Abdominal radiology

It is a refined study of the dental arches for evaluation of implant or oncologic surgery at the level of the maxilla and mandible.

How it is performed
It is performed with a simple acquisition while squeezing a plastic shim between the teeth (for stability of position in modest opening), and the acquired thin-layer images are reconstructed in the three planes of space, on a curved plane along the curvature of the arches, and with normal and 3D reconstructions for complete evaluation. No fasting is required. It takes only a few minutes and generally even claustrophobic people can undergo it without any problems. It is an examination with ionizing radiation and as such standard precautions apply in pregnant persons and minors.

It is a conventional contrastographic radiology study that, by administering barytized or, more rarely, iodinated contrast medium, allows evaluation of the complex stages of swallowing.

Principal indications
It is a particularly important investigation in patients who, due to neurological disorders of muscle coordination, encounter aspiration or penetration of contrast medium into the trachea.

How it is performed
By seriate imaging while the patient swallows the contrast medium, the movements of the tongue and palate, the tilting of the epiglottis, and the exclusion upon passage of food from the respiratory spaces can be seen.

Preparation
Fasting for a couple of hours is sufficient as preparation. The examination is not difficult but one must stand in front of the equipment for about ten minutes; in selected cases the investigation can be done while sitting. The baryta contrast medium has a pleasant taste and you can feel the powder in suspension (somewhat chalky drink), the iodinated contrast medium has a strong aniseed taste and some people find it unpleasant. It is an examination with ionizing radiation and as such standard precautions apply in pregnant persons and minors.

It is a conventional contrastographic radiology study that, by administering barytized or, more rarely, iodinated contrast medium, allows evaluation of the lumen of the esophagus and stomach.

Principal indications
It is used to identify the site of an esophageal lesion, to assess the shape and motility of the esophagus, stomach, and duodenum, and to evaluate the possible presence of a jatal hernia. It is no longer a first-line examination except for functional disorders. It is still current for the study of surgical complications on the organs under examination.

How it is performed
It is performed with the patient first standing and then lying down, with various projections. Fasting for about 4 hours is required, and it can also be performed in patients who cannot cooperate or stand.
Barytized contrast medium has a pleasant taste and you can taste the powder in suspension (somewhat chalky drink); iodinated contrast medium has a strong aniseed taste and some people find it unpleasant. It is an examination with ionizing radiation and as such standard precautions apply in pregnant persons and minors.

It is a conventional radiology examination that, through the administration of barytized or more rarely iodinated contrast medium, allows evaluation of gastric emptying and peristaltic movement of the small intestine up to the colon and rectum.

Principal indications
It finds use in the evaluation of post-surgical adhesion states to assess the level of the problem. It has been largely supplanted by Entero MRI, but retains partial validity for direct observation in patients who, due to surgical outcomes, have a short bowel remnant that is poorly studied with Entero MRI.

How it is performed
Fasting for at least 6 hours is required as preparation.
The examination is not difficult; after an initial part that is performed standing or semi-recumbent, images are acquired at varying distances to observe the progression of the mdc. The baryta contrast agent has a pleasant taste and you can feel the powder in suspension (somewhat chalky drink), the iodinated contrast agent has a strong aniseed taste and some people find it unpleasant. It is an examination with ionizing radiation and as such standard precautions apply in pregnant persons and minors.

This is an MRI examination aimed at studying the bowel loops, which are preemptively distended by administering laxatives that retain fluids within the intestines.

Main indications
In addition to the study of the anatomy and the possible presence of inflammatory or polypoid disease of the small intestine, it also allows the evaluation of its movement.

How it is performed
A light dinner is planned the day before the examination and fasting on the day of the examination; it is necessary to be at the hospital 30 minutes before the start of the examination.
About two liters of laxative solution are usually administered in about 20 to 25 minutes. A drug that relaxes the bowel walls and reduces the discomfort given by distention (Buscopan) is also injected in patients without contraindications. Contrast medium will also be injected toward the end of the examination to better assess the structures and activity of any inflammatory forms.

Virtual colonoscopy is a simple, accurate and well-tolerated examination for patients. It is a noninvasive diagnostic examination that, using low-dose CT acquisition and mild bowel preparation, allows visualization of the colon through three-dimensional images. The examination does not require the use of either endoscopic probes or forms of sedation and allows visualization of diverticula, polyps, and other abdominal findings such as aneurysms, stones, etc.
The examination is routinely used in cases of incomplete conventional colonoscopy, and in patients who are debilitated or have contraindications to conventional colonoscopy.

