Previous Year DRDT 2nd

Year Questions & Answers.

“Clinical Radiography”
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1. Answer the following questions.
1. Role of Hydrocortisone:
It works by calming down your body’s immune response
to reduce pain, itching and swelling (inflammation). It can
also be used as hormone replacement for people who do not
have enough of the natural stress hormone, cortisol.
Hydrocortisone is used to treat many health problems.

2. Meatogram:
Meatographies were performed with a small quantity of
contrast medium, and restricted to the visualization of the
structures in the auditory canal. Tomographies of antero-
posterior view were utilized in all the cases. Normal
tomomeatograms were classified into 4 types.
1. In the first type the internal auditory canal not opacified,
2. In the second the contrast medium recognized as a single
stream along the superior wall of the internal auditory
canal,
3. In the third another parallel line of contrast medium is
recognized close to the middle of the internal auditory
canal,
4. In the fourth the contrast medium fills the internal
auditory canal.

3. Fistulogram/Sinogram:
A fistulogram is an x-ray procedure used to view a fistula,
an abnormal passage between two or more parts of your body
that often drains out of your skin. A sinogram is a similar
procedure done to assess a sinus, an abnormal passage or
cavity that originates or ends in one opening, often on the

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skin. Contrast material is used to help fill the track and
determine what parts of your body are involved.
4. Barium Swallow Indication:
 Dysphagia ( Difficulty in Swallow )
 Polyps ( Any Growth in Oesophagus)
 Hiatus Hernia
 Epigastric Pain
 Tumor, Cysts in the Oesophagus
 Ulcer in the Oesophagus

5. Cystogram:
A cystogram is a fluoroscopic procedure used to examine
the urinary bladder. Water-soluble contrast solution is injected
into the bladder via a Foley catheter and images are taken
using fluoroscopy. A cystogram may indicate how well the
bladder empties during urination and whether any urine backs
up into the kidneys. And it is also used to diagnose the
Vesicouretral Reflux (VUR), Cystitis and Cysts or Tumor.

6. IVU:
An IVU is an X-ray examination of your kidneys and
bladder. During the test you will be given an injection of a
contrast agent (an X-ray ‘dye’), which highlights your kidneys
and bladder making them stand out much better than on an
ordinary X-ray image. It is possible to see some detail of the
internal structure of the kidneys and assess roughly how well
each kidney is working.

7. AUG:
An ascending urethrogram is a radiological examination to
visualize the male urethra. During the test you will injected the
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contrast dye in the urethra through the small catheter and take the
dynamic images. It is used to diagnose the strictural urethra, bulbar
urethra, urethral diverticulum and urethral fistula.
8. single contrast Barium Enema:
In a single-contrast study, the colon is filled with barium.
This outlines the intestine and shows large abnormalities.

9. Arthrography:
Arthrography is a special radiological examination of to
visualize the joint problems. To take the contrast dye is
injected into the joints though the Chiba Needle and take the
radiographic images. It is used to diagnose the,
 Hip labral tears
 Partial ligament tears
 Partial tendons tears
 Repaired of retears tendons
 Repaired of retears meniscus

10. Myelogram:
A myelogram is a diagnostic imaging test generally done
by a radiologist. It uses a contrast dye and X-rays or computed
tomography to look for problems in the spinal canal. Problems
can develop in the spinal cord, nerve roots, and other tissues.
This test is also called myelography.

2. Answer The Following Questions.

1. Advantages and Disadvantages of barium

contrast:
Advantages:
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  Excellent coating of Mucosa
 Cost effective
 High density
 Provide positive contrast nature
 Radio-opaque material
 Insoluble in water
 Not absorbed or metabolized
 Eliminate easy from the body
Disadvantages:
 Leakage of mediastinum or peritoneum can cause
Fibrosis.
 Subsequent Abdominal CT and USG.
 Intravasation – this may result in a barium pulmonary
embolus which carries a mortality of 80%.
 Poor distended.
 Operator dependent.
 Time consuming.

2. Hypotonic Duodenography:
Hypotonic duodenography is a method for showing
duodenal anatomy without interference from peristaltic
activity. It involves duodenal intubation, drug-induced atony,
and visualization with barium and air.
Indications:
 Tumors of the head of the pancreas.
 Where meets the pancreatic and bile ducts in the Small
intestine.
 Acute or Chronic Pancreatitis.
Contra-Indications:
 Suspected pregnancy.
 RFT is abnormal.
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  Glaucoma.
 Intestinal muscle spasms.
 Severe diabetes.
Patient Preparation:
 Patient take starvation for 6-8hours before the
examination.
 Patient must be write and sign the consent before the
examination.
 Patient should be remove the all Radio-opaque materials.
Procedure:
Hypotonic duodenography is also referred to as x ray of
the duodenum or simply as duodenography. The patient is
seated while the radiologist places a catheter in the nose and
down into the stomach. Then the patient lies down and the
tube is continued to the duodenum. The radiologist is guided
in this placement by a fluoroscopic image. Next, either the
glucagon is administered intravenously or anticholinergic is
injected into the patient to relax the muscles of the intestine.
After several minutes, the physician will administer barium
through the catheter. Barium is a contrast agent that will help
highlight the area on the fluoroscopy screen and x rays. After
a few films are taken, some of the barium is withdrawn and
air is sent in through the catheter. Additional images are
acquired and the catheter is then removed. The procedure
takes from 30-60 minutes.
Complications:
 Spiculation,
 thickened mucosal folds,
 nodularity or mass indentation or both,
 ulceration, and
 reflux of barium into the common bile duct.
Aftercare:
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The barium should be expelled within two to three days. Extra
fluids and/or an agent given by the physician to help
encourage bowel movement may aid in barium elimination.
3. Defecogram:
Defecography, or evacuation proctography, is an X-ray
test that shows the rectum and anal canal as they change
during defecation (having a bowel movement). This test is
used to evaluate for disorders of the lower bowel that are not
evident by tests such as colonoscopy or sigmoidoscopy.
Indications:
 Chronic constipation – evaluating for functional
obstruction
 Rectal prolapse
 Rectocele (an outpouching of the rectum)
 Fecal incontinence
 Anismus (inappropriate spasm of the anal sphincter)
Contra-Indications:
 Hypersensitivity to iodinated contrast.
 Renal functional test is abnormal.
 Suspected pregnancy.
 Acute infection in the anal area.
Patient preparation:
1. Patient take starvation for 6-8 hours before the
examination.
2. Patient give the vegetable laxative oil such as
coaster oil before the examination for bowel
preparation.
3. Patient give the dulcolex tablet before the
examination for bowel preparation

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 4. Patient take the low residue diet before the
examination.
5. Patient must be write and sign the consent before
the examination.
6. Patient immobilized during the exposure.
Procedure:
Defecography is a technique in which a barium contrast
medium is introduced into your rectum after the radiologist
performs a rectal examination. The barium is visible within
the rectum on X-rays. During the test, you are instructed to
defecate (empty the rectum) on a commode while X-rays of
the pelvis are taken. These X-rays are taken while the person
is sitting at rest, straining, squeezing, and during defecation.
This test allows the doctor to evaluate the pelvic floor muscles
and rectum during defecation. This type of test, although
awkward, provides valuable information that may aid your
doctor in diagnosing your problem.

Occasionally X-rays of other areas are needed for the test.

You may be asked to drink two cups of barium and two cups
of water. This is done to show the small intestine in the pelvis
if there is a problem with pelvic floor relaxation. Rarely, the
radiologist will also fill the vagina in women with barium
contrast.
Complications:
Defecography is painless and very safe. However, in more
rare cases there may be complications such as local
inflammation or intestinal perforation if you have other
underlying conditions, such as Crohn’s disease or rectocolitis.
After care:

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 Drink plenty of liquid for 24-48 hours. The barium may
make your stool white for several days. Your study will be
read by the imaging physician and results sent to your
physician, usually within 48 hours.

4. HSG:
Aim:
Hysterosalpingography examination of the uterus, uterine
tube or fallopian tubes. The following injection of contrast
medium it is usually employed in the investigation of
infertility. In most department the gynecologist and
radiologist and controlling the examination.
Indications:
 Infertility of the uterus.
 Block of the fallopian tubes.
 Development of uterus.
 Hypoplastic uterus
 Endometrial tumor.
Contra-Indications:
 Allergic reaction.
 RFT is abnormal.
 Active UTI.
Patient preparation:
 Timing of examination is very important is must.
 During a week and after menturation.
 The best time of the patient mid cycle after
menturation 10 days.
 Clean and shaved the pelvic region.
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  The patient should micturate immediately before the
examination.
Materials:
 Valsellum forceps.
 Vaginal speculum.
 Uterine sound.
 Leach Wilkinson cannula.
 Tenaculum.
 Sponge stick.
 20ml syringe.
 Povidone.
 Bowel.
 Gloves and Cotton.
Procedure:
 The patient is placed in lying supine position or
lithotomy position.
 The knee and hips are flexed and buttocks are raised
on a sand bags.
 The vaginal area is cleaned with anti-septic solutions.
 The vaginal speculum is inserted into the vagina and
dilated.
 The uterine sound is introduced into the length and
direction of the uterus and injection cannula is inserted
and speculum is removed into the cervical canal.
 The cervical dilator or used to dilated the cervix.
 Then take the leach Wilkinson cannula is inserted into
the cervical canal and take the 20 ml of diluted
contrast medium is injected into the cervix and take
the radiographic images.
Standard Radiographic Projection:
Pelvis AP View:
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Patient positioning:
 Place the patient in lying supine position to the middle
of the table.
 The both hands kept away from the body.
 The both knees are together and given the sandbag for
supporting.
 To cover the upper border anterior superior iliac spine
and lower border below the pubic symphysis.
 Patient is immobilized during the exposure.
Tube positioning:
The central ray passes through the anterior superior iliac
spine.
Accessories:
 Cone to cover .
 Bucky to be used.
Technique:
 15 mAs.
 80 kVp.
 40” FFD.
Note:
The first film to see the uterus, fallopian tubes and
peritoneal spill not seen the second picture is also taken.
Complications:
 Vssovagal reaction with bradycardia, hypotension,
potentially resulting in syncope.
 Pelvic infection.
 In rare cases, infection can damage the fallopian tubes
or make it necessary to remove them.
After care:

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 Your provider may recommend that you take over-the-
counter pain medicines for a few days after your HSG to help
ease your symptoms.

5. Handling of Trauma patients:

 Airway & alertness with cervical immobilization
 Breathing/ventilation
 Circulation and control of hemorrhage
 Disability (neurologic status)
 Exposure and environmental control
 Full set of vitals and family presence
 Get resuscitation adjuncts (LMNOP)
 Laboratories: ABG, lactic acid, CBC, and CMP
 Monitor: telemetry, ECG
 Naso/orogastric tube
 Oxygenation/ventilation
 Pain assessment and management.

6. Methyl Cellulose:
General uses:
It increases the bulk in your stool, an effect that helps to
cause movement of the intestines. It also works by increasing
the amount of water in the stool, making the stool softer and
easier to pass. Methylcellulose absorbs water in the
gastrointestinal lumen thereby increasing the bulk of the stool.
Contrast Procedure Uses:
Methylcellulose enteroclysis:
 Better for evaluation of mucosal detail than single-
contrast
 May be better for short segment disease

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  Easier to visualize through bowel loops
 Some consider it a more consistent double-contrast exam
than air-contrast enterocylsis
 More discomfort for the patient than single contrast.
Technique:
 Enteric contrast coats the bowel wall and methylcellulose
distends the small bowel.
 There are multiple different techniques. One source
recommends 220-300 mL of barium infused at 60-
80 mL through a syringe until half of the expected
intestinal loops are visualized.
 Methylcellulose is instilled through an electric
pump
 Methylcellulose may induce vomiting if it refluxes
into the stomach. It will also cause urgency and
profuse diarrhea when it reaches the colon, and an
enema tip in the rectum may be helpful.

3. Answer the following questions:

1. MCU:
Aim:
MCU is the radiology examination of the bladder and
urethra( urinary bladder).
Indications:
 Cystitis.
 Vesico-ureteric reflex (VUR).
 Posterior urethral valve.
 Tumor, cyst in the bladder.
Contra-Indications:
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  Active UTI.
 Allergic reaction.
 Suspected pregnancy.
 Pre and post operative cases should not allowed.
Patient preparation:
 Patient take starvation for 6 to 8 hours before the
examination.
 Patient must be write & sign the consent before the
examination.
 Patient remove the all radio opaque materials before
the examination.
 Patient pelvic region is clean and shaved before the
examination.
 Patient must be v before the examination.
Contrast medium:
12.5% of NaI solution or Water soluble iodinated contrast
medium is mixed with a normal saline In the ratio of 1:4.
Materials:
 X-ray machine.
 Contrast Dye.
 2% of Xyclocaine Gel.
 Sterilized bin.
 20 ml disposable syringes.
 Sprit.
 Cotton.
 Emergency drugs.
Procedure:
1. The patient is placed in lying supine position with
midline of the table.
2. The urethra is cleaned with anti-septic solution.

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 3. A sterilized urinary catheter is inserted through the tip
of the urethra into the bladder.
4. Now the dye injected into the bladder through the
urinary catheter.
5. Remove the catheter undertake the radiographic
images.
Standard Radiographic Projection:
 Pilot Image
 Full bladder
 Voiding phase
 After evacuation
Position:
 The first picture a contrast is filled by the bladder
pelvis AP view taken.
 The second picture pelvic RAO view the patient is
asked to pass urine at the time of radiography is taken.
KUB AP View:
 Place the patient in lying supine position to the middle
of the table.
 The both hands kept away from the body.
 The both knees are together and given the sandbag for
supporting.
 To cover the upper border anterior superior iliac spine
and lower border below the pubic symphysis.
 Patient is immobilized during the exposure.
Tube positioning:
The central ray passes through the umbilical region.
Accessories:
 Cone to cover .
 Bucky to be used.

