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 CHAPMAN & NAKIELNY’S

GUIDE TO
RADIOLOGICAL
PROCEDURES
For Carole, Alexander and Liv
For Richard and Emer
CHAPMAN & NAKIELNY’S

GUIDE TO
RADIOLOGICAL
PROCEDURES
Edited by
Nick Watson FRCP FRCR
Consultant Radiologist, University Hospitals of North Midlands,
Stoke-on-Trent, UK

Hefin Jones FRCR

Consultant Radiologist, University Hospitals of North Midlands,
Stoke-on-Trent, UK

SEVENTH EDITION

Edinburgh • London • New York • Oxford • Philadelphia • St Louis

• Sydney 2018 iii
© 2018 Elsevier Ltd. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by
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This book and the individual contributions contained in it are protected under
copyright by the publisher (other than as may be noted herein).
First edition 1981
Second edition 1986
Third edition 1993
Fourth edition 2001
Fifth edition 2009
Sixth edition 2014
Seventh edition 2018
ISBN 9780702071669
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A catalog record for this book is available from the Library of Congress

Notices
Practitioners and researchers must always rely on their own experience and
knowledge in evaluating and using any information, methods, compounds or
experiments described herein. Because of rapid advances in the medical sciences,
in particular, independent verification of diagnoses and drug dosages should be
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 Contents

1 General notes
David M. Rosewarne
Radiology 1
Radionuclide Imaging 9
Radiopharmaceuticals 9
Computed Tomography 11
Magnetic Resonance Imaging 13
Safety in Magnetic Resonance Imaging 14
Ultrasonography 19

2 Intravascular contrast media

David M. Rosewarne
Historical Development of Radiographic Agents 21
Adverse Effects of Intravenous Water-Soluble Contrast Media 25
Toxic Effects on Specific Organs 25
Idiosyncratic Reactions 28
Mechanisms of Idiosyncratic Contrast Medium Reactions 30
Prophylaxis of Adverse Contrast Medium Effects 30
Contrast Agents in Magnetic Resonance Imaging 33
Historical Development 33
Mechanism of Action 33
Gadolinium 34
Gastrointestinal Contrast Agents 38
Contrast Agents in Ultrasonography 39

3 Gastrointestinal tract
Ingrid Britton
Methods of Imaging the Gastrointestinal Tract 43
Introduction to Contrast Media 43
Water-Soluble Contrast Agents 43
Gases 44
Barium 45
Pharmacological Agents 46

v
vi Contents

Contrast Swallow 49
Barium Meal 51
Small Bowel Follow-Through 55
Small-Bowel Enema 57
Barium Enema 60
Enema Variants 63
The ‘Instant’ Enema 64
Air Enema 64
Reduction of an Intussusception 65
Contrast Enema in Neonatal Low Intestinal Obstruction 68
Sinogram 69
Retrograde Ileogram 69
Colostomy Enema 70
Loopogram 70
Herniogram 70
Evacuating Proctogram 72
Coeliac Axis, Superior Mesenteric and Inferior Mesenteric
Arteriography 73
Ultrasound of the Gastrointestinal Tract 74
Endoluminal Examination of the Oesophagus and Stomach 74
Transabdominal Examination of the Lower Oesophagus and
Stomach 75
Hypertrophic Pyloric Stenosis 75
Small Bowel 75
Appendix 76
Large Bowel 76
Endoluminal Examination of the Anus 76
Endoluminal Examination of the Rectum 77
Computed Tomography of the Gastrointestinal Tract 78
Computed Tomographic Colonography 80
Complications 81
Aftercare 81
Magnetic Resonance Imaging of the Gastrointestinal Tract 82
Radionuclide Gastro-Oesophageal Reflux Study 85
Radionuclide Gastric-Emptying Study 87
Radionuclide Meckel’s Diverticulum Scan 89
Radionuclide Imaging of Gastrointestinal Bleeding 90
Labelled White Cell Scanning in Inflammatory Bowel Disease 92
 Contents vii

4 Liver, biliary tract and pancreas

Ingrid Britton
Methods of Imaging the Hepatobiliary System 93
Methods of Imaging the Pancreas 93
Plain Films 94
Ultrasound of The Liver 94
Ultrasound of the Gallbladder and Biliary System 96
Ultrasound of the Pancreas 98
Computed Tomography of the Liver and Biliary Tree 99
Computed Tomographic Cholangiography 101
Computed Tomography of the Pancreas 102
Magnetic Resonance Imaging of the Liver 103
Magnetic Resonance Cholangiopancreatography 106
Magnetic Resonance Imaging of the Pancreas 106
Endoscopic Retrograde Cholangiopancreatography 107
Intraoperative Cholangiography 110
Postoperative (T-Tube) Cholangiography 111
Percutaneous Transhepatic Cholangiography 112
External Biliary Drainage 115
Internal Biliary Drainage 115
Percutaneous Extraction of Retained Biliary Calculi (Burhenne
Technique) 117
Angiography 118
Coeliac Axis, Superior Mesenteric and Inferior Mesenteric
Arteriography 118
Radionuclide Imaging of Liver and Spleen 119
Radionuclide Hepatobiliary and Gallbladder Radionuclide Imaging 121
Investigation of Specific Clinical Problems 123
The Investigation of Liver Tumours 123
The Investigation of Jaundice 124
The Investigation of Pancreatitis 125
Pancreatic Pseudocysts 125

