Page No.

Video Swallowing Examination                                                                                                  3

Esophagram                                                                                                                              4

Upper GI: Single Contrast                                                                                                          5

Upper GI: Double Contrast                                                                                                        6

Small Bowel Study                                                                                                                    8

Small Bowel Enema / Enteroclysis                                                                                              9

Peroral Pneumocolon                                                                                                               11

Barium Enema: Air Contrast                                                                                                     12

Barium Enema: Single Column                                                                                                  14

Enema Through Ileostomy or Colostomy                                                                                  16

Sinogram/Fistulagram                                                                                                               17

Feeding Tube Studies                                                                                                              18

T-Tube Cholangiogram                                                                                                            19

Excretory Urography                                                                                                               20

            Janet - CHANGE PAGE NUMBERS HERE TO END

 

            Steroid Prep                                                                                                                   

            Glucophage                                                                                                                    

            Attached:    Contrast Agent Data Form                                                     between pp.

        Alphabetical Drug List

        ABCD Approach for Patient Evaluation and Treatment

        Iodinated Contrast Media: Categories of Reactions

        Bristol-Myers Squibb Company - Revised Labeling for Glucophage

Cystogram                                                                                                                                  

Stress (Incontinence) Cystogram                                                                                                 

Attached:  Measurement of the Urethrovesical Angles

in Stress Incontinence                                                                                 between pp.

VCUG - Voiding Cystourethrogram                                                                                            

Hip Arthrogram                                                                                                                          

Lumbar Puncture                                                                                                                        

Myelogram                                                                                                                                 

ERCP                                                                                                                                        

HSG (Hysterosalpingogram)                                                                                                       

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.  Any study requiring video should be performed in the analogue rooms.

B.        Patient Positioning

            1.         If patient can maintain balance, perform the study in the standing position

            2.         If patient cannot maintain balance, use the video swallow chair

C.        Soft Palate Motility

            1.         Lateral video of soft palate

            2.         Patient says "candy"

D.        Overview of Oral/Pharyngeal Phase

            1.         One swallow high density barium, lateral video of mouth and pharynx

            2.         Take lateral spot film of pharynx while patient says "eee"

E.         Boluses

            1.         Boluses of varying consistencies

                        a.         Purees

                        b.         Soft solids (tuna)

                        c.         Hard solids (crackers)

                        d.         Liquids (thick, then thin barium)

            2.         Lateral video of pharynx

            3.         1st swallow is recorded centered over mouth and oropharynx

            4.         2nd swallow is recorded, centered to include the larynx and distal pharynx

F.         Frontal Examination (at the discretion of Speech Pathologist)

            1.         Videotape while patient says "aaaa" to assess vocal cord closure

            2.         Videotape of a single swallow of high density barium

            3.         Spot film while patient puffs his cheeks out against closed lips (to distend pharynx)

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.

B.        Preparation

            1.         NPO after midnight

C.        Materials Needed

            1.         Barium: 1 cup EZ HD with 67 cc of H20 (98% w/w)

            2.         Effervescent agent: 1 packet EZ Gas in 30 cc cup

            3.         Water:  5 cc in a 30 cc cup

            4.         1 cup liquid EZ paque (60% w/v; 40% w/w)

D.        Procedure

            1.         Upright LPO drinking films of esophagus (14 x 14, 3 on 1)

            2.         Cardia (10 x 12)

            3.         Prone RAO drinking films of esophagus (14 x 17; 3 on 1)

            4.         Rapid sequence AP/lateral pharynx/proximal esophagus (for dysphagia)

E.         Esophagram to R/O Perforation

            1.         Preparation

                        None required.

            2.         Materials

                        a.         Water soluble contrast (1 cup)

                        b.         1 cup liquid EZ paque

            3.         Procedure

                        a.         Prone RAO drinking films of esophagus (14 x 17, 3 on 1)

                        b          If no evidence of leak, then repeat with barium.

 

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.

