Download Special Radiographic Procedure

การตรวจพิเศษทางรังสี
Special Radiographic
Procedure
CONTRAST
1. Positive CM
2.Negative CM
MEDIA
Negative Contrast Media
 Low specific gravity
 More radiolucent to x-rays than
soft tissue
 Black appearance on radiography
 Gas : Air or oxygen, Carbon dioxide
Positive Contrast Media
 contain elements of high atomic
number
 absorb more x-rays than soft
tissue or bone
 CM are radiopaque to x-rays and
appear white on radiograph
 Barium sulphate (BaSo4 ) , Iodine
compound
Iodinated Contrast media
 Water soluble
- Sodium, Meglumine salts, reduce
toxicity, minimize high sodium
concentrate, less tissue irritability
- Normally injected into the vascular
system
- Ionic and Non-ionic CM
 Oil / viscous
- lymphography
Physicochemical properties
• Water solubility
• Viscosity/Temperature
• Osmolality ; milliosmol/kg water
(high osmol=strong toxicity)
• Lipophilia
Risk of contrast media
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Patient’s condition
kind of examination
type of CM
Dose
Possible toxicity
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Local irritant effect
Mild discomfort
Nausia
Cardiac arrest
Hypovolemia (ภาวะที่ร่างกายขาดสารน้า)
 Anaphylaxis
URINARY
SYSTEM
Intravenous pyelography
Cystography
Urethrography
URINARY SYSTEM
Robert T. O’Brien
Robert T. O’Brien
Intravenous pyelography
 Evaluate size, shape, position of
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kidneys, ureters, bladder
Calculi, masses
Cause and source of hematuria, pyuria,
Trauma
Post op
Allergy: Contrast media, renal fuction failure (Anuria)
Intravenous pyelography
• IVP
• patient preparation
• Contrast media : iodinated
• Procedure :
Nephrogram
Robert T. O’Brien
VD view of normal dog:5,10,20,40
min.
Robert T. O’Brien
VD view of normal cat after IV CM
Robert T. O’Brien
Excretory Urogram
Robert T. O’Brien
Robert T. O’Brien
Robert T. O’Brien
Cystouretrogram:
evaluation of the urinary
bladder and urethra
 Cystogram
 Double contrast cystgram
 Antegrateuretrogram
 Retrograteuretrogram
Indication
 Bladder , urethral mass
 calculi
 Evaluate functional information
 Anatomy abnormalities; fistula
 Bladder, urethral tear
Contraindication: risk for taer or rupture
Cystouretrogram
• patient preparation
• Contrast media: Diluted
iodinated
• Procedure
Urinary Bladder
Robert T. O’Brien
Robert T. O’Brien
Robert T. O’Brien
Robert T. O’Brien
อะไรเอ่ย???
Gastrointestinal
Tract
Contrast media
 Barium sulfate:
-Positive contrast media
 Double contrast study:
Barium + Negative contrast
agent ; Gases เช่น O2 , N2 ,CO2
Barium sulfate
• BaSO4 มีชนิดผง น้ำ paste
• เป็น suspension ไม่ละลาย,ไม่ absorb
• ต้องผสมให้ควำมเข้มข้น
เหมำะสมกับกำรตรวจ
ข้อควรระวัง
• Perforation in the alimentary
tract into the thorax or abdomen
• water- soluble contrast medium
is prefer
• Aspiration the agent into the
lungs
Fluoroscopy
เห็นการเคลื่อนไหวของorgan
บันทึกภาพที่ต้องการได้
การป้องกันอันตราย
จากรังสี
Basic “Imaging Chain”
Under table tubes
Remote – over the table tube
Mobile C-arm Fluoroscopy
การป้องกันอันตรายจากรังสี
 Lead apron,เสื้อตะกั่ว
 Thyroid shield
 Lead glove
ISOEXPOSURE CURVES
Patient preparation
• อดอาหาร 12- 24 ชั่วโมง
• ถ้าจ้าเป็น cleansing enema
• Sedative or anesthesia
Esophagography
To evaluate esophageal location,
morphology
• Fluoroscopy: function
• patient preparation
• contrast media ; thick
paste of Barium sulfate
Indication:
 suspected esophageal or pharyngeal
disease based on clinical signs of
regurgitation, gagging or dysphagia.
 a foreign body, stricture or trauma to
the esophagus.
 abnormal position in an animal with a
cervical or mediastinal mass.
 Assessment of esophageal motility.
Dilated esophagus
Ohio-State
Mega esophagus
Ohio-State
Normal anatomy
: Stomach
 Usually easily identified because it
contains gas and/or heterogeneous
ingesta.
 Four regions of the stomach can be Stomach : canine
identified (different distribution
between dog and cat)
 Cardia
 Fundus ( Largest compartment)
 Body
Stomach : feline
 Pylorus (antrum and canal).
Daniel Rodriguez, MZ
The Stomach
 Double contrast study
 Appearance of the stomach varies
with patient positioning
 This occurs because fluid and semiliquid contents will move down
(dependent portion) and gas will
move up (non dependent portion)
 Helps to highlight various areas of
the stomach.
Daniel Rodriguez, MZ
Ventrodorsal
 Gas located in body, near midline
 Some gas in pyloric antrum
 Fundus and pyloric canal usually
contain fluid
Daniel Rodriguez, MZ
Dorsoventral
 Gas in fundus and pyloric canal
 Fluid in body
Left Lateral Recumbent
 Gas present in the pyloric antrum
and canal
 Fluid in fundus
 Gas may also be noted in duodenum
Right Lateral Recumbent
 Gas is present in fundus
 Rugae may be well outlined
 Fluid moves to the pylorus
 Pylorus may appear as a discrete,
round “ball”
Upper Gastrointestinal
Study
• การเตรียมผู้ป่วย : Fast 12-24 hr.
• contrast media ; Single or Double contrast
study (positive and negative contrast media)
ไม่ใช้ในผู้ป่วย gastric distension, BaSO4 30-60%
• วิธีตรวจ ดูด,ใส่ผ่าน orogastric tube, Test ตาแหน่ง
GI study
 Evaluate size, shape, position
of stomach and small intestine
 FB or other causes
 Gastric outflow abnormalities
•กลืนไม่ได้ ,
• aspirate
• GI perforate : Iodine contrast
Ohio-State
Upper Gastrointestinal
Study
Ventrodorsal view
of upper GI study
Normal stomach and
intestines
15 minutes after barium
administration
45 minutes after barium
Online vets.com
Duodenum
 Descending duodenum is fixed by
hepatoduodenal ligament cranially
and the duodenocolic ligament
caudally
 Lies along right abdominal wall in VD
view, mid-abdomen on lateral
 Landmark for the pancreas
Small Intestine
Small Intestine
Small Intestine
Cecum
Dog
Cat
Cecum
(Cat)
Colon
 Consists of ascending, transverse,
and descending portions
 Contains varying amounts of gas
and heterogenous fecal material,
or may be empty
 Typically in the shape of a
question mark on VD view, but
exact position is variable
Colon
 Size varies, but should not be larger than 2.5
times endplate of L2
Colon
Rectum
 Portion of colon located in pelvic
canal and ending in anus
 Primary disease of rectum and
distal colon are rarely evaluated
radiographically
Rectum
Barium Enema
• การเตรียมผู้ป่วย : - อาหารกากน้อย
- อดอาหาร 12 hr.
- ยาระบาย
• Contrast media ; - Positive,
Negative, Double contrast study
• วิธีตรวจ : ใส่สายสวน, Foley
Q&A
http://www.cvm.umn.edu/vetrad/