Upright spot filming of the gallbladder using pneumatic compression

Abstract

Because gravity often causes gallstones to settle on the dependent gallbladder wall or to stratify in a horizontal layer, films taken with a horizontal x-ray beam often demonstrate gallstones which are not evident on films obtained with the conventional vertical beam technique. Consequently, cholecystography is incomplete unless one or more films are obtained using the horizontal beam technique [1 1. Although several different methods and patient positions are suitable for horizontal beam cholecystograms, the most convenient method consists of spot filming with the patient upright [2]. Fluoroscopic viewing enables the radiologist to determine the effect of respiration, rotation, and compression on gallbladder position relative to conflicting densities caused by gas, bony structures, or unabsorbed contrast material in the intestine. Unfortunately, routine maneuvers do not always separate the gallbladder from conflicting densities. in 1970, we suggested [1] a lateral bending maneuver as a helpful ancillary aid for upright spot filming of the gallbladder. During the past several years, however, we have adopted a pneumatic compression technique for upright spot filming of this organ which has largely replaced the lateral bending maneuver in our own radiology practice. This technique has not been emphasized in the radiologic literature.