Dr. Al-Howaimil Fluoroscopy / ROYMOSIS

7/29/2019 Dr. Al-Howaimil Fluoroscopy / ROYMOSIS

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Dr.Al-Howaimil- Fluoroscopy

SURFACE ANATOMY OF THE

ABDOMEN Part 1

Clinically, we can devide theabdomen into a series of regions bya series ofhorizontal and verticalplanes. This aids description of thesite of abdominal organs or

symptoms.

These divisions are illustrated onthis picture of the abdomen:

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The subcostal plane passesthrough the lowest parts of thecostal margins (SC). It liesapproximately at the level of the 3rdlumbar vertebra. It varies with age,lying higher in children. It also lieshigher in the supine subject, oftenlevel with the 2nd lumbar vertebra.

An alternative plane can be drawnthrough a point halfway betweenthe jugular notch and the pubicsymphysis called the transpyloricplane. This passes through thepylorus of the stomach. It should

also correspond to the level of thelower border of the first lumbarvertebra. The transtubercularplane passes through the tuberclesof the iliac crests (TT). Itcorresponds with the level of the

spinous process of the 5th lumbarvertebra.

Another plane often encountered isthe supracristal plane whichrepresents a line drawn through the

highest part of the iliac crests(SCR). It lies at the level of the 4th

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lumbar spinous process. Theumbilicus often lies just below thisplane.

When you examine a patient, youmust be familiar with the differentregions of the abdomen which areused to describe the location of anysymptoms, pain, lumps or organs

that might be found.

For example, if pain is described asbeing in the right iliac fossa, this ischaracteristic of appendicitis. If youthen examine the patient and find

they are acutely tender in this

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region, you could describe thetenderness as being in the sameregion ie right iliac fossa. Takenwith other signs and symptoms, youarrive at your diagnosis. Theseregions are described by surfaceanatomy and you should identifyeach region on the living subject.

Imagine a pair of vertical linesdrawn through a point which liesmidway between the anteriorsuperior iliac spine and thesymphysis pubis. This is called themid-femoral point. This line also

corresponds to the mid-clavicularline. These lines have been drawnin on the illustration of theabdomen.

Above the transpyloric plane, right

and left hypochondriac regions(HC) are separated by theepigastric region located betweenthem (E).

Below the transpyloric plane, butabove the transtubercular plane, is

the umbilical region(U) in the mid-

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abdomen, with right and leftlumbar regions(L) on either side.Below the transtubercular plane,the hypogastric region(HY)separates the two iliac fossae orregions. (RIF) - right: (LIF) - left).

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Dr. Al-Howaimil

L: 1

Digestive system:Alimentary canalAccessory organs

Alimentary canal:Hollow canalInclude:Mouth, pharynx, esophagus, stomach, small andlarge bowel, rectum, anus.

Accessory organs:Salivary gland, liver, biliry tract, pancreas

Function of digestive system:1- intake water, vitamins, mineral, digestive food

a- carbohydrate

b- Lipidsc- Protein

2-absorption of essential digestive food3-Elimination of any use material as solid west

product.

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Contrast mediaRadiolucent (- ve) air, co2, o2Radio-opaque (+ ve) barium selphate Ba So4Barium:

Powder, chalk like substance, extremity un-soluble in water.Ba + water = suspension (not solution)

Types:A-Thin:1 part of Ba of 1 part of waterUsed for internal GITMotility:

TemperatureGeneral condition of patient

Consistency of preparation

B-Thick:3-4 part of Ba of 1 part of waterUsed for esophagusDescend slowly and coat mucousShould be consistency of cooked cereal.

Ba- contraindication:

If any chance to escape into peritoneal cavity If surgery followed radiographic procedure

use alternative contrast (water soluble iodinated contrastmedia eg. Gastroview or Gastrografin because it is easilyremoved by absorption before & during surgery)

Type of Ba:Double: -ve and +veSingle: barium only.