B.        Preparation

            1.         NPO after midnight except necessary medicines with minimal amount of water

            2.         No smoking or chewing gum day of study

            3.         No insulin for diabetics the morning of the study

C.        Materials Needed

            1.         2 cups regular (single contrast) barium

D.        Procedure

            1.         Scout:  AP abdomen film

            2.         UGI films taken by Radiologist for studies performed with the non-digital units:

                        a.         Erect - esophagus and stomach  (10 x 12)

                        b.         Supine - stomach  (10 x 12)

                        c.         Prone RAO - esophagus (14 x 14)

                        d.         Prone RAO - duodenal bulb (with and without compression)

                                    (10 x 12) (Air contrast of duodenal bulb free of spine)

            3.         UGI films taken by Technologist:

                        d.         AP supine - abdomen  (14 x 17)

                        b.         RAO - stomach  (10 x 12)

                        c.         Prone - abdomen  (14 x 17)

                        d.         Right lateral - stomach  (10 x 12)

 

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.

B.        Preparation

            1.         NPO after midnight except necessary medicines with minimal amount of water

            2.         No smoking or chewing gum day of study

            3.         No insulin for diabetics the morning of the study

C.        Materials Needed

            1.         Barium:  cup of EZ HD Barium with 67 cc of water

                        (98% w/w)

            2.         Effervescent Agent: one packet of EZ Gas in 30 cc cup

            3.         Water:  5 cc in a 30 cc cup

            4.         1 cup liquid EZ paque (60% w/v, 40% w/w)

D.        Procedure

            1.         Scout: AP abdomen film (if patient has had any abdominal surgery or recent contrast examination)

            2.         UGI films taken by Radiologist on non-digital fluoroscopy units:

                        a.         Upright, LPO (2-3; 2-on-1 or 3-on-1 films), esophagus

                        b.         LPO (distal antrum)

                        c.         Supine (distal one-half stomach)

                        d.         Right lateral (fundus, retrogastric area, barium-filled duodenal bulb)

                        e.         Flow technique:

                                    One image of stomach RPO

                        f.          RPO (high lesser curvature en face)

                        g.         Duodenal bulb:

                                    i.          LPO

                                    ii.          LPO, erect

                                    iii.         Left lateral through antrum

                                    iv.         Prone on a bolster

                        h.         Supine or prone (duodenal sweep)

                        i.          Prone and RAO (esophageal motility and barium filled esophagus)

                        j.          Prone and RAO (compression of distal stomach and duodenum bulb)

                        k.         Upright (compression)

                                    i.          Frontal (lesser curvature)

                                    ii.          LPO (antrum)

                                    iii.         LPO (duodenal bulb

                                    iv.         RPO (anterior and posterior wall duodenal bulb in profile)

            3.         UGI films taken by Technologist:

                        a.         Prone abdomen (14 x 17 LW)

                                    Center above crest and MSP

                        b.         Additional views may be requested by radiologist

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.

B.        Materials Needed

            1.         Single contrast barium  -  500 cc orally

C.        Delayed Films

            1.         Scout supine abdomen.  Check film with radiologist.

            2.         15 minute prone abdomen.  Check film with radiologist.

            3.         45 minute prone abdomen.  Check film with radiologist.

            4.         Every 30 minutes until barium reaches terminal ileum.  Check films with radiologist.

            5.         Once contrast reaches colon, radiologist will fluoroscopically evaluate small bowel and will obtain spot radiographs of terminal ileum

 

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.

B.        Preparation

            1.         Clear liquid diet 24 hours prior to exam.

            2.         4 dulcolax capsules at 5:00 p.m. the evening prior.

