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Ky thuat su dung doi quang duong uong trong chup CT, Nguyen Trung Thanh (VI)

Nguyen Lam
Nguyen Lam

TI LI畛U H畛I NGH畛 K畛 THU畉T I畛N QUANG V Y H畛C H畉T NHN VI畛T NAM L畉N 7 (2019) Ngu畛n: https://hinhanhykhoa.com/

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9/6/2019 1 Diagnostic Imaging Department Friendship Hospital USING ORAL CONTRAST AGENT FOR ABDOMINAL CT CLINICAL EXPERIENCES Nguy畛n Trung Thnh. g y g Nguy畛n Vn Tu畉n. Nguy畛n Th叩i B狸nh. Case 1: INTRODUCTION
9/6/2019 2 Case 2 INTRODUCTION INTRODUCTION Using oral contrast agents depends on experiences of radiologists and technicians To date, there is no substantial concensus on the optimal and widely available method for using oral contrast agents in abdominal CT hinhanhykhoa.com
9/6/2019 3 OBJECTION Presentation of techniques for using oral contrast agents in computed tomography. Flexible experiences for praticing oral contrast agents in commonly gastrointestinal disease GASTROINTESTINAL CONTRAST AGENTS 1/ Barium, Baryt ( Barium sulfat ). 2/ Positive oral contrast agents => higher density than wall of bowel Gastrographine 380mgI/ml. Intravascular contrast agent that is also used for oral. 3/ Negative oral contrast agents=> lower density than wall of bowel CO2, O2 or air. Milk, pure wateras a negative contrast oral agent for fulfilling stomach, small intestinal and large interstinal.
9/6/2019 4 PREPARATION PRIOR TO SCANNING Patient Contrast agent Other devices PREPARING PATIENTS. Abstain from all food and drink for 4-6 hours prior to scanning Administer an enema prior to scanning, if suspected gastrointestinal disorders and other diseases Past medical history: allergic, surgery. Measuring height and weight of patient Explaining for performance preparation and advantages of preparation
9/6/2019 5 WATER: SALINE 0.9% ORAL CONTRAST AGENT Neutral contrast agent Isotonic solutions keep on fluid in lumen which do not absorb to circulatory system. Reasonable cost (~10000 vnd/bottle). Uncomfortable for taking Uncomfortable for taking. Some cases may be nauseous or vomitting. Contraindicated for renal failure patients IODINATED SOLUTIONS DILUTED WITH WATER. ORAL CONTRAST AGENT. A positive contrast agent Intravascular contrast agents can be used for orally Dispensing ratio: 10-15ml/ bottle 500ml. Syringe 5ml, 10ml
9/6/2019 6 OTHER DIVICES OTHER DIVICES Bottle and tube. Syringe 50ml (fill water into small balloon of catheter) Syringe 200ml (fill water into lumen of catheter) F l t th t Foley two-way catheter Gel . Clamps scissors. Nylon sheets , paper. MAIN PROCEDURES Taking saline 0.9% Taking iodinated solutions diluted with water/ saline 0.9% Using oral contrast during scanning Using oral contrast combined with rectal contrast
9/6/2019 7 TAKING SALINE 0.9% TECHNIQUE If patients weigh about 50-60 kilos. Ingesting 500ml water with 60 minutes prior to scanning. Prior to drinking water. Patient should go to toilet. Demand pateint doesnt go to toilet when starting to take oral contrast agents Record the time when pateints started taking the medicine In some cases, patients need to walk and massage the abdomen clockwise to allow the water to flow down into the intestine faster. TECHNIQUE Technique: First bottle: 500ml ingested over first 5 minutes. Second bottle: after 10 minutes, 500ml ingested over 5 minutes Third bottle: after 15 minutes, 500ml ingest over 5 minutes Addition 250 ml to fulfill stomach. 45 mins AFTER took the contrast agent
9/6/2019 8 Iodinated solutions diluted with water Dispensing ratio: Iodine content at 300mg/ml: ratio 12-15ml/ 500ml. Iodine content at 350 or 370mg/ml: ratio 10-12ml/ 500ml. Note: if the patient took an intestinal bleach before about 2-3 hours, then dispensing ratio: 15-18ml contrast agents /500ml saline 0.9%). TECHNIQUE Technique is applied similar cases 1 45 mins AFTER took the contrast agent
