[Link].
Medical Imaging
Technology
Special Radiological
Procedures & Contrast Media
(BSCMICO301T23)
Unit I
Topic Name- SIALOGRAPHY
(BMIT)III-year
Ms.
Alsemo Bhatt
NAAC (National Assessment and Accreditation Council)
An autonomous body under UGC for quality assessment and accreditation.
COURSE OUTCOMES
Course Outcomes are specific and measurable statements that define the
knowledge, skills and attitudes learners will demonstrate by the completion
of a course.
As per NAAC guidelines, this course is structured with 6 clearly defined
Course Outcomes (COs).
1. CO1-Remember the principles, indications and contra indications of
specialized radiological procedures
2. CO2- Understand the Principles of Contrast Media Use
3. CO3- Ensure Radiation Safety and Infection Control
4. CO4- Analyze Images for Technical Adequacy
5. CO5- Demonstrate Patient Preparation and Care
6. CO6- Create critical thinking and problem solving skills to adapt to
technological advancements in radiological procedures
PROGRAM OUTCOMES(PO)
Program outcomes are statements that describe what the knowledge, skills
and attitudes students should have at the time of graduation from [Link].
Medical Imaging Technology Program. According to NAAC framework there
are 12 (Pos).
POs clearly state what a student should be able to know, do, and
demonstrate by the end of a program. This includes:
Clinical knowledge
Patient Centered Care
Technical Profeciency
Professional skills
Communication, ethics, and teamwork
Learning Outcomes
•Learn the indications for sialography, which include evaluating
salivary ductal abnormalities (like obstructions, strictures, or
stones) and assessing gland function.
•Detailed Anatomy: Gain a deeper understanding of the major
salivary glands (parotid, submandibular, and sublingual) and their
duct systems.
•Understanding of the Procedure
INTRODUCTION
Indications
Contraindications
Contrast Media used
Equipments
Preparation of patient
Techniques
Filming
Aftercare of pateint
DEFINITION
Sialography
It is a specialized radiological imaging technique used to visualize the salivary glands and
their ductal systems. It involves the injection of a contrast medium into the salivary ducts,
followed by X-ray imaging, to assess the anatomy and function of the salivary glands and
to detect abnormalities such as blockages, stones, strictures, infections, or tumors.
Advantages of Sialography
Detailed Ductal Visualization
Provides excellent visualization of the ductal architecture of the
salivary glands, especially useful for detecting strictures, obstructions,
or sialoliths (stones).
Functional Assessment
Helps assess salivary gland function by evaluating contrast flow and
retention within the ducts and glandular tissue.
Cost-Effective
Compared to more advanced imaging techniques like MRI or CT, sialography is
generally less expensive.
Disadvantages of Sialography
Invasive Procedure
Requires cannulation (insertion of a small tube) into the duct opening, which can be
uncomfortable and technically challenging.
Radiation Exposure
Involves the use of ionizing radiation (X-rays), although the dose is relatively low.
Risk of Allergic Reaction
Potential for allergic reactions to the iodine-based contrast medium used in the
procedure.
Contraindicated in Acute Infection
Should not be performed during acute sialadenitis due to risk of worsening the
infection.
.
INDICATIONS
Sialolithiasis (salivary stones)
To locate and assess the size, number, and position of stones within the
ductal system.
Ductal strictures or stenosis
To detect narrowing or blockage in the salivary ducts
Chronic sialadenitis
To evaluate persistent inflammation or infection of the salivary glands.
Salivary Fistulas or Ductal Injuries To evaluate duct integrity and identify
abnormal salivary drainage (fistulas)..
Suspected Tumors (Limited Role)
To detect displacement or compression of ducts by a mass (though MRI/CT is
preferred for soft tissue characterization).
Contraindications
• Acute Sialadenitis (Active Infection)
• Reason: Injecting contrast into an actively inflamed gland can worsen the
infection, increase pain, or spread the infection.
• Recommendation: Delay the procedure until the acute phase subsides.
• Allergy to Iodinated Contrast Media
• Reason: Risk of allergic reactions or anaphylaxis.
• Alternative: Use non-contrast imaging like ultrasound or MRI sialography.
• Complete Ductal Obstruction
• Reason: If the duct is completely blocked (e.g., by a large stone), the contrast
cannot pass through, making the procedure ineffective and potentially painful.
