A T-tube cholangiogram is a radiological procedure to visualize the biliary tract after surgery involving placement of a T-tube. Contrast medium is injected through the T-tube under fluoroscopy and images are taken in various views. It is used to identify any obstructions in the biliary tract post-surgery. Precautions include having bleeding parameters within normal limits and administering antibiotics prior. The T-tube cholangiogram provides important information about the biliary system after surgery involving placement of a T-tube for biliary drainage.

1. RADIOLOGICAL PROCEDURE
QUESTIONS AND ANSWERS – 3 MARKS
By
Iniya sanjana
Melhin hebi
Nithya
Simon
Barath
Nandha kumar
Mano
Guided by
G Yogananthem
Dr.Harshavardhan

2. 1. Osmolarity (by Iniya Sanjana)
Osmolarity refers to the the concentration of a solution expressed as the total number
of solute particles per kilogram.
There are two types of osmolarity they are high osmolarity and low osmolarity.
High osmolarity:
It means more particles are in the serum.(eg. Diatrizoic acid, iothalamic acid these are
ionic monomers).
Low osmolarity:
It means they are more dilated. Non-ionic compounds do not dissociate In
water ; therefore they are lower in osmolarity.
Low osmolarity contrast media(LOCM) have undergone further evolution with
increased hydroxyl groups replacing carbonyl group for additional solubility in
water (eg. Iohexol (NIM) , ionic dimers).
Indication:
History of cardiac disease or dysfunction
History of asthma or allergy
Age< 1 year
2. PERCUTANEOUS NEPHROSTOMY ( by Nandha kumar)
Percutaneous nephrostomy is widely used interventional procedure for
upper Urinary diversion and decompression of the renal collecting system and
it has been performed as a minimally invasive method of removing kidney
stone.
➢ PCN can be done under Fluoroscopy or ultrasound guidance
INDICATION
➢ Urinary tract obstruction
➢ Urinary diversion (eg :ureteric injury, urine leak)
➢ Access for Percutaneous procedures (eg :stone treatment, antegrade
ureteric stenting)
➢ Diagnostic testing (eg : antegrade pyelography)
CONTRAINDICATION :
• Uncorrectable bleeding diathesis
• Uncooperative patient
• Severe respiratory disease
• Pregnancy

3. PATIENT PREPARATION :
1. Patient should be well explained about the procedure
2. Patient fasting for four hours before procedure
3. Do not dehydrate the patient
4. Informed consent should be taken beforehand
5. Bleeding parameters should be within normal limits
6. Antibiotics should be given half an hour piror to procedure
EQUIPMENT :
PROCEDURE:
• Fluoroscopy or ultrasound guidance
• Local anesthesia with 1% or 2% lidocaine
• 18 gauge puncture needle an alternative to be
use micropuncture set with 21 or 22 gaugeneedle
• 0.035 inch stiff guidewire
• Water soluble contrast media

4. Step 1: patient positioning
With a patient in prone position. A roller pack is placed underneath pelvic region and
another under upper abdomen and chest region. The side be operated should be brought
at the edge of operating table. The area should be cleaned with povidone iodine and
draped.
Step 2: surface making
If we place PCN in quadrangle of safety formed by posterior axillary line as lateral limit,
upper margin of iliac crest as lower limit, lateral margin of paraspinous muscles as medial
limit. The 11th and 12th rib border as upper limit, there are less chances of associated
intrabdominal visceral injuries
Step 3: Percutaneous puncture
The 5ml LA in form of 2% lignocaine is injected. Puncture site
selection is crucial for the risk of hemorrhage the best route for needle entry into the renal
collecting system is via an oblique posterolateral approach along the end of the posterior
calyx. This line is near the posterior axillary line and is about 2-3 cm below the 12th rib
Step 4: guide wire insertion
Once position of needle is ensure, guide wire is introduced through the needle under
Fluoroscopy. Once done Occluder is taken out with the guide wire and attached to an external
drainage bag. Final position of malecot catheter is confirmed by repeating dye study
AFTER CARE :
• Vitals should be record ever half hourly for first 6 hours post
procedure
• Bed rest should be advised for around 4 hours
3.Indications for Single contrast Barium enema (by Nithya)
It is radiographic examination under fluoroscopy that can detect changes or
abnormalities in the large intestine. It is performed by radiologist and assessed
by x-ray technologist. An enema is injected of a liquid into your rectum through
a small tube. In this case, the liquid contains a metallic substance barium that
coats the lining of the colon.
Single contrast barium enema refers to imaging the colon is filled
with barium sulfate, without addition of air or CO2. Single contrast study may
be sufficient for suspected colon cancer

5. Barium suspension; low density 30%
Volume- 30gram of barium + 70g water
=100g (1gm of water=1ml of
water)
Barium 1 to 1 and half litre.
Indications
Colorectal neoplasia
Uncooperative, very debilitated or immobile patient
Malabsorption
Inflammatory bowel
Large bowel obstructive
Polyposis
Diverticulosis

