Contrast media 4
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The document provides guidance on performing an oral cholecystography procedure to visualize the gallbladder. It begins by explaining that oral cholecystography involves administering a radiopaque contrast agent by mouth that is then excreted by the liver and collects in the gallbladder. The examination involves three stages - a control radiograph, administration of the contrast agent the evening before, and imaging the following day. Factors like diet, contrast agent dose, and imaging after a fatty meal are discussed to optimize visualization of the gallbladder and any gallstones. Contraindications to the procedure and different contrast agents used are also mentioned.
Contrast media 4
- 1. IN THE NAME Of GOD Amir al-Muminin, peace be upon him, said: There is no wealth like wisdom, no destitution like ignorance, no inheritance like refinement and no support like consultation. املومنينرامي(ع)فرمودند: هيچينيازيبنچو،عقلوهيچيفقرنچوناداني،نيستهيچثيرانچو،ادبوهيچ پشتيبانينچوترمشونيست.
- 2. Contrast Media September, 2014 Prepared by: Behzad Ommani Bachelor of Radiology Master of Medical Engineering Instructor Radiology Group
- 4. In vertebrates the gallbladder (Cholecyst, Biliary Vesicle) is a small organ that aids mainly in fat digestion and concentrates bile produced by the liver. Human anatomy
- 5. Human anatomy The gallbladder is a hollow system that sits just beneath the liver. In adults, the gallbladder measures approximately 8 centimetres (3.1 in) in length and 4 centimetres (1.6 in) in diameter when fully distended. It is divided into three sections: fundus, body and neck. The neck tapers and connects to the biliary tree via the cystic duct, which then joins the common hepatic duct to become the common bile duct. At the neck of the gall bladder is a mucosal fold called Hartmann's pouch, where gallstones commonly get stuck. The angle of the gallbladder is located between the costal margin and the lateral margin of the rectus abdominis muscle.
- 7. Function When food containing fat enters the digestive tract, it stimulates the secretion of cholecystokinin (CCK). In response to CCK, the adult human gallbladder, which stores about 50 millilitres (1.7 U.S. fl oz; 1.8 imp fl oz) of bile, releases its contents into the duodenum. The bile, originally produced in the liver, emulsifies fats in partly digested food. cholecystokinin (CCK) is a peptide hormone of the gastrointestinal system responsible for stimulating the digestion of fat and protein
- 8. Oral cholecystography (O.C.G) Oral cholecystography is a procedure used to visualize the gallbladder by administering, by mouth, a radiopaque contrast agent that is excreted by the liver. This excreted material will collect in the gallbladder, where reabsorption of water concentrates the excreted contrast. Since only 10% of gallstones are radiopaque, the remaining 90% will appear as translucent on an opaque background in an abdominal x-ray
- 9. • Proven hypersensitivity to iodinated contrast agents • Sever hepatic renal disease • Dehydration • Cholecystectomy • Malabsorption syndrome • Diarrhea • Drug Vomiting • Bilirubin higher than 3 milligram Contraindications
- 10. Contrast media nomens Past : • Tetra Bromophenolphtalein (Graham) • Tetra Aiodophenolphtalein (Graham) • Priodax • Telepaque (Hopp & Archer 1952) Today : • Obsil • Cholebrine • Bliopaque • Biloptin • Solu-Biloptin
- 11. Contrast media Dose Telepaque or Biloptin: Normal patient 6 (Tablet) × 0/5 (gram iodine) = 3 gram iodine Fat patient 12 (Tablet) × 0/5 (gram iodine) = 6 gram iodine Higher Dose is danger and to be affected with kidney .
- 12. Exam Stages The examination is a three stage process : 1) Day 1 the patient takes a laxative for two days prior to the examination days, (check contraindications to laxative preparation, care with diabetics, and conditions like Crohns disease)
- 13. 2) Day 2 a single control radiograph of the whole abdomen or the right side of the abdomen. (This film is then examined to determine, the position of the gallbladder (level with the upper margin of the hepatic flexure of the colon, to demonstrate any radio opaque calculi, evaluate the efficacy of the laxative preparation and judge the exposure for the second part of the examination.) The evening before the examination the patient takes the oral contrast agent tablets as directed by the manufacturer, typically 3 grams of Calcium Ipodate (Biloptin) with plenty of water, the patient remains nil by mouth except for water until the examination 14 hours after taking the contrast medium. Exam Stages
- 14. 3) The day of the examination check the patient has taken the tablets as directed, followed the dietary instructions and not been sick or had diarrhea. The evening of the day before the examination the patient is encouraged to have a high fat meal to empty the gall bladder. It can help to better absorb Telepaque but it is not affect on Bilopaque and Biloptin. AFM or After Fatty Meal Film. If the gall bladder is adequately demonstrated with obvious calculi then a fatty meal is given, either a proprietary product such as "Prosperol" or a glass of full fat milk or two eggs , 40 minutes later the gall bladder is imaged in whichever projection best demonstrated . Exam Stages
- 15. Exam case
- 16. Gallstone A gallstone is a crystalline concretion formed within the gallbladder by accretion of bile components. These calculi are formed in the gallbladder, but may pass distally into other parts of the biliary tract such as the cystic duct, common bile duct, pancreatic duct, or the ampulla of Vater. On the basis of their composition, gallstones can be divided into the following types: Cholesterol stones Cholesterol stones vary in color from light-yellow to dark-green or brown and are oval 2 to 3 cm in length, often having a tiny dark central spot. To be classified as such, they must be at least 80% cholesterol by weight.
