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Fluoroscopy
Fluoroscopy Procedures
| Question | Answer |
|---|---|
| What are the two types of contrast media used? | Barium sulfate and Water-soluble iodinated contrast |
| When is water-soluble iodinated contrast used? | In case of perforation or fistula |
| What are some advantages to water soluble iodinated contrast? | easily removed and readily absorbed by the body and excreted by kidneys |
| What is the biggest challenge of GI radiography? | Eliminate motion |
| Which body position best affects peristalsis? | RAO |
| Name the fluoroscopic exam.A series of x-rays of the esophagus. The x-ray pictures are taken after the person drinks a solution that contains barium. The barium coats and outlines the esophagus on the x-ray. | Esophagram (barium swallow or UGI series) |
| For HMC what overhead projections are taken? | AP, RAO (PA Oblique), Right Lateral |
| This is performed by forcibly exhaling against a closed nose and mouth; increases venous pressure making a hernia more evident. | Valsalva |
| What does the acronym GERD stand for? | Gastroesophageal Reflux Disease |
| Stomach Protrudes through cardiac orifice through tear or weakness of diaphragm. | hiatal hernia |
| What are the two kinds of hiatal hernia? | sliding (most common) and paraesophageal (most dangerous) |
| Zenkers diverticulum | a pouch at the back of the throat at a weak spot where the throat and esophagus join. |
| Achalasia | The smooth muscle layer of the esophagus loses normal peristalsis (muscular ability to move food down the esophagus), and the lower esophageal sphincter (LES) fails to relax properly in response to swallowing. |
| Schatzki's ring | This is a ring of tissue in the lower esophagus located at or near the border of the lower esophageal sphincter. |
| Abnormal change in cells of lower esophagus. Caused by chronic acid reflux and damages to mucosa. | Barrett's esophagus |
| For the AP and Right Lateral positions of the esophagram where does your central ray enter? | enters perpendicular at the level of T5 T6 (sternal angle) |
| T5 T6 | sternal angle |
| For the PA oblique (RAO) where does the central ray enter? | Enters perpendicular at the level of T5 T6, 2" lateral to MSP |
| What is a UGI? | Fluoroscopic study of esophagus, stomach and duodenum using injedsted contrast. |
| What does UGI stand for? | upper gastrointestinal series or gastrointestinal series |
| What are some reasons we may be doing a UGI? | tumors, blockages, dysphagia, blood in stool, nausea and vomiting, constipation or diarrhea, abdominal pain, anemia, weight loss |
| What two ways can an UGI be done? | single contrast or double contrast? |
| If an exam is single contrast what is meant by that? double contrast? | single - just bariumdouble - barium with air |
| What is a biphasic exam? | combination of single and double contrast during same procedure |
| At HMC, What projections are done for an UGI? | AP scout (high KUB), AP, LPO, PA, RAO, Right Lateral |
| In the PA, where does your central ray enter? | Enters at the level of L1 L2 and MSP (approximately between the xiphoid and umbilicus) |
| L1 L2 | Transpyloric plane |
| There is double contrast visualization in the _________ and ________filled within the ______. | fundus; barium; body and pylorus |
| Which position does this describe?CR perpendicular to L1 L2, midway between vertebral column and elevated lateral border. Patient is prone. | RAO |
| Air and barium are located in which parts of the stomach? | fundus - airbody and pylorus - barium |
| What is the position of the patient and entrance of CR in the right lateral? | Patient is placed on their right side with no rotation. Hands up by face. CR enters perpendicular at the level of L1 L2. Midway between the midcoronal plane and anterior surface of abdominal cavity |
| The right lateral position allows us to see what better? | Allows duodenal loop to open up better with less superimposition |
| In the AP position air is better visualized in the body and pylorus. T/F | True |
| The patient is rotated ______ degrees in the AP Oblique ____. | 45; LPO |