7. Cystography (by Mano)
A Cystogram is a Radiological examination under fluoroscopy, that takes pictures of our
urinary bladder and urethra and it is performed by a Radiologist and assisted by an x-ray
technologist. A thin flexible tube (catheter) is inserted through our urethra into our bladder.
Contrast material is introduced into our bladder through the catheter, then x-rays are taken with
the contrast material in our bladder. Additional x-rays may be taken while urine flows out of our
bladder, in which case the test is called a voiding cystogram..
We are using urographinas contrast medium for this investigation of
strength 350mg. we are mixing it with sterile water in 1:2ratio. We may require 50
to 150 ml of prepared contrast medium solution.
LPO or RPO views of bladder may helpful to visualize bladder and urethra.
Indications;
- dysfunctional voiding
- hematuria
- trauma.

8. 1.Percutaneous transhepatic cholangiography
(By Melhin Hebi)
Percutaneous transhepatic cholangiography is a radiological technique under
fluoroscopy used to visualize the anatomy of the biliary tract.
A contrast medium is injected into a bile duct in the liver, after which x-ray are
taken
- Water soluble iodinated contrast is used
- Images are taken in PA, RAO LAO views
INDICATIONS
• Failure of ERCP
• High biliary strictures
• To identify obstructive jaundice
• Intra and extra hepatic biliary calculi
CONTRA INDICATION
• Bleeding diathesis
• Gross ascites
• Biliary tract sepis

9. MYELOGRAPHY (by Simon)
Description
Myelography is an imaging examination that involves the introduction of a
spinal needle into the spinal canal and the injection of contrast material in the space around
the spinal cord and nerve roots (the subarachnoid space) using a real-time form of x-ray
called fluoroscopy
●It uses a contrast dye and X-rays or computed tomography (CT) to look for problems in the
spinal canal.
●Problems can develop in the spinal cord, nerve roots, and other tissues.
INDICATIONS:
• Intraspinal abnormalities
• Nerveroot abnormalities
. Disc prolapse (skipped disck)
• Spinal stenosis (spinal canal narrows and compresses spinal cord and nerves)
• Tumours
• Metastases
CONTRINDICATION:
• Blood in CSF
• Increased intracranial pressure
• Decreased platelet count,patient on anticoagulation
• Arachnoditis
Done in spinal region especially in cervical and lumbar region are done

10. Cervical myelography – chin downwards touching eternal area
Lumbar myelography – knee flexed towards abdomen chin close to knee
patient be in lumbar puncture position.
Needles – 25 and 26 gauge spinal needle.
Contrast - a liquid (usually iodine or gadolinium) that is injected into your body
to make certain tissues show up clearly during diagnostic imaging
(angiography, CT, myelogram, MRI).
BARIUM ENEMA ( by Bharath)
A barium enema also known as lower gastro intestinal series, is
a procedure in which a liquid containing barium sulfate is introduced into the
rectum to obtain high contrast xray images of large intestine (colon).
CONTRAINDICATIONS FOR BARIUM ENEMA:
1. Pregnancy
2. Complete bowel obstruction
3. Allergy to iodinated contract media
4. Acute inflammatory conditions
5. Suspected perforation
6. Active bleeding
7. Paralytic ileus
8. Patient with cardiac insufficiency

11. 10 DAY RULE (by Iniya Sanjana)
●The “10 day rule” recommended that, in women of child-bearing potential,
non-urgent x ray examinations that entailed pelvic irradiation should be done to
the first 10 days onset of the menstrual cycle.
● Its rationale was to avoid irradiating a fetus before the mother realised that
she was pregnant.
● There was little, if any, risk of damaging the fetus during the first two weeks
of gestation—that is before the first period was missed.
●For examinations in which the uterus will be within or close to the irradiated
area, radiographers and radiologists ask patients if there is any chance that they
may
● the 'ten day rule,' which states that "whenever possible, one should confine
the radiological examination of the lower abdomen and pelvis to the 10-day
interval following the onset of menstruation." ... If there is a missed period, a
female should be considered pregnant unless proved otherwise.
☆1 – 10 days safe to x Ray’s.
☆10 – 28 days no safe for fetus under radiological examination especially x
Ray's l.

12. ASCENDING URETHROGRAPHY IN MALE (by Nandha kumar )
AUG is the Fluoroscopy study of lower Urinary tract in which the
contrast is introduced into the bladder via the catheter
It is mainly used to demonstrate the anterior urethra
INDICATION :
• Pelvic trauma
• Urethral diverticula
• Urethral obstruction
• Urethral mucosal
• Suspected Urethral fistula
CONTRAINDICATION :
Acute Urinary tract infection
CONTRAST MEDIA :
Water soluble contrast media like conray 280, trivideo 400 mg,
urographin 60 are used which is diluted in normal saline 1 :3 ratio
EQUIPMENT :
1. Fluoroscopy unit and spot film device and fitting table
2. Video recorder
3. Jagues or foley’s catheter
4. In small infants fine feeding tube is adequate
5. Xylocaine jelly 1-2 %
PATIENT PREPARATION :
- Patient should be well explained about the procedure.
Informed consent should be taken beforehand

