Digestive system imaging 1 class
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The document discusses radiographic techniques for examining the pharynx, esophagus, and stomach. It describes 3 parts of the pharynx and techniques for visualizing each part, including lateral views with the mouth open or Valsalva maneuver. Esophagography techniques include single- and double-contrast studies to evaluate the esophageal walls and detect lesions or disorders. Stomach examinations involve prone, upright, and oblique views under single- or double-contrast to assess mucosal lining and identify abnormalities.
![Pharynx
Why does the adenoid enlarge?
Increase in size of the adenoid can occur on its own or due
to inflammation [infection, allergy]](https://image.slidesharecdn.com/digestivesystemimaging1class-191205092517/85/Digestive-system-imaging-1-class-5-320.jpg)
Digestive system imaging 1 class
- 1. Radiographic Technique 3 May, 2014 Prepared by: Behzad Ommani Bachelor of Radiology Master of Medical Engineering
- 2. Pharyography
- 3. Pharynx Pharynx has 3 Parts: 1. Nasopharynx 2. Oropharynx 3. Laryngopharynx
- 4. Pharynx Nasopharynx The Nasopharynx (nasal part of the pharynx) is the uppermost part of the pharynx. It extends from the base of the skull to the upper surface of the soft palate. Radiography: 1. Lateral with open mouth 2. Lateral with Valsalva's manuver
- 5. Pharynx Why does the adenoid enlarge? Increase in size of the adenoid can occur on its own or due to inflammation [infection, allergy]
- 6. Pharynx Radiography: 1. Lateral with open mouth
- 7. 2. Lateral with Valsalva's manuver The Valsalva maneuver or Valsalva manoeuvre is performed by moderately forceful attempted exhalation against a closed airway, usually done by closing one's mouth, pinching one's nose shut while pressing out as if blowing up a balloon. Pharynx
- 8. Oropharynx Radiography with Thick Barium : 1. AP 2. Lateral Laryngopharynx 1. AP 2. Lateral 3. Oblique Pharynx
- 9. Pharynx
- 10. Pharynx
- 11. Esophagography
- 12. Esophagus • The esophagus (oesophagus) is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. During swallowing, food passes from the mouth through the pharynx into the esophagus and travels via peristalsis to the stomach. • The word esophagus is derived from the Latin œsophagus, which derives from the Greek word oisophagos, lit. "entrance for eating.“ • In humans the esophagus is continuous with the laryngeal part of the pharynx at the level of the C6 vertebra. The esophagus passes through posterior mediastinum in thorax and enters abdomen through a hole in the diaphragm at the level of the tenth thoracic vertebrae (T10).
- 13. • It is usually about 10–50 cm long depending on individual height. It is divided into cervical, thoracic and abdominal parts. Due to the inferior pharyngeal constrictor muscle, the entry to the esophagus opens only when swallowing or vomiting. Esophagus
- 14. Esophagus CONTRAST STUDIES The esophagus may be examined by performing a full- column. Single-contrast study in which only barium or another radiopaque contrast agent is used to fill the esophageal lumen. A double-contrast procedure also may be used. For this study, barium and carbon dioxide crystals (which liberate carbon dioxide) are the two contrast gents. No preliminary preparation of he patient is necessary.
