This document discusses several older radiological imaging techniques that have been replaced by more modern techniques that provide improved diagnostic accuracy and outcomes for patients. It outlines techniques like bronchography, chest photofluorography, and pneumoencephalography that were commonly used in the past but are now rare. The document also discusses gastrointestinal imaging techniques like barium studies that were traditionally used but have been replaced by CT scans, MRIs, and endoscopy in most cases due to advantages like faster imaging times and better detection abilities. Intravenous pyelograms for urinary tract imaging are also discussed as a technique that was replaced by CT urography for similar reasons.

1. Brig. Physician / Mohamed Abdel Aziz Abo Shanab
Hospitals
Consultant of radiology, Armed Forces
mshanabo@yahoo.com

2. Old imaging techniques that are rarely
used are different from Historical
imaging techniques, such as
 Bronchography
 Chest photofluorography
 Conventional tomography
 Pneumoencephalography
 Translumbar aortography

3.  The field of diagnostic and therapeutic
radiology has always been characterized by
constant innovation & creativity to evolve to
its current form.
 There are numerous imaging techniques that
were once prevalent but have become
outdated & replaced by the current
examinations and modalities, which improve
diagnostic accuracy and patient outcomes.

4.  Knowledge of these old radiologic
examinations and procedures is important to
understand how we have arrived at the
current practice of radiology & how our field
can continue to evolve to improve our
diagnostic and therapeutic abilities to fit the
changing needs of our patients.

5.  Fluoroscopy uses X-rays to capture an image
of an organ while it is functioning.
 It includes both lower and upper GITs.
 A lower GI is an X-ray evaluation of the large
intestine (the colon).
 This includes the right or ascending colon,
the transverse colon, the left or descending
colon and the rectum.

6.  An upper GI Study is an X-ray examination of
the esophagus, stomach and first part of the
small intestine.
 Upper GIT must be coated or filled with a
contrast material called barium, an element
that appears bright white on radiographs.

7.  The barium is given to the patient to drink.
 Some patients are asked to swallow baking-
soda crystals to create gas and further
improve the images; this procedure has the
modified name of air-contrast or double-
contrast upper GI.

9.  Esophogram
 Barium Meal, UGI Series
 Barium Follow through, Small Bowel and
UGI
 Barium Enema

11.  The dedicated small bowel follow-through
has been replaced to a lesser degree by CT
Abdomen, CT and MR Enterography &
capsule endoscopy.
 For lower GI symptoms and colon cancer
screening, the double-contrast barium enema
has increasingly been discarded in favor of
Colonoscopy, CT Abdomen, CT
Colonography.

12.  Barium studies are considered by radiologists
as a “low-tech” form of imaging.
 CT and MR, are seen more appealing “high-
tech” imaging modalities.
 Barium studies are also physically taxing,
labor-intensive procedures and, arguably, one
of the more difficult skill sets for radiologists
to master.

13.  Decline of barium radiology, Alarm
 Barium studies are highly operator
dependent.
 No Sufficient Instructors to train residents
 Performance needs training, experience and
expertise in barium radiology
 This is another disincentive for clinicians to
order barium studies in community practice.

15.  IVP
 Cystogram
 IVP with Tomograms
 Retrograde Pyelogram

16.  An Intravenous Pyelogram (IVP) is an x-ray
examination of the kidneys, ureters, and
urinary bladder.
 An IVP study uses a contrast material to
enhance urinary structures in x-ray images.
 The iodine contrast material is injected into
the patient's venous system, and its progress
through the urinary tract is then recorded on a
series of quickly captured images.
 Show the anatomy & function of the kidneys
and urinary tract.

18.  Renal colic
 Renal stone disease
 Calyceal pathology
 Hematuria
 Chronic upper urinary tract obstruction.
 The commonest situation in which the CTU
& MRU are now being suggested as an
alternative to an IVU is in the investigation of
suspected renal colic.

19.  Radiation dosage:-
- 3-shot IVU 1.5 mSv (millisievert).
- Unenhanced CT 4.5 mSv
 CT scan, performed within few minutes.
 IVU need delayed films, may prolong the
examination for more than 12 h.

20. IVP vs CT
 CTU detection for the cause of haematuria is high
(sensitivity 92 - 100 %, specificity 89 - 97 %) &
significantly better than IVP (sensitivity 61 %,
specificity 97 %).
 Radiation doses of IVP < CT but varies with the
number of films
 Many practices no longer have tomographic
equipment.
 Many " younger " radiologists have never
performed or interpreted an IVP

23.  IVP may be inconvenient to the patient as its
procedures include, puncture by cannula
(pain), allergy to contrast medium,

24.  It is interesting to speculate about which of
the imaging modalities and techniques we
rely on today will become the antiquated
examinations of the future!!
 AI may replace jobs, personnel as radiologists
in the future!

25. THANK YOU