Post exam elimination:On the large bowel absorption of water so Ba may becomea hardened and solidified and difficult to evacuate so patientmay require laxative after exam but if laxative iscontraindication, fluid or mineral oil used until stools are freefrom all erases of white.

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Barium swallow

The abdominal viscera can be made visible

on radiographs by the use of a suitablecontrast medium, a radio-opaque dyewhich absorbs the x-rays as they passthrough the abdominal structures. Bariumsulphate solution is such a radio-opaquesubstance. The patient is given a glass of a

milky white solution (the barium sulphate)which is swallowed. This creates a bolus of

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medium which passes down theoesophagus into the stomach and then intothe duodenum, small bowel and eventuallythrough the whole intestine. A thin coatingof barium allows the radiologist andclinician to identify the surface of the gutmucosa. The barium meal is widely used tovisualise the oesophagus, stomach,duodenum and small bowel.

Introducing barium sulphate usingan enema via the anus, a techniquecalled a barium enema, permits theexamination of the large bowel.

Barium contrast studies can be used tooutline the anatomy of the oesophagus as

the barium passes through the chest.These examinations are called a barium

swallow

. The barium can be seen in theoesophagus(1). The oesophagushas walls which normally havelongitudinal folds within them.These may be seen as irregular

white lines. Swallowing a glass of

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barium sulphate suspensioncreates a bolus which passes downthe oesophagus in the same way asfood would. This fills the lumen andappears as a white shadow (2). Thelower end of the oesophaguspasses through the diaphragm andenters the stomach(3). Thesphincteric action of thediaphragm occludes or closes theoesophagus as it pierces thediaphragm preventing the acidicstomach contents passingbackwards up into the oesophagus.

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Dr, Al-HowaimilL; 2

Barium swallow

Radiographic examination to study the form and functionof pharynx and esophagus by using C\M

Indication:1. Anatomical anomalies2. Foreign body obstruction3. Esophageal reflux4. Esophageal Artesia5. Dysphasia.

Contraindication:Non

Patient preparation:Non

Procedure:Patient in erect RAO position, to throw the esophagusclear of spine. Given cup of Ba and start swallow. Spot

films are taken.

After care:Non

Complication:1. Aspiration,2. Unsuspected perforation.

Infants:To demonstrate a trecho-oesphageal fistula in infants anaso-gastric tube is introduce to the level of the mid-esophagus, C\M injected forced to indicate any fistula .Filmsare taken at the same time.

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. The barium can be seen in the oesophagus(1). Theoesophagus has walls which normally have longitudinalfolds within them. These may be seen as irregular whitelines. Swallowing a glass of barium sulphate suspensioncreates a bolus which passes down the oesophagus inthe same way as food would. This fills the lumen and

appears as a white shadow (2). The lower end of theoesophagus passes through the diaphragm and entersthe stomach(3). The sphincteric action of thediaphragm occludes or closes the oesophagus as itpierces the diaphragm preventing the acidic stomachcontents passing backwards up into the oesophagus.

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L; 3

Barium meal

Radiographic examination to investigate upper alimentarytract including esophagus, stomach and duodenum.To detect any abnormal anatomical or functionalconditions.

Indication:1- Peptic ulcers,2- hiatus hernia,3- gastritis,4- tumor,

5- divertculae,6- bezoars,7- dyspepsia,8- gastro-intestinal hemorrhage,9- Partial obstruction.

Contraindication:Perforation

Patient preparation:Patient must arrive with empty stomachNPO from midnight until the exam time.No smoking or chewing during NPO periodFemale patient check the LMP & apply 10 day role.

