Introduction of the Radiology

1. Introduction of the Radiology Suppat Ittimakin, MD.

3. What is the radiology?

4. Radiology Radiology is a medical specialty that uses imaging to diagnose and treat diseases seen within the body. https://en.wikipedia.org/wiki/Radiology

5. Radiographic modality Plain radiographs Ultrasonography Computer tomography (CT) Magnetic resonance imaging (MRI) Fluoroscopy

6. Plain radiography

7. X-ray production

8. Image production

10. Density of the plain radiographs Air  air in the bowel loops and stomach Fat  subcutaneous layer of the abdominal wall Water  same density as other soft tissue and internal organ Bone  all of the bony structures and calcification Metallic  medical instrument and foreign bodies

12. Fluoroscopy

13. Contrast agents • Barium sulfate • Water-soluble contrast • Negative contrast

14. Barium sulfate • White crystalline powder • High specific gravity • Inert, not support bacterial growth • Radiodensity • Coat GI mucosa

15. Adverse effect of barium sulfate Do not use in case of suspected leakage within thorax or abdomen • Inflammation of the abdominal cavity or mediastinum - Mediastinitis - Peritonitis

16. Water-soluble contrast agents Iodine compound Do not coat the GI mucosa Use in case of suspected leakage or post operative evaluation High cost Adverse effect  cause pneumonia or pulmonary edema if aspirate into lung

17. Negative contrast agent Air  use for double-contrast study Carbon dioxide Drug  Simeticone

18. Esophagography

19. Esophagography Contrast-enhanced fluoroscopy of the esophagus Ingestion of the contrast while performing radiographic study Can detect intraluminal/transmural esophageal lesion Interesting in anatomy and function Indication: Evaluation of the esophageal obstruction and function

20. Double-contrast esophagography Contrast Air

21. Upper GI study/GI follow through

22. Area of interest • GI follow through • Esophagus • Hypopharynx/larynx • Stomach • Duodenal bulb and duodenal loop • Small bowel loops • Ceacum • Upper GI study • Esophagus • Hypopharynx/larynx • Stomach • Duodenal bulb and duodenal loop

24. Anatomy on upper GI study

25. GI follow through

26. Barium enema

27. Barium enema Double contrast study Area of interest: Colon, sigmoid colon and rectum Introduce barium into rectum via rectal tube, through colon to ceacum Push air into colon 

28. BE machine

31. Intravenous pyelography (IVP)

32. Intravenous pyelography (IVP) Good modality to evaluate urinary system Can evaluate  Anatomical and functional abnormality Indication  Urinary tract obstruction, Urinary leak from trauma or post operation, urothelial tumor

33. Procedure of IVP “ Plain radiographs along phases of the renal function and excretion” Plain radiographs on 1. Pre-contrast (Scout film)  to detect stone, renal shadow, psoas shadow 2. 1 minute after contrast administration  evaluate nephrogram 3. 3 minutes after contrast administration  evaluate excretory function

34. Procedure of IVP 4. 10 minutes after contrast administration  evaluate pelvocaliceal system and ureter 5. 25-30 minutes after contrast administration  evaluate lower part of ureter and urinary bladder 6. Full bladder  evaluate urinary bladder 7. Post voiding  residual urine

35. IVP device

36. Principle of IVP

37. Scout film

38. 1 minute

39. 3-5 minutes

40. 10 minutes

41. 25-30 minutes

42. Both oblique views

43. Full bladder

44. Retrograde pyelography

45. Retrograde pyelography Retrograde injection of the contrast material into ureters  extending to pelvocaliceal system Use to evaluate collecting system of the patient who has poor renal function Quality of the imaging can be controlled by concentration of the contrast material and rate of injection

47. Left retrograde pyelography

48. Intraluminal filling defect within right upper pole calyx

49. Cystography/Voiding cystourethrography

50. Cystography/voiding cystourethrography (VCUG) Input contrast material into urinary bladder Imaging of the urinary bladder on AP, lateral and both oblique views Evaluate urothelial tumor, diverticulum or leakage from trauma or surgery