Ductography by prof j venkat
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Ductography is a special type of contrast enhanced mammography used for imaging the breast ducts. • Ductography can aid in diagnosing the cause of an abnormal nipple discharge and is valuable in diagnosing intraductal papillomas and other conditions. • It is also called as Galactography or Ductogalactography
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Ductography by prof j venkat
- 1. DUCTOGRAPHY By Prof J Venkat Professor in Radiography Chennai India +919444923675 WhatsApp venkatdgr8@gmail.com SPECIAL PROCEDURE SERIES IN RADIOGRAPHY
- 2. OBJECTIVE • Definition • Anatomy • Indications • Contraindications • Equipment needed • Materials needed • Contrast media • Preparation • Procedure • Filming • Positive findings • Complications • Post procedural care/Instructions By Prof J Venkat Professor in Radiography Chennai India
- 3. • Ductography is a special type of contrast enhanced mammography used for imaging the breast ducts. • Ductography can aid in diagnosing the cause of an abnormal nipple discharge and is valuable in diagnosing intraductal papillomas and other conditions. • It is also called as Galactography or Ductogalactography DEFINITION - DUCTOGRAPHY By Prof J Venkat Professor in Radiography Chennai India
- 4. ANATOMY • Each breast has 15 to 20 sections, called lobes. • Each lobe has many smaller structures called lobules. These end in dozens of tiny bulbs that can produce milk. • The lobes, lobules, and bulbs are all linked by thin tubes called ducts. • These ducts lead to the nipple in the center of a dark area of skin called the areola. • Fat fills the spaces between lobules and ducts. • There are no muscles in the breast, but muscles lie under each breast and cover the ribs. By Prof J Venkat Professor in Radiography Chennai India
- 5. INDICATIONS • Any Discharge from single duct • Blood discharge from any duct • Lesion involving duct • DCIS ( Ductal Carcinoma In Situ ) • Now obsolete, because of high quality Mammography and MR ductography By Prof J Venkat Professor in Radiography Chennai India
- 6. CONTRAINDICATIONS • Allergy to Contrast media • Multiductal discharge By Prof J Venkat Professor in Radiography Chennai India
- 7. EQUIPMENT NEEDED • Mammography Unit By Prof J Venkat Professor in Radiography Chennai India
- 8. MATERIALS NEEDED • Gloves • Dilators • Rabinov sialography catheter or Venflon • Connecting tube • Plaster • 10 CC syringe • Dressing tray • Gauze • Cotton • Cups • Forceps • Blade handle • Kidney tray Picture from Techniques in Diagnostic Imaging Edited by Graham H. White House and Brian s. Worthington By Prof J Venkat Professor in Radiography Chennai India
- 9. CONTRAST MEDIA • Water soluble Iodinated contrast • Non-Ionic or Ionic Contrast media • Iohexol 240mg I/mL • Omnipaque • Contrapaque • Dosage 0.5 -1ml , until patient feel fullness or pain By Prof J Venkat Professor in Radiography Chennai India
- 10. PREPARATION • Patient asked to remove all metal ornaments around head and neck • Nil oral for 4 hours • Patient asked to remove the cloths and wear hospital gown • IV line should be ready • Blood tests report should be available • Informed consent to be obtained. By Prof J Venkat Professor in Radiography Chennai India
- 11. PROCEDURE – IN SHORT • Patient lie down on the table in supine • The origin of Duct is identified and wiped with gauze • The orifice slightly massaged and look for a bead of blood or discharge • Catheter filled with contrast inserted into orifice • Catheter taped at with plaster • Various view taken during injection of the contrast By Prof J Venkat Professor in Radiography Chennai India
- 12. PROCEDURE • Before cannulation, a craniocaudal subareolar magnification view is obtained and assessed for suspicious calcifications or masses. • Gentle periareolar pressure is used to elicit discharge. • This area is known as the “trigger point” or “trigger zone” By Prof J Venkat Professor in Radiography Chennai India