C\M:Double contrast (Ba + CO2)

Gas producing agents:1- produce adequate amount of gas i.e 200-400 ml2- no interference with Ba coating3- no bubble production4- rapid dissolution, leaving no residue5- easily swallow6- low cost

Procedure:

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Patient is giving a gas producing agents, Then givenBarium to drink while he is laying on his left sidesupported by his elbow to prevent Ba. Not to movequickly to the duodenum and obscuring the greater

curvature of the stomach .Then the patient is asked to lay supine with slightly to hisright side to bring up the Ba. To the gastro-esophageal

junction and the patient screened to check the reflux byasking the patient to cough or swallow water

Then injected with bascopan 20 ml or glucagons 0.3 ml torelax the smooth muscle

Then asked to roll in Rt side to complete circle and finishin RAO position for good coating .Films are taken.

After care:1- patient is warned about white bowel2- patient is asked not to leave department until

blurred vision is resolved

Complication:1- unsuspected perforation,2- aspiration ,

3- partial obstruction may lead to completeobstruction,4- Side affect of pharmacological agents.

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L; 4

Barium follows through or small bowel serious (SBS)Radiographic examination of the small intestine to study

the form and function of the 3 components of smallbowel.

Indication:1. Pain,2. Enteritis,3. Neoplasm,4. Hemorrhage,5. Ileus,

6. Malabsorpation.

Contraindication:1. Perforation,2. Large bowel obstruction

Patient preparation:Laxative on eveningMetoclopramide 20 min oral before exam to enhance therate of gastric emptying.

Preliminary film:Plain ABD film

Procedure:4 techniques:1-upper GI- small bowel comp.:Routine upper GI + routine stomach studyDuring upper GI study, patient should ingest 1 full cup of

Ba & exact time is recorded.When flouro. of stomach is finished time is recorded30 min after ingest 1 full cup of Ba PA film of proximalsmall bowel (around 15 min after finishing upper GI)1\2 hrs interval films (with centering to iliac crest) until Bareach large bowel usually 2 hrs1 hr interval until Ba passes through the ileo-ceacal valveSpot films of ileo-ceacal valve & terminal ileum are taken.Radiologist may need delayed films are order to followthough large bowel usually after 24 hr.

2- Small bowel serious only:

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Plain ABD film2 cup of Ba ingested, record the timeAfter 30 min take film high centering to include proximalsmall bowel

1\2 hrs interval films (with centering to iliac crest) until Bareach large bowel usually 2 hrs1 hr interval until Ba is well into ascending colon.

3- Intubations:Nasogastric tube is passed though the patient nose,

esophagus, stomach, duodenum, and into jejunum,CM ingested in RAO position and that will help in passing

the tube by peristalsis movement and record the timeAfter 15- 30 min films are taken.

1 hr interval when required.

4- Enteroclysis:Patient is intubated under fluoroscopyC\M with special Enteroclysis catheter which pass into the

region of duodenal-jejunum junctionBa sulphate is instilled air or methyl cellulose is injected

into the bowel to distend it and provide double DCDC dilated the loops of small bowel while increase visible

of mucosa.Films are taken.Disadvantage:

1- increase patient discomfort2- long exam time3- possible perforation

Advantage:Ideal for patient with bowel obstruction and malabsorption

After care:Complication: the same as the Ba. Meal

L; 5

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Barium enemaA method of investigation of colon by using C\M to study theform and function of large intestine.

Indication:1. colitis,2. neoplasm,3. divertcullum,4. Volvus.

Contraindication:1. rectal biopsy,2. colonscopy, or sigmoidscopy3. sever diarrhea,

4. Inflammation lesions e..g. appendicitis .5. obstruction

Patient preparation:The patient must arrive with empty colon

1. Patient kept to low residue diet for 4 days2. laxative agent 48 hrs before exam.3. colon washout4. NPO 4-6 hrs before exam.

5. Patients undress copletly &wear gown.

Procedure:Patient on lat. position with opposite knee flexed,Well lubricated catheter is inserted 10 cm into rectumPatient may injected with with Bascopan,

Then patient is Positioned in prone,Enema reservoir is 100 cm over the table and table tilted sohead is at an angel 100Ba runs until reach splenic flexure

Air pumped to produce DCPatient rotated, films are taken.