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Technique:
 15 mAs.
 80 kVp & 40” FFD.
Second and third pictures are taken in supine oblique view
when the patient is micturate. This pictures includes KUBU
region. To see the reflux of contrast medium into the ureters
and kidneys.
Complications:
Complications are uncommon after MCU. Mild
haematuria (blood in the urine) is the most common. This
should clear over a few days. Injury to the urethra or bladder
from the insertion of the catheter is extremely rare.
After care:
You can eat and drink normally. The contrast media will
not be noticeable in your urine. You may notice spotting when
you urinate; this may be due to the tiny tube scratching the
inside wall of your urethra, and this should only last a short
time.

2. Adverse reactions to iodinated contrast medium:

Hypersensitivity reaction to iodinated contrast medium:
 Hypersensitivity reaction to iodinated contrast media
can be classified into two types,
 Immediate anaphylactic reaction.
 Delayed reaction.
 Reactions may be classified as mild, moderate and
severe.
Mild contrast media:
 Mild contrast media reactions include flushing,
nausea, pruritus, vomiting, headache and mild itching.
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  They are usually self limited and resolve without
specific treatment.
 It can be used to avil, Hydrocortisone and adrenaline
drugs.

Moderate contrast media:

 Moderate contrast media reactions include severe vomiting,
bronchospasms or other respiratory symptoms, facial or
laryngeal edema and vasovagal attacks.
 It is used to adrenaline, sodium bicarbonate and atropine
drugs.
Severe contrast media:
 Severe contrast media include hydrolaemic shock,
respiratory arrest, cardiac arrest.
 Severe anaphylactic reactions are uncommon
occurring in less than 1 in 1,00,000 patients.
 These is an approximate tenfold increase in reactions
to both ionic and non-ionic contrast, media following
previous hypersensitivity reaction.
 Patient with history of asthma experience can
approximate six – fold increased this of a
hypersensitivity contrast media reactions.
 Skin irritating or allergic to topical iodine antiseptic
solution is not associated with an increased risk of
adverse reactions to intravenous iodinated contrast
media.
Reactions:
 Delayed contrast media reactions occur between
one hour and one week after intravenous
iodinated contrast media administered.

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  There are typically skin reactions with a rash
begin most common.
 Less frequent skin reaction include angioedema.
 Delayed hypersensitivity reaction are not
typically associated with bronchospasms or
laryngeal edema.
3. Barium Enema:
Aim:
The barium enema is a radiological examination of the
large intestine.
Indications:
 Any obstruction in the large intestine.
 Any ulcer in the large intestine.
 Crohn’s disease.
 Celiac disease.
 Any growth of the large intestine (polyps).
 Any tumor in the large intestine (malignant).
 Volvulus in the large intestine.
Contra-Indications:
 Hypersensitivity to iodinated contrast medium.
 RFT is abnormal.
 Suspected pregnancy.
 Pre and post operative cases.
Patient Preparation:
 The patient will be given vegetable laxative such as
castor oil for 2- days Consecutive days prior to be x-
ray examination to clear the bowel.
 The patient will be given Dulcolex Tablets (charcoal
Tablets).

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  The patient is given diet on the previous night. A low
residue
 The patient is request to come to the X-ray department
in the early morning 8 AM with an empty stomach.
 The patient is requested not to smoke. Because
smoking stimulates gastric Secretions Which will
dilute the contrast medium.
 On enema -1 hours warm Soap water is given to of the
Investigation.
Contrast medium:
The Contrast Medium barium sulphate powder is prepared
in ratio of 1:3 to an amount of 1500 ml depending upon the
physical conditions the patient.
Materials:
 Enema Cane.
 Iv – stand.
 50 ml Syringe
 Barium Powder.
Procedure:
 The Contrast Medium prepared is taken in a plastic
cave, which is gradually to know the level of the
solution:
 The cane is provided with the rubber tube at the
bottom and the tip of rubber tuba there & metal
catheter. The cane filled with Barium Sulphate
(BaSo4) solution is hanged from the higher level than
the Iv stand at x-ray couch.
 The patient is requested to remove all the dress and
radio-opaque metals and proper gown is given to the
patients.
 At first the patient is placed in the Left Lateral position
over the x-ray couch Vaseline or Jelly is applied at the
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 tip of the metal catheter. The Catheter is inserted
through the Anus by allowing a patient to win the
confidence of the radiograph.
 A stirrer is used to mix the Solution and the rubber
tube is opened during which solution gradually enters
in the sigmoid colon.
 The patient is requested to forced respiration which
helps for the easy entrance of the Contrast medium
into the descending Colon.
 Now a patient is requested to rotated right lateral
position. The Contrast medium completely ascending
colon. The patient is again placed the Supine position.
The metal Catheter removed from anus the radiograph
are taken.

Standard Radiographic Projection of Barium Enema:

Abdomen AP View:
Patient positioning:
 Place the patient in lying supine position to the middle
of the table.
 The both hands kept away from the body.
 The both knees are together and given the sandbag for
supporting.
 To cover the upper border anterior superior iliac spine
and lower border below the pubic symphysis.
 Patient is immobilized during the exposure.
Tube positioning:
The central ray passes through the umbilical region.
Accessories:
 Cone to cover.
 Bucky to be used.

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Technique:
 15 mAs.
 80 kVp & 40” FFD.

Left anterior oblique position:

In Certain Cases the flexure of The descending colon,
transverse colon. ‘Splenic Flexure will not be seen clearly. So
that the left oblique view is taken to diagnosis the splenic
Flexure.
Patient positioning:
The patient is placed in the lying Supine position. From
this position, the right Side of the abdomen raised 45° and
Supported with pillow. The big cassette is placed in bucky
with upper border. At the level of Nipple line and lower
border is Pubis Symphysis. The patient is immobilized. The
side mark is always kept. The exposure is arrest of expiration.
Tube positioning:
X-ray tube is Vertical. So that Central ray should pass
through the lower costal Margin (Middle of the film).
Technique:
 KVp 70-80
 MAS 100-120.
 FFD 90 cm.
Right anterior oblique:
In some cases hepatic flexure ascending colon will not be
seen clearly. Right oblique view is taken. Hepatic Flexure are
clearly seen.
Patient positioning:
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 The patient is lying supine position From this position the
left Side of the abdomen raised 15” and Supported with pillow
the big cassette is placed in bucky. The upper border at the
level of Nipple line. The lower border in Pubis Symphysis.
The patient is immobilized. The side mark is always kept. The
exposure is arrest of respiration.
Tube positioning:
X-ray tube is vertical So that central ray should pass
through the Middle of the Film.
Technique:
 kVp 1-80
 mAs 80-120

A.E (After Evacuation):

After showing the above x-ray to the radiologist or doctor,
depending upon the requested. The patient is Send to latrine to
evacuated. The contrast media and the patient come back Ap
view abdomen taken Called After Evacuation. Picture.
Abdomen AP View:
Patient positioning:
 Place the patient in lying supine position to the middle
of the table.
 The both hands kept away from the body.
 The both knees are together and given the sandbag for
supporting.
 To cover the upper border anterior superior iliac spine
and lower border below the pubic symphysis.
 Patient is immobilized during the exposure.
Tube positioning:
The central ray passes through the umbilical region.

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Accessories:
 Cone to cover.
 Bucky to be used.
Technique:
 15 mAs.
 80 kVp & 40” FFD.
Complications:
 Inflammation in tissues surrounding the colon.
 Obstruction in the gastrointestinal tract.
 Tear in the colon wall.
 Allergic reaction to barium.
After care:
You may have white stools for a few days as your body
naturally removes any remaining barium from your colon.
Barium may cause constipation, so you may find you can
reduce your risk of constipation by drinking extra fluids in the
days following your exam. Your doctor may recommend a
laxative, if needed.

4. Diagnose & therapeutic angiography:

Angiography:
Angiography is one of the Radiology imaging procedure
available for the detailed investigation of heart & blood
vessels after injecting the contrast media. Angiography can be
more specifically described as follows:
 Angiography : imaging of the arteries.
 Venography : imaging of the veins.
 Angiocardiography : imaging of the heart & associated
structures.
 Lymphography : imaging of the lymphatic vessels.

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 During the procedure, the interventional radiologist places a
catheter or small tube into one of your arteries and injects contrast
material (commonly called “dye”) into vessel while taking x-rays of
the area. Angiography followed by the Angioplasty and Stenting
could be life saving in case of arterial blockage or narrowing of blood
vessels.

Diagnose:
 Peripheral Artery Occlusive Disease (PAOD).
 Popliteal Artery Disease.
 Atherosclerosis.
 Aneurysm of the blood vessels.
 Arteriovenous Malformations.
 Artery ischemia, Stenosis or Occlusion.
 Congenital abnormalities.
 Trauma to a limb arterial involvement.
 Blockage of the lowerlimb blood vessels.
 Angiomas.
 Buerger’s Disease.

Therapeutic angiography:
Treatment for Lowerlimb Arterial Disease:
Treatment for Lower Extremity Arterial Disease
To clear large blockages in a leg artery, they may suggest
minimally invasive surgery, such as
 Atherectomy (plaque removal),
 balloon angioplasty,
 use of stents.
Lifestyle changes can help stop the progression of lower extremity
arterial disease.
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Atherectomy:

Atherectomy is a peripheral intervention that opens arteries

blocked by plaque. During atherectomy, your provider uses a catheter
(a long, narrow tube) with a sharp blade, laser or rotating device on
the end to scrape away, dissolve or break up plaque without making a
large incision.

Types of atherectomy:

1. Excisional atherectomy: A blade cuts plaque in one

direction.
2. Laser ablation atherectomy: A laser destroys plaque.
3. Orbital atherectomy: A spinning tool works like
sandpaper to remove plaque.
4. Rotational atherectomy: Tiny blades cut plaque in a
circular motion.
Balloon Angioplasty:

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 Balloon angioplasty is a procedure used to open narrowed or
blocked arteries. It uses a balloon attached to a catheter that's inserted
into an artery. At the place where deposits of plaque have closed off
or narrowed the channel for blood flow, the balloon is inflated.

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28
1. Answer the following questions:

1. Fistulogram:
A fistulogram is an x-ray procedure used to view a fistula,
an abnormal passage between two or more parts of your body
that often drains out of your skin. Contrast material is used to
help fill the track and determine what parts of your body are
involved.

2. RGP:
Retrograde pyelography is a form of x-ray used to get
detailed pictures of the ureters and kidneys. Retrograde
pyelography uses a special dye (“contrast agent”) injected into
the ureters. The dye makes the ureters and kidneys more
easily seen in the x-ray images. This test like an intravenous
pyelogram (IVP), But IVP, the dye is injected into the vein
instead of ureters.

3. Barium Enema:
A barium enema is a radiographic (X-ray) examination of
the lower gastrointestinal (GI) tract. The large intestine,
including the rectum, is made visible on X-ray film by filling
the colon with a liquid suspension called barium sulfate
(barium). Barium highlights certain areas in the body to create
a clearer picture.

4. ERCP:
Endoscopic retrograde cholangiopancreatography (ERCP) is an
endoscopic procedure used to identify the presence of stones, tumors,
or narrowing in the biliary and pancreatic ducts. After the endoscope

29
is properly placed, a catheter is advanced which will inject a contrast
agent through the ducts.
5. What is Dacryocystogram:
This is a special radiographic test to see if there is
blockage of the lacrimal ducts or tear canals. Radiographic
dye is injected into the tear canal and then radiographic
pictures are taken to determine if the duct is blocked or if
there is free flow of tears from the eye into the nose.

6. Some non-ionic contrast medium:

 Omnipaque 350
 Visipaque pro
 Ultravist pro
 Optiray 320

7. Some ionic contrast medium:

 Gadodiamide
 Gastrografin pro
 Conray 43
 Renografin 60

8. What is splenoporto venogram:

This technique requires the placement of a catheter into a
patent portal vein branch. The catheter is advanced into the
main portal vein, and contrast is injected to demonstrate the
portal venous anatomy.
9. Myelogram:
A myelogram is a diagnostic imaging test generally done by a
radiologist. It uses a contrast dye and X-rays or computed tomography
to look for problems in the spinal canal. Problems can develop in the
30
spinal cord, nerve roots, and other tissues. This test is also called
myelography.
10. HSG:
Hysterosalpingography (HSG) is an X-ray procedure that
is used to view the inside of the uterus and fallopian tubes. It
often is used to see if the fallopian tubes are partly or fully
blocked. It also can show if the inside of the uterus is a normal
size and shape.

2. Answer the following questions:

1. Uses of Fluoroscopy:
 Fluoroscopy is used in many types of examinations and
procedures.
 Barium study (Barium Swallow, meal, enema and
Loopogram).
 Cardiac catherization.
 Arthrography (To evaluate the joints).
 Lumber Puncher (Myelogram).
 Placement of intravenous IV catheter (Hollow tube
placed to the arteries and veins).
 Biopsies.
2. Ascending urethrogram:
Aim:
A urethrogram is an examination of the urethra
by X-ray imaging, almost always carried out on males.
This information sheet relates to the procedure being
carried out on a male. The urethra is the tube that runs
from the bladder through the prostate and penis.
A urethrogram is usually carried out to show the
cause of poor urinary flow thought to be caused by
31
narrowing (a stricture) of the urethra. The most
common cause for narrowing of the urethra in men is
benign (non-cancerous) enlargement of the prostate
gland. A urethrogram is most often used to diagnose
causes of narrowing of the urethra that are not caused
by benign enlargement of the prostate gland.
Indications:
Strictural Urethra.
Bulbar Urethra.
Stenosis or Occlusive in the Urethra.
Suspected Urethral Fistula.
Post Operative Tests( Plastic Surgery).
Pelvic Trauma.
Urethral Diverticula.
Urethral obstruction.
Suspected urethral foreign bodies.
Urethral mucosal tumors.
Contra-Indications:

 Allergic to iodinated contrast media.

 Renal Functional Test is Abnormal.
 Acute Urinary Tract Infection.
 Recent Instrumentation of Urethra.
Patient Preparation:
 The patient should be take a Starvation 6-8 hours before
the examination.
 The patient should be remove the all radiopaque
materials in the pelvic area.
 The Patient should be write & signed the consent before
the examination.