Preparation
Virtual colonoscopy requires mild bowel preparation. The patient, in the three days prior to the examination, should follow a simple diet that includes the exclusion of fiber. He must also take a mild laxative dissolved in water three times a day.

How it is performed
To allow optimal distension of the colon wall, carbon dioxide is safely insufflated through a thin rectal probe, which will be rapidly reabsorbed through the intestinal wall. After distending the colon, two CT scans will be performed, in the prone and supine positions.
The acquired data will later be reprocessed by sophisticated programs capable of generating three-dimensional images of the colon and a virtual exploration of it, simulating a real colonoscopy.

It is an MRI examination aimed at the study of anorectal problems, whether of tumor or inflammatory origin, which by acquiring images in multiple planes and weighted with various parameters, allows for a good assessment of the involvement of the walls of the rectum and anal canal and the surrounding spaces and organs. In some cases the basic examination is sufficient, but mostly the examination is also acquired after administration of contrast medium.

These are techniques for the dynamic study of pelvic floor problems, particularly related to difficulty emptying or retaining fecal contents. Conventional defecography is giving way to the MRI study, both of which allow assessment of possible failure of the rectal wall or pelvic floor.The RX study requires, in cases of difficulty in emptying, opacification of the loops of the small bowel, for which contrast medium is administered by mouth about 1 hour before the examination, while MRI allows the use of intrinsic tissue contrast medium and visualization of both the loops of the small bowel and the bladder and excretory system.
A rectal enema about 3 hours prior to the examination is indicated; about 1 hour after the examination, contrast medium for radiographic study is administered if necessary, the rectal ampulla is then filled with contrast medium, and then images are acquired at rest, under abdominal stress, and during emptying.

It is a radiological technique that allows moving images (fluoroscopy) or radiographs of good anatomical detail using X-rays and iodine- or barium-based contrast agents, and allows evaluation of cavities and movement of the tracts under investigation.
Its use has declined over time as CT and MRI techniques have improved, but it still has a role in the study of the digestive tract, and in some cases the urinary and musculoskeletal systems.

It is a method using X-rays and fluoroscopic guidance, by which guides and catheters can be directed within the arterial and venous vascular system to reach certain districts of the human body. Typically, an arterial or venous vessel is punctured at the groin or arm level to reach any internal organ. In the case of pancreatic hepatobiliary radiology, it is used for studies of the liver or pancreas.

The investigation is performed by puncturing the common femoral vein in the groin or the right internal jugular vein at the level of the neck, and uses fluoroscopic guidance. It is usually aimed at measuring the portal gradient in patients with portal hypertension, ascites, and severe degenerative liver disease, such as cirrhosis.

It is performed for the purpose of taking a small tissue sample from an organ, in this case liver or pancreas, in order to obtain more diagnostic elements in addition to those obtained from imaging methods. Ultrasound or CT scans are used as a guide to reach the desired target within the human body, thanks to the use of very thin needles (usually about 1mm in diameter).

It is performed using fluoroscopic guidance through a venous access at the neck and later reaching the suprahepatic veins below the diaphragm. Using a long, very thin needle (about 1mm in diameter), a liver biopsy sampling is performed through the wall of a suprahepatic vein. This procedure is reserved for patients who cannot undergo percutaneous sampling because, for example, coagulation parameters do not allow it, or because of the presence of liquid effusion in the abdomen.

Method used to study the intra- and extrahepatic biliary tract. It is performed by performing percutaneous puncture of the liver with fluoroscopic guidance and injecting contrast medium directly within the biliary system. In some cases, intrabiliary biopsy sampling may be required, which is performed with small, remote-guided forceps. In some situations, in order to reach a more precise diagnosis, a special instrument can be used to observe the biliary tract from the inside: the cholangioscope. Generally this procedure is performed in collaboration with gastroenterologists, and it is possible to use the percutaneous approach or, alternatively, the endoscopic approach.

With the exception of transhepatic cholangiography, all of the examinations mentioned can be performed on an outpatient basis, with local anesthesia or mild sedation, and do not necessarily require hospitalization or general anesthesia. However, it is necessary to evaluate on a case-by-case basis in order to be able to identify the most appropriate treatment for the patient.