9/6/2019 9 USING ORAL CONTRAST DURING SCANNING Step 1:Patient drinks a sip of water and then hold a sip of water in the mouth Step 2:. At the beginning of scanning, ask the patient to swallow the sip of water Step 3: The same way as prior to scanning and after contrast injection Dispensing ratio : 6-7ml/ 250ml salin 0.9 %. USING RECTAL CONTRAST COMBINED WITH ORAL CONTRAST Step 1:The patient drunk 2 bottles of saline 0.9%(~ 1 liter) prior to scanning about 20-30 mins Step 2: On the table, cleaning colon with about 1 liter of water through the anus using Foley sonde, then proceed scanning. If pateint combined orally and rectally rectally Dispensing ratio: 12-15ml/500ml. If patient doesn't bowel preparation , let him take oral contrast agents and wait for feeling defecation, proceed the scanning
9/6/2019 10 APPLYING ORAL CONTRAST AGENTS IN COMMON GASTROINTESTINAL DISEASES ESOPHAGEAL DISEASES Esophageal tumor Tumor < 1cm Lesion at mucous layer Oral contrast agents: water or saline 0 9% 0.9% hinhanhykhoa.com
9/6/2019 11 ESOPHAGEAL DISEASES Esophageal tumor Follow-up after esophagectomy Esophageal fistula Iodinated solutions diluted with water (+) GASTRIC DISEASES Gastritis and an ulcer Tumor or polyp of gastric Saline 0.9 % or water (-)
9/6/2019 12 GASTRIC DISEASES Gastric cancer: Follow up gastric tumor Follow up postoperative gastric cancer Iodinated solutions diluted with water (+) GASTRIC DISEASES GASTRIC TUMORS Follow up lesions protruding into gastric lumen Iodinated solutions diluted with saline (+). hinhanhykhoa.com
9/6/2019 13 SMALL INTESTINAL DISEASES Suspected to small bowel bleeding Follow up inflammatory bowel disease,intestinal tuberculosis, Crohn di disease GIST of small intestine. Negative oral contrast: saline 0.9% SMALL INTESTINAL DISEASES INTESTINAL TUMORS Lymphoma of small intestine. Following to mesenteric tumor tu o Following to mesenteric lymphomas Evaluation of diverticulitis Iodinated solutions diluted with water (+)
9/6/2019 14 APPENDIX DISEASES APPENDIX: Follow up appendicular abscess Plaston appendicitis Suspected to appendicitis but not fi di di l d finding appendix on ultrasound Neoplasms of the appendix Iodinated solutions diluted with water (+) COLORECTAL DISEASES Follow-up colitis. Detection of polyps of colorectal Oral contrast agents +enema with saline (-). hinhanhykhoa.com
9/6/2019 15 COLON COLORECTAL DISEASES COLON Colon tumors Follow-up after surgery for colorectal cancer. Follow up postoperative colon cancer with colostomy Taken iodinated solutions diluted with saline by orally combined with enema (+) PANCREAS: DISEASES OF LIVER-PANCREAS- BILIARY SYSTEM PANCREAS: Pancreatic cancer invasion Tumors of ampulla of Vater Postoperative pancreaticodoudenectomy. Pancreatic pseudocyst Pancreatic pseudocyst Iodinated solutions diluted with saline(+).
9/6/2019 16 DISEASES OF THE GALLBLADDER AND BILIARY TREE. DISEASES OF LIVER-PANCREAS- BILIARY SYSTEM Follow-up biliary tract neoplasms Gallbladder tumors Postoperative biliary enteric anastomosis . Iodinated solutions diluted with water(+). Follow up biliary stone disease. Saline(-). IDIOPATHIC ASCITE (ASCITES OF UNKNOWN ORIGIN) PERITONEAL DISEASE IDIOPATHIC ASCITE (ASCITES OF UNKNOWN ORIGIN). Ascites not caused by cirrhosis Suspected for tuberculous peritonitis, peritonitis, peritoneal metastases Iodinated solutions diluted with water(+). hinhanhykhoa.com
9/6/2019 17 RETROPERITONEAL RETROPERITONEAL DISEASES RETROPERITONEAL The differential diagnosis retroperitoneal masses with adjacent structures Retroperitoneal adenopathy. Iodinated solutions diluted with water(+) by orally or orally combined with enema PELVIS MASSES PELVIS DISEASES PELVIS MASSES Follow up ovarian tumors. Follow up cervical cancer. Distinguished origin of pelvis mass from ovary or adjacent structures structures Taken iodinated solutions diluted with saline by orally combined with enema
9/6/2019 18 CONCLUSION The use of oral contrast agents should be very flexible It is necessary to have detail medical history of patient to choose the appropriate oral contrast. Clearly revealed the lesions that help radiologist make the diagnosis more accurately and faster hinhanhykhoa.com

