Fluoroscopic Placement Research Articles

Dose reduction during fluoroscopic placement of feeding tubes.

By both increasing the optical iris of the video camera and removing the grid in fluoroscopic procedures involved in placement of a Dubbhoff feeding tube, the radiation dose to patients and staff was reduced by five to seven times. An average expected dose to a patient of about 300 mGy per procedure was reduced by two to three times when the grid was removed and by an additional three times when an iris of increased diameter was used. Because Dobbhoff procedures do not involve obtaining a diagnosis, the image degradation was acceptable and did not affect the total exposure times or ability to conduct the procedure. With the grid out, the difference between the mean exposure times of 5.1 minutes in 96 patient studies done with a normal iris opening and 4.0 minutes in 52 studies done with an enlarged iris was not statistically significant. The importance of reducing patient dose is reinforced by the finding that one-third of the patients underwent repeated procedures, accounting for almost 60% of the total.

String placement and progressive dilatations in the management of high membranous rectal atresia

A newborn with rectal atresia underwent a sigmoid colostomy followed by fluoroscopic placement of a string across the membrane. Progressive dilatations were done until normalization of the rectal canal occurred at 4 months. At 6 months, the colostomy was closed. Although moderate sigmoid dilatation persisted initially, the boy is now developing well and has a normal stooling pattern 3 years following the last procedure. The technique demonstrates the feasibility of high rectal-membrane management without excision.

Fluoroscopic placement of nasojejunal feeding tubes with immediate feeding using a nonelemental diet.

A method for fluoroscopic placement of an Erythrothane (8 French) feeding nasojejunostomy tube with a wire stylet is described. Two hundred thirty-eight feeding tubes were passed successfully to or beyond the Ligament of Treitz in 141 patients with an average fluoroscopy time of 5.3 min/patient. A nonelemental diet was administered without difficulty through the tubes by continuous infusion immediately after placement. This technique was found useful in avoiding total parenteral nutrition in patients with poor gastric emptying in situations such as the immediate postoperative period, drug-induced nausea, and in the presence of an altered mental status.

Feeding tube for fluoroscopic placement.

HomeRadiologyVol. 145, No. 3 PreviousNext Feeding tube for fluoroscopic placement.P R Frederick, M H Miller, W J MorrisonP R Frederick, M H Miller, W J MorrisonP R FrederickM H MillerW J MorrisonPublished Online:Dec 1 1982https://doi.org/10.1148/radiology.145.3.6815710MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: 1982 FiguresReferencesRelatedDetailsCited ByCurrent Problems in Diagnostic Radiology, Vol. 24, No. 2Critical Care Clinics, Vol. 8, No. 4ANZ Journal of Surgery, Vol. 61, No. 1Current Problems in Diagnostic Radiology, Vol. 19, No. 3Critical Care Clinics, Vol. 2, No. 4Journal of Parenteral and Enteral Nutrition, Vol. 10, No. 1Journal of Parenteral and Enteral Nutrition, Vol. 8, No. 6Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 145, No. 3 Metrics Altmetric Score PDF download

Tomographic evaluation of the internal auditory canal using positive contrast material.

The authors describe a new technique for specific filling of the internal auditory canal with iophendylate (Pantopaque). Following fluoroscopic placement of the contrast material, the patient is turned supine for tomography of the internal auditory canal, thus avoiding false negative results due to loss of contrast material into the middle cranial fossa. Contrast material retained in the lumbar subarachnoid area can be used to follow the course of suspected small intracanalicular lesions.

Radiological aspects of fetal intrauterine transfusion.

WITHIN THE past few years, considerable progress has been made in the management of erythroblastosis fetalis. Although introduction of high-titer anti-D gamma globulin (RhrrGam)2 will inevitably decrease the potential population who might require intrauterine transfusion (IUT), the already highly sensitized mother cannot be treated with RhoGam and must still be controlled by IUT. Therefore, further development and refinement of procedures must be continued. Intrauterine transfusion is dependent upon several roentgenographic technics— radioisotopic localization of the placenta, grid localization of the fetus, localization of the fetal abdominal structures by injection of radiopaque medium, and fluoro-scopic placement of the transfusion needle. Ease of performance and low morbidity (to both mother and fetus) of the aforementioned procedures are just as important as the quality and quantity of information that can be obtained. Since intrauterine transfusion is still in the adjustment phase and newer approaches must be devised to overcome problems of the current technic, the authors will present the roentgenographic methods employed at the Yale-New Haven Medical Center. Results and complications related to these radiographic procedures will be discussed. Materials and Methods All patients who exhibited Rh sensitization (positive maternal blood Coombs titer of 1:8 or greater) in the current pregnancy or in a previous one were considered candidates for further evaluation by amnio-centesis and spectrophotometric analysis of the amniotic fluid. The initial step for each patient was localization of the placenta by radioisotopic scanning. The patient was given Lugol's solution followed by an injection of 10 µCi of albumin-tagged 131I. After fifteen minutes a scintillation scan of the abdomen was obtained. The area of the placenta was revealed by elevated counts. Whenever possible, amniocentesis was initially undertaken at twenty weeks gestation and at appropriate intervals thereafter. If spectrophotometric analysis revealed an optical density difference in the upper quarter of Zone II or in Zone III in a pregnancy of less than thirty-two weeks gestation, the patient was considered a candidate for repeat amniocentesis and possible intrauterine transfusion. Once the clinical and laboratory findings indicated the necessity for intrauterine fetal transfusion, the next step was the determination of the lie of the fetus and the location of the fetal abdomen. A wire grid was placed over the maternal abdomen (Fig. 1, A), and an anteroposterior radiograph was taken (Fig. 1, B). The fetal skeletal structures could thus be related to the grid markings. If the fetus was in a direct anteroposterior lie, a lateral film was obtained to determine whether the spine was anterior or posterior (Fig. 1, C).

The importance of fluoroscopic tube placement during gastric analysis.

The ability to properly position a nasogastric tube for adequate collection during gastric analysis was evaluated in 103 patients both before and after correct tube length had been determined fluoroscopically. Even with the knowledge of proper tube length for each patient, placement was considered to be satisfactory in only 49.6% of cases. These findings support the concept that proper collection of gastric secretions for present-day gastric analysis technics requires fluoroscopic placement of the nasogastric tube.