After care:1. patient is warned about white bowel2. patient is asked not to leave department until blurred

vision is resolved3. Patient must be fit enough to leave department.

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Safety concerns during Ba enema;1- review patients chart2- never force an enema tip into rectum

3- the height of enema bag should not exceed 100 cm4- verify the water temperature of C\M5- Escort the patient to rest room.

BARIUM STUDIES: LARGE BOWEL

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You should be able to identify the various components ofthe bowel on these films. Note the caecum(1), ascendingcolon(2), transverse colon(3), descending colon(4) andthe rectum (5). On the right, the ascending colon turnstowards the midline. This is called the right colic flexure

(6) (also known as the hepatic flexure - so called as it isadjacent to the liver). On the left, the transverse colon turnsdownwards, creating the left colic flexure (7) (or splenicflexure - so called as it is adjacent to the spleen).

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BARIUM STUDIES: LARGE BOWEL 2

The sigmoid colon and the rectum can also be examined inthe barium enema studies. Views may be taken in theprone postero-anterior position or in lateral or obliquepositions. Make sure you understand what these termsmean.

Therectum appears well filled with barium (10). Superiorto the rectum and hidden by its outline can be seen thesigmoid colon(11). The lower part of the descendingcolon can also be identified (12).

L: 6Sialography

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Definition:

A radiographic visualization of salivary glands and its ducts *

provides both diagnostic and preoperative information in case of

salivary glands pathology).

Indication:

1- Pain

2- Calculi

3- strictures of ducts

4- sialctasis

5- tumor

Contraindication:

Sever inflammatory of salivary glands ducts

History of sensitivity of iodinated contrast media

Contrast media:

1- oily: Ethiodol (have slow excretion rate, give a greatest

density, but may cause granulomatus tissue.

2- W.S.I .: Renografin (good for routine sialography)

Patient preparation:

None but check history of allergies

Procedure:

In case of suspected sialothiasis scout films are required.

Determination of salivary ducts by: palpation ducts or sucking

on a lemon slice.Ducts are dilated by standard double-ended blunt dilators or

lacrimal probes

Then ducts canulated (the most preferred; Abbott butterfly set)

Wing is secured with hemostat

cannula should be refilled with CM to avoid Injection of air

bubbles and immobilized The tubing with syringe are taped to

shoulder or chest Then CM injection slowly under fluoroscopy

------then Spot films are taken

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Views:Delayed films are taken to study the function emptying of gland

Films:

Preliminary films:Parotid gland:

1- AP with head rotated 5 away from the side under

investigation

2- Lat

3- Lat-oblique

Submandibular gland:

1- infer superior using occulusal

2- lat3- lat-oblique

After injection of CM:

1- infer superior using occulusal

2- lat

3- lat-oblique

Post secretary:

1. infer superior using occulusal

2. lat

3. lat-oblique

After care: -----None

Complication:

Pain

Damage to duct orificeRupture of duct

Infection

L: 7Maylography

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A radiographic study of spinal cord and itsnerve root branches

Indication:Detect any lesion may be presented withinspinal canalFor example:Space occupying lesionsDegenerative disease of central nervoussystem(CNS)

Malformation of the spinal cord.

Contraindication:Blood in CSFArachnoiditisIncrease intracranial pressureLumber puncture performed 2 weeks ofcurrent examination

Patient preparation:

Patient encouraged drinking fluids before

exam to decrease incidence of lumberpuncture headache

Patient maturate before exam

To decrease anxiety and to relax patient,

sedative relaxant agent may be given 1 hrbefore exam

NPO 4hr before exam.