32
  The Patient should be clean the pelvic area before the
examination.
 The patient should be micturated before the examination.

Contrast Media:
 Omnipaque Iohexol 350 mgI/ml is non-ionic and water
soluble contrast media are used which is diluted with
Normal Saline.
 To prepare 10 ml contrast mixed with 10 ml normal
saline.
Equipments:
X-ray Machine.
Omnipaque iohexol 350 mgI/ml.
20 ml disposable syringe.
Infant Feeding Tube.
Lignocaine gel.
Povidone -iodine.
Gauge piece.
Bowl.
Emergency Drugs.
Gloves.
Lead & Neck Apron.
Procedure:
 Place the patient in supine Position to the midline of the
table.
 Flex the right knee & given the sand bag for supporting.
 The pelvis is clean with Betadine and take infant feeding
tube to cut about 1cm and connect to 20 ml contrast
loaded Syringe.

33
  Then, the syringe tip is pour into the lignocaine gel and
inserted the penile urethra and injected to the Contrast
medium during the exposure.

Standard Radiographic Projection:

 Pilot Film.
 Dynamic Film.
Pilot Film:
Pilot film of pelvic area is taken to see the bowel
preparation before the examination .Pilot film provides
valuable information and sometimes indicates probable
diagnosis,
 Ureter Stone.
 Kidney Stone.
 Calcification.
 Foreign body.
Right Anterior Oblique View of Pelvis:
Patient Positioning:
 Place the patient in supine Position to the midline of the
table.
 Flex the knee & given the sandbag for supporting.
 Patient should be immobilized during the exposure.
Tube Positioning:
 No angulation.
 Central ray passes through the ASIS( Anterior Superior
Iliac Spine).
Film Positioning:

34
  1” above the iliac crest and 1” below the Pubis
symphysis.
Accessories:
 Necessary to cone cover.
 Bucky to be used.
Technique:
 10 mAs, 76 kVp & FFD is 40”.
Complications:
 Urinary tract infection.
 Bleeding.
 Intravasation.

After Care:
Up to 48 hours later, you may feel discomfort. Your urine
may be a little pink. Still, you can return to normal activities
right after this test. If the pain doesn't go away, if you get a
fever, or if your urine turns bright red, tell your health care
provider.

3. Responsibility of Radiographer in OT procedure:

 The Radiographer shifted to OT dress before entering
operation theatre.
 After change the dress and her hand full wash and
sterilization using hot water and anti biotic solution.
 After wear lead apron, thyroid shield and gonads shield
and must be wear the TLD batch inside of the lead apron.
 After wear the gloves, mask and head cap for avoid the
hair fall in operation theatre.

35
  Radiographer inside the operation theatre check the C-
arm conditions and image storage space and movement
of the machine conditions.
 Double check the details and make sure the surgeon is
operating on the correct side.
 Carefully move the C-Arm during open surgery and after
surgery cleaning must important for C-Arm machine.
4. Central Venography:
Venography is an x-ray examination that uses an injection
of contrast material to show how blood flows through your
veins. Your doctor may use it to find blood clots, identify a
vein for use in a bypass procedure or dialysis access, or to
assess varicose veins before surgery.
There are divided into two types,
1. Superior veno cavography.
2. Inferior veno cavography.
Superior Veno Cavography:
Indications:
 SVC Thrombosis or Obstruction.
 SVC Stenosis or Narrowing.
 Congenital abnormalities.
 Carcinoma bronchus
Contrast Medium:
Iopromide 300 or Urograffin 76% (50-80ml).
Procedure:
The examination is bilateral or unilateral based on
indications. The catheter is inserted into the subclavian veins
under by fluoroscopy. Then 30-50ml contrast injected at the
rate of 5-10ml using a pressure injector and take the
radiographs.
36
Inferior veno cavography:
An inferior vena cavagram is a procedure in which a thin
flexible tube called a catheter is inserted through a vein
usually in the neck or groin which allows the physician to take
x-ray pictures of the large central vein that serves as a
highway for blood return to the heart from the extremities.
Indications:
 IVC Stenosis or Narrowing.
 IVC Blockage or Obstruction.
 Congenital abnormalities.
Contrast Medium:
Urograffin 76% or water soluble iodinated contrast
medium 30-50ml
Procedure:
Femoral vein or Neck groin is punched and 5F pigtail
catheter is into the external or common iliac vein under
fluoroscopy central. About 30-50ml contrast is injected at 8-
10ml using a pressure injector after care. Pressure at venous
puncher site. And take the radiographic images.

5. Barium Swallow:
Aim:
To study the pathology of pharynx and Oesophagus.
Indications:
 Dysphagia - motility disorder, Growth, stricture
 Oesophagus varies
 Left atrial enlargement
Contra-Indications:
Suspected perforation in the Oesophagus.
37
Contrast Medium:
 Barium sulphate powder thick paste.
 150% weight/volume (150g Barium sulphate+ 100ml
water)
 This is routine for stricture and fistula.
 Thin Barium is used as 50% weight/volume
Equipment:
300 mA x ray unit with Fluoroscopy.
Patient Preparation.
 No Preparation of the patient.
 Pilot film is not necessary.
Procedure:
1. First patient is asked to stand in front of the
Fluoroscopy screen.
2. Barium is given to the patient mouth.
3. Then, he is asked to swallow the Barium.
4. The flow of Barium comes from Oesophagus.
5. This is followed with Fluoroscopy.
6. If any obstruction or pathological lesion is notes in any
place.
7. Radiography in taken in AP,LAT, RAO & LAO which
is needed.
Standard Radiographic Projection of Barium Swallow:
Neck AP View:
Patient positioning:
The patient is placed in the erect standing supine position
facing the tube with a 10x8 cassette is Supported it Vertically
chest stand. The chin is raised and kept at the top edge of the
Cassette. The arms are allowed to clasp the Supports and the
radiation field is Collimated and the patient is immobilized.

38
Tube positioning:
X-ray tube s horizontal. So, that • central ray should pass
through the Middle of the Neck. (C6 Vertebra).
Technique:
 kVp-70-75
 mAs-10-15
 FFD-40”
Lateral view:
Patient positioning:
The patient is erect standing Lateral position with any one
of the side in bronco duct , with the Cassette. The Cassette is
supported vertically chest stand. The arms are effected mi
back, wards and crossed. The Immobilized patient. The
another table spoon barium powder is given to the patient
retain on the mouth for Swallowing the time of exposure
"Lateral view taken.
Tube positioning:
X-ray tube is horizontal. So that central ray should pass
through the Middle of the neck.
Technique:
 kVp 70-75
 MAS 15-20
 FFD- 90cm

Right anterior oblique:

The patient is placed in erect Standing Lateral position
with the right side of the trunk (chest) is contact with the
Cassette. A big cassette is Supported Vertically chest stand:
The upper border is pinna The patient is provided with
39
another table spoon of barium paste, is given to be retained in
the mouth and Should be advised to swallow. The right trunk
(Chest) is rotated forward to about 60° and the left arms are
allowed to the clasp the Supported. The arms is allowed to
touch the hip, shoulder is forward. The patient is immobilized
and the radiation field is collimated: The exposure is alone at
the time of swallowing.
Tube positioning:
X-ray tube is horizontal. So that central ray should pass
through the middle of the film.
Technique:
 Kvp 10-15
 MAS 15-20
 FFD 90 cm.
This is the best position to diagnosis the abnormalities of
the Oesophagus. Because the full extend of Oesophagus is
shown in the picture Separate from Sternum in front and
vertebral bodies from behind.

6. Arthrography:
An arthrogram (or arthrography) is a commonly performed
procedure in musculoskeletal radiology, which can refer to
both an injection into a joint, and cross-sectional imaging after
a joint is injected.
Indications
Arthrograms are performed for a variety of indications
including:
 Labral tear after shoulder dislocation
 Hip labral tears
 Partial-thickness tendon tears
 Partial-thickness ligament tears
40
  Hand ligament tears
 Retear of repaired tendon
 Retear of repaired meniscus
 Pain relief
 Surgical planning
 Arthrogram injections
 Three main categories of injections are performed:
Patient Preparation:
No special preparation is necessary before direct
arthrography. Food and fluid intake do not need to be
restricted, unless a sedative will be given.
You should inform your physician of any medications you
are taking and if you have any kidney problems or allergies,
especially to iodinated or gadolinium-based contrast
materials. Also, inform your doctor about recent illnesses or
other medical Equipment:
This exam typically uses a radiographic table, one or two
x-ray tubes, and a video monitor. Fluoroscopy converts x-rays
into video images. Doctors use it to watch and guide
procedures. The x-ray machine and a detector suspended over
the exam table produce the video.
The traditional MRI unit is a large cylinder-shaped tube
surrounded by a circular magnet. You will lie on a table that
slides into a tunnel towards the center of the magnet.
Procedure:
The patient is positioned on the examination table. X-rays
of the joint may be taken prior to the procedure to help in
guiding the injection and also to provide a baseline exam to be
compared later with the arthrogram images. If recent x-rays
are available, the physician may choose to use these for
reference. Next, the skin around the joint is cleansed with
antiseptic and is often covered with a sterile surgical drape.
41
Using a small needle, the physician injects local anesthetic
into the area. You may feel a minor sting that will usually
subside after 15 to 20 seconds. After the local anesthetic has
taken effect, a longer needle is then inserted into the joint. The
radiologist, a physician specially trained to supervise and
interpret radiology examinations, will often use fluoroscopy
or ultrasound to guide the needle into the correct position. The
physician will sometimes use a syringe to drain (or aspirate)
the joint fluid, which may be sent to a laboratory for analysis.
Aspiration is typically performed when an infection is
suspected. The contrast material and sometimes air are
injected into the joint space while the radiologist observes
with fluoroscopy or ultrasound. In some cases, additional
medications, such as anti-inflammatory steroids, may be
injected into the joint along with the contrast material. After
the needle is removed, the patient will be asked to move the
affected joint to distribute the contrast material throughout the
space. The radiologist may move the joint while evaluating
the joint motion under fluoroscopy. A conventional direct
arthrography exam is usually completed within 30 minutes.
Exams involving MRI may take more than one hour.
Benefits:
Direct arthrography is particularly effective for detecting
disease of the structures within the joints such as ligaments,
labrum, tendons and cartilage. This is particularly true for the
shoulder in the setting of shoulder dislocation and in the hip,
wrist and elbow.
Exams involving x-ray imaging:
1. No radiation stays in your body after an x-ray exam.
2. X-rays usually have no side effects in the typical
diagnostic range for this exam.
Exams involving MR imaging:
42
 1. MRI is a noninvasive imaging technique that does not
involve exposure to radiation.
2. MRI can detect abnormalities that might be obscured by
bone with other imaging methods.
3. The MRI gadolinium contrast material is less likely to
cause an allergic reaction than the iodine-based contrast
materials used for x-rays and CT scanning.
4.
Answer the following questions:

1. MCU:
Aim:
MCU is the radiology examination of the bladder and
urethra( urinary bladder).
Indications:
 Cystitis.
 Vesico-ureteric reflex (VUR).
 Posterior urethral valve.
 Tumor, cyst in the bladder.
Contra-Indications:
 Active UTI.
 Allergic reaction.
 Suspected pregnancy.
 Pre and post operative cases should not allowed.
Patient preparation:
 Patient take starvation for 6 to 8 hours before the
examination.

43
  Patient must be write & sign the consent before the
examination.
 Patient remove the all radio opaque materials before
the examination.
 Patient pelvic region is clean and shaved before the
examination.
 Patient must be v before the examination.
Contrast medium:
12.5% of NaI solution or Water soluble iodinated contrast
medium is mixed with a normal saline In the ratio of 1:4.
Materials:
 X-ray machine.
 Contrast Dye.
 2% of Xyclocaine Gel.
 Sterilized bin.
 20 ml disposable syringes.
 Sprit.
 Cotton.
 Emergency drugs.
Procedure:
6. The patient is placed in lying supine position with
midline of the table.
7. The urethra is cleaned with anti-septic solution.
8. A sterilized urinary catheter is inserted through the tip
of the urethra into the bladder.
9. Now the dye injected into the bladder through the
urinary catheter.
10. Remove the catheter undertake the radiographic
images.
Standard Radiographic Projection:
 Pilot Image
44
  Full bladder
 Voiding phase
 After evacuation
Position:
 The first picture a contrast is filled by the bladder
pelvis AP view taken.
 The second picture pelvic RAO view the patient is
asked to pass urine at the time of radiography is taken.
KUB AP View:
 Place the patient in lying supine position to the middle
of the table.
 The both hands kept away from the body.
 The both knees are together and given the sandbag for
supporting.
 To cover the upper border anterior superior iliac spine
and lower border below the pubic symphysis.
 Patient is immobilized during the exposure.
Tube positioning:
The central ray passes through the umbilical region.
Accessories:
 Cone to cover .
 Bucky to be used.
Technique:
 15 mAs.
 80 kVp & 40” FFD.
Second and third pictures are taken in supine oblique view
when the patient is micturate. This pictures includes KUBU
region. To see the reflux of contrast medium into the ureters
and kidneys.
Complications:
45
 Complications are uncommon after MCU. Mild
haematuria (blood in the urine) is the most common. This
should clear over a few days. Injury to the urethra or bladder
from the insertion of the catheter is extremely rare.
After care:
You can eat and drink normally. The contrast media will
not be noticeable in your urine. You may notice spotting when
you urinate; this may be due to the tiny tube scratching the
inside wall of your urethra, and this should only last a short
time.

