Radiological Procedures

Iiitravenoiis Pyelography, Intravenous Urography, Excretory Urography, and Computed Tomography 

Many body and head CT studies (Figs. 13-14 and 13-IS) U.SC intravenous contrast material to improve the quality of the study. The type of contra.st material and their doses are similar to those in excretory urography except that higher volumes of conlrast and a more rapid injection system arc often used. The contrast material increases the relative conlrast between space-occupying lesions (tumors, cy.sts. and 

Angiography refers to the radiographic visualization of blood vessels by contrast injection directly into an anen (arteriography) (Fig. 13-16) or a vein (venography). Their are many types of arteriograms, including those from ceit bral angiography (visualization of head and neck vc.s.scM. 

Clwlecyxiogrui liy rel crs to contrast visualization of the gallbladder. Modem gallbladder visualization and diagnosis rely mainly on abdominal ultrasonography or nuclear medicine and rarely use traditional radiological techniques. 

Great care must be taken when performing contrast injection into the subarachnoid space. Improper technique could lead to a dcva.stating infection or spinal injury, and the use of the wntng contra.st agent can also have devastating results such us convulsions and subsequent, seven arachnoid in-riummution. 

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Different radiological procedures are available for clarifying these diagnostic issues, (s. tab. 8.1)... 

Tab. 8.1 Radiological procedures used in the diagnosis of hepatobiliary diseases...

There are wide variations in the reported incidence of contrast nephrotoxicity because of differences in patient selection, the type of radiological procedure, and the definition of renal impairment. Contrast nephrotoxicity is relatively uncommon in people with normal renal function, in whom it is 0-10%. Pre-existing renal impairment increases the frequency, with a reported incidence of 12-27% in several prospective controlled studies. In some studies the incidence was as high as 50%, in spite of the use of low-osmolar contrast agents and adequate hydration. Dialysis may be required in some of these patients (SEDA-22, 502). 

The incidence of CMIN in the hterature ranges from less than 1% to over 70% [23-27]. This discrepancy results from the lack of a single reliable definition, different methods of investigation, different types of radiological procedures, use of high or low osmolar contrast media and the presence or absence of risk factors. In patients without any risk factor the incidence is less than 1% despite the use of up to 800 ml of contrast media [28]. In patients at high risk the frequency of CMIN has been reported to increase in the last few years, which seems to be related to the wider use of diagnostic and therapeutic interventions in elderly and critically ill patients [29]. Multivariate analysis revealed in-hospital dialysis and an increase in baseline serum creatinine levels as the most important predictors of... 

Physician services, physical and occupational therapy services, radiological procedures, clinical laboratory tests, other medical diagnostic procedures, hearing and vision services, transportation services including ambulance Medical suppliesj orthotic and prosthetic devices, durable medical equipment... 

Radiologic procedures rely on the differential absorption of radiation of adjacent tissues to highlight anatomy and pathology. Radiologic procedures important in evaluating the GI tract include plain radiography, upper GI series, lower GI series, and enteroclysis. ... 

Radiologic procedures CT scan Postresuscitation initially with repeat scan(s) as needed based on degree of neurologic instability (e.g., decrease in GCS)... 

Bowel evacuants are known as bowel cleansing solutions. They are used before surgery or radiological procedures to empty the bowel. They can cause bloating and nausea. Examples are magnesium salts and Picolax and polyethylene glycol. 

Chapman, S. and Nakielny, R. (2001) A Guide to Radiological Procedures, 4th edn, Saunders, China. 

Parra D, Legreid AM, Beckey NP, Reyes S. Metformin monitoring and chaise in serum creatinine levels in patients undergoing radiologic procedures involving administration of intravenous contrast media, Pharmacotherapy (2004) 24, 987-93, Erratum ibid, 1489. 

Dea TJ, Geise RA, Ritenour ER (1999) The potential for radiation-induced skin damage in interventional neuro-radiological procedures a review of 522 cases using automated dosimetry. Med Phys 26 2027-2033... 

Hysterectomy is a definitive cure in patients with a symptomatic multifibroid uterus. Both abdominal and vaginal hysterectomy is associated with a low mortality and morbidity. However, given that uterine leiomyomas are benign lesions, the large number of hysterectomies performed worldwide to treat this condition appears to be disproportionate [16]. As an alternative to hysterectomy, uterus-sparing operative, ablative, and interventional radiological procedures are available, depending on location and size of fibroids present, the patient s age, desire to have children, and personal preferences. 

During the previous decade, radiologists made fundamental contributions to the study and diagnosis of colon diseases with the introduction of single and double contrast barium examinations of the colon. Due to progress in endoscopic techniques both classical radiological procedures have rapidly lost their importance. 

As for many other radiological procedure, meticulous methodology and appropriate training in the interpretation of the imaging features are needed in order to obtain optimal results with this new method. 

FDG-PET and FDG-PET-CT can be of benefit in interventional radiological procedures (Fig. 33.10). Compared with CT alone, PET and PET-CT have been found of higher accuracy when assessing the liver for residual disease after radiofrequency ablation (RFA) of liver metastases (Barker et al. 2005). However, a substantial number of false-negative cases caused by very small tumor residuals must be kept in mind. These small tumor residuals, not visible on CT or PET, lead to early tumor recurrence and require a close followup of patients (Veit et al. 2006). Other authors report promising results when following-up patients with liver metastases undergoing therapy with application of microspheres (Lewandowski et al. 2005). 

Carlson 8K etal. (2001) Benefits and safety of CT fluoroscopy in interventional radiologic procedures. Radiology 219 515-520... 

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