Contrast media:must meet the following requirements:

1-miscible (mixed well with CSF)2-has good radopacity

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3-easily absorbed4-non toxic5-inert(non reactive)

-----------------------------------------------------------1-oily contrast media 5-6 ml of myodilAdvantage:Provides good radiopacityLittle complicationDisadvantage:Not demonstrate root broches adequatelyNot absorbed by the body, so must beremovedNeedle is placed in place, so positioning ofpatient is difficultResidual oil-based CM is absorbed by thebody----------------------------------------------------------2-WSI c/m 8-10 ml

Provides good visualization of nerve rootAbsorbed quicklySpinal needle can be removed so patient canbe positionedAbsorption begins 30 min post injection.

Procedure:

Lumbar puncture method:By injection of CM into subrachnoid space

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Patient placed in seated or lat-decubitus forinjection.Skin is prepared and infiltrated with

anesthetic agentStylist needle inserted into subrachnoidspaceStylet removed spinal fluid flows from theneedleSite of injection is lower lumbar region, thisarea reduce the possibility of trauma to thespinal cordBetween 2nd -3rd lumber vertebrae(For cervical c3 c4 or c4-c5 )Small sample of spinal fluid is collected forlaboratoryAt the same time Blood pressure can betaken after CM is injected(Withdrawing a small amount of spinal fluid

and replacing it with equal amount of CM)Patient rotated into prone position and headkept straight i.e. with chine resting on padand table is tilted so CM move upward andnot entering the head)

Views:Patient porn position usually 2-3 exposures on 24 * 30 or35 * 35 and L or R markers should be usedLat view are taken in porn and anterioroblique

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After care:Patient returned to the word on stretcherPatient lies flat for at least 8 hr

Patient trunk raised and supported bybillows at an angle of 45 to prevent residueCM from entering the headPulse and blood pressure are checked andrecorded Every hr for next 4 hr then 4hourly for 24 hr.

L: 8

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Micturating CystoUrethroGraphy (MCUG)

Indication:1- Vesico-ureteric reflux.

2- Study of the urethra during minctrution.

3- Abnormalities of the bladder.

4- Stress incontinence.

Contraindication:

1- Acute urinary tract infection.

CM:

HOCM or LOCM 150.

Equipment:

1- Fluoroscopy unites with spot film.

2- Video recorder.

3- Foley catheter.

Patient preparation:The patient micturate prior the examination to empty the bladder.

The purpose of MCUG:

1- To demonstrate Vesico-ureteric reflux.

2- To demonstrate Vesico-vaginal or recto-vesical fistula.

3- To demonstrate stress incontinence.

Preliminary film:Coned view to bladder.

Procedure:

1- TO DEMONSTRATE VESICO-URETERIC REFLUX

1- Patient lies supine on the x-ray table.

2- Using aseptic technique.

3- Insert catheter in to bladder.

4- Residual urine is drained.

5- CM is slowly dripped in and the bladder filling.

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6- The catheter should not be removed until no more CM will

be drip into the bladder.

7-sopt films are taken during micturation and any reflux

recorded. The lower ureter is best seen in to AO position. Boys

should micturate with AO position with opposite knee flexed.8- A full-length view of the Abd. Is taken to demonstrate any

reflex of CM that might have occurred unnoticed into the

kidneys and to record the post-micturation residue.

2- TO DEMONSTRATE VESICO-VAGINAL OR RECTO-

VESICAL FISTULA

As above, but films are taken in lat position.

3- TO DEMONSTRATE STRESS INCONTINENCE

As above, but the catheter is left in situ until the patient is in the

erect position.

Films should include sacrum and symphysis pubis because

bony land marks are used to assess bladder neck descent.

Views:

1- Lat bladder.

2- Lat bladder, straining.3- Lat bladder during micturation.

After care:

Patient should be warned about dysuria.

Complication:

DUE TO CM:

1- Adverse reaction may result from obstruction of CM BY the

bladder mucosa.2- CM induced cystitis.

DUE TO TECHNIQUE:

1- Acute urinary tract infection.

2- Catheter trauma- may produce dysuria, frequency,

haematuria and urinary retention.

3- Retention of a Foley catheter.