2. CT Enteroclysis:
CT enterography (CTE) is a non-invasive technique for the
diagnosis of small bowel disorders.
Indications:
1. suspected small bowel bleeding, usually performed
after negative endoscopy.
2. suspected small bowel tumor, e.g. carcinoid, polyposis
syndromes.
3. celiac disease: assess for complications such as
lymphoma.
4. partial small bowel obstructions, e.g. postoperative
adhesions, radiation enteritis, scleroderma.
5. chronic diarrhea and/or abdominal pain.
6. suspected chronic mesenteric ischemia.
7. Crohn's Disease.
Advantages:
useful in the assessment of the solid organs and provides a
global overview of the abdomen.
46
Disadvantages:
exposure to ionizing radiation.
Bowel preparation:
1. abstain from all food and drink 4-6 hours before the
exam.
2. patients drink about 1.5 L of oral contrast over 30-60
minute.
3. Fluid distension of the small bowel allows better
assessment of mucosal enhancement, mural thickness as
well as mesenteric vasculature, this is important
especially in the evaluation of Crohn disease.
Procedure:
1. CT scanning is ideally performed on a multidetector
computed tomography (MDCT) scanner
2. intravenous contrast:
* Crohn disease, celiac disease, postoperative
adhesions, radiation enteritis, and scleroderma: a
single enteric phase where peak mucosal
enhancement is achieved is sufficient - either enteric
phase (45-50s) or portal venous phase (60-70s)
* small bowel tumors: an additional arterial phase
can be performed, in particular for the assessment of
hyper vascular lesions (e.g. neuroendocrine tumors)
* in cases of suspected GI bleeding, pre-contrast,
arterial, portal venous, and delayed phases should
be considered
3. data interpretation with the use of axial and
coronal reformatted images for proper evaluation.

47
Complications:
The CT enterography procedure doesn’t cause any lasting
side effects. You won’t need recovery time because the test
doesn’t require any incisions or sedation. You can resume
your regular activities as soon as the procedure is completed.

3. Lowerlimb Angiography:
Aim:
A CT Angiography Lower Limb is an imaging test in
which a contrast medium is used to diagnose the vessel’s
injury of the lower limb. Peripheral extremity CTA can
nowadays be performed rapidly with high spatial resolution
and a decreased amount of both intravenous contrast and
radiation exposure. In patients with peripheral artery disease
(PAD), this technique can be used to delineate the bilateral
lower extremity arterial tree.
Indications,
Peripheral Artery Occlusive Disease (PAOD).
Popliteal Artery Disease.
Atherosclerosis.
Aneurysm of the blood vessels.
Arteriovenous Malformations.
Artery ischemia, Stenosis or Occlusion.
Congenital abnormalities.
Trauma to a limb arterial involvement.
Blockage of the lowerlimb blood vessels.
Angiomas.
Buerger’s Disease.
Contra-Indications,
 Hypersensitivity to iodinated contrast media.
48
  Blood clotting disorder or Bleeding disorder.
 Anti coagulant medication.
 Impaired renal function.
 Unable to do vascular surgery.
 Low HB.
 Renal Functional Test is Abnormal.
 Pregnancy ladies should not allowed.
 Asthma.
 Severe diabetes.
Patient Preparation,
1. Patient should not eat or drink anything for 6-8 hours
before the test.
2. Patient may be told to stop talking certain medications
such as aspirin or other blood thinners for a short while before
the test.
3. Patient should be write and signed the consent before
the examination.
4. Patient should be put new 18G Venflon to the upper
limb before the examination.
5. Patient requested to do not smoke at least 24 hours
before the examination because smoke is react & dilute the
contrast medium.
6. The patient should be told that she is pregnant before
taking the test.
7. Patient should be removed all radiopaque materials
before the examination because prevent the metallic artifact
such as ( Mobile Phone, Coins, Hairpins, Chains, etc., )
8. Patient should be wear the Hospital Gown.

49
Equipments,
 Computed Tomography machine.
 Omnipaque iohexol 350 mgI/ml.
 Imaxeon Salient Dual CT Power Injector.
 Plastic 150 cm Y extension tube Dual.
 190 ml syringe with QFT.
 10 ml syringe.
 Normal Saline.
 Gloves.
 Emergency Drugs.
 Spirit.
 Cottons or Gauze pieces.
Patient Positioning,
1. The patient is placed feet-first and supine on the couch
of the scanner.
2. Both arms should be extended above the head.
3. The IV should be connected to the power injector.
Mode of Scanning:
Helical with single breath hold technique .
Scan Orientation:
Craniocaudal,
 Starting location: 1’’ above the
Xiphisternum.
 Ending location: 1’’ below the foot.
Gantry tilt:
50
 No tilt or If necessary the tube is tilt.

Contrast Administration:
Intravenous Monophasic.
Volume of Contrast:
100-120 ml.
Rate of Injection Contrast:
3-4ml/sec.
Slice Thickness:
1.25-5mm.
Complications of this procedure:
 Bleeding causing a collection of blood.
 Swelling or inflammation of the blood
vessels (vasculitis).
 Damage to the artery.
 Loss of limb.
 Allergic reaction to the equipment, materials
and contrast medium.
 Kidney Damage.
 Vomiting or Nausea.
After care:
After your CT Lowerlimb angiogram is completed, you
can return to your normal daily activities. You should be able
to drive yourself home or to work. Drink plenty of water to
help flush the dye from your body.

51
Write the following questions:
1. Skyline View:
Patella Skyline or axial View special x-ray Projection
of patella-femoral joint. It suited the patient is Semi-
recumbent position (45°). The pathology of the skyline
view is interior Patella fractures, cysts, arthritis
2. Carpal Bones:
It is classified into eight types,
 Scaphoid.
 Lunate.
 Triquitral.
 Pisiform.
 Trapezium.
 Trapezoid.
 Capitate.
 Hamate.
3. Barium enema:
A barium enema is a radiographic (X-ray)
examination of the lower gastrointestinal (GI) tract. The
large intestine, including the rectum, is made visible on
X-ray film by filling the colon with a liquid suspension
called barium sulfate (barium). Barium highlights certain
areas in the body to create a clearer picture.
4. High frequency x-ray:
High frequency x-ray A differ significantly from the
transitional. There are more efficient easy to use and the quality
of the image is remarkable. This is few advantages after high
frequency X ray overcomes to single phase X-ray generator it is
able to twice a efficient as single phase generators.
52
5. Babygram:
A radiograph that includes the whole body or just the
chest and abdomen (thoracoabdominal babygram) on a
single image. It is most commonly ordered for line
placement.
6. Occlusal Radiography:
Occlusal radiography is defined as those intraoral
radiographic techniques taken using a dental X-ray set
where the image receptor. It is used to find extra teeth,
teeth that have not yet broken through the gums, jaw
fractures, a cleft palate, cysts, abscesses or growths.
7. Anthonsan’s view:
Anthonsan’s radiological calcaneum Patient the table
leg and view is the examination Subtalar joint. The
patient leg is fully extended on the table and Foot is
dorso flexed 90°. And central ray passes through the
medial malleolus. Yusuf angle in 5 degree anterior under
23 degree caudal it is useful to diagnose the subtalar
arthritis, fractures and inflammations.
8. Grid Cassette:
Grid cassette is used to reduce the patient radiation
dose, scattered radiation and improve the radiographic
image quality.
9. Auto tomogram:
Auto tomography permits improved visualization of
the atlas-axis and occipito-cervical articulations with
virtually any x-ray equipment in less time than is
required for anteroposterior and lateral tomograms.

53
10. Non-ionic contrast medium:
Contrast media is used in radiographic is improve the
image quality. A non-ionic contrast media is does not
contain iodine. and it is low osmolarity media but it is
comparatively less toxic than high osmolarity media.
Therefore, there is a high demand in the non ionic type.
Answer the following questions:
1. Handling of unconscious and uncooperative
patients:
1. Initially explain the Radiology procedure to the
patient attender.
2. Number of x ray should be minimal without take
re-exposure
3. Put small amount of sedation drugs to the patient
4. In case over reacting, relax few hours and repeat
the procedures
5. Ask help from emergency staff
6. *Add Your own point*
2. Discus about Radiographs of Cervical spine x-ray:
Intro:
Your cervical spine the neck area of your spine
consists of seven stacked bones called vertebrae. The
first two vertebrae of your cervical spine are unique in
shape and function. Your first vertebra (C1), also called

54
the atlas, is a ring-shaped bone that begins at the base of
your skull.

Common pathology:
Common cervical spine disorders include: Cervical
spondylosis: cartilage and vertebrae wear out
abnormally. Cervical herniated disc: discs between the
vertebrae rupture, protrude, or bulge out. Degenerative
disc disease: discs between the vertebrae break down.
Standard Projection of C-spine:
 C-spine AP
 C-spine Lateral
 C-spine Oblique
 C-spine flexion
 C-spine extension
C-spine AP View:
Positioning of the patient:
1. Place the patient in supine position
2. The median sagittal plane of the skull is the to the
table top.
3. The OMBL is 40° to thế table.
Positioning of the tube:
1. Angle the tube 5 to 10° cephalad or may be left
without any angulation.
2. Centre thro' the thyroid cartilage.
Positioning of the film:
1. Size: 10" x 8"
55
 2. lengthwise
3. Place the film top ear. I" above the upper part of

Accessories:
1. Cone to cover
2. Bucky to be used
Technique:
1. kVp-70-75
2. mAs-10-15
3. FFD-40”.
Lateral View:
Positioning of the patient:
1. The patient is placed in an erect posture either in
sitting or standing with one shoulder against film
holder.
2. The back should be straight-Med. Sag Plane o
head and body parallel to film holder.
3. The shoulders are bags may be given on relaxed
and depressed. San both hands to keep th
shoulders in depressed position.
4. The chin is raised moderately.
Positioning of the tube:
1. No angulation
2. Centre 1” behind the angle of mandible at th level
of C, vertebra.
Positioning of the film:
1. Size: 10” x 8”
56
 2. Lengthwise
3. The upper border of the film is 2” above the ed
auditory meatus.

Accessories:
1. Cone to cover
2. Bucky not necessary
Technique:
1. kVp-70-75
2. mAs-10-15
3. FFD-40”.
3. Forensic radiology:
It is the discipline which comprises the performance,
interpretation and reportage of the radiological
examinations and procedures which are needed in court
procedures or law enforcement. Radiological methods
are widely used in identification, age estimation and
establishing cause of death. Comparison of ante mortem
and post mortem radiographs is one of the means of
identification. The scanning of baggage, vehicles and
individuals have many applications.
Tools like multislice helical computed tomography
can be used for detailed documentation of injuries, tissue
damage and complications like air embolism and
pulmonary aspiration of blood. These types of digital
autopsies offer certain advantages when compared to
traditional autopsies.
4. Mammography:

57
 A mammogram is an X-ray examination of the breast. It is
used to detect and diagnose breast disease in women who either
have breast problems, such as a lump, pain, or nipple discharge,
as well as for women who have no breast complaints. The
procedure allows detection of breast cancers , benign tumors,
and cysts before they can be detected by palpation (touch).

Different types of mammograms:

Screening mammogram:
A screening mammogram is an X-ray of the breast
used to detect breast changes in women who have no
signs or symptoms of breast cancer. It usually involves 2
X-rays of each breast. Using a mammogram, it is
possible to detect a tumor that cannot be felt.
Diagnostic mammogram:
A diagnostic mammogram is an X-ray of the breast
used to diagnose unusual breast changes, such as a lump,
pain, nipple thickening or discharge, or a change in
breast size or shape. A diagnostic mammogram is also
used to evaluate abnormalities detected on a screening
mammogram. It is a basic medical tool and is appropriate
in the workup of breast changes, regardless of a woman’s
age.
Adequate Craniocaudal (CC) views:
 All glandular tissue identified
 Nipple in profile
 Nipple in the midline of image
 Length of posterior nipple line (PNL) within 1 cm
in size (cf. PNL on MLO)
 Images symmetric
58
Adequate Mediolateral oblique (MLO) views:
 Pectoral shadow is seen down to the level of the
nipple or lower
 Inframammary fold is well seen
 Nipple in profile
 Length of posterior nipple line (PNL) within 1 cm
in size (cf. PNL on CC)
 Images symmetric.
5. Responsibility of Medical Legal Cases:
1. Most important and sensitive part in radiology
department
2. Maintain separate protocol
3. MLC are RTA, ASSAULT, poison etc.
4. In radiology department, Radiographer must
have extra responsibility
5. Should take x ray MLC in severity of patient
conditions, like Red injury case give more
important than yellow and green
6. Take x ray without patient discomfort
7. Should take all x ray from doctor requisition
form
8. Should be present Marker in all x ray
9. Maintain separate room
10. Maintain atleast 5 yrs.
6. Developmental of Hip Dysplasia:
Developmental dysplasia of the hip (DDH) is a
spectrum of disorders affecting the proximal femur and
acetabulum that leads to hip subluxation and dislocation.
It results from abnormal hip development and presents in
infancy or early childhood ranging from dysplasia to
dislocation of the hip joint. DDH is the most common
59
congenital abnormality of the musculoskeletal system.
Early diagnosis and treatment is important because
failure to diagnose DDH in neonates and young infants
can result in significant morbidity

Imaging modalities:
1. Ultrasound:
Ultrasonography (US) is the preferred modality for
evaluating the hip in infants who are 6 months or
younger. US enables direct imaging of the cartilaginous
portions of the hip that cannot be seen on plain
radiographs. Furthermore, US enables dynamic study of
the hip with stress maneuvering. Practically speaking, the
examination can often be successfully performed after 6
months of age (even up to 10-12 months) depending on
the degree of ossification of the capital femoral
epiphysis. An attempt at US examination is suggested, to
limit the neonates exposure to ionizing radiation. If
unsuccessful, plain films can follow.
2. Radiography
Plain radiographs of the pelvis are most helpful when
significant ossification of the capital femoral epiphyses
has occurred and when adequate ultrasound evaluation
cannot be performed. Plain radiographs of the pelvis are
obtained in the frontal projection with the legs in the
neutral position. Before the femoral heads begin to
ossify, the projected locations must be estimated.
3. CT and MRI

60
 Computed tomography (CT) is useful for evaluating
complicated dislocations and for postoperative
evaluation of the hip. CT can depict osseous blocks to
relocation, as well as iliopsoas tendon capsule
constriction, a thick ligamentum teres, and fibrofatty
pulvinar hypertrophy. CT can also be used to evaluate
femoral and acetabular anteversion.
MRI can be useful in the preoperative and
postoperative evaluation of a hip with many
complications. MRI can be used to distinguish the
labrum, capsule, and acetabular cartilage. MRI is useful
for detecting the complications of DDH and treatment for
DDH, such as avascular necrosis of the femoral head and
joint effusions. MRI can also be used to demonstrate
iliopsoas tendon compression, a thick ligamentum teres,
and pulvinar hypertrophy.