5 Urinary tract
Peter Guest
Plain Film Radiography 128
Intravenous Excretion Urography 128
Ultrasound of the Urinary Tract 130
Computed Tomography of the Urinary Tract 132
viii Contents

Magnetic Resonance Imaging of the Urinary Tract 135

Magnetic Resonance Imaging of the Prostate 136
Magnetic Resonance Urography 137
Magnetic Resonance Imaging of the Adrenals 138
Magnetic Resonance Renal Angiography 138
Micturating Cystourethrography 138
Ascending Urethrography in the Male 140
Retrograde Pyeloureterography 141
Conduitogram 142
Percutaneous Renal Cyst Puncture and Biopsy 143
Percutaneous Antegrade Pyelography and Nephrostomy 144
Percutaneous Nephrolithotomy 146
Renal Arteriography 148
Static Renal Radionuclide Scintigraphy 149
Dynamic Renal Radionuclide Scintigraphy 151
Direct Radionuclide Micturating Cystography 153

6 Image guided ablation techniques for cancer treatment

Tze Min Wah
Types of Ablative Technology 155
Radiofrequency Ablation 155
Microwave Ablation 156
Cryoablation 157
Irreversible Electroporation 158
Tips 160
Key Challenges 160

7 Reproductive system
Balashanmugam Rajashanker
Hysterosalpingography 163
Ultrasound of the Female Reproductive System 166
Ultrasound of the Scrotum 168
Computerized Tomography of the Reproductive System 169
Magnetic Resonance Imaging of the Reproductive System 169
Gynaecological Malignancy 171
Cervical Cancer 171
Uterine Carcinoma 171
Ovarian Cancer 172
Omental Biopsy 173
 Contents ix

Pet Computerized Tomography 174

Uterine Artery Embolization 174

8 Respiratory system
Nick Watson
Computed Tomography of the Thorax 177
Computed Tomography-Guided Lung Biopsy 179
Methods of Imaging Pulmonary Embolism 182
Radionuclide Lung Ventilation/Perfusion Imaging 183
Computed Tomography in the Diagnosis of Pulmonary Emboli 186
Pulmonary Arteriography 187
Magnetic Resonance of Pulmonary Emboli 188
Ultrasound of the Diaphragm—The ‘Sniff Test’ 190
Magnetic Resonance Imaging of the Respiratory System 191
PET and PET-CT of the Respiratory System 192

9 Heart
Hefin Jones
Angiocardiography 193
Coronary Arteriography 195
Cardiac Computed Tomography 198
Cardiac Magnetic Resonance 203
Radionuclide Ventriculography 206
Radionuclide Myocardial Perfusion Imaging 209

10 Arterial system
Chris Day
Noninvasive Imaging 217
Vascular Ultrasound 217
Computed Tomographic Angiography 218
Peripheral (Lower Limb) Computed Tomographic Angiography 218
Magnetic Resonance Angiography 219
Vascular Access 220
General Complications of Catheter Techniques 227
Angiography 229
Angioplasty 230
Stents 233
Catheter-Directed Arterial Thrombolysis 234
Vascular Embolization 236
Thoracic and Abdominal Aortic Stent Grafts 238
x Contents

11 Venous system
Chris Day
Ultrasound 243
Lower Limb Venous Ultrasound 244
Upper Limb Venous Ultrasound 245
Computed Tomography 245
Magnetic Resonance 246
Peripheral Venography 247
Lower Limb 247
Upper Limb 249
Central Venography 250
Superior Vena Cavography 250
Inferior Vena Cavography 250
Portal Venography 251
Transhepatic Portal Venous Catheterization 253
Venous Interventions 254
Venous Angioplasty and Stents 254
Gonadal Vein Embolization 255
Inferior Vena Cava Filters 256
Thrombolysis 258
Pulmonary Embolism 260