            3.         Metoclopramide:  20 mg administered by mouth 20-30 minutes prior to intubation

C.        Materials Needed

            1.         Catheter:  Balloon-tip catheter from E-Z-Em

            2.         Barium:  Enterobar

            3.         Methylcellulose:  0.5% solution

            4.         4 60 cc slip top syringes

            5.         Tongue depressor

            6.         Xylocaine spray

            7.         Surgilube

            8.         20 cc syringe

            9.         Lead strip

D.        Procedure

            1.         Scout film: AP abdomen

            2.         20 mg Metoclopramide orally 30 minutes prior to catheter insertion

            3.         Spray patient's throat with cetacaine spray to obtain partial anesthesia

                        Note:   Warn patient that the spray stings and that they should not inhale the spray into their lungs

            4.         Lubricate catheter and guide-wire with silicone spray and pull guide-wire back approximately 30 cm from catheter tip

            5.         While patient is in sitting position, place catheter in back of mouth or through nose and have patient swallow tube

                        a.         Advance the tube until its tip reaches into the first loop of the jejunum

                        b.         If a balloon catheter is used, insufflate with 15 cc of air

            6.         Approximately 180-240 ml of barium is injected through the tube at a rate of approximately 75-100 ml per minute

            7.         The methylcellulose is then introduced using a total quantity of 1.5 to 2 liters

            8.         Compression spot films are taken of each intestinal loop  (total of about 10-14 spot films - 10 x 12)

            9.         Technologist obtains:

                        a.         14 x 17 AP of abdomen

                        b.         14 x 14 prone angle view of the pelvis

                        c.         14 x 17 B/L oblique views

 

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.

B.        Preparation

            1.         NPO after midnight

C.        Materials

            1.         Single contrast barium (EZ paque 60% w/v) 500 cc orally

            2.         Foley catheter (check size with radiologist)

            3.         Air insufflator

            4.         Glucagon 1 mg IV

D.        Procedure

            1.         Scout film of abdomen

            2.         Patient drinks barium

            3.         15 minute prone abdomen

            4.         Abdominal film every 30 minutes* until barium reaches terminal ileum (TI)

                        * Note:    Each radiograph should be shown to the radiologist performing the study who may alter this time interval.

            5.         Once barium reaches cecum, 1 mg IV glucagon given, a Foley is inserted in the rectum and air is insufflated to distend TI.  Spot films are obtained.

 

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.

B.        Preparation  (must have colon adequately cleaned)

            1.         Clear liquid diet for 24 hours

            2.         Two Senokot S tablets given approximately 12 hours before the study

            3.         Approximately 18 hours before the exam - the patient is given a cathartic (usually 2.5 oz. of magnesium citrate)

            4.         The morning of the examination, a bisacodyl suppository is given per rectum

C.        Scout Film

                        14 x 17 supine abdomen

D.        Contrast

                        Use a High Density Barium suspension (85% w/v, administered undiluted)

E.         Procedure

            1.         1 mg Glucagon given IV (do not give to patient with insulinoma or pheochromocytoma) as needed

            2.         The rectal tip inserted and secured either by taping the tube or by inflating the balloon

F.         Summary of Films

1.         Spot Films (10 x 12) when using non-digital fluoroscopy units

a.         LPO                       sigmoid

b.         RPO                      sigmoid

c.         Prone                     rectum

d.         Left lateral              rectum

e.         Erect LPO              hepatic flexure

f.          Erect RPO             splenic flexure

g.         Erect frontal            transverse colon

h.         LPO                       cecum

i.          Prone                     cecum

j.          Supine                    rectum

k.         LPO                       terminal ileum

2.         Overheads

a.         Prone - 14 x 17 lengthwise

b.         Supine - 14 x 17

c.         L side down decub - 14 x 17

d.         R side down decub - 14 x 17

e.         Prone 40o angled view rectosigmoid - 14 x 14

f.          X-table lateral rectum after tube removal

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.