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Ky thuat su dung doi quang duong uong trong chup CT, Nguyen Trung Thanh (VI)

  • 1. 9/6/2019 1 Diagnostic Imaging Department Friendship Hospital USING ORAL CONTRAST AGENT FOR ABDOMINAL CT CLINICAL EXPERIENCES Nguy畛n Trung Thnh. g y g Nguy畛n Vn Tu畉n. Nguy畛n Th叩i B狸nh. Case 1: INTRODUCTION
  • 2. 9/6/2019 2 Case 2 INTRODUCTION INTRODUCTION Using oral contrast agents depends on experiences of radiologists and technicians To date, there is no substantial concensus on the optimal and widely available method for using oral contrast agents in abdominal CT hinhanhykhoa.com
  • 3. 9/6/2019 3 OBJECTION Presentation of techniques for using oral contrast agents in computed tomography. Flexible experiences for praticing oral contrast agents in commonly gastrointestinal disease GASTROINTESTINAL CONTRAST AGENTS 1/ Barium, Baryt ( Barium sulfat ). 2/ Positive oral contrast agents => higher density than wall of bowel Gastrographine 380mgI/ml. Intravascular contrast agent that is also used for oral. 3/ Negative oral contrast agents=> lower density than wall of bowel CO2, O2 or air. Milk, pure wateras a negative contrast oral agent for fulfilling stomach, small intestinal and large interstinal.
  • 4. 9/6/2019 4 PREPARATION PRIOR TO SCANNING Patient Contrast agent Other devices PREPARING PATIENTS. Abstain from all food and drink for 4-6 hours prior to scanning Administer an enema prior to scanning, if suspected gastrointestinal disorders and other diseases Past medical history: allergic, surgery. Measuring height and weight of patient Explaining for performance preparation and advantages of preparation
  • 5. 9/6/2019 5 WATER: SALINE 0.9% ORAL CONTRAST AGENT Neutral contrast agent Isotonic solutions keep on fluid in lumen which do not absorb to circulatory system. Reasonable cost (~10000 vnd/bottle). Uncomfortable for taking Uncomfortable for taking. Some cases may be nauseous or vomitting. Contraindicated for renal failure patients IODINATED SOLUTIONS DILUTED WITH WATER. ORAL CONTRAST AGENT. A positive contrast agent Intravascular contrast agents can be used for orally Dispensing ratio: 10-15ml/ bottle 500ml. Syringe 5ml, 10ml
  • 6. 9/6/2019 6 OTHER DIVICES OTHER DIVICES Bottle and tube. Syringe 50ml (fill water into small balloon of catheter) Syringe 200ml (fill water into lumen of catheter) F l t th t Foley two-way catheter Gel . Clamps scissors. Nylon sheets , paper. MAIN PROCEDURES Taking saline 0.9% Taking iodinated solutions diluted with water/ saline 0.9% Using oral contrast during scanning Using oral contrast combined with rectal contrast
  • 7. 9/6/2019 7 TAKING SALINE 0.9% TECHNIQUE If patients weigh about 50-60 kilos. Ingesting 500ml water with 60 minutes prior to scanning. Prior to drinking water. Patient should go to toilet. Demand pateint doesnt go to toilet when starting to take oral contrast agents Record the time when pateints started taking the medicine In some cases, patients need to walk and massage the abdomen clockwise to allow the water to flow down into the intestine faster. TECHNIQUE Technique: First bottle: 500ml ingested over first 5 minutes. Second bottle: after 10 minutes, 500ml ingested over 5 minutes Third bottle: after 15 minutes, 500ml ingest over 5 minutes Addition 250 ml to fulfill stomach. 45 mins AFTER took the contrast agent
  • 8. 9/6/2019 8 Iodinated solutions diluted with water Dispensing ratio: Iodine content at 300mg/ml: ratio 12-15ml/ 500ml. Iodine content at 350 or 370mg/ml: ratio 10-12ml/ 500ml. Note: if the patient took an intestinal bleach before about 2-3 hours, then dispensing ratio: 15-18ml contrast agents /500ml saline 0.9%). TECHNIQUE Technique is applied similar cases 1 45 mins AFTER took the contrast agent