7. Pelvimetry:
Pelvimetry is the measurement of the female pelvis.
[1] It can theoretically identify cephalo-pelvic
disproportion, which is when the capacity of the pelvis is
inadequate to allow the fetus to negotiate the birth canal.
However, clinical evidence indicate that all pregnant
women should be allowed a trial of labor regardless of
pelvimetry results.
Components:
The terms used in pelvimetry are commonly used in
obstetrics. Clinical pelvimetry attempts to assess the

61
62
End points Normal
Measures

The iliopectineal 13 to 14.5 cm.

lines, at widest
transverse distance.

The line between the 10 to 12 cm.

done by radiography and MRI.

closest bony points of

the sacral promontory
and the pubic bone
next to the symphysis
estimating the main pelvimetry parameters,

The line between the 9.5 to 11.5 cm.

closest bone points of
pelvis by clinical examination. Pelvimetry can also be

Low-dose 3D-rendered CT scans can be used for

the ischial spines

63
Parameters Thin slices

Sagittal pelvic Same, but may The closest bony 9.5Coronal cm.
to 11.5plane
Transverse
outlet diamete require minor side- points of the
diameter of the
to-side scrolling to sacrococcygeal joint
pelvic inlet
visualize both end and the pubic bone
points next to the
symphysis. This is
also called
Obstetricthe Same, but may
require minor
obstetricconjugate
side-to-side
anteroposterior scrolling to
diameter of the visualize both end
pelvic outlet points.

Intertuberous Axial plane The closest bony 10 to 12 cm.

diameter points of the ischial
Interspinous
tuberosities Axial plane
distance
Answer the following questions:

1. Skull Bone and Radiographies:

The skull is a bony structure that supports the face
and forms a protective cavity for the brain. It is
comprised of many bones, which are formed by
intramembranous ossification, and joined by sutures
(fibrous joints).

The bones of the skull can be considered as two groups:

those of the cranium (which consist of the cranial roof
and cranial base) and those of the facial.
Cranial Bones:
The cranium (also known as the neurocranium) is formed
by the superior aspect of the skull. It encloses and protects the
brain, meninges, and cerebral vasculature.
Anatomically, the cranium can be subdivided into a roof and a
base:
Cranial roof – comprised of the frontal, occipital and two
parietal bones. It is also known as the calvarium.
Cranial base – comprised of the frontal, sphenoid, ethmoid,
occipital, parietal, and temporal bones. These bones articulate
with the 1st cervical vertebra (atlas), the facial bones, and the
mandible (jaw).
64
Facial:
The facial skeleton (also known as the viscerocranium)
supports the soft tissues of the face.
It consists of 14 bones, which fuse to house the orbits of
the eyes, the nasal and oral cavities, and the sinuses. The
frontal bone, typically a bone of the calvaria, is sometimes
included as part of the facial skeleton.
The facial bones are:
 Zygomatic (2) – forms the cheek bones of the face
and articulates with the frontal, sphenoid, temporal
and maxilla bones.
 Lacrimal (2) – the smallest bones of the face. They
form part of the medial wall of the orbit.
 Nasal (2) – two slender bones that are located at the
bridge of the nose.
 Inferior nasal conchae (2) – located within the
nasal cavity, these bones increase the surface area of
the nasal cavity, thus increasing the amount of inspired
air that can come into contact with the cavity walls.
 Palatine (2) – situated at the rear of oral cavity and
forms part of the hard palate.
 Maxilla (2) – comprises part of the upper jaw and
hard palate.
 Vomer – forms the posterior aspect of the nasal
septum.

65
  Mandible (jaw) – articulates with the base of the
cranium at the temporomandibular joint (TMJ).
Pathology of Skull bones:
Pathology is damage that may be the result of
trauma, disease, or infection.
Standard Projection of Skull injury:
 Skull AP
 Skull PA
 Skull lateral
 Base of skull
 PNS
 Skull LAO or RAO
Skull AP View:
Patient positioning:
 The patient is placed in erect position, in sitting position, or
in supine position.
 Match midsagittal plane (MSP) of head with vertical axis
crossing the middle of image receptor (IR).
 Bend cervical vertebrae forward enough to make
orbitomeata) line (OMI) perpendicular to IR.
 Lean occipital region on IR gently to place nasion on the
center of IR.
Tube positioning:
 No angulation
 Central ray passes through the perpendicular to
the glabella.
66
Accessories:
 Cone to cover
 Bucky to be used
Technique:
 kVp – 70-89
 mAs – 15-25
 FFD – 40”.
Skull PA view:
Patient positioning:
 The patient is placed in erect position, in sitting
position or in prone position.
 Match midsagittal plane (MSP) of head with
vertical axis crossing the middle of image
receptor (IR).
 Bend cervical vertebrae forward enough to make
orbitomeatal line (OMI) perpendicular to IR.
 Lean forehead and nose on IR gently to place
nasion on the center of IR.
Tube positioning:
 No angulation
 Central ray passes through the perpendicular to
the glabella.

67
Accessories:
 Cone to cover
 Bucky to be used
Technique:
 kVp – 70-89
 mAs – 15-25
 FFD – 40”.
Skull lateral view
Patient positioning:
 Patient is asked to lie down over the table in prone
position.
 The opposite arm and knee are flexed and must
support the body,
 The opposite shoulder is raised and supported by sand
bags or pillows.
 The same arm is extended behind the trunk, with the
palm upwards.
Tube Positioning:
 Patient is asked to turn the head so that the affected
side is near the table.
 Non opaque wedge is placed under the jaw or fist of
the patient may be used.
 Inter orbital line is perpendicular to the film.
 Median plane is parallel to the film.
Positioning of the tube:
 Tube is kept without any angulation and parallel to
the interorbital line.
68
  Centre 2cms above and in front of external auditory
meatus
Positioning of the Film:
 Size of the film: 12” x 10”
 The top of cassette should be 11” above the vertex of
the skull.
 12” part crosswise
Accessories:
 Cone to cover
 Bucky to be used.
Technique:
 kVp-70-75
 mAs – 10-15
 FFD – 40”.

3. Explain the steps involved in the operation theatre

for C-Arm procedure:
The C-Arm X-ray procedure in the operating room goes
through the following steps:
Step 1:
The technician prepares technical equipment including: C-
Arm X-ray machine, film, cassette, system storage, set of
shielding and protective equipment (lead shield, lead jacket),
sterile plastic bag wrapped machine.
Step 2:
Check the machine: Voltage source: 220V - AC, 50 - 60
Hz. Step 3:

69
 Turn on the machine - the screen: check the specifications
are working properly.
Step 4:
Set specifications before putting the machine into the
surgical intervention position.
Step 5:
The surgeon or radiology technician, the nurse will press
the projection button or pedal the projection pedal, the
projection time is fast or slow depending on whether the
surgeon has determined the intervention position. Projection
time can be from: 1-2 seconds
Step 6:
Take a film at the request of the surgeon.

Step 7:
Disconnect the power to the machine, clean the machine,
change the plastic wrap, and return the device to the storage
position. Therefore, the C-Arm X-ray procedure in the
operating room is an essential imaging method used right in
the tissue room when doctors are performing surgery and
intervention. For example, bone grafting, follow-up in bowel
dissection.

70
4. Principle of Fluoroscopy:
Fluoroscopy is a study of moving body structures—similar
to an X-ray “movie.” A continuous X-ray beam is passed
through the body part being examined. The beam is
transmitted to a TV-like monitor so that the body part and its
motion can be seen in detail.

Uses of Fluoroscopy:
 Fluoroscopy is used in many types of examinations and
procedures.
 Barium study (Barium Swallow, meal, enema and
Loopogram).
 Cardiac catherization.
 Arthrography (To evaluate the joints).
 Lumber Puncher (Myelogram).
 Placement of intravenous IV catheter (Hollow tube
placed to the arteries and veins).
 Biopsies.

71
72
Write the following questions:
1. PTC:
A percutaneous trans hepatic cholangiography is a way of looking
at your bile ducts using x-rays. This test is also called PTC. Your
doctor puts a long thin needle through the skin and into your liver and
bile ducts. They take x-rays of the pancreas, gallbladder and bile
ducts. They can also take samples (biopsies) of any abnormal looking
areas.
2. Meatogram:
Meatographies were performed with a small quantity of
contrast medium, and restricted to the visualization of the
structures in the auditory canal. Tomographies of antero-
posterior view were utilized in all the cases. Normal
tomomeatograms were classified into 4 types.
1. In the first type the internal auditory canal not
opacified,
2. In the second the contrast medium recognized as a
single stream along the superior wall of the internal
auditory canal,
3. In the third another parallel line of contrast medium is
recognized close to the middle of the internal auditory
canal,
4. In the fourth the contrast medium fills the internal
auditory canal.
3. Negative Contrast:
 Air
 CO2
 NO2
4. Different types of barium study:
 Barium Swallow
73
  Barium meal
 Barium enema
 Loopogram

5. Pnemoperitonium:
Pnemoperitonium is the presence of air or gas in the
abdominal (peritoneal) cavity. It is usually detected on x-ray,
but small amounts of free peritoneal air may be missed and
are often detected on computerized tomography (CT).
6. Orbitomeatal base line:
This is the line joining the center of the orbits or outer
canthus of eye and center of the external auditory meatus it is
called orbitomeatal base line.
7. Triage:
Triage is utilized in the healthcare community to
categorize patients based on the severity of their injuries and,
by extension, the order in which multiple patients require care
and monitoring. It is classified into 5 level,
1. Level 1 - Resuscitation (immediate life-saving
intervention)
2. Level 2 – Emergency
3. Level 3 – Urgent
4. Level 4 – Semi-urgent
5. Level 5 – Non-urgent.
8. Cyanosis:
Cyanosis is the medical term for when your skin, lips or
nails turn blue due to a lack of oxygen in your blood. If you
have darker skin, cyanosis may be easier to see in your lips,
gums, nails and around your eyes.
9. Uses of adrenaline:
74
 Adrenaline may be used to provide rapid relief of severe
hypersensitivity reaction to drugs and other allergens, and in
the emergency treatment of anaphylactic shock. IM Injection:
Adults: The usual dose is 500 micrograms (0.5ml of
adrenaline 1/1000).
10. Consent:
Consent is the process in which a health care provider
educates a patient about the risks, benefits, and alternatives of
a given procedure or intervention. The patient must be
competent to make a voluntary decision about whether to
undergo the procedure or intervention.

Answer the following questions.

1. Bronchial artery embolization:
A bronchial-artery embolization (BAE) is a procedure
where X-rays are used to examine the bronchial arteries
(arteries in your lung). This allows the doctor to find the
bronchial artery which is bleeding and causing your
haemoptysis (coughing up of blood).
Indications:
 Haemoptysis (Coughing up of blood)
 Tuberculosis
 Bronchiectasis
 Aspergilomas
Contra-Indications:
 Suspected pregnancy
 Allergic reactions
 Recent surgery
Patient preparation:

75
  Patient take starvation for 6 to 8 hours before the
examination.
 Patient must be write & sign the consent before the
examination.
 Patient remove the all radio opaque materials before
the examination.
 Patient pelvic region is clean and shaved before the
examination.
 Patient must be v before the examination.
Procedure:
A catheter with a diameter of less than 2 mm is inserted at
the base of the foot (femoral artery) or the artery in the wrist
(radial artery). The tip of the catheter is inserted into the
orifice of the bronchial artery (normally smaller than 1 mm)
or other non-bronchial hemoptysis-related arteries. Contrast
agent is injected through the catheter, and when abnormal
findings are observed, such as systemic–pulmonary shunts,
proliferations of the capillary vessels, or extravasation of the
contrast medium to the lung tissues, they were super
selectively embolized using the 3 Fr microcatheter system. A
thinner microcatheter (about 0.8 mm) is passed through the
catheter into the blood vessel, and then, embolic material is
injected into the appropriate site. Thus, hemostasis is
performed by ceasing or reducing the pressure applied to a
bronchial (or non-bronchial)-pulmonary shunt (abnormal
anastomosis). BAE is performed under local anesthesia, and
the required time is about 1 hour to 3 h.
Complications:
Minor complications that are common are pain and a
burning sensation in the area of the body supplied by the
blood vessels that have been blocked. This usually last for
only a few days but may persist longer. Injury to the bronchial
artery with life threatening bleeding – this is rare.
76
After care:
Patients can return to eating and drinking 2 hours after the
procedure. On the other hand, the patient can also walk and
return to normal activities after 18 hours. Usually patients are
discharged after 3 days.

