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Angiography: A procedure performed to view blood vessels after injecting them with a radioopaque dye that outlines them on x-ray. This technique can be usefully used to look at arteries in many areas of the body, including the brain, neck (carotids), heart, aorta, chest, pulmonary circuit, kidneys, gastrointestinal tract, and limbs.

Last Editorial Review: 5/27/2002

Detail: Coronary angiography: The most accurate method (the "gold standard") for evaluating and defining coronary artery disease (CAD). Coronary angiography is used to identify the exact location and severity of CAD. During coronary angiography, a small catheter (a thin hollow tube with a diameter of 2-3 mm) is inserted through the skin into an artery in the groin or the arm. Guided with the assistance of a fluoroscope (a special x-ray viewing instrument), the catheter is then advanced to the opening of the coronary arteries, the blood vessels supplying blood to the heart. Next, a small amount of radiographic contrast (a solution containing iodine, which is easily visualized with x-ray images) is injected into each coronary artery. The images that are produced are called the angiogram. Angiographic images accurately reveal the extent and severity of all coronary arterial blockages. Coronary angiography is performed with the use of local anesthesia and intravenous sedation, and is generally not terribly uncomfortable. The procedure takes approximately 20-30 minutes. After the procedure, the catheter is removed and the artery in the leg or arm is sutured, "sealed," or treated with manual compression to prevent bleeding. There is a small risk of serious complications from coronary angiography, as it is an "invasive" test, but in the hands of an experienced physician, this risk is quite small (well below one per cent). In patients for whom the test is appropriate, the therapeutic information learned from the coronary angiogram is far more valuable than the relatively small risk of the procedure. For patients with severe angina or myocardial infarction, or those who have markedly abnormal noninvasive tests for CAD, the angiogram also helps the doctor select the optimal treatment, which may include medications, balloon angioplasty, coronary stenting, atherectomy ("rotorooter"), or coronary bypass surgery. The coronary angiogram is the only test which allows the precise quantification of the extent and severity of CAD to optimally make these treatment decisions.
Last Editorial Review: 8/25/1999 8:12:00 PM

cholecystography : Visualization of the gallbladder by x-rays after the administration of a radiopaque substance. The
purpose of the examination is to determine the ability of the gallbladder to fill, concentrate bile, and empty. The dye is administered in tablets the evening before the x-ray films are made. an x-ray examination of the gallbladder. At least 12 hours before the study the patient has a fat-free meal and ingests a contrast material containing iodine, usually in the form of tablets. It may also be given intravenously. The iodine, which is opaque to x-rays, is excreted by the liver into the bile in the gallbladder. After the procedure the patient consumes a fatty meal or cholecystokinin, which stimulates the gallbladder to contract, expelling bile and contrast material into the bile duct. Additional x-ray films are taken about 1 hour later. The test is useful in the diagnosis of cholecystitis, cholelithiasis, and tumors and in the differential diagnosis of a mass in the upper right quadrant of the stomach.

A method for examining the structure and functionality of urinary system. A special dye is injected, and X-ray machines record its progress through the urinary tract. Urography is particularly useful for discovering cysts or other internal blockages.

Intravenous urography is a test which x rays the urinary system using intravenous dye for diagnostic purposes. Of the many ways to obtain images of the urinary system, the intravenous injection of a contrast agent has been traditionally considered the best. The kidneys excrete the dye into the urine. X rays can then create pictures of every structure through which the urine passes. The procedure has several variations and many names.

Intravenous pyelography (IVP). Urography. Pyelography. Antegrade pyelography differentiates this procedure from "retrograde pyelography," which injects dye into the lower end of the system, therefore flowing backward or "retrograde." Retrograde pyelography is better able to define problems in the lower parts of the system and is the only way to get x rays if the kidneys are not working well. Nephrotomography is somewhat different in that the x rays are taken by a moving x ray source onto a film moving in the opposite direction. By accurately coordinating the movement, all but a single plane of tissue is blurred, and that plane is seen without overlying shadows.