13. PROCEDURE :
Using steile technique a catheter introduced into the bladder. A 5f
feeding tube side holes are used in children and older children 8f or 10 f
polyethylene or soft rubber catheter with end holes are suitable
Retracted Forenskin and clean the tip of the penis with betadine and the
catheter is introduced into the bladder via the catheter.
The catheter is should be lubricated with an anaesthetic jelly and inserted
slowly and gently into the urethra holding a penis on the vertical position. the
patient position should be oblique to visualize the full length of the urethra.
Inject the contrast and Ideal image demonstrate the entire length of the
urethra
AFTER CARE :
• Observation for 6 hours
• No special after care is necessary complication

14. 2. Types of First Line Treatment of Acute
Contrast Adverse Reaction . ( by Nithya )
In all acute contrast media reaction call for radiologist have emergency drugs and
equipment readily. Check for nausea, vomiting, skin erythema, urticaria, decreased
bp, abnormal heart rate, bronchospasm
anaphylactoid generalized reaction
- call for resuscitation team
- suction airway is needed
- elevate patient leg if hypertensive
-oxygen by mask 6-10I/min
-Intramuscular adrenaline 1:1000,0.5 in adult
-Intravenous fluid rapidly
BARIUM MEAL ( by Mano)
Barium meal procedure is radiological study under The fluoroscopy imaging, to be seen
gastrointestinal tract.
CONTRAINDICATION;
- Complete bowl obstruction
- suspected perforation
- Pregnancy
CONTRAST;

15. Two types of contract
*Single contrast
*Double contrast
Single contrast
Using thick barium (80-90%)and more Amount of barium suspension alone to
fill the Gastrointestinal tract.
Double contrast
Using thin barium (30-40%) and small amount Of barium suspension with air to coat
the gastrointestinal Tract.
Loopogram (by Melhin Hebi)
A loopogram is a diagnostic test that is performed on the section of bowel
that functions in place of the urinary bladder. Patients who do not have a
bladder or have a malfunctioning bladder may undergo a surgical procedure
called a urinary diversion to reroute the flow of urine through an opening in the
abdomen.
- Loopogram is a fluorouscopic imaging and is done with a
contrast called X-ray dye.
- The contrast dye shows up on images and allows the radiologist to clearly see and
check the internal organs.

16. LEAD SHIELDING (by Simon)
☆Lead metal is the preferred material for radiation shielding.
☆The use of lead shielding can prevent exposure of regions adjacent to the
area that is to be imaged from being exposed to any ionizing radiation.
☆Small lead shields can be placed on the table underneath the patient,
directly in front of the x-ray beam before it penetrates the patient to protect
the gonads or the fetus.
LEAD GLOVES:
● Radiation resistant gloves are often used to offset the risk of scatter
beam radiation exposure during fluoroscopy, cardiac cath lab and
electrophysiology lab procedures. Pair of gloves made up of lead..
▪0.5mm Pb (1.2% @90kv)
LEAD APRON:
● An apron that contains lead or equivalent material and issufficiently
pliable to wear as protection from ionizing radiation. It is used to shield
patients and personnel during radiological procedures.
☆ Person assisting the patient must wear the lead apron and the lead gloves if
their hands will be in the beam.
☆LEAD EQUIVALENT - 0.2MM.

17. ANTEGRADE PYELOGRAM (by Bharath)
Antegrade pylography is the procedure used to visualize the upper collecting
system of the urinary tract,.i.e.kidney and ureter. It is done in cases where the
excretory or retrograde pylography has been failed or contraindicated or when
a nephrostomy tube in a place or the deliniation of upper tract is desired.
INDICATION OF ANTEGRADE PYELOGRAM:
* narrowing of the ureter (stricture)
* kidney stone
* blood clot
* tumor
CONTRAINDICATIONS :
* Pregnancy patients
* an allergic to contrast dye or iodine
* kidney failure
COMPLICATIONS OF ANTEGRADE PYELOGRAM:
* bleeding
* sepsis
* formation of urine filled cyst
* blood clots in nephrostomy tube
CONTRAST DYE:
Contrast dye used in antegrade pylography is intravenous urography(contrast
medium)

18. PROCEDURE:
* The kidney will be initially examine with ultrasound probe or CT scan. After
they are located, the overlying skin will be anesthetized and a needle will be
passed directly into the kidney.
*The needle is used to inject dye to outline the renal collective system(part of
the urinary tract draining urine between kidney and bladder) on xray images
and detect any blockages or obstruction
AFTER CARE:
After , the procedure the patient should be taken to recovery room. The patients
blood pressure, pulse and breathing should be checked. And the flow of urine is
checked for a day, if it is any abnormalities the aspirin or other tablets should be
recommended.
Hysterosalpingography (by Iniya Sanjana)
* It is a radiological procedure in which the contrast
is injected into the uterus to study the uterine cavity
and fallopian tubes.
* It is also known as uterosalpinogography.
Indications:

19. * Infertility
* Recurrent abortions
* Tubal surgery
* Migrated IUCD
* Uterine and tubal lesions like fibroids, polyps
Contra-indication:
* Pregnancy
* Severe renal or cardiac disease
* Week prior to and the week following onset of menstruation.
Patient preparation:
* patient should be abstain from intercourse between booking
the appointment and the time of examination unless a reliable method of
contraception is used to avoid the possibility of irradiating an early pregnancy.
* Patient should be fasting for 4 hours prior to the procedure.
* Must follow 10 day .