- 13. • Testing for the presence of blood is useful to identify suspicious discharge ; a standard test strip may be used By Prof J Venkat Professor in Radiography Chennai India
- 14. • First, the nipple is gently cleansed and sterilized • with an alcohol swab to loosen and remove dried secretions with Betadine • Then, the tip of the cannula is placed on the orifice By Prof J Venkat Professor in Radiography Chennai India
- 15. • If necessary, the nipple may be stabilized between the thumb and forefinger By Prof J Venkat Professor in Radiography Chennai India
- 16. • The cannula is seamlessly attached to a 1–3-mL syringe filled with full-strength of Contrast without air bubble By Prof J Venkat Professor in Radiography Chennai India
- 17. • The cannula is secured with Micropore tape. • A volume of 0.2–0.3 ml of contrast material is slowly administered. If pain begins, stop By Prof J Venkat Professor in Radiography Chennai India
- 18. FILMING • A single craniocaudal digital spot magnification view is obtained with Mammography machine If necessary additional views such as MLO taken By Prof J Venkat Professor in Radiography Chennai India
- 19. FILMING A single craniocaudal digital spot magnification view is obtained with Mammography machine • CC View • MLO View By Prof J Venkat Professor in Radiography Chennai India
- 20. POSITIVE FINDINGS DUCTAL ECTASIA. CRANIOCAUDAL DUCTOGRAM SHOWS A DILATED DUCTAL SYSTEM. FIBROCYSTIC CHANGES. NINETY-DEGREE MEDIOLATERAL DUCTOGRAM SHOWS CYSTS COMMUNICATING WITH THE DUCTAL SYSTEM. By Prof J Venkat Professor in Radiography Chennai India
- 21. POSITIVE FINDINGS CRANIOCAUDAL DUCTOGRAM SHOWS CONCOMITANT FIBROCYSTIC CHANGES (BLACK ARROW, AND A PAPILLOMA (WHITE ARROW) NINETY-DEGREE MEDIOLATERAL DUCTOGRAM SHOWS A FILLING DEFECT (ARROWS) WITHIN DILATED DUCTS, WHICH REPRESENTS A PAPILLOMA.. By Prof J Venkat Professor in Radiography Chennai India
- 22. POSITIVE FINDINGS CARCINOMA. CRANIOCAUDAL DUCTOGRAM SHOWS LARGE FILLING DEFECTS NEAR THE NIPPLE (ARROW). CARCINOMA IN A PATIENT, MAGNIFIED CRANIOCAUDAL DUCTOGRAM BETTER SHOWS THE FILLING DEFECTS WITHIN THE DILATED DISTAL DUCTAL SYSTEM (BLACK ARROW) By Prof J Venkat Professor in Radiography Chennai India
- 23. COMPLICATIONS • Craniocaudal ductogram shows immediate extravasation (arrow). By Prof J Venkat Professor in Radiography Chennai India
- 24. ARTEFACTS • Air bubbles. • Craniocaudal ductogram shows dark air bubbles (straight arrows) within contrast material, which were inadvertently administered. • Note the air bubbles obstructing side channels (curved arrows). By Prof J Venkat Professor in Radiography Chennai India
- 25. ARTEFACTS Reflux • Craniocaudal ductogram shows the cannula within a papilloma (arrow). • Note the reflux of contrast material to the surface. By Prof J Venkat Professor in Radiography Chennai India
- 26. POST PROCEDURAL CARE • Remove the cannula catheter • The dilation of the duct can sometimes be uncomfortable; however it is usually not painful. The nipple may be squeezed to remove the contrast. • Pain killers may be given By Prof J Venkat Professor in Radiography Chennai India
- 27. THANK YOU • References • Radiological Procedures - A Guideline Edited by Dr Bhushan N. Lakhakar • A Guide to Radiological Procedures Edited by Stephen Chapman • Fundamentals of Special Radiographic Procedures Edited by ALBERT M. SNOPEK • Clark’s Positioning in Radiography By Kathleen C Clark (1896-1968) • Techniques in Diagnostic Imaging Edited by Graham H. White House and Brian s. Worthington • Wikipedia, The Free Encyclopedia • Ductography: How To and What If S. Horatio Slawson, MD • Bradley A. Johnson, MD By Prof J Venkat Professor in Radiography Chennai India +919444923675 WhatsApp venkatdgr8@gmail.com