OCG (Oral cholecystogram) BY Akash Das
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Oral cholecystography is a radiographic examination of the gallbladder using oral contrast media. It was developed in 1924 but has now been largely replaced by ultrasound and MRCP. The exam involves patients consuming contrast media 14 hours prior to imaging. Radiographs are taken in various positions including before and after a fatty meal to visualize the gallbladder and assess for any abnormalities like inflammation, polyps, tumors or gallstones. Precautions must be taken to minimize radiation exposure to the patient and staff during the exam.
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Oral cholecystography
An oral cholecystography is a radiological investigation that involves administering contrast media orally to visualize the gallbladder. It was first described in 1925 but is now largely replaced by ultrasound and MRCP due to its low success rate. The document discusses the indications, contraindications, technique, additional techniques, complications of an oral cholecystography.
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- 1. By, Akash Das Student Code- BWU/BRI/19/005 Paper Code- BMRIT-305 Oral Cholecystography (OCG)
- 2. • Definition: Oral Cholecystography or Oral Cholecystogram is the radiographic study of gallbladder by the oral administration contrast media. Oral Cholecystography (OCG) • It was developed in 1924 by American surgeons E.A Graham & W. H Cole. • But now days it is largely superseded by ultrasound and MRCP. • This is the initial examination for the investigation of biliary tract. Fig- 1: Gallbladder
- 3. • Inflammation of the organ. • Other abnormalities like polyps. • Tumors • Gallstones • To visualizing cystic duct and common bile. • To demonstrate suspected pathology in the gallbladder. Fig- 3: Gallstone Formation Fig- 2: Polyp Inside Gallbladder
- 4. • Pr severe hepatorenal disease. • Acute cholecysititis • Iodine sensitivity • Pregnancy • Dehydration • An IV cholecystography within the previous week evious cholecystectomy. Fig- 4: Acute Cholecysititis Fig- 5: Pregnancy
- 5. • Patient should take low residue diet for 2 days prior to examination. • A laxative 2 days prior to the examination. • The CM is taken with water 14 hours prior to the examination. • A fat-containing meal after preliminary film, if the gallbladder is not visualize by contrast media. • Food is forbidden until the examination is completed. Fig-6: Gall Stone Formation Fig-7: Radiographic Appearance of GB
- 6. 1. Biloptin 2. Telepaque 3. Cholebrin 4. Solu-Biloptin 1. Prone 20º LAO 2. Supine 20º RPO 3. Erect 20º LAO 4. Fatty meal provided. • Prone 20º LAO 30 minutes after a fatty meal. Fig- 9: Positioning of patient for OCG Fig- 8: Biloptin Capsules
- 7. • A night before the examination 6 tablet of Teleopaque or Biloptin is given orally. • After 12-16 hours a prone oblique view with right side raised to 20º is taken for gallbladder visualization. • After the preliminary film taken, the patient lie in the supine position and appropriate spot film of the gallbladder are taken. • Ask the patient to eat fatty meal. • After 30-40 min. films are taken to assess the contractibility of the gallbladder and small filling defect. (stones or polpyps) • Cystic and common bile duct also visualized in post fatty meal films. * If the GB not visualized a "double dose" OCG may have to be performed where the patient takes in all 12 tablets of CM.
- 8. • Mild gastrointestinal disturbances • Skin reactions • Uricosuric action • Impaired renal function • Psedoalbuminuria • Abnormal thyroid function tests • Increased effect of protein-bound drugs because of shared binding with albumen Fig- 11: Gastrointestinal Disturbances Fig- 10: Skin Reactions
- 9. There are many ways by which we can protect our self from scattered radiation, like- By using • Protective apron:0.5mmPb • Lead shield:0.5mm Pb • Lead protective gloves. • Film badge or TLD monitor. And also we should always the rule of TDS & ALARA principle We can also use beam limiting devices like cone to minimize the radiation dose. Fig- 14: Beam Limiting Device (Cone) Fig- 13: Cardinal’s principle (TDS) Fig- 12: Lead apron, shield, gloves & TLD
- 10. THANK YOU