2. Fistulogram:
A fistulogram is an x-ray procedure used to view a fistula,
an abnormal passage between two or more parts of your body
that often drains out of your skin. A sinogram is a similar
procedure done to assess a sinus, an abnormal passage or
cavity that originates or ends in one opening, often on the
skin. Contrast material is used to help fill the track and
determine what parts of your body are involved.
Indications:
 Two loops of intestine
 The anal canal and skin near the anus
 The vagina and another body part such as the colon,
rectum, small intestine or bladder.
Contra-Indications:
 Hypersensitivity to iodinated contrast medium
 Suspected pregnancy
 Renal functional test is abnormal
Patient preparation:
Tell your doctor about all the medications you take. List
any allergies, especially to iodine contrast materials. Tell your
doctor about recent illnesses or other medical conditions.
Instructions are typically provided prior to your exam. You
may be asked to refrain from eating solid foods before the
procedure but you may usually drink small amounts of clear

77
fluid with medications. Please ask your radiology provider if
you have any questions.
Equipment:
This exam typically uses a radiographic table, one or two x-ray
tubes, and a video monitor. Fluoroscopy converts x-rays into video
images. Doctors use it to watch and guide procedures. The x-ray
machine and a detector suspended over the exam table produce the
video.
Procedure:
1. You may be asked to change into a hospital gown.
You also may receive an intravenous (IV) line in your
arm for the delivery of painkillers and/or sedatives to
help make you more comfortable during the
procedure.
2. You will be taken into the x-ray room where the
technologist will position you on the x-ray table. The
x-ray machine will be positioned so that the radiologist
can easily view the contrast material-enhanced
fistula/sinus.
3. The area around the fistula/sinus will be cleaned with
an antiseptic solution. Occasionally, a local anesthetic
is injected into the area.
4. The radiologist will use the x-ray equipment to guide
the catheter into the fistula/sinus track or ultrasound to
help guide a needle into the dialysis artery/vein . When
the catheter is in the correct place, the radiologist will
inject contrast material through the catheter. X-ray will
be used to show where the contrast goes.
5. You must hold very still and may need to hold your
breath for a few seconds while the technologist takes
the x-ray. This helps reduce the possibility of a blurred
image. The technologist will walk behind a wall or
into the next room to activate the x-ray machine.

78
 6. When all the x-rays have been taken, the catheter will
be removed. If your fistula/sinus has an opening on the
outside of the body, the doctor or nurse will clean your
wound site and cover your skin with a dressing. If
your fistula/sinus is inside your rectum or vagina, you
will be able to use the bathroom to pass any remaining
contrast.
Complications:
Fistulogram is generally very safe but as with any
procedure complications are possible. Bruising There may be
a bruise around the site where the needle has been inserted.
Infection This is a rare complication and it may require
antibiotics or further treatment.
After care:
You may resume your regular activities (including driving)
after 24 hours, unless you have been restricted for another
reason. No exercising, lifting heavy objects, or strenuous
activity for the next 24 hours. You may shower 24 hours after
the procedure.

3. Medical legal aspects in radiology:

Introduction:
A Medico-legal case is one where besides the medical
treatment, investigation by low enforcing agencies are
essential to fix the responsibility regard the present state/
conditions of the patients The case therefore has both medical
and legal implications.
Management Priorities:
 Assessment and Establishment of airway and
ventilation.
 Assessment of circulation and perfusion
79
  Hemorrhage Control
 Shock Management
 Fracture Stabilization.
 Patient Transplant
Life threatening injuries to be addressed to and to be ruled out
before definitive orthopedic Management of fracture:
 Head injury
 Thoracic Injuries
 Abdominal injuries.
 Genitourinary injuries

Radiologic Evaluation of poly trauma patient from.

Orthopedic point of view:
Lateral cervical spine x-ray. Must see all cervical vertebrae
and top of T1, If cervical spine injuries cannot be ruled out in
absence of proper of x-rays, a rigid cervical
 A CT scan is done
 AP view of Pelvis
 AP view of chest
Possibly lateral thoracolumbar spine x-ray Pelvis with or
without contrast as dictated by injury pattern
Other x-rays like skull x-rays, abdomen should be taken as the
case suggests.
Before shifting the patient for the before addressing to any
time fracture any life threatening medical and surgical
condition. Should be addressed to and ruled out, open/
compound fractures.
An open fractures refers the appear disruption in which a
break in the spin underlying soft tissue communicates directly
with fracture and its hematoma.

80
4. Adverse reactions to iodinated contrast medium:
Hypersensitivity reaction to iodinated contrast medium:
 Hypersensitivity reaction to iodinated contrast media
can be classified into two types,
 Immediate anaphylactic reaction.
 Delayed reaction.
 Reactions may be classified as mild, moderate and
severe.
Mild contrast media:
 Mild contrast media reactions include flushing,
nausea, pruritus, vomiting, headache and mild itching.
 They are usually self limited and resolve without
specific treatment.
 It can be used to avil, Hydrocortisone and adrenaline
drugs.

Moderate contrast media:

 Moderate contrast media reactions include severe vomiting,
bronchospasms or other respiratory symptoms, facial or
laryngeal edema and vasovagal attacks.
 It is used to adrenaline, sodium bicarbonate and atropine
drugs.
Severe contrast media:
 Severe contrast media include hydrolaemic shock,
respiratory arrest, cardiac arrest.
 Severe anaphylactic reactions are uncommon
occurring in less than 1 in 1,00,000 patients.
 These is an approximate tenfold increase in reactions
to both ionic and non-ionic contrast, media following
previous hypersensitivity reaction.

81
  Patient with history of asthma experience can
approximate six – fold increased this of a
hypersensitivity contrast media reactions.
 Skin irritating or allergic to topical iodine antiseptic
solution is not associated with an increased risk of
adverse reactions to intravenous iodinated contrast
media.

Reactions:
 Delayed contrast media reactions occur between
one hour and one week after intravenous
iodinated contrast media administered.
 There are typically skin reactions with a rash
begin most common.
 Less frequent skin reaction include angioedema.
 Delayed hypersensitivity reaction are not
typically associated with bronchospasms or
laryngeal edema.

5. Loopogram:
A Loopogram is an X-ray examination done on patients
who have an opening of bowel out onto the surface of the
abdomen (a stoma). Contrast (X-ray dye) is introduced into
the stoma through a small tube in order to visualize the large
or small bowel extending to the stoma on X-rays.
Indications:
 Urostomy, which redirects your urinary tract.
 Colostomy, which redirects your colon (large intestine).
 Ileostomy, which redirects your small intestine.
82
Patient preparation:
1. Wear comfortable clothing that’s easy to change out of
and minimal jewelry. You’ll wear a hospital gown for
the procedure. The provider may ask you to remove
certain types of jewelry, like belly chains.
2. Tell your provider if you might be pregnant. You may
be asked to take a pregnancy test at a provider’s office
before the procedure.
3. Bring along a new stoma bag and dressings. The
provider performing the procedure will remove your
current stoma bag for the Loopogram.
4. You can eat, drink and take your medications as usual
before a Loopogram.

Procedure:
 Help you get into position on the table.
 Remove your stoma bag.
 Clean the area around the stoma.
 Insert a tube (catheter) into the stoma.
 Inject contrast fluid into the catheter.
 Take several X-ray images of your urinary tract. They
may ask you to change positions to get different
pictures.
 Remove the catheter and put on a new stoma bag.
Complications:
Loopogram has minimal risk. There’s a small risk of
infection or allergic reactions to the contrast agent. You
shouldn’t have a Loopogram if you’re pregnant.
After care:
After the test, you’re free to resume your normal activities
unless your provider gives you specific instructions not to.

83
6. Maintain hygiene in Radiology:
 Strict adherence to hand hygiene procedures refer to
ISID’s Guide to Infection Control in the Healthcare
Setting; Hand Hygiene)
 Clean X- ray equipment, cassettes, and all other
equipment with alcohol wipes and or chlorhexidine-
based disinfectant between examinations.1
 Cover surfaces coming into direct contact with patients,
with a disposable sheet [MRI Non-Magnetic Poly Vinyl
Chloride (PVC)] that is changed between patients.
 Use wipes and alcohol gel (70% alcohol) for
decontamination of radiographic markers.1 Specific
attention is required for ribbon markers; the most
difficult to decontaminate.42
 Disinfect MRI machine by 500–2000 mg/L chlorine-
containing disinfectant.
 Use radiation therapy filmcards for a single patient.
Properly dispose of after each use.
 Use syringe, tube, and connector of the automatic
injectors for only one patient. Regular unannounced
evaluations of the hygiene of the CT department are
recommended.
7. Record maintenance in Radiology:
 Maintenance of nominal register as name, age, sex and
study is to be informed for every patients.
 For medical legal cases MLC report given by the
radiologist should be maintained.
 Sub stocks kept for proper film usage and how much
film is used per day as noted.
 Records such as Reports of the patient number of
cases taken per day ( contrast and non contrast
studies).
84
  Radiography taken and stored in the computer for the
future use PACS from one institution to another for
emergency purpose.
 Report given by the radiologist and radiography issued
to the patient for clinical correlation.

Answer the following questions:

1. MRI Indications:
 Ischemia/infarct
 Vascular anomalies
 Hemorrhage
 Infection
 Tumors and masses
 Trauma and diffuse axonal injuries
 Neurodegenerative disorders and dementias
 Inflammatory conditions
 Congenital abnormalities
 Seizures
 Headaches
 Cranial neuropathies and Fetal brain (see image
below).
Contra-Indications:
 Any electrically, magnetically or mechanically
activated implant (e.g. cardiac pacemaker, insulin
pump bio stimulator, neuro stimulator, cochlear
implant, and hearing aids)
 Intracranial aneurysm clips (unless made of titanium)
 Pregnancy (risk vs benefit ratio to be assessed)
 Ferromagnetic surgical clips or staples
 Metallic foreign body in the eye
 Metal shrapnel or bullet.

85
2. Various views and techniques in Shoulder Joint:
The shoulder joint (glenohumeral joint) is an articulation
between the scapula and the humerus. It is a ball and socket-
type synovial joint, and one of the most mobile joints in the
human body.
Various views of Shoulder joints:
 Shoulder AP
 Shoulder lateral
 Shoulder internal rotation
 Shoulder external rotation
 Shoulder striker notch view
 Scapula Y view
 Shoulder axial View
Shoulder AP View:
Patient Portioning:
 The patient is placed either in supine position or in
erect position.
 Adhere shoulder to image receptor (IR) by leaning the
body toward the filming axis.
 Place coracoid process on the center of IR and place
the end of IR 5cm above the shoulder.
 Pose patient’s arm in natural rotation position.
Tube positioning:
The center ray passes through the perpendicular to the
coracoid process.
Accessories:
 Cone to cover
 Bucky to be used.
Technique:
 kVp - 70-75

86
  mAs - 10-15
 FFD- 40”.
Shoulder Lateral View
Patient positioning:
 The patient is placed either in supine position or in
erect position.
 Place the filming shoulder on the middle of image
receptor (IR).
 Abduct humerus 90° while flex forearm 90°.
Tube positioning:
The center ray passes through the perpendicular to the
center of the scapula.
Accessories:
 Cone to cover
 Bucky to be used.
Technique:
 kVp - 70-75
 mAs - 10-15
 FFD- 40”.

Shoulder striker notch View:

Patient Portioning:
 Coracoid process and clavicle should be shown in stack
 Major axis of humerus should be in parallel with major
axis of torso.
 Fine structures of humeral head must show clearly.
Tube positioning:
The central ray passes through the 10° cephalad towards
the center of the coracoid process.

87
Accessories:
 Cone to cover
 Bucky to be used.
Technique:
 kVp - 70-75
 mAs - 10-15
 FFD- 40”.
3. Barium Meal Series:
Aim:
Barium is Meal is the radiological Examination of the
stomach and Duodenum. In some cases in the x-ray is
requested to may be mentioned as through which means
Barium Meal Follow that the x-ray examination will be
prolonged to taken pictures of Small Intestine and large
intestine etc.
Indications:
 Gastric ulcer, Duodenum ulcer, Pain in the stomach
after food).
 Hyper, acidity, Peristalsis, etc.
 Pyloric stenosis
 Any tumor of the stomach (Begin and Malignant)
 Hematemesis (Vomiting in the Blood)
 Malena (Dark motion)
 Obstruction in the Ileo-caecal junction.
 Any growth in the stomach (Polyps).
Contra-Indications:
 Allergic reaction
 Suspected pregnancy
 RFT is abnormal.
 Pre and post operative cases.
Patient Preparation:
88
  The patient will be given vegetable laxative such as
castor oil for 2- days Consecutive days prior to be x-
ray examination to clear the bowel.
 The patient will be given Dulcolex Tablets (charcoal
Tablets).
 The patient is given diet on the previous night. A low
residue
 The patient is request to come to the X-ray department
in the early morning 8 AM with an empty stomach.
 The patient is requested not to smoke. Because
smoking stimulates gastric Secretions Which will
dilute the contrast medium.
 On enema -1 hours warm Soap water is given to of the
Investigation.
Contrast Medium:
The barium Sulphate powder is mixed with water in the
ratio of 1:1 to make a Fluid suspension upto volume of 300-
500 ml is given to the patient in adult cases. The barium meal
examination of the infants (Children’s). There is a special,
Contrast medium, which is given orally Called Grastrograffin
(Microbar).

Procedure:
At first the prepared Contrast medium of (300-500 ml) half
glass of the barium Solution already is given to the patient to
drink and the first picture are taken. Either -by Screening or
by using cassette radiograph taken.
Standard Projection of Barium Meal:
Abdomen AP View:
Patient positioning:

89
  Place the patient in lying supine position to the middle
of the table.
 The both hands kept away from the body.
 The both knees are together and given the sandbag for
supporting.
 To cover the upper border anterior superior iliac spine
and lower border below the pubic symphysis.
 Patient is immobilized during the exposure.
Tube positioning:
The central ray passes through the umbilical region.
Accessories:
 Cone to cover.
 Bucky to be used.
Technique:
 15 mAs.
 80 kVp & 40” FFD.
Right anterior oblique:
Within 30 minutes picture the barium is excreted from the
stomach and it is filling the duodenal cup. This view diagnose
in duodenal obstruction, growth of head of the pancreas.
Patient positioning:
The patient is lying supine position From this position the left Side
of the abdomen raised 15” and Supported with pillow the big cassette
is placed in bucky. The upper border at the level of Nipple line. The
lower border in Pubis Symphysis. The patient is immobilized. The
side mark is always kept. The exposure is arrest of respiration.
Tube positioning:
X-ray tube is vertical So that central ray should pass
through the Middle of the Film.
Technique:

90
  kVp 1-80
 mAs 80-120
Abdomen PA view (90 minutes):
Abdomen AP View:
Patient positioning:
 Place the patient in lying prone position to the middle of the
table.
 The both hands kept away from the body.
 The both knees are together and given the sandbag for
supporting.
 To cover the upper border anterior superior iliac spine and
lower border below the pubic symphysis.
 Patient is immobilized during the exposure.
Tube positioning:
The central ray passes through the umbilical region.
Accessories:
 Cone to cover.
 Bucky to be used.
Technique:
 15 mAs.
 80 kVp & 40” FFD.
Complications:
 Trouble with bowel movements or you are unable to
have a bowel movement or pass gas.
 Pain or swelling of the abdomen.
 Stools that are smaller in size than normal.
 Fever.
After Care:
After the examination you can eat and drink as normal.
The barium may take several days to pass through your

91
system. You should drink plenty of fluids and eat high fibre
foods such as fruit, vegetables, wholemeal bread for the next
few days. This will help the barium pass through more
quickly.