20. 16.T-TUBE CHOLANGIOGRAM
(by Nandha kumar)
INTRODUCTION :
A T-tube cholangiogram is a fluoroscopic procedure in which
contrast medium is injected through a T-tube into the patient's biliary tree. The
T-tube is most commonly inserted during a cholecystectomy operation when
there is a possibility of residual gall stones within the biliary tree.
INDICATION :
• patient's with possibility of residual small gallstones post
cholecystectomy
• obstructive jaundice

21. • bile duct stricture
• surgeon unable to explore bile duct during cholecystectomy surgery
CONTRAINDICATION :
• non-consent by patient to procedure
• contrast or iodine allergy
• pregnancy
• barium study within last 3 days
PREPARATION :
• Patient should be wearing a hospital gown
• consent should be taken beforehand
• no diet restrictions (some centres suggest fast from solids for 4 hours
prior)
• collect relevant previous imaging for ease of access prior to procedure
• prophylactic dose of broad spectrum antibiotic prior to procedure
(immunosupressed patients
PROCEDURE
• The patient is positioned supine on the X-ray table
• A slightly RPO position can help to ensure the CBD is not superimposed
over the patient's spine.
• A scout image of the RUQ should be acquired.

22. • The tip of the T-tube is cleaned with antiseptic
• T-tube should be raised and tapped to ensure there are no airbubbles
lurking in the tube.
• A butterfly needle should be inserted into the T-tube
• The syringe plunger is withdrawn to remove bile from within the duct.
(optional)
• The entire biliary tree should be imaged during injection of contrast
medium.
• Injection should continue until the entire biliary tree is opacifiedand
there is passage of contrast into the deuodenum.
• If the intrahepatic ducts do not fill, the patient can be tilted
trendelenburg and further contrast injected into the T-tube.
• The patient may need to lie on their left hand side to fill the left hepatic
duct.
• At least 2 views of the entire biliary tree should be recorded by spot film
• oblique views are often taken
• The T-tube is made of very flexible plastic. The flexibility of the plastic
facilitates the percutaneous remove of the T-tube without surgical
intervention. T-tubes are usually sized between 10 French (10F) and 16
French (16F).
• This is an AP/PA supine T-tube cholangiogram image. The biliary tree is
outlined with contrast medium. There appears to be extravasation of
contrast medium outside the biliary tree and minimal contrast in the
deuodenum.

23. AFTER CARE:
• patient can eat and drink normally
• warn patient to advise of any itching or rash post procedure
• patient should remain in hospital for observation for at least 24 hours
post procedure
• If the T-tube is removed at the end of the procedure, the wound should
be check.

24. 17.Nephrogram ( by Nithya)
• Is the radiographic examination of the kidney after the intravenous
injection of contrast media.
• Contrast media is usually given as a i.v.bolus injection within 30-60
seconds. The density of the nephrogram is directly proportional to the
plasma concentration of contrast media. More iodine increase the
density of nephrogram
• A nephrotomogram at 12-20 seconds after commencement of
contrast injection (arm-kidney time) may demonstrate a vascular
phase with delineation of renal vascularity.
It aim to show the nephrogram i.e renal outlines, renal parenchyma
opacified by contrast medium in renal tubules
Indications
Mass lesion of renal parenchyma
Exact localization of the mass
Adrenal tumours
Renal trauma
Poor contrast concentration
Contraindication for intravenous urogram ( by Nithya)
Intravenous urogram is the radiographic examination of urinary tract
including renal parenchyma, calyces, and pelvis after intravenous injection of
contrast media
Contraindication

25. 1. Iodine sensitivity
2. Pregnancy
3. Hepatorenal syndrome
4. Renal failure
5. Previous history of allergy to contrast
6. Severe history of anaphylaxis previously
GASTROGRAFIN ENEMA (by Mano)
A gastrografin enema is radiological study under the x ray series. Gastrografin
enema involves the injection of water soluble gastrografin into the rectal using a
Foley catheter.the abdomen to show the outline of the colon, rectal and anus.
Indications ,high risk of intestinal perforation .
They are two types of contracts
1.single contrast
2. A double contrast.