B.        Preparation  (must have colon adequately cleaned)

            1.         Clear liquid diet for 24 hours

            2.         Two Senokot S tablets given approximately 12 hours before the study

            3.         Approximately 18 hours before the exam, the patient is given a cathartic (usually 2.5 oz. of magnesium citrate)

            4.         The morning of the examination, a bisacodyl suppository is given per rectum

C.        Scout Film

                        14 x 17 supine abdomen

D.        Contrast

                        Use Solo-Pake Barium suspension which is 17% w/v

E.         Procedure

            1.         Spot Films (10 x 12) when using non-digital fluoroscopy units

            a.         Sigmoid RPO crosswise

            b.         Sigmoid LPO crosswise

            c.         Splenic flexure

            d.         Hepatic flexure

            e.         Cecum

            2.         Overhead Films

            a.         Prone

            b.         Supine

            c.         RPO

            d.         LPO

            e.         Angled rectosigmoid view

            f.          Lateral rectum

            3.         14 x 17 post-evacuation films if requested by radiologist

                        a.         Lengthwise

                        b.         Crosswise, if needed

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.

B.        Materials Needed

            1.         Contrast material at the request of the radiologist or specified by referring physician

            2.         50 cc syringes

            3.         Connecting tubing and adapters

            4.         Foley catheter (size requested by radiologist) with 5 cc empty syringe

            5.         Topper sponges

            6.         Tape

C.        Procedure

            1.         Take AP scout film of abdomen

            2.         Show scout film and request to radiologist doing fluoro

            3.         Radiologist will determine the contrast material to be used and the size of Foley catheter

            4.         Prepare contrast material as specified

            5.         Place all the necessary materials on the table readily available for the radiologist

            6.         Radiologist will insert catheter into ostomy opening and inflate the balloon

                        Note:   Be sure to test the catheter's balloon before using !!

            7.         Radiologist will then place topper sponges over stoma and tube and tape firmly to abdomen

            8.         Spot films will be taken by the radiologist

            9.         Overheads will be requested by radiologist after fluoro

            10.       Post-evacuation film as per radiologist

 

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.

B.        Materials Needed

            1.         Water soluble contrast (Reno M-60 or Cystografin Dilute)

            2.         1  50 cc syringe (catheter tip)

            3.         Small Foley catheter (pediatric 10 or 12 F)

C.        Procedure

            1.         Scout AP abdomen

            2.         Injection of contrast

            3.         AP - 10 x 12 lengthwise

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.

B.        Preparation

            No preparation necessary

C.        Materials Needed

            1.         60 cc syringe (catheter tip or Luer loc depending on the type of feeding tube)

            2.         60 cc water soluble contrast material (Gastrografin)

D.        Procedure

            1.         Scout:  AP abdominal film

            2.         Contrast is injected under fluoroscopic guidance and spot films obtained

            3.         Supine AP abdominal obtained by the technologist following contrast injection

 

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.

B.        Materials Needed

            1.         Water soluble contrast (Isovue 30)

            2.         IV tubing connected to bottle

            3.         18 g needle to allow air to enter system

            4.         Run Conray through tubing to clear air

C.        Procedure

            1.         AP - 10 x 12 crosswise: 2-on-1 exposure

            2.         Oblique - 10 x 12 crosswise: 2-on-1 exposure

            3.         Lateral - 10 x 12 crosswise: 2-on-1 exposure

D.        Specifics of Procedure

            1.         Scout view of upper abdomen

            2.         T-tube:  Directly connect the 20 cc syringe to the end of the t-tube.       

            3.         Under fluoroscopy, start to instill contrast and image the CHD and CBD as they fill.  Attempt to demonstrate patency of the distal duct as contrast passes into the duodenum.

            4.         Observe the ductal system to determine if there is any leakage of contrast from the ducts.

            5.         Get a post-procedure overhead supine view with ducts filled with contrast.

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.

B.        Materials Needed

            1.         Water soluble contrast (Isovue 30)

            2.         18, 19 or 20 g butterfly needle

            3.         50 cc syringe

            4.         IV tubing

            5.         Run Conray through tubing to clear air

C.        Procedure

            1.         AP - 10 x 12 crosswise: 2-on-1 exposure

            2.         Oblique - 10 x 12 crosswise: 2-on-1 exposure

            3.         Lateral - 10 x 12 crosswise: 2-on-1 exposure

D.        Specifics of Procedure

            1.         Scout view of upper abdomen

            2.         Insert butterfly needle into t-tube rubber tubing

            3.         Under fluoroscopy, start to instill contrast and image the CHD and CBD as they fill.  Attempt to demonstrate patency of the distal duct as contrast passes into the duodenum.

