T- tube, Delayed or Post Operative Cholangiography I-tube cholangiography is also known as Delayed or post operative cholangiography. This examination performs after the cholecystectomy (surgical removal of gallbladder) if surgeon suspects residual stone in Biliary tract, and operative cholangiography was not performed. After cholecystectomy, the surgeon places a T tube catheter into the commor bile duct The catheter is extended outside the patient’s body and clamped off. The examination is performed in radiology department after 10th postoperative day, J Indication- ¢ Suspect biliary duct stenosis and obstruction ¢ Suspected stone in ducts « To evaluate biliary tract « Suspected strictures, Dilation and lesions in biliary tractTechnique: og -Contraindication- e Hypersensitivity to lodine e Suspected pregnancy e Severe infection of biliary tract O Equipments- ¢ X-ray machine with Fluoroscopic unit and spot film device e T tube catheter + Contrast media water soluble Iodinated nonionic or ionic 10 ml-20 mi rmal saline nge e Gloves e Sterile towel e Gauze e Lead apron Patient preparation- © Previous biliary tract Investigation report « Patient previous history, medication must be reviewed by Radiologist. e Describe the whole procedure to the patient. Technologist should obtain consent from patient for permission of procedure. © -Procedure- T tube cholangiography performed in the radiology domed I. Ask the patient to remove clothing and wear Hospital gown. 2. Intravenous line is inserted into the patient arm and sedative medication 1s given through line to make patient relax. 3. Place the patient in supine position on the fluoroscopic table. 4, Take a scout film of abdomen area then turn the patient in right posterior oblique. The oblique position displays the vertebrae away from biliary tack 5, Remove the clamp of T tube and dilute contrast media injected slowly from the end of T tube under fluoroscopic guidance.Delayed or Po holangiography acaiihe 6. The radiologist observed patency of duct, leakage from duct, unt hat no fluoroscopic control, During the injection of contrast media ensure thal of air Bubbles should be introduced because air bubble may give shadow radiolucent stones, When the duct filled with the Contrast media the radiographs are taken in various position; like right posterior oblique, left gnterior oblique and abdomen standing (PA position) to evaluate the residual stone and abnormalities 8. Dilute contrast media reduced the Biliary duct spasm and give better visualization of small stones. gh Aftereare- After completion of procedure catheter will be clamped off. The radiographs will send for interpretation, If the residual stone or the Biliary system abnormalities are not detected surgeon may remove the T Tube.