102 CARE OF PATIENT IN DIAGNOSTIC RADIOGRAPHY

On these radiographs opaque calculi will remain in constant relation

to the opacified gall bladder. Cholesterol stones, which cannot be detected
on the plain film owing to their radiolucency, will now appear as dark
areas (negative shadows) superimposed on the image of the gall bladder:
sometimes, if they are numerous and small, they adopt a characteristic
string formation when a radiograph is taken in the erect posture. Reference
has already been made to the possibility of confusing intestinal gas with
these cholesterol stones and to the significance of good preparation of the
patient in this connection.

The Fatty Meal

When the second part of the examination has been satisfactorily performed,
the final stage completes the assessment of gall bladder function. It may
obtain visualization of the common bile duct if this has not been apparent
on the earlier series, and will show calculi maintaining their relation to
the now contracted and diminished gall bladder shadow.
As preliminary to this last stage of cholecystography, the patient must
a

take a meal containing fat. In most cases, for convenience' sake, this
'meal' is actually a synthetic product containing fat in a concentrated
form: for example, 2 oz 'Prosparol' given as a drink.
'Prosparol' is a fluid of milky appearance and is not unattractive to the
eye as on pouring from the container it develops a slight frothy 'head'.
The average subject should not find it nauseous to take in a small quantity.
It must be borne in mind, however, that many patients undergoing
cholecystography are readily sickened by fat and there is a definite
psychological advantage in presenting this draught as attractively as
possible. Details such as a paper napkin and a pleasant cup and saucer or
glass may appear trivial, but are important factors in sustaining morale
and even a sense of physical well-being.
Alternatively to the use of the synthetic product, the diet kitchen may
be asked to supply an appropriate light meal. In this case the choice of
food can be important. A glass of milk and some buttered toast are likely
to prove more appetizing than fried fare of any kind. In some instances
the patient may prefer to go out for a meal, but this is not usually so
convenient an arrangement if radiographs are to be taken within 10min
utes of the ingestion of fats. When the patient is given a meal in the
department he should be provided with peaceful and relatively private
surroundings in which to take it.