaphragm at the level of the tenth thoracic
vertebrae (T10).

13. • It is usually about 10–50 cm long depending on individual
height. It is divided into cervical, thoracic and abdominal
parts. Due to the inferior pharyngeal constrictor muscle, the
entry to the esophagus opens only when swallowing or
vomiting.
Esophagus

14. Esophagus
CONTRAST STUDIES
The esophagus may be examined by performing a full-
column. Single-contrast study in which only barium or
another radiopaque contrast agent is used to fill the
esophageal lumen.
A double-contrast procedure also may be used. For this
study, barium and carbon dioxide crystals (which liberate
carbon dioxide) are the two contrast gents.
No preliminary preparation of he patient is necessary.

15. Barium sulfate mixture
A 30% to 50% weight/volume suspension is useful for the
full-column, single contrast technique.
A low viscosity, high density barium developed for double
contrast gastric examinations may be used for a double-
contrast examination.
Whatever the weight/volume concentration of the barium,
the most important criterion is hat the barium flows
sufficiently to coat the walls of the esophagus.
The barium manufacturer's mixing instructions must be
closely followed to attain optimum performance of the
contrast medium.
Esophagus

16. Opaque foreign bodies lodged in the pharynx or in the
upper part of the esophagus can usually be demonstrated
without the use of a contrast medium. A soft tissue neck or
lateral projection of the retrosternal area may be taken for
this purpose.
The following steps are observed:
 Obtain a lateral neck radiograph at the height of
swallowing for the delineation of opaque foreign bodies
in the upper end of the intra thoracic esophagus.
Esophagus

17.  Have the patient swallow. This elevates the intra
thoracic esophagus a distance of two cervical
segments, placing it above the level of the clavicles.
 Tufts or pled gets of cotton saturated with a thin barium
suspension are sometimes used to demonstrate an
obstruction or to detect nonopaque foreign bodies in the
pharynx and upper esophagus.
Esophagus

18.  Single :
Fistulae such as between Esophagus & Trachea
Tumor side organ such as Bronchi carcinoma
Aneurysm such as Aorta
Enlargement side organ such as Cardiac, Lymphatic nodule
 Double :
Diverticuli
Ulcer
Carcinoma
Strictures
Varices
Esophagus

19. AP, PA, OBLIQUE, AND LATERAL PROJECTIONS
Image receptor: 35 x 43 cm lengthwise and centered so the
top of the IR is positioned at the level of the mouth for
inclusion of the entire esophagus.
AP OR PA PROJECTION
•The following steps are observed:
Place the patient in the supine or prone position with the
arms at the side and the shoulders and hips equidistant from
the table.
•Center the midsagittal plane to the grid. Turn the head
slightly, if needed, to facilitate drinking of the barium
mixture.
Esophagus

20. AP OR PA OBLIQUE
RAO or LPO position
The steps are as follows:
Position the patient in the RAO or LPO position with the
midsagittal plane forming an angle of 35 to 40 degrees from
the grid device.
Adjust the patient's arms in a comfortable position with the
shoulders lying in the same plane.
Center the elevated side to the grid through a plane
approximately 2 inches (5 cm) lateral to the midsagittal
plane.
Esophagus

21. LATERAL PROJECTION
R or L position
The procedure is as follows:
•Place the patient in the lateral position facing the
radiographer.
•Place the patient's arms forward.
•Center the midcoronal plane to the grid.
Central ray: Perpendicular to the midpoint of the IR (the
central ray will be at the level of (T5- T6).
Esophagus

22. Esophagus

23. Diverticulum
A diverticulum is a pouch extending out from the normal wall of the
swallowing channel. Diverticula (the plural of diverticulum) can
develop in either the pharynx or esophagus. Although small diverticula
may not cause symptoms, larger diverticula can cause dysphagia for
liquids and solids. Regurgitation of undigested food, often hours after
ingestion is a characteristic symptom of patients with diverticula.
Disorder

24. Luminal Stenosis
Luminal stenosis occurs as a result
of mechanical narrowing of the
esophageal lumen in patients with
esophageal strictures. Symptoms
arise when the swallowed food is
too large to pass. The typical
symptom in a patient with an
esophageal stricture is dysphagia
for solid food, often followed by
regurgitation of undigested
material.
Disorder

25. Disorder
Spastic Disorders
Whereas spastic disorders
of the pharynx are rare,
those of the esophagus are
common. A certain amount
of motor dysfunction may
be seen in normal
individuals.
Esophageal dysmotility may
range from mild, infrequent
events that are within
normal limits, to profound
incardination associated
with every swallow.