26. 18. SINOGRAM ( by Melhin Hebi)
A sinogram is an X-ray (fluoroscopic) procedure to view an abnormal passage
(fistula /sinus) or cavity that originates or ends in one opening, often on the skin.
A thin catheter(venflon) is introduced into the fistula /sinus .
Urographin is used as a contrast medium. contrast medium is introduced into
the catheter. A contrast medium is used to identify the starting of the fistula
/sinus, its pathway and what organs are involved.
A sinogram /fistulogram is used to diagnose and assess the size and shape of
fistulas and sinuses and prepare a treatment plan.
Digital Subtraction Angiography (by Simon)
*Digital subtraction angiography (DSA) is a fluoroscopy technique
used in interventional radiology.
*DSA provide image of the blood vessels in the brain to detect problem with
the blood flow.
*The procedure involves inserting a catheter into an artery in the leg and
passing it up to the blood vessels in the brain.
*Digital images are obtained before and after injection of contrast
medium to differentiate vascular pathology from surrounding
anatomy.

27. Principles of DSA:
*Mask principle:
Image of a particular anatomical region is recorded.
*Contrast image:
The patient is injected with Contrast to fill the vessels and the
image is taken.
*Contrast-mask image:
The mask image is substracted from the contrast image by pixel
basis and stored as contrast-mask image.
Advantages:
• Relatively non-invasive procedure ,that improves image quality with
lesser use of contrast medium.
• Real time imaging
• Can be performed on outpatient basis therefore Cost
effective.
Disadvantages:
• Limited spatial resolution
• Artefacts.

28. • Small visual field.
19.BILBAO DOTTER TUBE ( by Bharath)
An intestinal tube placed into the duodenum or jejunum for the performance
of various gastrointestinal radiological studies.
This is placed with the aid of a stiffening guide wire. It is Used for enteroclysis
procedure to infuse the contrast medium into The distal duodenum
USES OF BILBAO DOTTER TUBE:
* It is a catheter used through the channel of the endoscope to Produce short
duration internal access.
*The tube is made up of polyethylene and easy
to operate inside the body.

29. 20. Higginson's pump ( by Iniya sanjana)
° The Higginsons Syringe allows to overcome liquid flow obstructions
through occasional pumping. This helps greatly in avoiding cramps and
achieving a thorough colon cleanse.
° A syringe or higginson enema is like a pump that can be used to pump an
enema solution into the patient. Like a syphon hose, the syringe includes an
in-line bulb that can be pumped to provide pressure and flow.
This higginson syringe is made from a red rubber and you can expect
about 1-3 ounces per pump depending on how completely you squeeze
the bulb.

30. Sialogogues (by Iniya Sanjana)
Sialogogues are the agents which enhance salivary secretions. They
activate muscarinic cholinergic receptors of the parasympathetic
nervous system to increase salivary flow.
All commercially available preparations have a limited duration of action,
making frequent application necessary.
Pilocarpine – is regularly used.
cevimeline is newly introduced drug enchanes salivary secretions by
directly stimulating the muscular receptors.
They are used to treat sialadinitis that may be se
sialolithiasis. neck.Xerostomia often seen after radiotherapy of head and Sjogren's syndrome cevimeline
is Used.
21. MYELOGRAM (by Nandha kumar)
INTRODUCTION :
Myelogram is a radiographic study combining the use of a
contrast medium with a Fluoroscopy to evaluate abnormalities of the spinal
cord and its nerve root system
INDICATION :
• Spinal cord tumers
• Cysts
• Spinal nerve root injury

31. • Compression of the spinal cord by a herniated disc
CONTRAINDICATION :
• Blood in the CSF
• Increase intracranial pressure
• Decreased platelet count or patient on
anticoagulation
• Arachnoditis
CONTRAST MEDIA :
• Omnipaque Non-ionic, water soluble, lodine
based contrast media
• Water soluble contrast media providesexcellent
radiographic visualization of the nerve root
system, is easily absorbed into the vascular
system and is excreted by the kidney
PUNCTURE POSITIONS:
Body position for lumbar puncture
• Lumbar puncture (L3-L4)
• Prone position
• Left lateral position with spin flexed to
widen the interspinous space.
Body position for cervical puncture
• Cervical puncture (C1-C2)
• Erect position
• Prone position with the head flexed to
open the interspinous space.
INJECTION OF THE CONTRAST MEDIUM :
• The radiologist looks at the spine under
Fluoroscopy to find best location to
position the needle
• The skin is cleaned

32. • The needle is inserted and the contrast
medium is injected through into the
subarachnoid space.
22.DEFECOGRAPHY (by Nithya)
Defecography is the radiographic study under fluoroscopy.
It shows the rectum and anal canal as the change during defecation (having a
bowel movement). This test is used to evaluate for disorder of the lower
bowel.
Defecography is a technique in which a barium contrast
medium is introduced into your rectum after the radiologist performs a rectal
examination. The barium is visible within the rectum on x-rays. During the test
patient is instructed to defecate empty the rectum. This x-rays are taken while
the person is sitting at rest, straining, squeezing and during defecation.
INDICATION
• Chronic constipation
• Rectal prolape
• Rectocele
• Fecal incontinence
• Anismus
Examples of double contrast study (by Nithya)
The double contrast refers to the use of positive and negative contrast
agents to increase the sensitivity of the examination.