            4.         Observe the ductal system to determine if there is any leakage of contrast from the ducts.

            5.         Get a post-procedure overhead supine view with ducts filled with contrast.

 

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.

B.        Preparation

            1.         Hydration:  Do not over-hydrate

                        a.         A.M. patients: NPO after midnight

                        b.         P.M. patients: Light breakfast

                        c.         E.R. patients: Turn off IV for at least 30 minutes

C.        Scout Film

D.        Contrast

            1.         Contrast Agent Data Form (copy attached) is filled out by the technologist.  The radiologist shall review the patient request, records, if available, and the Data Form and will also question the patient personally as to allergic and other pertinent medical history.

2.         Steroid Prep for IV Contrast

            a.         Med – 50 mg Prednisone

            b.         Preparation

                        i.          Night before study:

·        6:00 p.m.

·        12 midnight

·        6:00 a.m.

                                    ii.          Day of study:

·        50 mg Benedryl

·        150 mg AXID

            3.         Glucophage® - Revised labeling - June 1998 (copy attached)

                        a.         Glucophage® (metformin hydrochloride tablets) should be stopped at the time of or prior to the procedure involving intravascular administration of iodinated contrast materials.

                        b.         Assure normal renal function 48 hours after procedure before restarting Glucophage® therapy. 

            4.         Non-ionic (Optiray) 100 cc

            5.         Need approximately 200 mg iodine/pound body weight for average adult, so mean dose is usually 20-30 gm  - 18g antecubital butterfly with hand injection in 30-60 sec

E.         Filming Technique

            1.         Normal low kV (65-70) and high mA (600-1000)  - exposure times < 0.1 sec

            2.         Tomograms:  kV (60-75), arc of 25-30

F.         Film Sequence

            1.         Patient must void before starting study

            2.         14 x 17 scout film

            3.         Tomoscout

            4.         3 immediate post-injection tomograms of kidneys

            5.         5 minute 14 x 17 abdomen supine

            6.         Apply compression.

                        Note:    No compression with:

a.         Acute pain

b.         Abdominal aneurysm

c.         IVC filter

d.         Recent abdominal surgery

e.         Urinary tract catheters/diversions

f.          Distended abdomen

            7.         10 minute 14x17 abdomen supine with compression

            8.         Release compression – 14x17 LPO and RPO films

            9.         Show films to radiologist who may choose to obtain additional post-void films, i.e., prone

            10.       Bladder film optional at radiologist’s discretion

            11.       Post-void film (full film 14 x 17)

            12.       Optional:

                        a.     Prone 14 x 17 to help visualize ureters

                        b.    Delayed films

                        c.     Fluoroscopic evaluation of ureters

 

 

 

 

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.

B.        Materials Needed

            1.         1 bottle 300 cc Cystografin Dilute

            2.         Catheterization kit:  includes sterile towel, Betadine, sterile gloves, syringe to inflate Foley balloon

            3.         Foley catheter or feeding tube (size to be chosen by radiologist)

            2.         Intravenous administration set

C.        Procedure

            1.         14 x 17 scout of abdomen

            2.         After catheter has been placed into bladder, contrast instilled via gravity drip by radiologist under fluoroscopic guidance.  At times, fluoroscopically guided slow hand injection may be necessary.

            3.         Fluoro spot films taken during bladder filling

                        a.         First 2-on-1 (10 x 12)

                                    i.          Bladder partially filled

                                    ii.          Bladder completely filled

                        b.         Second 2-on-1 (10 x 12)

                                    i.          RPO and LPO of full bladder

D.        Post-Void Film

            1.         14 x 17 film of the abdomen including the bladder after the patient has satisfactorily voided; must include region of kidneys and bladder

 

A.        Digital Fluoroscopy

For all studies performed on the digital fluoroscopy unit, the physician will choose which images will be filmed after each study is completed.