Most diseases of the kidneys, ureters, and bladder will yield information to this procedure, which actually has two phases. First, it requires a functioning kidney to filter the dye out of the blood

into the urine. The time required for the dye to appear on x rays correlates accurately with kidney function. The second phase gives detailed anatomical images of the urinary tract. Within the first few minutes the dye "lights up" the kidneys, a phase called the nephrogram. Subsequent pictures follow the dye down the ureters and into the bladder. A final film taken after urinating reveals how well the bladder empties. IVPs are most often done to assess structural abnormalities or obstruction to urine flow. If kidney function is at issue, more films are taken sooner to catch the earliest phase of the process.

Stones, tumors and congenital malformations account for many of the findings. Kidney cysts and cancers can be seen. Displacement of a kidney or ureter suggests a space-occupying lesion like a cancer pushing it out of the way. Bad valves where the ureters enter the bladder will often show up. Bladder cancers and other abnormalities are often outlined by the dye in the bladder. An enlarged prostate gland will show up as incomplete bladder emptying and a bump at the bottom of the bladder.

IVPs are usually done in the morning. In the x ray suite, the patient will undress and lie down. There are two methods of injecting the dye. An intravenous line can be established, through which the dye will be consistently fed through the body during the procedure. The other method is to give the dye all at once through a needle that is immediately withdrawn. X rays are taken until the dye has reached the bladder, an interval of half an hour or less. The patient will be asked to empty the bladder before one last x ray.

Computed radiography :

radiography using a solid-state imaging device, such as a photostimulable phosphorplate, and recovering, enhancing, and displaying the image using a digital computer.

radiography of the lymphatic channels and lymph nodes, after injection of radiopaque material in a lymphatic vessel. OR
Roentgenographic examination of lymph nodes and lymph vessels after injection of a radiopaque contrast medium; produces a lymphangiogram

Bronchography is X-ray examination of the tracheobronchial tree after instillation of a radiopaque iodine contrast agent through a catheter into the lumens of the trachea and bronchi. The contrast agent coats the bronchial tree, permitting visualization of any anatomic deviations. Bronchography of a localized lung area may be accomplished by instilling contrast dye through a fiber-optic bronchoscope placed in the area to be filmed. Since the development of computed tomography scanning, bronchography is used less frequently. It may be performed using a local anesthetic instilled through the catheter or bronchoscope, although a general anesthetic may be necessary for children or during a concurrent bronchoscopy.


To help detect bronchiectasis, bronchial obstruction, pulmonary tumors, cysts, and cavities and, indirectly, to pinpoint the cause of hemoptysis To provide permanent films of pathologic findings


X-ray computed tomography, also Computed tomography (CT) or Computed axial tomography (CAT):is a medical imaging method employing tomography created by
computer processing.[1] Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken.

Diagnostic use
Since its introduction in the 1970s, CT has become an important tool in medical imaging to supplement X-rays and medical ultrasonography. It has more recently been used for preventive medicine or screening for disease, for example CT colonography for patients with a high risk of colon cancer, or full-motion heart scans for patients with high risk of heart disease. A number of institutions offer full-body scans for the general population.

[edit] Head
Main article: CT head

Computed tomography of human brain, from base of the skull to top. Taken with intravenous contrast medium.

Bone reconstructed in 3D

CT scanning of the head is typically used to detect infarction, tumours, calcifications, haemorrhage and bone trauma. Of the above, hypodense (dark) structures indicate infarction or tumours, hyperdense (bright) structures indicate calcifications and haemorrhage and bone trauma can be seen as disjunction in bone windows. Ambulances equipped with small bore multi-sliced CT scanners respond to cases involving stroke or head trauma.

[edit] Lungs
CT can be used for detecting both acute and chronic changes in the lung parenchyma, that is, the internals of the lungs. It is particularly relevant here because normal two-dimensional X-rays do not show such defects. A variety of techniques are used, depending on the suspected abnormality. For evaluation of chronic interstitial processes (emphysema, fibrosis, and so forth), thin sections with high spatial frequency reconstructions are used; often scans are performed both in inspiration and expiration. This special technique is called high resolution CT. Therefore, it produces a sampling of the lung and not continuous images.