33. The double contrast study is sensitive to visualize mucosal irregularities
Positive contrast: barium or barium like agent e.g gastrografin
Negative contrast: air or co2
Double contrast study are used in
Barium swallow
Barium meal
Enteroclysis small bowel enema
Barium enema
23.Intensifier ( by Mano)
Fluoroscopy was performed by viewing the live ,produced by x-ray on a thick
intensifying screen.
The patient side of the vacuum bottle has the Al window (1 mm) which is a
curved one to withstand air pressure.
The evacuated glass envelope limits the size of the level and diameter ranges
from 23 to 57 cm .
The field size can be reduced electronically using electrostatic
focusing.
The glass envelope is mounted inside a metal container, which will avoid
damage and rough handling.

34. The image intensified is an evacuated glass envelope, which contains
four basic elements.
They are
1.input screen
2.focusing electrodes
3.anode
4.output screen.
PROPERTIES OF AN IDEAL BARIUM
PREPARATION
➢ High density for optimum study being performed.
➢ Stable suspension which does not settle.
➢ Should not flocculate with secretions .
➢ Low melting characteristics to give a good and stable
mucosal coating.

35. 1. SIALOGRAPHY ( by Melhin Hebi)
Sialography is the x ray fluorouscopic study of salivary glands. It usually involves
the injection of a small amount of contrast medium into the salivary duct of a
single gland. A small flexible tube called a catheter is introduced in to the opening
of the duct. Then the contrast medium is injected into the duct.
Contrast agents are classified into two groups : fat soluble and water soluble
contrast agents.
• Water soluble contrast agents can fill the finer elements of
the ductal system.
• Fat soluble contrast agents are viscous and can cause allergic
reactions. These can also cause discomfort to the patient .fat
soluble contrast agents do not fill finer elements of theduct.
•Images are taken in lateral oblique view of the face.
2. TYPES OF CONTRAST REACTIONS (by simon)
Barium Sulfate Contrast Materials
You should tell your doctor if these mild side effects of barium-sulfate
• contrast materials become severe or do not go away:
• Stomach cramps
• diarrhoea
• nausea
• vomiting
• Constipation
Tell your doctor immediately about any of these symptoms:

36. • hives
• Itching
• Red skin
• Swelling of the throat
• Difficulty breathing or swallowing
• Hoarseness
• Agitation
• Confusion
• Fast heartbeat
• Bluish skin color
You are at greater risk of an adverse reaction to barium-sulfate
contrast materials if:
you have a history of asthma, hay fever, or other allergies,which will
increase your risk of an allergic reaction to the additives in the barium-sulfate
agent.
you have cystic fibrosis, which will increase the risk of blockage in the
small bowel.
Iodine-based Contrast Materials
Mild reactions include:
• nausea and vomiting
• headache
• itching
• flushing
• mild skin rash or hives
Moderate reactions include:
• severe skin rash or hives
• wheezing
• abnormal heart rhythms
• high or low blood pressure
• shortness of breath or difficulty breathing
Severe reactions include:

37. • difficulty breathing
• cardiac arrest
• swelling of the throat or other parts of the body
• convulsions
• profound low blood pressure
A very small percentage of patients may develop a delayed reaction with a rash
which can occur hours to days after an imaging exam with an iodine-based
contrast material. Most are mild, but severe rashes may require medication
after discussion with your physician.
Allergic-type reactions can be immediate or
delayed
Immediate reactions take place within an hour
after injection of the contrast medium. These reactions can be
mild (nausea, vomiting, mild urticaria, pallor), moderate (severe
vomiting, extensive urticaria, dyspnea, rigor, laryngeal edema) or
severe (pulmonary edema, cardiac arrhythmias or arrest,
circulatory collapse). The incidence of immediate reactions to
nonionic contrast media ranges from 0.01%–0.04% (severe) to
3% (mild).1 Nonionic agents are associated with a decreased risk
of adverse reactions.2 Delayed reactions, occurring hours to
weeks after injection of the contrast medium, are usually self-
limiting and cutaneous (rash, erythema, urticaria,angioedema).
They may be accompanied by fever.
“Iodine allergy” is not a risk factor for allergic-type
contrast reactions Predisposing risk factors for immediate
allergic-type reactions include a previous adverse reaction,
atopy, asthma, dehydration, heart disease, existing renal disease,
hematologic disease (e.g., sickle-cell anemia), age less than 1
year or more than 65 years, and use of β-blockers or non-
steroidal anti-inflammatory drugs. Allergy or sensitivity to
seafood is not associated with an increased risk of allergic-type
contrast reactions.