- 17. Gallstone 2. Pigment stones Pigment stones are small, dark stones made of bilirubin and calcium salts that are found in bile. They contain less than 20% of cholesterol (or 30%, according to the Japanese classification system). 3. Mixed 75 % people have mixed stones.
- 18. Gallstone
- 19. Intra venous cholangiography (I.V.C) X-ray examination of the bile ducts, using a radiopaque dye as a contrast medium. In the intravenous method, the dye is administered intravenously and is excreted by the liver into the bile ducts. Preparation of the patient for the intravenous method requires restriction of fluids to concentrate the dye and may also include cleansing of the intestinal tract on the day prior to the examination with a laxative or enema so that fecal material and gas will not obscure the biliary tract. X-ray films are taken at 10-minute intervals as the dye is excreted via the cystic, hepatic, and common bile ducts into the intestinal tract. The excretion is usually completed within 4 hours.
- 20. I.V.C Application • Cholecystectomy • O.C.G is not satisfactory • Coldo-colelitiasis • Bilirubin higher than 3 milligram Contraindications : • Sever hepatic renal disease • Bilirubin higher than 5 milligram
- 21. Contrast media nomens Cholografin Cholevue Biligram Endobil Biligrafin This contrast media after injection to be connected Albumin Protein more than O.C.G contrast media, then they have higher toxicity than O.C.G Contrast media.
- 22. T-tube Cholangiogram 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.
- 23. Indications & Contraindications Indications Patient must have T-Tube insitue Patient's with possibility of residual small gallstones post cholecystectomy Obstructive Jaundice Bile duct Stricture Surgeon unable to explore Bile duct during cholecystectomy surgery Contraindications Contrast or iodine allergy Pregnancy ( pregnancy test required) Barium study within last 3 days
- 24. Examination 1. The drainage tube is clamped the day preceding the examination to let the tube fill with bile as a preventive measure against air bubbles entering the ducts, where they would simulate cholesterol stones. 2. The preceding meal is withheld. 3. When indicated, a cleansing enema is administered about 1 hour before the examination. Premedication is not required.
- 25. Examination The patient is positioned supine on the X-ray table than a slightly RPO position 20ْ can help to ensure the CBD is not superimposed over the patient's spine. A preliminary/scout image of the RUQ should be acquired. Injection should continue until the entire biliary tree is opacified and there is passage of contrast into the duodenum. If the Intra Hepatic 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.
- 26. Contrast media The density of the contrast medium used in postoperative cholangiograms is recommended to be no more than 25% to 30% because small stones may be obscured with a higher concentration. Urografin 60% Conray 280 Omnipaque
- 27. Case
- 28. Endoscop Retrograde Cholangio paceratography (E.R.C.P) Endoscopic retrograde cholangiopancreatography is an endoscopic procedure that involves the use of fiberoptic endoscopes. You will be lightly sedated and your doctor will insert an endoscope through the mouth, down the esophagus, and into the stomach and small bowel. A smaller tube or catheter is passed through the endoscope and into the bile ducts. Dye is injected into the ducts, and the doctor takes X-rays that can show whether a tumor is present in the bile ducts.
- 29. E.R.C.P
- 31. Arthrogrphy An arthrogram is a series of images, often X-rays, of a joint after injection of a contrast medium An arthrogram is used to: Find problems in your joint capsule, ligaments, cartilage (including tears, degeneration, or disease), and the bones in the joint. In your shoulder, it may be used to help find rotator cuff tears or a frozen shoulder. Find abnormal growths or fluid-filled cysts. Confirm that a needle has been placed correctly in your joint before joint fluid analysis, a test in which a sample of joint fluid is removed with a thin needle. Check needle placement before a painkilling injection, such as a corticosteroid injection.
- 32. Arthrogrphy The joint area will be cleaned and a local anesthetic will be injected into the tissues around the joint to reduce pain. Next, if fluids are present in the joint, the physician may suction them out (aspirate) with a needle. These fluids may be sent to a laboratory for further study. Contrast agents are then injected into the joint through the same location by attaching the aspirating needle to a syringe containing the contrast medium. The purpose of contrast agents in x-ray procedures is to help highlight details of areas under study by making them opaque.
- 33. Contrast media Agents for arthrography are generally air and water-soluble dyes, the most common containing iodine. Air and iodine may be used together or independently. After the contrast agent is administered, the site of injection will be sealed and the patient may be asked to move the joint around to distribute the contrast. Radiolucent Contrast media : Air Carbon dioxide Oxygen Radioopaque Contrast media : Urografin 60% - Conray 240 – Hexabrix Omnipaque - Visipaque - Ultravist
- 34. Case
- 35. Radiographic examination involving opacification of pathological tracks or extravasation of contrast medium from hollow organs (gastrointestinal tract, bladder) or tubular structures (bile ducts, ureter) . One of the main indications of fistulography is to look for postoperative anastomotic leaks or injuries of the bile ducts and ureters. Fistulous tracks may also develop from infections, inflammatory or tumour lesions and may brake through to the skin (abscesses, osteomyelitis). In these cases the fistulous track may be demonstrated by inserting a blunt needle or small catheter into the mouth of the fistula. Fistulography
- 36. Contrast media Oily Contrast media : lipiodol Ethiodol Myodile Water soluble Contrast media : Urografin 76% - Conray 240 – Hypaque Omnipaque - Visipaque - Niopam
- 37. Case