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L. 8

Micturating Cystourethrogram (MCUG) Indications for imaging

Vesicoureteric reflux in children - in recurrent UTI

Stress incontinence

Urethral stricture

Bladder dysfunctions

Contra Indications

Current - urinary tract infection

Contrast media allergies - cautions-

Anatomy Demonstrated

Technique (typical for demonstration of reflux in a child)

This is normally a paediatric procedure, therefore all normal paediatric imaging considerations

are vitally important in this embarrassing and invasive procedure

Some centres give prophylactic antibiotic cover.

The patient lies supine on the examination table for catheterisation if not already catheterised

outside the department, the patient is catheterised. Bladder catheterisation is an aseptic

procedure undertaken by a suitable trained and qualified person.

The contrast media warmed to body temperature is slowly infused through the catheter using a

"giving set" into the bladder, intermittent pulsed fluoroscopy is used to check the filling and for

reflux up the ureters. The contrast media reservoir should be no more than 1 metre above the

table to limit the pressure.

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An alternative to spot films is to video tape the fluoroscopy.

1) Spot films are taken of the bladder, kidneys and ureters to record the normal or abnormal

anatomy.

2) When the bladder is considered full or the contrast leaks round the catheter the balloon isdeflated and the catheter withdrawn. depending on the age of the patient the patient is asked to

micturate into a receiver either erect or supine, suitable privacy and sympathy may be required.

3) Spot films are taken during micturition and any reflux recorded,

The patient is rotated into the 30 degree left and right anterior obliques to demonstrate the

bladder ureteric junctions, to demonstrate the male urethra the left anterior oblique position is

adopted with flexion of the right hip and knee to visualise the whole of the male urethra.

4) A final full length abdominal film is taken to visualise the kidneys.

VariationsFor stress incontinence the film series is taken to include , at rest, straining and micturating in

the lateral position, some centres have special sitting fluoro arrangements.

For fistulae and bladder tract abnormalities a series of films in AP. lateral and oblique positions

may be required.

Contrast Media

Low strength (approx 25% weight/volume) contrast agent i.e. Hypaque 25% urografin 150,

suitable volume to fill the bladder, typical 20 ml in an infant to 500 ml in an adult, the contrast

media should be warmed to body temperature.

Radiation protection

General fluoroscopic dose limiting precautions should be employed.

Equipment

Nursing-

Catheterisation pack - and aseptic procedure pack..

Sterile towels

Skin prep./ wash

Sterile lubricant

Giving set-

Selection of Foley catheters 5 -7 gauge French in infants larger in adults.

Drip stand

Radiographic

Fluoroscopy set with spot film or video recording devices.

Complications

Temporary Dysuria

Transient Haematuria from catheterisation.

CystitisAftercare

Non specific, general patient post procedure care.

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Evaluation of the Image

ID and anatomical markers must be present and correct in the appropriate area of the film.

Optimal exposure should penetrate all the bone structures and contrast should be low enough to

visualise fully the bone and soft tissue structures. Images should be marked with contrast

volume and indications of voiding or straining.

Radiographs

Full length voiding film showing reflux into the right kidney

Additional modalities

Ultrasound is a useful adjunct

RNI may be used to assess renal scarring in cases of proven reflux.

Useful Text: A Guide to Radiological Procedures, Chapman & Nakielny

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L: 8

ArthrographyA contrast media study of synovial joints & related softstructures including hip, shoulder, elbow, ankle, wrist, TMJand kneeKnee tech. mostly similar for all joints.

Knee arthrographyPerformed to demonstrate & assess the knee joint &associated soft tissue structures for pathology including joint

capsule, menisci, (Collateral, cruciate, minor)ligaments

Indication:

Traumatic:

Tears of joint soft structures capsule Non-traumatic: pathology (Bakers cyst)

Contraindication:Allergy to C\M

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Contrast media :-

Double contrast5 ml of low density CM e.g. Renografin80-100 cc of CO2, O2 , or air

Preliminary film:AP + Lat

AP Lat.