38. Barium follow through
This test is similar to a barium meal but aims to look for problems in the small
intestine. Therefore, you drink the barium liquid but then need to wait 10-15
minutes before any X-rays are taken. This allows time for the barium to reach
the small intestine. You may then have an X-ray every 30 minutes or so until
the barium is seen to have gone through all the small intestine and reached the
large intestine (colon). This test will last longer than the previous ones. The
overall time taken will depend on how quickly your gut moves thingsalong.
Barium follow through showing small bowel

39. 3. INDICATIONS OF RETOGRADE PYELOGRAM
( by Bharath)
† Non visualization of uretral segment on IVU and CTU
* A retrograde pyelogram may be able to better image the
Segment of ureter
† Better characterization of pelvicalcyeal abnormalities than the
IVU and CTU
† In case of obstruction such as tumour, stone, stritchures in
the kidney or ureters.
SAILOGRAPHY:
Sailography is the radiographic examination of the salivary glands. It is
usually involves the injection of small amount of contrast media into the
Salivary duct of single gland followed by routine xray projections.

40. INDICATIONS:
* In case of obstruction
* To evaluate the ductal pattern
* In case of intraglandular neoplasms
CONTRAINDICATIONS:
* patients allergic to iodine and contrast medium
* patients with thyroid function tests
4. Advantages of barium sulfate (by Iniya
sanjana)
• Excellent coating of mucosa
• Cost effective
• High density

41. • Provides a positive contrast in x-ray
• Radiopaque material
• Insoluble material
• Non absorbed or metabolized
• Eliminated from the body
*Barium is not absorbed into the blood, allergic reactions are extremely rare
*Non absorbable, hence barium does nor degrade in the bowel.
Fluoroscopy
Fluoroscopy is an imaging modality that uses x-rays to
allow real-time visualization of body structures. During fluoroscopy, x-ray
beams are continually emitted and captured on a screen, producing a
real-time, dynamic image.
This allows for dynamic assessment of anatomy and
function. High density contrast agents may be introduced into the patient
to allow for greater differentiation between structures.

42. Write shot notes on IVU? (By Nandha kumar)
It is the radiographic examination of Urinary tract including renal parenchyma
Calyces pelvis and bladder after the intravenous injection of contrast media
UROGRAM:
Visualization of kidney, parenchyma, Calyces and pelvis resulting from iv
injection of contrast
INDICATION :
• Ureteric fistula and strictures
• Suspected Urinary tract Pathology
• Renal/Ureteric calculi
• Hydronephrosis
• Suspected renal injury
• TB of the urinary tract
• Disease of renal collecting system and renal pelvis
• Ureter abnormalities
CONTRAINDICATION :
• Renal failure
• Pregnancy
• Allergic conditions
• Diabetes

43. CONTRAST :
Non-ionic, iodinated, Water soluble, Locm used in procedure.
1ml in 1kg body weight concentration adult 600 ml/gm
hydrated .
What are the advantages of non ionic iv
contrast?
• Non-ionic contrast agents are a group of contrast media thatdo
not dissociate into charged particles.
• Non-ionic contrast agents have a low osmolality and tend to have
less toxicity. However, as with all iodinated contrast agents.
• Less patient allergic reaction
• Non-ionic contrast media do not dissolve into charged particles.
When it enters a solution
• For every three iodine molecules in non-ionic solution. One
neutral molecule is produced
• Non-ionic contrast media are referred to as 3:1 compounds
• These types of contrast media will have little attenuation of the x- ray beam.
SIDE EFFECTS OF IV CONTRAST MEDIA :
Late adverse reactions after intravascular iodinated contrast
medium include symptoms such as
• Nausea
• Vomiting
• Headache
• Itching

44. • skin rash
• musculoskeletal pain
• fever.
DISADVANTAGE :
More money
What are the contraindication of barium swallow
Barium swallow is a radiographic study of pharynx and
esophagus up to the level of stomach with the help of contrast
INDICATION :
• Dysphasia
• Retrosternal pain
• Hiatus hernia
• Reflex esophagitis
• Foreign body impaction
• Motility disorder of oesophagus (eg: Achalasia)
CONTRAINDICATION :
• Suspected leakage from oesophagus into the mediastinum
• Trachea – oesophagus fistula
• Blockage in intestines or Severe constipation
CONTRAST :
• Water soluble contrast Barium sulphate is used

45. • It is used to examination upper gastrointestinal tract with
include esophagus to lower extent the stomach
5. ALARA
The aim of radiation protection should prevent deterministic effect and
minimize the probability of stochastic effect to levels deemed to be
acceptable. this could be achieved,
By setting limits well below threshold dose to deterministic effects, and
The probability of stochastic effects could be reduces by limiting exposure as
low as reasonably achievable.
ALARA PRINCIPLES

46. • Minimizing time in radiation field
• Maximizing the distance from radiation source
• Using proper shielding
Short notes on fistulogram
Fistulogram is the radiological examination under fluoroscopy to
view an abnormal passage (fistula/sinus) between two or more anatomic
spaces. It may include a passage from inside the body to an opening on the
skin.
A small tube is inserted into the opening of the fistula/sinus. Barium
based contrast is injected into the fistula to identify its pathway.
Types of fistula
• Arteriovenous fistula- b/w artery and vein
• Anal fistula -infected tunnel b/w skin and anus
• Obstetric fistula- b/w rectum and vagina
6. Retrograde ileogram (by Mano)
o A retrograde pyelogram is an imaging test that uses X- rays to look at
your bladder, ureters, and kidneys.
• The ureters are the long tubes that connect your kidneys to your
bladder.
• The ureters are the long tubes that connect your kidneys to your
bladder.