4. Explain the steps involved in the operation theatre

for C-Arm procedure:
The C-Arm X-ray procedure in the operating room goes
through the following steps:
Step 1:
The technician prepares technical equipment including: C-
Arm X-ray machine, film, cassette, system storage, set of
shielding and protective equipment (lead shield, lead jacket),
sterile plastic bag wrapped machine.
Step 2:
Check the machine: Voltage source: 220V - AC, 50 - 60
Hz. Step 3:
Turn on the machine - the screen: check the specifications
are working properly.
Step 4:
Set specifications before putting the machine into the
surgical intervention position.
Step 5:
92
 The surgeon or radiology technician, the nurse will press
the projection button or pedal the projection pedal, the
projection time is fast or slow depending on whether the
surgeon has determined the intervention position. Projection
time can be from: 1-2 seconds
Step 6:
Take a film at the request of the surgeon.

Step 7:

93
 Disconnect the power to the machine, clean the machine,
change the plastic wrap, and return the device to the storage
position. Therefore, the C-Arm X-ray procedure in the
operating room is an essential imaging method used right in
the tissue room when doctors are performing surgery and
intervention. For example, bone grafting, follow-up in bowel
dissection.

94
Write the following questions:
1. Sialogram:
A sialogram is an x-ray of the salivary ducts and
glands. The radiologist will then squirt some bitter liquid
(like lemon juice) into your mouth to activate the salivary
glands. A very small tube is inserted into the salivary duct and
some contrast media is injected to show the salivary glands.
This causes slight discomfort due to gland fullness, but should
not be painful. X-rays are then taken.
2. Arthrography:
Arthrography is a special radiological examination of to
visualize the joint problems. To take the contrast dye is
injected into the joints though the Chiba Needle and take the
radiographic images. It is used to diagnose the,
 Hip labral tears
 Partial ligament tears
 Partial tendons tears
 Repaired of retears tendons
 Repaired of retears meniscus
3. Venography:
Venography is an x-ray examination that uses an injection
of contrast material to show how blood flows through your
veins. Your doctor may use it to find blood clots, identify a
vein for use in a bypass procedure or dialysis access, or to
assess varicose veins before surgery.
4. PTC:
A percutaneous trans hepatic cholangiography is a way of looking
at your bile ducts using x-rays. This test is also called PTC. Your
doctor puts a long thin needle through the skin and into your liver and
bile ducts. They take x-rays of the pancreas, gallbladder and bile

95
ducts. They can also take samples (biopsies) of any abnormal looking
areas.

5. Complications of IVU:
 A minor sting with the injection.
 A flush of warmth.
 A mild itching sensation.
 A mild metallic taste.
 Nausea.
 Vomiting.
 Feeling flushed (your face, chest or neck turn red).
 Breathing difficulties.
 Low blood pressure.
 Hives.
 Swelling in your mouth or throat.
 Cardiac arrest.
6. Emergency drugs:
Drugs Uses
Adrenaline Allergic reaction

Atropine Anti arythmatic

Buscopan Relief pain

Hydrocortisone Allergic reaction

Dopamine Increase blood

pressure

Sodium bicarbonate Electrolyte imbalance

96
 Diazepam Sedation
Avil Allergic reaction

Various Equipment in radiology department:

 O2 Cylinder
 First aid kits
 Pulse and Saturation meter
 Wheel chair or stretcher
 Sprit and cottons.
7. Preparation of Barium Meal:
 The patient will be given vegetable laxative such as
castor oil for 2- days Consecutive days prior to be x-
ray examination to clear the bowel.
 The patient will be given Dulcolex Tablets (charcoal
Tablets).
 The patient is given diet on the previous night. A low
residue
 The patient is request to come to the X-ray department
in the early morning 8 AM with an empty stomach.
 The patient is requested not to smoke. Because
smoking stimulates gastric Secretions Which will
dilute the contrast medium.
 On enema -1 hours warm Soap water is given to of the
Investigation.
8. Fluoroscopy:
Fluoroscopy is a study of moving body structures—
similar to an X-ray “movie.” A continuous X-ray beam
is passed through the body part being examined. The
beam is transmitted to a TV-like monitor so that the
body part and its motion can be seen in detail.

97
9. Enteroclysis:
Enteroclysis is an examination of the small bowel. X-rays
are used to take single pictures and a special form of x-ray
called fluoroscopy is also used in this examination. The
radiologist can see internal organs like the bowel in motion
using fluoroscopy.
A liquid called a contrast agent is put into the small bowel
through a tube passed through your nose and stomach into the
beginning of the small bowel. The contrast agent most
commonly used for this study is called barium. The
radiologist will watch to see how the contrast moves through
the small bowel.
10. Implied Consent:
Consent is the process in which a health care provider
educates a patient about the risks, benefits, and alternatives of
a given procedure or intervention. The patient must be
competent to make a voluntary decision about whether to
undergo the procedure or intervention.

Answer the following questions:

1. Ascending urethrogram:
Aim:
A urethrogram is an examination of the urethra by X-
ray imaging, almost always carried out on males. This
information sheet relates to the procedure being carried out on
98
a male. The urethra is the tube that runs from the bladder
through the prostate and penis.
A urethrogram is usually carried out to show the cause of
poor urinary flow thought to be caused by narrowing (a
stricture) of the urethra. The most common cause for
narrowing of the urethra in men is benign (non-cancerous)
enlargement of the prostate gland. A urethrogram is most
often used to diagnose causes of narrowing of the urethra that
are not caused by benign enlargement of the prostate gland.
Indications:
Strictural Urethra.
Bulbar Urethra.
Stenosis or Occlusive in the Urethra.
Suspected Urethral Fistula.
Post Operative Tests( Plastic Surgery).
Pelvic Trauma.
Urethral Diverticula.
Urethral obstruction.
Suspected urethral foreign bodies.
Urethral mucosal tumors.
Contra-Indications:

 Allergic to iodinated contrast media.

 Renal Functional Test is Abnormal.
 Acute Urinary Tract Infection.
 Recent Instrumentation of Urethra.
Patient Preparation:
 The patient should be take a Starvation 6-8 hours before
the examination.
 The patient should be remove the all radiopaque
materials in the pelvic area.

99
  The Patient should be write & signed the consent before
the examination.
 The Patient should be clean the pelvic area before the
examination.
 The patient should be micturated before the examination.

Contrast Media:
 Omnipaque Iohexol 350 mgI/ml is non-ionic and water
soluble contrast media are used which is diluted with
Normal Saline.
 To prepare 10 ml contrast mixed with 10 ml normal
saline.
Equipments:
X-ray Machine.
Omnipaque iohexol 350 mgI/ml.
20 ml disposable syringe.
Infant Feeding Tube.
Lignocaine gel.
Povidone -iodine.
Gauge piece.
Bowl.
Emergency Drugs.
Gloves.
Lead & Neck Apron.
Procedure:
 Place the patient in supine Position to the midline of the
table.

100
  Flex the right knee & given the sand bag for supporting.
 The pelvis is clean with Betadine and take infant feeding
tube to cut about 1cm and connect to 20 ml contrast
loaded Syringe.
 Then, the syringe tip is pour into the lignocaine gel and
inserted the penile urethra and injected to the Contrast
medium during the exposure.

Standard Radiographic Projection:

 Pilot Film.
 Dynamic Film.
Pilot Film:
Pilot film of pelvic area is taken to see the bowel
preparation before the examination .Pilot film provides
valuable information and sometimes indicates probable
diagnosis,
 Ureter Stone.
 Kidney Stone.
 Calcification.
 Foreign body.
Right Anterior Oblique View of Pelvis:
Patient Positioning:
 Place the patient in supine Position to the midline of the
table.
 Flex the knee & given the sandbag for supporting.
 Patient should be immobilized during the exposure.
Tube Positioning:
 No angulation.
101
  Central ray passes through the ASIS( Anterior Superior
Iliac Spine).
Film Positioning:
 1” above the iliac crest and 1” below the Pubis
symphysis.
Accessories:
 Necessary to cone cover.
 Bucky to be used.
Technique:
 10 mAs, 76 kVp & FFD is 40”.
Complications:
 Urinary tract infection.
 Bleeding.
 Intravasation.

After Care:
Up to 48 hours later, you may feel discomfort. Your urine
may be a little pink. Still, you can return to normal activities
right after this test. If the pain doesn't go away, if you get a
fever, or if your urine turns bright red, tell your health care
provider.

2. Myelogram:
A myelogram is an imaging test that takes detailed pictures
of your spine. It uses a contrast material to highlight issues in
your spinal cord and the areas around it, like your nerves and
soft tissues. A myelogram also looks at the relationship
between your vertebrae (the small bones that make up your
backbone) and the disks that cushion them.
Indications:
102
  Herniated (bulging) disks.
 Arthritis in your spinal joints.
 Spinal stenosis (when the spaces in your spine
narrow and press on your spinal cord).
 Bone spurs (osteophytes).
 Spinal tumors.
Patient preparation
 Arrange for a trusted friend or family member to drive
you to and from your appointment. (You shouldn’t
drive immediately after your myelogram test because
of the sedative you may receive.)
 Start drinking lots of clear fluids (4 to 8 ounces every
two hours) the day before your test.
 Stop eating six hours before your test.
 You can drink clear fluids in the six hours before your
myelogram. Examples include water, tea (without
cream), clear soda, black coffee, fruit juice (without
pulp) and broth.
Procedure:
 Ask you to lie on an exam table (usually on your
stomach or side).
 Clean your lower back with an antiseptic and give you
local anesthesia.
 Inject a contrast material into the fluid-filled sac
around your spinal cord. (You might feel pressure and
a bit of discomfort during this step.)
 Tilt the exam table slightly. This helps the contrast
material flow to a specific area of your spine. Your
radiologist may also ask you to tilt or move your head.
 Take X-rays and a CT scan of your spine.
Complications
 Headaches.
103
  Nausea and vomiting.
 Fever.
 Stiff neck.
 Tingling in your legs.

After care:
On average, it takes about 24 hours. You’ll need to sit still
or lie down for several hours after your myelogram test.
Resting reduces your risk of a cerebral spinal fluid (CSF)
leak. You can go back to normal routines after one full day.

3. HSG
HSG:
Aim:
Hysterosalpingography examination of the uterus, uterine
tube or fallopian tubes. The following injection of contrast
medium it is usually employed in the investigation of
infertility. In most department the gynecologist and
radiologist and controlling the examination.
Indications:
 Infertility of the uterus.
 Block of the fallopian tubes.
 Development of uterus.
 Hypoplastic uterus
 Endometrial tumor.
Contra-Indications:
 Allergic reaction.
 RFT is abnormal.
 Active UTI.
104
Patient preparation:
 Timing of examination is very important is must.
 During a week and after menturation.
 The best time of the patient mid cycle after
menturation 10 days.
 Clean and shaved the pelvic region.
 The patient should micturate immediately before the
examination.
Materials:
 Valsellum forceps.
 Vaginal speculum.
 Uterine sound.
 Leach Wilkinson cannula.
 Tenaculum.
 Sponge stick.
 20ml syringe.
 Povidone.
 Bowel.
 Gloves and Cotton.
Procedure:
 The patient is placed in lying supine position or
lithotomy position.
 The knee and hips are flexed and buttocks are raised
on a sand bags.
 The vaginal area is cleaned with anti-septic solutions.
 The vaginal speculum is inserted into the vagina and
dilated.
 The uterine sound is introduced into the length and
direction of the uterus and injection cannula is inserted
and speculum is removed into the cervical canal.
 The cervical dilator or used to dilated the cervix.

105
  Then take the leach Wilkinson cannula is inserted into
the cervical canal and take the 20 ml of diluted
contrast medium is injected into the cervix and take
the radiographic images.
Standard Radiographic Projection:
Pelvis AP View:
Patient positioning:
 Place the patient in lying supine position to the middle
of the table.
 The both hands kept away from the body.
 The both knees are together and given the sandbag for
supporting.
 To cover the upper border anterior superior iliac spine
and lower border below the pubic symphysis.
 Patient is immobilized during the exposure.
Tube positioning:
The central ray passes through the anterior superior iliac
spine.
Accessories:
 Cone to cover .
 Bucky to be used.
Technique:
 15 mAs.
 80 kVp.
 40” FFD.
Note:
The first film to see the uterus, fallopian tubes and
peritoneal spill not seen the second picture is also taken.
Complications:
106
  Vssovagal reaction with bradycardia, hypotension,
potentially resulting in syncope.
 Pelvic infection.
 In rare cases, infection can damage the fallopian tubes
or make it necessary to remove them.
After care:
Your provider may recommend that you take over-the-
counter pain medicines for a few days after your HSG to help
ease your symptoms.

4. Record maintenance in Radiology:

 Maintenance of nominal register as name, age, sex and
study is to be informed for every patients.
 For medical legal cases MLC report given by the
radiologist should be maintained.
 Sub stocks kept for proper film usage and how much
film is used per day as noted.
 Records such as Reports of the patient number of
cases taken per day ( contrast and non contrast
studies).
 Radiography taken and stored in the computer for the
future use PACS from one institution to another for
emergency purpose.
 Report given by the radiologist and radiography issued
to the patient for clinical correlation.