[edit] Pulmonary angiogram

Example of a CTPA, demonstrating a saddle embolus (dark horizontal line) occluding the pulmonary arteries (bright white triangle)

CT pulmonary angiogram (CTPA) is a medical diagnostic test used to diagnose pulmonary embolism (PE). It employs computed tomography to obtain an image of the pulmonary arteries.

[edit] Cardiac
Main article: Cardiac CT

With the advent of subsecond rotation combined with multi-slice CT (up to 320-slices), high resolution and high speed can be obtained at the same time, allowing excellent imaging of the coronary arteries (cardiac CT angiography).

[edit] Abdominal and pelvic

Main article: Abdominal and pelvic CT

CT Scan of 11 cm Wilms' tumor of right kidney in 13 month old patient.

CT is a sensitive method for diagnosis of abdominal diseases. It is used frequently to determine stage of cancer and to follow progress. It is also a useful test to investigate acute abdominal pain.

[edit] Extremities
CT is often used to image complex fractures, especially ones around joints, because of its ability to reconstruct the area of interest in multiple planes. Fractures, ligamentous injuries and dislocations can easily be recognised with a 0.2 mm resolution.[8][9].

Myelogram: An x-ray of the spinal cord and the bones of the spine. During a myelogram, a
contrast material that is injected into the spinal canal is used to visualize the structures of the spinal cord and nerve roots. The purpose of a myelogram is to evaluate the spinal cord and nerve roots for suspected compression. Pressure on these delicate structures causes pain or other symptoms. A myelogram is performed when precise detail about the spinal cord is needed to make a definitive diagnosis. In most cases, myelography is used after other studies, such as magnetic resonance imaging (MRI) or a computed tomography scan (CT), have not provided enough information to be certain of the diagnosis. Sometimes myelography followed by CT scan is an alternative for patients who cannot have an MRI scan, because they have a pacemaker or other implanted metallic device. Read more: Myelography - procedure, recovery, test, blood, pain, complications, time, medication, heart, risk, cancer, nausea, Definition, Purpose, Description, Preparation, Aftercare, Risks

Myelograms can be performed in a hospital x ray department or in an outpatient radiology facility. The patient lies face down on the x ray table. The radiologist first looks at the spine under fluoroscopy, and the images appear on a monitor screen. This is done to find the best location to position the needle. The skin is cleaned, numbed with local anesthetic, and then the needle is inserted. Occasionally, a small amount of cerebrospinal fluid, the clear fluid that

surrounds the spinal cord and brain, may be withdrawn through the needle and sent for laboratory studies. Contrast material (dye that shows up on x rays) is then injected. The x-ray table is tilted slowly, allowing the contrast material to reach different levels in the spinal canal. The flow is observed under fluoroscopy, and x rays are taken with the table tilted at various angles. A footrest and shoulder straps or supports keep the patient from sliding. In many instances, a CT scan of the spine is performed immediately after a myelogram, while the contrast material is still in the spinal canal. This helps outline internal structures more clearly. A myelogram takes approximately 30 to 60 minutes. A CT scan adds about another hour to the examination. If the procedure is done as an outpatient exam, some facilities prefer the patient to stay in a recovery area up to four hours. Patients who are unable to lie still or cooperate with positioning should not have this examination. Severe congenital spinal abnormalities may make the examination technically difficult to carry out. Patients with a history of severe allergic reaction to contrast material (x-ray dye) should report this to their physician prior to having myelography. Medications to minimize the risk of severe reaction may be recommended before the procedure. Given the invasive nature and risks of myelograms and increased anatomic detail provided by MRI or CT, myelograms are generally not used as the first imaging test.

Read more: Myelography - procedure, recovery, test, blood, pain, complications, time, medication, heart, risk, cancer, nausea, Definition, Purpose, Description, Preparation, Aftercare, Risks