47. • The exam is done using anesthesia.
Contraindications :
1.pregnacy
2.Iodine sensitively
3.kidney failure
Indications:
1.Tumor
2.stone
ATOMIC NO OF IODINE AND BARIUM
BARIUM;
Barium is a chemical element with
the symbol Ba and atomic number 56. It is the fifth element in group 2 and is a
soft, silvery alkaline earth metal. Because of its high chemical reactivity, barium
is never found in nature as a free element.
IODINE ;
Iodine is a chemical element with
the symbol I and atomic number 53. The heaviest of the stable halogens, it
exists as a lustrous, purple-black non-metallic solid at standard conditions that
melts to form a deep violet liquid at 114 degrees Celsius, and boils to a violet
gas at 184 degrees Celsius.

48. 33. DACRYOCYSTOGRAPHY (DCG) ( by Melhin)
- Dacryocystography is a fluorouscopic examination of the nasolacrimal
apparatus. It is used to diagnose the condition causing problems of the tear
duct. Non -ionic iodinated contrast medium is used.
- Dilate the punctum to insert the cannula. Non -ionic iodinated contrast is
injected into a cannulated duct, avoiding air bubbles.
- The most frequent indication is epiphora (excessive tearing or watering of the
eyes).
Endoscopic Retrograde
CholangioPancreatography (ERCP)
ERCP is a procedure to examine the pancreatic and bile duct. It
combines the use of endoscopy and fluorouscopy to diagnose and treat certain
problems of
• the duodenum
• the bile ducts
• the gall bladder and the pancreatic duct
Water soluble iodine based contrast is used. The upper GI tract must be empty.
Generally, no eating or drinking is allowed 8 hours before ERCP.
A flexible, lighted tube (endoscope) about the thickness of our index finger is
placed through the mouth and into the stomach and first part of the small
intestine (duodenum). The region can be directly visualized with the
endoscopic camera.

49. 34.BARIUM SWALLOW (by Simon)
It’s a radiological procedure that examines the
GI(gastro intestinal) tract with the help of barium swallowed by the patient at
the right and the x ray is taken The process of getting x-ray pictures of the
esophagus or the upper gastrointestinal (GI) tract (esophagus, stomach, and
duodenum). The x-ray pictures are taken after the patient drinks a liquid that
contains barium sulfate (a form of the silver-white metallic element barium).
The barium sulfate coats and outlines the inner walls of the esophagus and the
upper GI tract so that they can be seen on the x-ray pictures.
Indications
However, there remain many indications for a barium swallow including:
• high or low dysphagia
• gastro-oesophageal reflux disease (GORD/GORD)
• assessment of a hiatus hernia
• generalised epigastric pain.
• globus pharyngeus
• persistent vomiting
• assessment of fistula
Contraindications
Water-soluble contrast agents should be used instead of barium in the
following cases:
• suspected perforation
• post-operative assessment for leak .

50. Nephrogenic systemic fibrosis:
• Nephrogenic systemic fibrosis (NSF), also known as nephrogenic fibrosing
dermopathy (NFD), is a disease of fibrosis of the skin and internal organs
reminiscent but distinct from scleroderma or scleromyxedema.
• It is caused by gadolinium exposure used in imaging in patients who have renal
insufficiency.
• Nephrogenic systemic fibrosis almost always occurs in patients with renal
insufficiency who have had imaging studies (eg, magnetic resonance
angiography) with gadolinium, a contrast agent used in imaging studies.
• Gadolinium can be found in tissue samples of nephrogenic systemic
fibrosis, and alternative contrast agents are being sought.
35.HYPOTONIC DUODENOGRAPHY (by Bharath)
Hypotonic duodenograpghy is the radiological examination
of the duodenum without interference from peristalsis activity. It involves
duodenal intubation, Contrast media is inserted and visualization with barium
and air.
INDICATIONS:
* In case of tumours in the head of pancreas
* patients with chronic pancreatitis
* lesions on the upper abdominal
* Any abnormalities in the pancreas and bile ducts meet the small intestine

51. HYPOTONIC DUODENOGRAPGHY
SHOULDER ARTHROGRAPHY:
Shoulder arthrography is an imaging technique used to
evaluate the glenohumeral Joint to evaluate the joint components. A shoulder
arthrography is a procedure usually performede Fluorscopic guidance and also
through the ultrasound and CT.
Double contrast or single contrast examination can be
utilized, depending upon the nature of the suspected underlying process.
INDICATIONS:
* shoulder instability
* To access joint structure
† rotator cuff
† glenohumeral articular cartilage

52. † glenoid labrum.
SHOULDER ARTHROGRAPHY
Thank you