- 15. Barium sulfate mixture A 30% to 50% weight/volume suspension is useful for the full-column, single contrast technique. A low viscosity, high density barium developed for double contrast gastric examinations may be used for a double- contrast examination. Whatever the weight/volume concentration of the barium, the most important criterion is hat the barium flows sufficiently to coat the walls of the esophagus. The barium manufacturer's mixing instructions must be closely followed to attain optimum performance of the contrast medium. Esophagus
- 16. Opaque foreign bodies lodged in the pharynx or in the upper part of the esophagus can usually be demonstrated without the use of a contrast medium. A soft tissue neck or lateral projection of the retrosternal area may be taken for this purpose. The following steps are observed: Obtain a lateral neck radiograph at the height of swallowing for the delineation of opaque foreign bodies in the upper end of the intra thoracic esophagus. Esophagus
- 17. Have the patient swallow. This elevates the intra thoracic esophagus a distance of two cervical segments, placing it above the level of the clavicles. Tufts or pled gets of cotton saturated with a thin barium suspension are sometimes used to demonstrate an obstruction or to detect nonopaque foreign bodies in the pharynx and upper esophagus. Esophagus
- 18. Single : Fistulae such as between Esophagus & Trachea Tumor side organ such as Bronchi carcinoma Aneurysm such as Aorta Enlargement side organ such as Cardiac, Lymphatic nodule Double : Diverticuli Ulcer Carcinoma Strictures Varices Esophagus
- 19. AP, PA, OBLIQUE, AND LATERAL PROJECTIONS Image receptor: 35 x 43 cm lengthwise and centered so the top of the IR is positioned at the level of the mouth for inclusion of the entire esophagus. AP OR PA PROJECTION •The following steps are observed: Place the patient in the supine or prone position with the arms at the side and the shoulders and hips equidistant from the table. •Center the midsagittal plane to the grid. Turn the head slightly, if needed, to facilitate drinking of the barium mixture. Esophagus
- 20. AP OR PA OBLIQUE RAO or LPO position The steps are as follows: Position the patient in the RAO or LPO position with the midsagittal plane forming an angle of 35 to 40 degrees from the grid device. Adjust the patient's arms in a comfortable position with the shoulders lying in the same plane. Center the elevated side to the grid through a plane approximately 2 inches (5 cm) lateral to the midsagittal plane. Esophagus
- 21. LATERAL PROJECTION R or L position The procedure is as follows: •Place the patient in the lateral position facing the radiographer. •Place the patient's arms forward. •Center the midcoronal plane to the grid. Central ray: Perpendicular to the midpoint of the IR (the central ray will be at the level of (T5- T6). Esophagus
- 22. Esophagus
- 23. Diverticulum A diverticulum is a pouch extending out from the normal wall of the swallowing channel. Diverticula (the plural of diverticulum) can develop in either the pharynx or esophagus. Although small diverticula may not cause symptoms, larger diverticula can cause dysphagia for liquids and solids. Regurgitation of undigested food, often hours after ingestion is a characteristic symptom of patients with diverticula. Disorder
- 24. Luminal Stenosis Luminal stenosis occurs as a result of mechanical narrowing of the esophageal lumen in patients with esophageal strictures. Symptoms arise when the swallowed food is too large to pass. The typical symptom in a patient with an esophageal stricture is dysphagia for solid food, often followed by regurgitation of undigested material. Disorder
- 25. Disorder Spastic Disorders Whereas spastic disorders of the pharynx are rare, those of the esophagus are common. A certain amount of motor dysfunction may be seen in normal individuals. Esophageal dysmotility may range from mild, infrequent events that are within normal limits, to profound incardination associated with every swallow.
- 26. Disorder Achalasia Achalasia is a motor disorder of the esophagus without an obvious etiology. In achalasia, nerve cells (myenteric plexus) located between the esophageal muscle layers are damaged (degenerate). The result is a complete loss of coordinated esophageal contractions (peristalsis) and failure of lower esophageal sphincter (LES) relaxation (Figure 21). This combination produces obstruction at the esophagogastric junction and loss of effective propulsion
- 28. PRELIMINARY PREPARATION An empty stomach is ensured by withholding both food and water after midnight for a period of 8 to 9 hours before the examination. This restriction is made to prevent excessive fluid from accumulating in the stomach and diluting the barium suspension enough to interfere with its coating property. Because it is believed that nicotine and chewing gum stimulate gastric secretion and salivation, some physicians tell patients not to smoke or chew gum after midnight on the night before the examination. Stomach
- 29. CONTRAST STUDIES 1. Single-contrast 2. Double-contrast The principal advantages of this method over the single contrast method are that small lesions are less easily obscured and the mucosal lining of the stomach can be more clearly visualized. Stomach
- 30. Stomach
- 31. PA PROJECTION Image receptor: 30 x 35 cm lengthwise. Positionof patient : For radiographicstudies of the stomach and duodenum, place the patient in the recumbent position. However, the upright position is sometimes used to demonstrate the relative position of the stomach. In adjusting thin patients in the prone position, support the weight of the body on pillows or other suitable pads positioned under the thorax and pelvis. This adjustment keeps the stomach or duodenum from pressing against the vertebrae, with resultant pressure-filling defects. Stomach
- 32. Position of part : • Adjust the patient's position, either recumbent or upright, so that the midline of the grid coincides with a sagittal plane passing halfway between the vertebral column and the left lateral border of the abdomen. • Center the IR about 1-2 inches above the lower rib margin at the level of L1- L2 when the patient is prone. For upright images, center the IR 3 to 6 inches (7.6 to 15 cm) lower than Ll - L2. The greatest visceral movement between the prone and the upright positions occurs in asthenic patients. Respiration: Suspend at the end of expiration unless otherwise requested. Stomach
- 33. Stomach Central ray : Perpendicular to the center of the IR.