26. Disorder
Achalasia
Achalasia is a motor disorder of the esophagus without an obvious
etiology. In achalasia, nerve cells (myenteric plexus) located between
the esophageal muscle layers are damaged (degenerate). The result is a
complete loss of coordinated esophageal contractions (peristalsis) and
failure of lower esophageal sphincter (LES) relaxation (Figure 21).
This combination produces obstruction at the esophagogastric junction
and loss of effective propulsion

27. Gastrointestinal Series

28. PRELIMINARY PREPARATION
An empty stomach is ensured by withholding both food
and water after midnight for a period of 8 to 9 hours
before the examination.
This restriction is made to prevent excessive fluid from
accumulating in the stomach and diluting the barium
suspension enough to interfere with its coating property.
Because it is believed that nicotine and chewing gum
stimulate gastric secretion and salivation, some
physicians tell patients not to smoke or chew gum after
midnight on the night before the examination.
Stomach

29. CONTRAST STUDIES
1. Single-contrast
2. Double-contrast
The principal advantages of this method over the single
contrast method are that small lesions are less easily
obscured and the mucosal lining of the stomach can be
more clearly visualized.
Stomach

30. Stomach

31. PA PROJECTION
Image receptor: 30 x 35 cm lengthwise.
Positionof patient : For radiographicstudies of the stomach
and duodenum, place the patient in the recumbent position.
However, the upright position is sometimes used to
demonstrate the relative position of the stomach.
 In adjusting thin patients in the prone position, support
the weight of the body on pillows or other suitable pads
positioned under the thorax and pelvis. This adjustment
keeps the stomach or duodenum from pressing against the
vertebrae, with resultant pressure-filling defects.
Stomach

32. Position of part :
• Adjust the patient's position, either recumbent or upright,
so that the midline of the grid coincides with a sagittal
plane passing halfway between the vertebral column and
the left lateral border of the abdomen.
• Center the IR about 1-2 inches above the lower rib margin
at the level of L1- L2 when the patient is prone.
For upright images, center the IR 3 to 6 inches (7.6 to 15
cm) lower than Ll - L2. The greatest visceral movement
between the prone and the upright positions occurs in
asthenic patients.
Respiration: Suspend at the end of expiration unless
otherwise requested.
Stomach

33. Stomach
Central ray :
Perpendicular to the center of the IR.

34. Stomach

35. PA AXIAL PROJECTION
Image receptor: 30 x 35 cm lengthwise.
Positionof patient : Place the patient in the prone position
Position of part : Similar PA.
Respiration: Similar PA.
Stomach

36. Central ray :
Directed to the midpoint of the IR at an angle of 35 to 45
degrees cephalad. Gugliantinil recommended a cephalic
angulation of 20 to 25 degrees for demonstration of the
stomach in infants.
Stomach

37. Stomach

38. PA OBLIQUE PROJECTION
RAO position
Image receptor: 30 x 35 cm lengthwise.
Positionof patient : Place the patient in the prone position
Position of part :
• After the PA projection, instruct the patient to rest the head
on the right cheek and to place the right arm along the side
of the body.
• Have the patient raise his or her left side and support the
body on the left forearm and flexed left knee
Stomach

39. • Adjust the patient's position so that a sagittal plane
passing midway between the vertebrae and the lateral
border of the elevated side coincides with the
midline of the grid.
•Center the IR about I to 2 inches above the lower rib
margin at the level of L1-L2 when the patient is prone.
•Make the final adjustment in body rotation. The
approximately 40 to 70 degrees of rotation required to give
the best image of the pyloric canal and duodenum depend
on the size, shape and position of the stomach.
In general, hypersthenic patients require a greater degree of
rotation than do sthenic and asthenic patients.
Stomach

40. Stomach
• The RAO position is used for serial studies of the pyloric
canal and the duodenal bulb because gastric peristalsis is
usually more active when the patient is in this position.
Respiration: Suspend at the end of expiration unless
otherwise requested.
Central ray : Perpendicular to the center of the IR.

41. Stomach

42. AP OBLIQUE PROJECTION
LPO position
Image receptor: 30 x 35 cm lengthwise.
Positionof patient : Place the patient in the Supine position
Position of part :
• Have the patient abduct the left arm and place the hand
near the head, or place the extended arm alongside the
body.
• Place the right arm alongside the body or across the
upper chest, as preferred.
• Have the patient turn toward the left, resting on the left
posterior body surface.

43. • Flex the patient's right knee, and rotate the knee toward
the left for support.
• Place a positioning sponge against the patient's elevated
back for immobilization.
• Adjust the patient's position so that a sagittal plane
passing approximately midway between the vertebrae and
the left lateral margin of the abdomen is centered to the IR.
Adjust the center of the IR at the level of the body of the
stomach. The centering will be at a point midway between
the xiphoid process and the lower margin of the ribs.
Stomach

44. • The degree of rotation required to best demonstrate the
stomach depends on the patient's body habitus. An average
angle of 45 degrees should be sufficient for the sthenic
patient, but the degree of angulation can vary from 30 to 60
degrees.
Respiration: Suspend at the end of expiration unless
otherwise instructed.
Stomach

45. Stomach

46. lATERAL PROJECTION
Image receptor: 30 x 35 cm lengthwise.
Positionof patient : Place the patient in the Supine position
Position of part :
• Have the patient abduct the left arm and place the hand
near the head, or place the extended arm alongside the
body.
• Place the right arm alongside the body or across the
upper chest, as preferred.
• Have the patient turn toward the left, resting on the left
posterior body surface.
Stomach

47. Stomach
• The degree of rotation required to best demonstrate the
stomach depends on the patient's body habitus. An average
angle of 45 degrees should be sufficient for the sthenic
patient, but the degree of angulation can vary from 30 to 60
degrees.
Respiration: Suspend at the end of expiration unless
otherwise instructed.

48. Stomach