5. Barium Swallow:
Aim:
To study the pathology of pharynx and Oesophagus.
Indications:
 Dysphagia - motility disorder, Growth, stricture
107
  Oesophagus varies
 Left atrial enlargement
Contra-Indications:
Suspected perforation in the Oesophagus.
Contrast Medium:
 Barium sulphate powder thick paste.
 150% weight/volume (150g Barium sulphate+ 100ml
water)
 This is routine for stricture and fistula.
 Thin Barium is used as 50% weight/volume
Equipment:
300 mA x ray unit with Fluoroscopy.
Patient Preparation.
 No Preparation of the patient.
 Pilot film is not necessary.
Procedure:
8. First patient is asked to stand in front of the
Fluoroscopy screen.
9. Barium is given to the patient mouth.
10. Then, he is asked to swallow the Barium.
11. The flow of Barium comes from Oesophagus.
12. This is followed with Fluoroscopy.
13. If any obstruction or pathological lesion is notes in
any place.
14. Radiography in taken in AP,LAT, RAO & LAO
which is needed.
Standard Radiographic Projection of Barium Swallow:
Neck AP View:
Patient positioning:

108
 The patient is placed in the erect standing supine position
facing the tube with a 10x8 cassette is Supported it Vertically
chest stand. The chin is raised and kept at the top edge of the
Cassette. The arms are allowed to clasp the Supports and the
radiation field is Collimated and the patient is immobilized.
Tube positioning:
X-ray tube s horizontal. So, that • central ray should pass
through the Middle of the Neck. (C6 Vertebra).
Technique:
 kVp-70-75
 mAs-10-15
 FFD-40”
Lateral view:
Patient positioning:
The patient is erect standing Lateral position with any one
of the side in bronco duct , with the Cassette. The Cassette is
supported vertically chest stand. The arms are effected mi
back, wards and crossed. The Immobilized patient. The
another table spoon barium powder is given to the patient
retain on the mouth for Swallowing the time of exposure
"Lateral view taken.
Tube positioning:
X-ray tube is horizontal. So that central ray should pass
through the Middle of the neck.
Technique:
 kVp 70-75
 MAS 15-20
 FFD- 90cm

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Right anterior oblique:
The patient is placed in erect Standing Lateral position
with the right side of the trunk (chest) is contact with the
Cassette. A big cassette is Supported Vertically chest stand:
The upper border is pinna The patient is provided with
another table spoon of barium paste, is given to be retained in
the mouth and Should be advised to swallow. The right trunk
(Chest) is rotated forward to about 60° and the left arms are
allowed to the clasp the Supported. The arms is allowed to
touch the hip, shoulder is forward. The patient is immobilized
and the radiation field is collimated: The exposure is alone at
the time of swallowing.
Tube positioning:
X-ray tube is horizontal. So that central ray should pass
through the middle of the film.
Technique:
 Kvp 10-15
 MAS 15-20
 FFD 90 cm.
This is the best position to diagnosis the abnormalities of
the Oesophagus. Because the full extend of Oesophagus is
shown in the picture Separate from Sternum in front and
vertebral bodies from behind.

6. Handling of Trauma patients:

 Airway & alertness with cervical immobilization
 Breathing/ventilation
 Circulation and control of hemorrhage
 Disability (neurologic status)
 Exposure and environmental control
 Full set of vitals and family presence
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  Get resuscitation adjuncts (LMNOP)
 Laboratories: ABG, lactic acid, CBC, and CMP
 Monitor: telemetry, ECG
 Naso/orogastric tube
 Oxygenation/ventilation
 Pain assessment and management.

7. Open mouth view:

Positioning of the Patient:
 Place the patient in supine position.
 The medial sagittal plane is perpendicular to the film.
 Ask the patient to open the mouth completely & place
a radiolucent cork in between the jaws.
 Extend the head so that a vertical line dropped from
the upper lip is perpendicular to the film.

Positioning of the tube:

 No angulation
 Centre the tube from the sides so that the central ray
passes thro' the junction of the upper & lower lips.
Positioning of the film:
 Size: 10" x 8" or smaller
 Kept lengthwise
 Centre the film to the center of the mouth.
Accessories:
 Extension cone
 Bucky to be used
Technique:
 kVp-70-75
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  mAs – 10-15
 FFD – 40”.
Cone view of Sella Tunica:
Patient positioning:
 Patient is asked to lie down over the table in prone
position.
 The opposite arm and knee are flexed and must
support the body,
 The opposite shoulder is raised and supported by sand
bags or pillows.
 The same arm is extended behind the trunk, with the
palm upwards.
Tube Positioning:
 Patient is asked to turn the head so that the affected
side is near the table.
 Non opaque wedge is placed under the jaw or fist of
the patient may be used.
 Inter orbital line is perpendicular to the film.
 Median plane is parallel to the film.
Positioning of the tube:
 Tube is kept without any angulation and parallel to
the interorbital line.
 Centre 2cms above and in front of external auditory
meatus
Positioning of the Film:
 Size of the film: 12” x 10”
 The top of cassette should be 11” above the vertex of
the skull.
 12” part crosswise
Accessories:
 Cone to cover
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  Bucky to be used.
Technique:
 kVp-70-75
 mAs – 10-15
 FFD – 40”.
8. Fistulogram:
A fistulogram is an x-ray procedure used to view a fistula,
an abnormal passage between two or more parts of your body
that often drains out of your skin. A sinogram is a similar
procedure done to assess a sinus, an abnormal passage or
cavity that originates or ends in one opening, often on the
skin. Contrast material is used to help fill the track and
determine what parts of your body are involved.
Indications:
 Two loops of intestine
 The anal canal and skin near the anus
 The vagina and another body part such as the colon,
rectum, small intestine or bladder.
Contra-Indications:
 Hypersensitivity to iodinated contrast medium
 Suspected pregnancy
 Renal functional test is abnormal
Patient preparation:
Tell your doctor about all the medications you take. List
any allergies, especially to iodine contrast materials. Tell your
doctor about recent illnesses or other medical conditions.
Instructions are typically provided prior to your exam. You
may be asked to refrain from eating solid foods before the
procedure but you may usually drink small amounts of clear
fluid with medications. Please ask your radiology provider if
you have any questions.
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Equipment:
This exam typically uses a radiographic table, one or two x-ray
tubes, and a video monitor. Fluoroscopy converts x-rays into video
images. Doctors use it to watch and guide procedures. The x-ray
machine and a detector suspended over the exam table produce the
video.
Procedure:
7. You may be asked to change into a hospital gown.
You also may receive an intravenous (IV) line in your
arm for the delivery of painkillers and/or sedatives to
help make you more comfortable during the
procedure.
8. You will be taken into the x-ray room where the
technologist will position you on the x-ray table. The
x-ray machine will be positioned so that the radiologist
can easily view the contrast material-enhanced
fistula/sinus.
9. The area around the fistula/sinus will be cleaned with
an antiseptic solution. Occasionally, a local anesthetic
is injected into the area.
10. The radiologist will use the x-ray equipment to
guide the catheter into the fistula/sinus track or
ultrasound to help guide a needle into the dialysis
artery/vein . When the catheter is in the correct place,
the radiologist will inject contrast material through the
catheter. X-ray will be used to show where the contrast
goes.
11. You must hold very still and may need to hold your
breath for a few seconds while the technologist takes
the x-ray. This helps reduce the possibility of a blurred
image. The technologist will walk behind a wall or
into the next room to activate the x-ray machine.
12. When all the x-rays have been taken, the catheter
will be removed. If your fistula/sinus has an opening
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 on the outside of the body, the doctor or nurse will
clean your wound site and cover your skin with a
dressing. If your fistula/sinus is inside your rectum or
vagina, you will be able to use the bathroom to pass
any remaining contrast.
Complications:
Fistulogram is generally very safe but as with any
procedure complications are possible. Bruising There may be
a bruise around the site where the needle has been inserted.
Infection This is a rare complication and it may require
antibiotics or further treatment.
After care:
You may resume your regular activities (including driving)
after 24 hours, unless you have been restricted for another
reason. No exercising, lifting heavy objects, or strenuous
activity for the next 24 hours. You may shower 24 hours after
the procedure.

3. Answer the following questions:

1. MCU:
Aim:
MCU is the radiology examination of the bladder and
urethra( urinary bladder).
Indications:
 Cystitis.
 Vesico-ureteric reflex (VUR).
 Posterior urethral valve.
 Tumor, cyst in the bladder.
Contra-Indications:

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  Active UTI.
 Allergic reaction.
 Suspected pregnancy.
 Pre and post operative cases should not allowed.
Patient preparation:
 Patient take starvation for 6 to 8 hours before the
examination.
 Patient must be write & sign the consent before the
examination.
 Patient remove the all radio opaque materials before
the examination.
 Patient pelvic region is clean and shaved before the
examination.
 Patient must be v before the examination.
Contrast medium:
12.5% of NaI solution or Water soluble iodinated contrast
medium is mixed with a normal saline In the ratio of 1:4.
Materials:
 X-ray machine.
 Contrast Dye.
 2% of Xyclocaine Gel.
 Sterilized bin.
 20 ml disposable syringes.
 Sprit.
 Cotton.
 Emergency drugs.
Procedure:
11. The patient is placed in lying supine position with
midline of the table.
12. The urethra is cleaned with anti-septic solution.

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 13. A sterilized urinary catheter is inserted through the
tip of the urethra into the bladder.
14. Now the dye injected into the bladder through the
urinary catheter.
15. Remove the catheter undertake the radiographic
images.
Standard Radiographic Projection:
 Pilot Image
 Full bladder
 Voiding phase
 After evacuation
Position:
 The first picture a contrast is filled by the bladder
pelvis AP view taken.
 The second picture pelvic RAO view the patient is
asked to pass urine at the time of radiography is taken.
KUB AP View:
 Place the patient in lying supine position to the middle
of the table.
 The both hands kept away from the body.
 The both knees are together and given the sandbag for
supporting.
 To cover the upper border anterior superior iliac spine
and lower border below the pubic symphysis.
 Patient is immobilized during the exposure.
Tube positioning:
The central ray passes through the umbilical region.
Accessories:
 Cone to cover .
 Bucky to be used.

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Technique:
 15 mAs.
 80 kVp & 40” FFD.
Second and third pictures are taken in supine oblique view
when the patient is micturate. This pictures includes KUBU
region. To see the reflux of contrast medium into the ureters
and kidneys.
Complications:
Complications are uncommon after MCU. Mild
haematuria (blood in the urine) is the most common. This
should clear over a few days. Injury to the urethra or bladder
from the insertion of the catheter is extremely rare.
After care:
You can eat and drink normally. The contrast media will
not be noticeable in your urine. You may notice spotting when
you urinate; this may be due to the tiny tube scratching the
inside wall of your urethra, and this should only last a short
time.

2. Explain the steps involved in the operation theatre

for C-Arm procedure:
The C-Arm X-ray procedure in the operating room goes
through the following steps:
Step 1:
The technician prepares technical equipment including: C-
Arm X-ray machine, film, cassette, system storage, set of
shielding and protective equipment (lead shield, lead jacket),
sterile plastic bag wrapped machine.
Step 2:
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 Check the machine: Voltage source: 220V - AC, 50 - 60
Hz. Step 3:
Turn on the machine - the screen: check the specifications
are working properly.
Step 4:
Set specifications before putting the machine into the
surgical intervention position.

Step 5:
The surgeon or radiology technician, the nurse will press
the projection button or pedal the projection pedal, the
projection time is fast or slow depending on whether the
surgeon has determined the intervention position. Projection
time can be from: 1-2 seconds
Step 6:
Take a film at the request of the surgeon.

Step 7:
Disconnect the power to the machine, clean the machine,
change the plastic wrap, and return the device to the storage
position. Therefore, the C-Arm X-ray procedure in the
operating room is an essential imaging method used right in
the tissue room when doctors are performing surgery and
intervention. For example, bone grafting, follow-up in bowel
dissection.

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3. Principle of Fluoroscopy:
Fluoroscopy is a study of moving body structures—similar
to an X-ray “movie.” A continuous X-ray beam is passed
through the body part being examined. The beam is

transmitted to a TV-like monitor so that the body part and its

motion can be seen in detail.
Uses of Fluoroscopy:
 Fluoroscopy is used in many types of examinations and
procedures.
 Barium study (Barium Swallow, meal, enema and
Loopogram).
 Cardiac catherization.
 Arthrography (To evaluate the joints).
 Lumber Puncher (Myelogram).
 Placement of intravenous IV catheter (Hollow tube
placed to the arteries and veins).
 Biopsies.
4. Skeletal Survey:

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 A skeletal survey is a series of radiographs, performed
systematically to cover the entire skeleton or the anatomic
regions appropriate for the clinical indications.
Its objective is to accurately identify focal and diffuse
abnormalities of the skeleton and to differentiate them from
developmental changes and other anatomic variants that may
occur in infants and children.
CT and MRI is also seen to be useful in demonstrating
bone abnormality in multiple myeloma1. For non accidental
injury however, x-ray is preferred due to the lower radiation
dose to pediatric patients.
Indications:
Common indications of skeletal survey include:
 Known or suspected physical child abuse
 Skeletal dysplasias
 Disseminated infection
 Metastatic bone disease
 Multiple myeloma
 Eosinophilic granuloma
 Osteogenesis imperfecta
 Paget’s disease
 Metabolic bone disease
o Rickets
o Scurvy
o Hyperparathyroidism
o Renal osteodystrophy
 Polyarticular arthropathy
Contra-Indications:

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 Any imaging study which uses X-rays involves radiation
exposure. A complete skeletal survey may require around 20
X-rays, and is associated with a moderate radiation dose.
Overall, there is a low risk of adverse health effects related to
radiation exposure from one skeletal survey.
Procedure:
A typical skeletal survey using conventional x-ray includes
Skull AP and Lateral, Whole Spine AP and Lateral, Chest PA
view and Pelvis AP View are taken and necessary to taken
joints.
Standard Projection of Skeletal Survey:
“Explain details about above the all Radiography views”

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