medicine radiology

1. Brig. Physician / Mohamed Abdel Aziz Abo Shanab
Hospitals
Consultant of radiology, Armed Forces
mshanabo@yahoo.com

2. Old imaging techniques that are rarely
used are different from Historical
imaging techniques, such as
 Bronchography
 Chest photofluorography
 Conventional tomography
 Pneumoencephalography
 Translumbar aortography

3.  The field of diagnostic and therapeutic
radiology has always been characterized by
constant innovation & creativity to evolve to
its current form.
 There are numerous imaging techniques that
were once prevalent but have become
outdated & replaced by the current
examinations and modalities, which improve
diagnostic accuracy and patient outcomes.

4.  Knowledge of these old radiologic
examinations and procedures is important to
understand how we have arrived at the
current practice of radiology & how our field
can continue to evolve to improve our
diagnostic and therapeutic abilities to fit the
changing needs of our patients.

5.  Fluoroscopy uses X-rays to capture an image
of an organ while it is functioning.
 It includes both lower and upper GITs.
 A lower GI is an X-ray evaluation of the large
intestine (the colon).
 This includes the right or ascending colon,
the transverse colon, the left or descending
colon and the rectum.

6.  An upper GI Study is an X-ray examination of
the esophagus, stomach and first part of the
small intestine.
 Upper GIT must be coated or filled with a
contrast material called barium, an element
that appears bright white on radiographs.

7.  The barium is given to the patient to drink.
 Some patients are asked to swallow baking-
soda crystals to create gas and further
improve the images; this procedure has the
modified name of air-contrast or double-
contrast upper GI.

9.  Esophogram
 Barium Meal, UGI Series
 Barium Follow through, Small Bowel and
UGI
 Barium Enema

11.  The dedicated small bowel follow-through
has been replaced to a lesser degree by CT
Abdomen, CT and MR Enterography &
capsule endoscopy.
 For lower GI symptoms and colon cancer
screening, the double-contrast barium enema
has increasingly been discarded in favor of
Colonoscopy, CT Abdomen, CT
Colonography.

12.  Barium studies are considered by radiologists
as a “low-tech” form of imaging.
 CT and MR, are seen more appealing “high-
tech” imaging modalities.
 Barium studies are also physically taxing,
labor-intensive procedures and, arguably, one
of the more difficult skill sets for radiologists
to master.

13.  Decline of barium radiology, Alarm
 Barium studies are highly operator
dependent.
 No Sufficient Instructors to train residents
 Performance needs training, experience and
expertise in barium radiology
 This is another disincentive for clinicians to
order barium studies in community practice.

15.  IVP
 Cystogram
 IVP with Tomograms
 Retrograde Pyelogram

16.  An Intravenous Pyelogram (IVP) is an x-ray
examination of the kidneys, ureters, and
urinary bladder.
 An IVP study uses a contrast material to
enhance urinary structures in x-ray images.
 The iodine contrast material is injected into
the patient's venous system, and its progress
through the urinary tract is then recorded on a
series of quickly captured images.
 Show the anatomy & function of the kidneys
and urinary tract.

18.  Renal colic
 Renal stone disease
 Calyceal pathology
 Hematuria
 Chronic upper urinary tract obstruction.
 The commonest situation in which the CTU
& MRU are now being suggested as an
alternative to an IVU is in the investigation of
suspected renal colic.

19.  Radiation dosage:-
- 3-shot IVU 1.5 mSv (millisievert).
- Unenhanced CT 4.5 mSv
 CT scan, performed within few minutes.
 IVU need delayed films, may prolong the
examination for more than 12 h.

20. IVP vs CT
 CTU detection for the cause of haematuria is high
(sensitivity 92 - 100 %, specificity 89 - 97 %) &
significantly better than IVP (sensitivity 61 %,
specificity 97 %).
 Radiation doses of IVP < CT but varies with the
number of films
 Many practices no longer have tomographic
equipment.
 Many " younger " radiologists have never
performed or interpreted an IVP

23.  IVP may be inconvenient to the patient as its
procedures include, puncture by cannula
(pain), allergy to contrast medium,

24.  It is interesting to speculate about which of
the imaging modalities and techniques we
rely on today will become the antiquated
examinations of the future!!
 AI may replace jobs, personnel as radiologists
in the future!

25. THANK YOU