  • 9. 9/6/2019 9 USING ORAL CONTRAST DURING SCANNING Step 1:Patient drinks a sip of water and then hold a sip of water in the mouth Step 2:. At the beginning of scanning, ask the patient to swallow the sip of water Step 3: The same way as prior to scanning and after contrast injection Dispensing ratio : 6-7ml/ 250ml salin 0.9 %. USING RECTAL CONTRAST COMBINED WITH ORAL CONTRAST Step 1:The patient drunk 2 bottles of saline 0.9%(~ 1 liter) prior to scanning about 20-30 mins Step 2: On the table, cleaning colon with about 1 liter of water through the anus using Foley sonde, then proceed scanning. If pateint combined orally and rectally rectally Dispensing ratio: 12-15ml/500ml. If patient doesn't bowel preparation , let him take oral contrast agents and wait for feeling defecation, proceed the scanning
  • 10. 9/6/2019 10 APPLYING ORAL CONTRAST AGENTS IN COMMON GASTROINTESTINAL DISEASES ESOPHAGEAL DISEASES Esophageal tumor Tumor < 1cm Lesion at mucous layer Oral contrast agents: water or saline 0 9% 0.9% hinhanhykhoa.com
  • 11. 9/6/2019 11 ESOPHAGEAL DISEASES Esophageal tumor Follow-up after esophagectomy Esophageal fistula Iodinated solutions diluted with water (+) GASTRIC DISEASES Gastritis and an ulcer Tumor or polyp of gastric Saline 0.9 % or water (-)
  • 12. 9/6/2019 12 GASTRIC DISEASES Gastric cancer: Follow up gastric tumor Follow up postoperative gastric cancer Iodinated solutions diluted with water (+) GASTRIC DISEASES GASTRIC TUMORS Follow up lesions protruding into gastric lumen Iodinated solutions diluted with saline (+). hinhanhykhoa.com
  • 13. 9/6/2019 13 SMALL INTESTINAL DISEASES Suspected to small bowel bleeding Follow up inflammatory bowel disease,intestinal tuberculosis, Crohn di disease GIST of small intestine. Negative oral contrast: saline 0.9% SMALL INTESTINAL DISEASES INTESTINAL TUMORS Lymphoma of small intestine. Following to mesenteric tumor tu o Following to mesenteric lymphomas Evaluation of diverticulitis Iodinated solutions diluted with water (+)
  • 14. 9/6/2019 14 APPENDIX DISEASES APPENDIX: Follow up appendicular abscess Plaston appendicitis Suspected to appendicitis but not fi di di l d finding appendix on ultrasound Neoplasms of the appendix Iodinated solutions diluted with water (+) COLORECTAL DISEASES Follow-up colitis. Detection of polyps of colorectal Oral contrast agents +enema with saline (-). hinhanhykhoa.com
  • 15. 9/6/2019 15 COLON COLORECTAL DISEASES COLON Colon tumors Follow-up after surgery for colorectal cancer. Follow up postoperative colon cancer with colostomy Taken iodinated solutions diluted with saline by orally combined with enema (+) PANCREAS: DISEASES OF LIVER-PANCREAS- BILIARY SYSTEM PANCREAS: Pancreatic cancer invasion Tumors of ampulla of Vater Postoperative pancreaticodoudenectomy. Pancreatic pseudocyst Pancreatic pseudocyst Iodinated solutions diluted with saline(+).
  • 16. 9/6/2019 16 DISEASES OF THE GALLBLADDER AND BILIARY TREE. DISEASES OF LIVER-PANCREAS- BILIARY SYSTEM Follow-up biliary tract neoplasms Gallbladder tumors Postoperative biliary enteric anastomosis . Iodinated solutions diluted with water(+). Follow up biliary stone disease. Saline(-). IDIOPATHIC ASCITE (ASCITES OF UNKNOWN ORIGIN) PERITONEAL DISEASE IDIOPATHIC ASCITE (ASCITES OF UNKNOWN ORIGIN). Ascites not caused by cirrhosis Suspected for tuberculous peritonitis, peritonitis, peritoneal metastases Iodinated solutions diluted with water(+). hinhanhykhoa.com
  • 17. 9/6/2019 17 RETROPERITONEAL RETROPERITONEAL DISEASES RETROPERITONEAL The differential diagnosis retroperitoneal masses with adjacent structures Retroperitoneal adenopathy. Iodinated solutions diluted with water(+) by orally or orally combined with enema PELVIS MASSES PELVIS DISEASES PELVIS MASSES Follow up ovarian tumors. Follow up cervical cancer. Distinguished origin of pelvis mass from ovary or adjacent structures structures Taken iodinated solutions diluted with saline by orally combined with enema
  • 18. 9/6/2019 18 CONCLUSION The use of oral contrast agents should be very flexible It is necessary to have detail medical history of patient to choose the appropriate oral contrast. Clearly revealed the lesions that help radiologist make the diagnosis more accurately and faster hinhanhykhoa.com