| Explain how the patient is positioned and where the CR enters in the AP oblique. | Patient is supine and rotated 45 degrees. The CR enters perpendicular at the level of L1 L2 midway between the vertebral column and the dependent lateral abdominal border at the level of L1 L2 |
| Where is the air visualized in the LPO? | Air filled body and pylorus. barium filled fundus |
| In the PA position where do the scotty dogs face? AP position? | face side up ; face side down |
| In the AP oblique which ribs are elongated? PA? | side down; side up |
| Small bowel series or follow through | A radiologic examination of the small intestine from the distal duodenum / duodenojejunal junction to the ileocecal valve. |
| When are the films taken? | Taken at timed intervals (every 15 mins.) |
| What projections are taken on a small bowel? | Scout KUB, AP (HMC) or PA taken at timed intervals |
| Where does the CR enter for the PA or AP projecton? | Enters perpendicularly at the level of L2 and MSP |
| What are some reasons the Small bowel series may be done? | Bowel obstruction, inflammatory bowel disease (chrohn's disease) |
| Barium Enema | A lower gastrointestinal series is a medical procedure used to examine and diagnose problems with the human colon (large intestine). X-ray pictures are taken while barium sulfate fills the colon via the rectum |
| How is the patient position? | Patient is placed in the Sim's position |
| Sim's Position | It is performed by having a patient lie on their left side, left leg extended and right leg flexed |
| The IV pole is no higher than ______ inches above level of anus. | 24 |
| Tip is inserted, in BE, _____ inches into the rectum. | 4 |
| What are the essential projections of the BE exam? | AP KUB scout, Right lateral decubitus, Left lateral decubitus, Left lateral (rectum), PA, Ap, RPO, LPO, LPO Axial (sigmoid shot), Post Evac AP |
| What kVp is used for Double contrast exams? Why? | 90-95 kVp; double contrast is for lining of organs do not need as much penetration |
| What kVp is used for single contrast exams? Why? | 105-110 kVp; single contrast is for filling of a structure need more penetration |
| For the AP scout, AP and PA of the BE where does the CR enter? | enters at the level of L4 L5, iliac crest |
| Which projection is decribed?CR perpendicular to median coronal plane at the level of the ASIS. Patient is placed on left side, flex knees slightly. Shoulders and hips perpendicular. Demonstrates the rectum and distal sigmoid. | Left Lateral rectum |
| What is demonstrated in teh LPO axial? | Sigmoid |
| How does the CR enter in the LPO axial projection? | CR angled 30-40 degrees cephalic to enter midline approx. 2" below the ASIS on elevated side |
| LPO is a AP oblique or PA oblique? | AP oblique |
| How does the CR enter in the LPO oblique? | Perpendicular to level of iliac crests approx. 1-2 inches lateral to midline on elevated side (3-4 fingers in from ASIS) |
| How much is the patietn obliqued in the LPO? | 35-45 degrees with left side down |
| Which flexure is open in the LPO? | hepatic flexure |
| Patient is obliqued 35-45 degrees with right side down. Right arm down by the side and left arm across the chest. What position is this? | RPO |
| How does the CR enter in the RPO? | Perpendicular to the film at the level of iliac crest, approx. 1-2 inches lateral to midline on the elevated side (3-4 fingers in from ASIS) |
| Which flexure is open in the RPO? | splenic flexure |
| When do you not do the left and right lateral decubs? | If you are using gastrografin. |
| In the right and left lateral decubs where the does the central ray enter? | horizontal to the floor, perpendicular to the level of the iliac crests |
| Will the AEC be utilized or will you have to set a manual technique for the decubs? | manual technique (watch read outs of other projections) |
| In the ___________ the "up" medial side of the ascending colon and the lateral side of the descending colon is best demonstrated. | right lateral decubitus |
| In the ___________ the "up" latral side of the ascending colon and the medial side of the descending colon is best demonstrated. | left lateral decubitus |
| How is the best way to determine if there is rotation in your lateral? | rotation of pelvis |
Created by:
sr4095
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