Procedure:Patient lies supine and pad is placed under popliteal fosseand knee slightly flexed.

Skin is cleaned and sterile towel is dropped around the knee

Skin infiltrated with local anesthetic and thin walled(19 21 gage) needle is inserted into the joint.

Fluid from joint is aspirated and 3 ml of 1\1000 adrenaline isinjected to reduce the rate of absorption of CM Which isuseful in case of sinovitis

The CM is injected under fluoroscopic control ,followed by40 ml of air until supra-patellar pouch is tense (like balloon)then needle is removed

Knee extends & flexed several time to distribute the CM

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Patient turned in prone position and (varus and valgus)being applieduntil each meniscus is separated by gas

Views:Usually 4 views of each quadrate of kneeAP + lat with knee flexed to demonstrate cruciatel

After care:No special after care but patient should be warned that hemay experience discomfort for several days

Knee will sequelsh when flexed or straightened.

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L: 9

T-tube postoperative [delayed]Cholangiography

Performed in the radiology department following acholecystectomy where the surgeon concerns about residualstones in the biliary duct, so he will place a special T tubecatheter into CBD (commune bile duct) and extend outsidethe body.

The purpose:1. Visualize any residual undetected stones

2. Evaluate the status of the biliary duct system

3- Demonstrate the small lesions, strictures ordilatation

Contraindication:

None

C\M:Hypaque

Preliminary film:Coned PA of Rt. side of abdomen.

Procedure:

This Procedure performed between 3rd

10th

days following acholecystectomyPatient lies supine and drainage tube clamped near thepatient and cleaned with antiseptic

23 G needle , extension tubing

and 20 ml syringe are assembled and filled with CM

after removing air bubbles , needle is inserted into tubingbetween the patient and clamp

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Films & views:

PARAOLAO

After care:Non

Complication:Adverse reactionSepticemia

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Hysterosalpingography:

Examination of the female reproductive system usingcontrast media.

Indication:

1. Infertility.

2. Recurrent miscarriages.

3. Following tubule surgery.

Contraindication:

1. Pregnancy.

2. Acute pelvic inflammatory disease.

3. Active uterine bleeding.

Contrast media:

Omnipaque300

Equipments:

They are inside a closed sterilized box.

1. Speculum vaginal: 2pices.

They come two sizes: large35cm. /medume20cm.

2. Tenaculums: 2pices.

Toothed 25cm

3.foceps: 2pices.Sponge 25cm.

4.bowls: 2

25cc

5.towels: 2

6.sterilized pair of

gloves.

Set of salpingograph:

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1.OB-Gyneleechcannula with 2 stylets: sml. /med./large.

2.Cones: small/med./large.

3.three-way stopcock

4.labrcating jell.5.tray

Position:

Patient is supine with knees flexed and legs abducted.

Procedure:

Patient lie supine with knee flexed and places her

feet at the end of the table.

With sterile towels and technique a vaginal

speculum is inserted into the vagina.

The vaginal walls and cervix are cleansed with an

antiseptic solution.

A cannula or ballon catheter is then inserted into

the cervical canal. Dilation with a balloon

catheter helps to occlude the cervix preventing

c/m from flowing out of the uterine cavity during

the injection phase.

A tenaculum may be necessary to aid in the

insertion and fixation of the cannula or catheter.

Once cervical placement of cannula or catheter is

obtained ,a syringe filled with c/m is attached to

the cannula or balloon catheter.Using fluoroscopy the physician slowly injects

the c/m into the uterine cavity.

If the uterine tubes are open c/m will flow from

the distal ends of the tubes into the peritoneal

cavity.

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Films:

1.preliminary film for the pelvic.2.when the c/m is injected.

3. When it reaches the tubes4. When c/m reaches the uterus.

After care:

The patient is tolled that she may have bleeding for1or 2

days and pain.

Documents

Dr. Al-Howaimil Fluoroscopy / ROYMOSIS