Contrast media used
Water-Soluble Iodinated Contrast Agents
Examples:
Iohexol (e.g. Omnipaque)
Iopamidol (e.g. Isovue)
Ioversol (e.g. Optiray)
Preferred type because they are:
Non-ionic (lower risk of allergic reaction)
Low osmolality (less irritation)
Easily absorbed if extravasated (leaks into tissues)
Oil-Based Iodinated Contrast Agents (less commonly used today)
Example: Ethiodized oil (e.g. Lipiodol)
Note: Used historically but now largely replaced due to risks of long retention
and inflammation.
Ideal Properties of Contrast for Sialography
Water-soluble
Non-ionic
Low osmolality
Radio-opaque (clearly visible on X-ray)
EQUIPMENTS
•X-ray machine / Fluoroscopy unit
• For real-time imaging during contrast injection and post-injection
radiographs.
• Digital systems preferred for better resolution and easier image
manipulation.
•Digital Radiography (DR) or Computed Radiography (CR) systems
• To capture high-quality static images after contrast injection.
•Contrast Injection Supplies
•Sialography cannula / Lacrimal probe
• Small, blunt-tipped metal probe to locate and dilate the duct opening.
•Sialography catheter (e.g. flexible plastic catheter)
• Used to inject contrast into the duct once the opening is located.
•Syringe (2–5 mL)
• For gentle manual injection of the contrast medium.
•Contrast media
• Non-ionic, water-soluble iodinated contrast (e.g., Iohexol, Iopamidol).
•Sterile Supplies
•Sterile gloves and drapes
•Antiseptic solution (e.g., povidone-iodine or chlorhexidine)
•Gauze, cotton rolls, and saliva ejector
•Local anesthetic (optional) – for patient comfort during duct cannulation
•Positioning Aids
•Headrest or support pad
• To stabilize the patient’s head during imaging.
•Bite block or tongue depressor (if needed to help visualize duct opening)
Patient Preparation for Sialography
Explain the Procedure:
Describe what sialography involves (injection of contrast into salivary ducts
followed by X-ray imaging).
Discuss Benefits and Risks:
Inform about potential discomfort, rare allergic reactions, and benefits of
accurate diagnosis.
Obtain Informed Consent:
Written consent should be obtained after explaining the procedure.
FILMING
Pre-contrast Film
Purpose: Provides a baseline view to compare with post-contrast images.
Injection (Filling) Phase
Taken during or immediately after contrast injection.
Purpose: Visualizes the ductal system (main duct and branches).
Views Taken:
Lateral view (for parotid and submandibular glands)
Posteroanterior (PA) view
Lateral oblique view (commonly used for the submandibular gland)
Occipitomental (Water's view) (occasionally for deeper gland
visualization)
Aftercare for Sialography
Encourage Saliva Stimulation
Give sour candy or lemon slices to stimulate saliva flow.
Purpose: Helps flush out residual contrast from the salivary ducts and glands.
Advise the patient to drink plenty of fluids after the procedure.
Purpose: Promotes natural clearance of the contrast medium.
Monitor for Complications
Observe for:
Pain or swelling in the gland area (mild discomfort is common but should not persist)
Signs of infection (e.g., fever, increasing redness/swelling)
Allergic reaction (rash, itching, difficulty breathing — rare but serious)
ASSESSMENT
[Link] is the primary purpose of a sialography procedure?
A) To assess the structure of the lungs
B) To visualize the salivary glands and ducts
C) To examine the brain and nerves
D) To detect blood clots in the heart
Answer: B) To visualize the salivary glands and ducts
[Link] contrast agent is commonly used during a sialography
procedure?
A) Barium sulfate
B) Iodine-based contrast
C) Gadolinium
D) Carbon dioxide
Answer: B) Iodine-based contrast
[Link] undergoing sialography, patients are typically advised to:
A) Fast for 4-6 hours
B) Drink plenty of water
C) Avoid caffeine the day before the procedure
D) Take over-the-counter pain relievers
Answer: A) Fast for 4-6 hours
[Link] of the following conditions can a sialography procedure help
diagnose?
A) Brain tumors
B) Blockages in the salivary ducts
C) Bone fractures
D) Kidney stones
Answer: B) Blockages in the salivary ducts
[Link] is the most common complication associated with sialography?
A) Nausea and vomiting
B) Infection at the injection site
C) Excessive bleeding
D) Severe headache
Answer: B) Infection at the injection site
TEXTBOOKS
[Link] Secrets" by Drew A. Torigian, Christopher M. K. Chow
[Link] Imaging: An Atlas of Diagnostic Imaging" by Dennis L. M. J.
WEB RESOURCES
https://
[Link]/document/524785650/Radiological-Procedures-A-Guideline-Dr-Bhusha
n-Lakhkar
[Link]
[Link]