- 34. Stomach
- 35. PA AXIAL PROJECTION Image receptor: 30 x 35 cm lengthwise. Positionof patient : Place the patient in the prone position Position of part : Similar PA. Respiration: Similar PA. Stomach
- 36. Central ray : Directed to the midpoint of the IR at an angle of 35 to 45 degrees cephalad. Gugliantinil recommended a cephalic angulation of 20 to 25 degrees for demonstration of the stomach in infants. Stomach
- 37. Stomach
- 38. PA OBLIQUE PROJECTION RAO position Image receptor: 30 x 35 cm lengthwise. Positionof patient : Place the patient in the prone position Position of part : • After the PA projection, instruct the patient to rest the head on the right cheek and to place the right arm along the side of the body. • Have the patient raise his or her left side and support the body on the left forearm and flexed left knee Stomach
- 39. • Adjust the patient's position so that a sagittal plane passing midway between the vertebrae and the lateral border of the elevated side coincides with the midline of the grid. •Center the IR about I to 2 inches above the lower rib margin at the level of L1-L2 when the patient is prone. •Make the final adjustment in body rotation. The approximately 40 to 70 degrees of rotation required to give the best image of the pyloric canal and duodenum depend on the size, shape and position of the stomach. In general, hypersthenic patients require a greater degree of rotation than do sthenic and asthenic patients. Stomach
- 40. Stomach • The RAO position is used for serial studies of the pyloric canal and the duodenal bulb because gastric peristalsis is usually more active when the patient is in this position. Respiration: Suspend at the end of expiration unless otherwise requested. Central ray : Perpendicular to the center of the IR.
- 41. Stomach
- 42. AP OBLIQUE PROJECTION LPO position Image receptor: 30 x 35 cm lengthwise. Positionof patient : Place the patient in the Supine position Position of part : • Have the patient abduct the left arm and place the hand near the head, or place the extended arm alongside the body. • Place the right arm alongside the body or across the upper chest, as preferred. • Have the patient turn toward the left, resting on the left posterior body surface.
- 43. • Flex the patient's right knee, and rotate the knee toward the left for support. • Place a positioning sponge against the patient's elevated back for immobilization. • Adjust the patient's position so that a sagittal plane passing approximately midway between the vertebrae and the left lateral margin of the abdomen is centered to the IR. Adjust the center of the IR at the level of the body of the stomach. The centering will be at a point midway between the xiphoid process and the lower margin of the ribs. Stomach
- 44. • The degree of rotation required to best demonstrate the stomach depends on the patient's body habitus. An average angle of 45 degrees should be sufficient for the sthenic patient, but the degree of angulation can vary from 30 to 60 degrees. Respiration: Suspend at the end of expiration unless otherwise instructed. Stomach
- 45. Stomach
- 46. lATERAL PROJECTION Image receptor: 30 x 35 cm lengthwise. Positionof patient : Place the patient in the Supine position Position of part : • Have the patient abduct the left arm and place the hand near the head, or place the extended arm alongside the body. • Place the right arm alongside the body or across the upper chest, as preferred. • Have the patient turn toward the left, resting on the left posterior body surface. Stomach
- 47. Stomach • The degree of rotation required to best demonstrate the stomach depends on the patient's body habitus. An average angle of 45 degrees should be sufficient for the sthenic patient, but the degree of angulation can vary from 30 to 60 degrees. Respiration: Suspend at the end of expiration unless otherwise instructed.
- 48. Stomach