B.        Materials Needed

            1.         Foley catheter or feeding tube (size to be chosen by radiologist)

            2.         Catheterization kit: includes sterile towel, Betadine, sterile gloves, syringe to inflate Foley balloon

            3.         300 cc bottle Cystografin Dilute

            4.         Tubing to connect Foley to contrast bottle

C.        Scout Film

            1.         14 x 17" supine film of abdomen and pelvis

D.        Technique

            1.         Catheterize the bladder in the usual fashion and instill a sufficient amount of contrast material to fill the bladder without provoking a detrusor response.  An appropriate end point would be the patient's first sensation that the bladder is "getting full."  (If a patient has a strong desire to void, you have injected too much.)  The contrast may be instilled by gravity or hand injection as you like.  Take 1 fluoroscopic spot film of the filled bladder in a frontal projection with the patient supine.  (Additional views can be made at this point if indicated.)

            2.         Place the fluoroscopy table in the erect position.  With the patient standing (but not straining), remove the catheter and expose 1 fluoroscopic spot film in the frontal projection with the beam centered at the bladder neck.

            3.         Without moving the patient, have the patient strain (a sustained Valsalva maneuver) and take another exposure in the frontal projection with the patient at the height of straining.

            4.         Turn the patient in the lateral position and take a fluoroscopic spot film exposure at rest.

            5.         Take a second exposure in the lateral position, this time with the patient straining.

            6.         Take lateral view of bladder and urethra during voiding: Measure urethrovesical angles as described in, "Measurement of the Urethrovesical Angles in Stress Incontinence" (copy attached)

            7.         The study is now complete unless a VCUG has also been requested.  If so, proceed with the VCUG in the usual fashion (see page 21).  If the patient is unable to void, it may be necessary to reinsert a fresh catheter and fill the bladder until a strong detrusor contraction is attained and then after removing the catheter, film the voiding sequence.

            8.         In addition to the usual observations of bladder size and shape, etc., the interpretation of the Incontinence Cystogram should address the following points, each of which should be mentioned specifically in the radiology report:

            a.         What is the position of the vesicoureteral junction at rest?  The reference point here is the inferior border of the symphysis pubis.

            b.         Is the bladder neck competent at rest?

            c.         How much descent of the vesicoureteral junction is there at straining?  (measured in centimeters)

            d.         Does urinary leakage or increased leakage occur with straining?

            9.         Any additional observations which you think noteworthy (e.g., marked funneling of the bladder neck during straining, etc.) may, of course, be noted, but the main considerations are those addressed above.  These points must be enumerated in the final radiographic report.  Along the same lines, the main points you should look for when doing a VCUG on a patient with incontinence are abnormal accumulation of urine into the vagina through the urethra or elsewhere, and whether there is evidence of a urethral diverticulum or other filling defect in the urethra.

 

A.        Cyclic Voiding Cystourethrogram (VCUG)

            1.         No preparation

            2.         Contrast:  CystografinDilute:  300 cc bottle

            3.         Materials

                        a.         Chux layered under patient's buttocks

                        b.         CystografinDilute:  300 cc bottle

                        c.         Intravenous Solution Administration Set

                        d.         Catheterization kit: includes sterile towel, Betadine, sterile gloves, syringe to inflate Foley balloon

                        e.         Catheter:  use feeding tube unless Foley is required, size to be indicated by radiologist

                        f.          KY jelly, preferably xylocaine jelly

                        g.         Tape

            3.         Shield table

B.        Catheterization

            1.         Use sterile technique to catheterize the bladder and tape catheter to inner thigh.

            2.         Catheter selection based on size of patient (5-12 F).

            3.         Attach tubing from bottle of Cystografin (300 cc, 50% dilution) to catheter.

            4.         Wrap Chux around patient as one would a diaper.

            5.         During fluoroscopic observation, check the position of the catheter by allowing the gravity drip to flow slowly.  Then proceed as follows:

C.        Procedure

            1.         Obtain KUB

            2.         In females:

a.         With the patient in a straight lateral position with the bladder minimally filled, check for a filling defect that may indicate a ureterocele.  If present, obtain spot film.

b.         Obtain supine AP view of filled bladder.  Note that the toes begin to curl when the bladder capacity limit is approaching.

c.         Obtain both obliques (45 degrees) of region of each uretero-vesical junction and ipsilateral retroperitoneum during maximum bladder capacity.

d.         As micturition begins, obtain images of the urethra with the catheter in place and, ideally, simultaneous images of each uretero-vesical junction and ipsilateral retroperitoneum during voiding.  If the patient is too large for simultaneous images of urethra and area of ureters, obtain both obliques of retroperitoneum during voiding as well as images of urethra.

e.         If reflux does not occur, repeat filling.  Do not repeat filming unless reflux is noted.

f.          Obtain postvoid AP supine view fluoroscopically in infants and with KUB in children who are too large for fluoroscopic inclusion of entire abdomen and pelvis.

g.         Remove catheter.  Note the bladder capacity by observing the amount of contrast left in bottle and indicate on the requisition the type of contrast and amount used to achieve bladder capacity.

            3.         In males:

                        a.         Proceed as in (B) and (C-2 a-d).  Note the bladder capacity.

                        b.         Refill the bladder to capacity.

                        c.         As the patient begins to void, remove the catheter and obtain films of the urethra in one or both oblique positions.

                        d.         Obtain postvoid AP supine films.

 

A.        Preparation

            AP and frog hip x-rays unless the patient has previous films available.

B.        Materials

            1.         Arthrogram tray

            2.         #18 or 20 spinal needle

            3.         Renografin 60 – 50 ml

            4.         Extra lidocaine

            5.         Sterile towels

            6.         Sterile gloves

            7.         10 ml saline – non-bacteriostatic (sodium chloride 0.9%)

            8.         Sterile water

C.        Remove fluoro tower shield

D.        Procedure

            The procedure will be requested by the orthopedic surgeon.  Unless the Orthopedic Surgeon will be performing the study, Dr. Wable is the Radiologist to notify.

E.         Position

            Position the patient on the table supine with the affected side closest to the doctor.

 

A.        Preparation:  NPO

B.        Materials

            1.         Lumbar puncture tray

            2.         Sterile gloves

            3.         Sterile towels

            4.         Right or left marker on tower

            5.         Myelogram stop lock ON

            6.         Shoulder restraints

            7.         Pillow and sponge for under the patient’s abdomen

C.        Remove fluoro tower shield

D.        Procedure

            Can be ordered by any in-house physician but will be performed by radiologist (Dr. Garfinkle).

E.         Position

            Position the patient prone with a sponge under the abdomen to arch the back.

 

A.        Preparation

            1.         Patient must be NPO

            2.         Ask about allergies

B.        Materials

            1.         Myelogram tray

            2.         Sterile gloves

            3.         Sterile towels

            4.         Shoulder restraints (on table)

            5.         Myelogram stop lock ON

            6.         Right and left marker on tower

            7.         Pillow for head and a sponge under the patient’s abdomen

            8.         Isovue

                        a.         200 for lumbar

                        b.         300 for cervical

                        c.         300 for thoracic

            9.         Consent form

            10.       Lab form

C.        Remove fluoro tower shield

D.        Procedure

            An orthopedic surgeon or neurologist will request the procedure, but a radiologist (Dr. Garfinkle) will perform the study

E.         Position

            Patient will be prone with a sponge under the abdomen to arch the back.

 

A.        The Department of Gastroenterology will perform the ERCP.

B.         The Department of Radiology will provide fluoroscopic support and obtain selected images of the procedure as requested by the gastroenterologist.

C.        A radiologist will read the films and dictate a report.

 

 

A.        The Department of Obstetrics and Gynecology will perform the HSG.

B.         The Department of Radiology will provide fluoroscopic support and obtain selected images of the procedure as requested by the gynecologist.

C.        A radiologist will read the films and dictate a report.