Recent Advances in Diagnosis from and Technic of Cholecystography

Abstract

THIRTEEN years have passed since the advent of the Graham test in roentgenology. As is usual with all new diagnostic procedures, it has taken some time to establish its real worth. Considerable stress used to be placed on the intravenous method of examination, but accumulated experience and improvement in technic of the oral method have placed the latter on a par with the intravenous method. Marked impetus was given oral cholecystography about three years ago by the introduction of the so-called “intensifying technic,” by Stewart and Illick (1). It combines the methods of Antonucci and Sandstrom, the former by utilizing glucose to aid in more rapid absorption of the iodine by the liver and the latter by using fractional doses of the tetraiodo at more frequent intervals and over a longer period of time. Credit must be given several roentgenologists for their contributions toward the development of cholecystography and establishing it to-day as a definite, exact method of diagnosis. Among these are Leonard, George, Sosman, Kornblum, Hall, Pendergrass, Hodes, Ettinger, Newcomer, Boyden, McNamee, Moore, Kirklin, Blake, Jenkinson, Stewart, and Illick. The statement is warranted, that the amount of accuracy of information obtainable from cholecystography is directly proportional to the care, precision, and attention to details in the course of the examination. Without these, the results are confusing and the examination of little or no value. As much attention must be given to the details concerning food ingestion and the administration of the dye as to technic of the examination. We have used the dye in capsule form because we have consistently found that better than other forms of administration. Patients are given typewritten instructions and advised to follow them to the letter. They are as follows: 1. During the afternoon have several cups of tea with excessive amounts of sugar. 2. Have a regular dinner at six o'clock. 3. Take six capsules one hour later. 4. During the evening have two or three cups of tea with excessive amounts of sugar. 5. Have a breakfast consisting of fruit juices and tea with excessive amounts of sugar. 6. Have a luncheon consisting of fruit juices, fruit salad, jello, and tea with sugar. 7. Take six capsules one hour after luncheon. 8. Have the same dinner as luncheon. 9. Take six capsules one hour after dinner. 10. Report for x-ray examination at ten o'clock the following morning without further food or drink. The initial phase of our examination, after making sure that the patient has followed our instructions to the letter and as certaining whether there has been any vomiting or diarrhea and the probable influence of same on the success of our examination, is to place the patient in a prone position on the table and make an 8 × 10 roentgenogram of the gall-bladder region. The exposure is a postero-anterior one, centering over a point half way between the middle of the spine and the tip of the last rib.