12 Radionuclide imaging in oncology and infection

Peter Guest
Positron Emission Tomography Imaging 263
2-[18F]Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography
Scanning 264
Other Pet Radiopharmaceuticals 267
18F-Choline 267
18F-Fluoride 267
68Gallium-Labelled Pharmaceuticals 267
67Gallium Radionuclide Tumour Imaging 268
Radioiodine Metaiodobenzylguanidine Scan 268
Somatostatin Receptor Imaging 270
Lymph Node and Lymphatic Channel Imaging 272
Radiography 272
Ultrasound 272
Computed Tomography 272
Magnetic Resonance Imaging 273
 Contents xi

Radiographic Lymphangiography 273

Radionuclide Lymphoscintigraphy 273
Radionuclide Imaging of Infection and Inflammation 276

13 Bones and joints

Philip Robinson and James Rankine
Musculoskeletal Magnetic Resonance Imaging—General Points 280
Arthrography—General Points 282
Arthrography 283
Arthrography—Site-Specific Issues 286
Knee 286
Hip 287
Shoulder 289
Elbow 294
Wrist 295
Ankle 296
Tendon Imaging 298
General Points 299
Ultrasound of the Paediatric Hip 299
Thermoablation of Musculoskeletal Tumours 300
Radionuclide Bone Scan 303

14 Brain
Amit Herwadkar
Computed Tomography of the Brain 308
Magnetic Resonance Imaging of the Brain 309
Imaging of Intracranial Haemorrhage 311
Computed Tomography 311
Magnetic Resonance Imaging 312
Imaging of Gliomas 313
Computed Tomography 313
Magnetic Resonance Imaging 313
Imaging of Acoustic Neuromas 314
Computed Tomography 314
Magnetic Resonance Imaging 314
Radionuclide Imaging of the Brain 315
Conventional Radionuclide Brain Scanning (Blood–Brain Barrier
Imaging) 315
Regional Cerebral Blood Flow Imaging 315
Positron Emission Tomography 317
xii Contents

201Thallium Brain Scanning 318

Dopamine Transporter Ligands 319
Ultrasound of the Infant Brain 320
Cerebral Angiography 321

15 Spine
James Rankine
Imaging Approach to Back Pain and Sciatica 326
Conventional Radiography 327
Computed Tomography and Magnetic Resonance Imaging of the
Spine 328
Myelography 330
Contrast Media 330
Cervical Myelography 330
Lumbar Myelography 332
Thoracic Myelography 335
Cervical Myelography by Lumbar Injection 336
Computed Tomography Myelography 336
Paediatric Myelography 336
Lumbar Discography 337
Intradiscal Therapy 340
Facet Joint/Medial Branch Blocks 340
Percutaneous Vertebral Biopsy 341
Bone Augmentation Techniques 343
Nerve Root Blocks 343
Lumbar Spine 343
Cervical Spine 344

16 Lacrimal system, salivary glands, thyroid and parathyroids

Polly S. Richards
Digital Subtraction and Computed Tomography
Dacryocystography 345
Magnetic Resonance Imaging of Lacrimal System 346
Ultrasound 347
Conventional and Digital Subtraction Sialography 348
Magnetic Resonance Imaging Sialography 350
Contrast Enhanced Magnetic Resonance Imaging and Computed
Tomography 350
Ultrasound of Thyroid 351
Ultrasound of Parathyroid 351
 Contents xiii

Computed Tomography and Magnetic Resonance Imaging of Thyroid

and Parathyroid 352
Radionuclide Thyroid Imaging 352
Radionuclide Parathyroid Imaging 354

17 Breast
Hilary Dobson
Methods of Imaging the Breast 357
Mammography 357
Ultrasound 360
Magnetic Resonance Imaging 361
Radionuclide Imaging 363
Image-Guided Breast Biopsy 363
Preoperative Localization 365

18 Role of the radiographer and the nurse in interventional

radiology
Dawn Hopkins and Nick Watson
Role of the Radiographer in Interventional Radiology 367
Role of the Nurse in Interventional Radiology 370

19 Patient consent
Floriana Coccia and Jonathan S. Freedman
Introduction 375
Voluntariness 375
Information 376
Capacity 378
Assessment of Capacity 378
Supporting Patients in Decision Making 379
Acting for a Person Who Lacks Capacity 380
Documenting Assessment of Capacity 382
Shared Decision Making 382

20 Sedation and monitoring

Zahid Khan
Sedation 385
Drugs 387
Local Anaesthesia 387
Inhalational Analgesia 387
Intravenous Analgesia 387
xiv Contents

Sedative Drugs 389

Monitoring 392
Sedation and Monitoring for Magnetic Resonance Imaging 394
Recovery and Discharge Criteria 394

21 Medical emergencies
Zahid Khan
Equipment 395
Respiratory Emergencies 397
Respiratory Depression 397
Laryngospasm 397
Bronchospasm 397
Aspiration 398
Pneumothorax 398
Cardiovascular Emergencies 399
Hypotension 399
Tachycardia 399
Bradycardia 400
Adverse Drug Reactions 400
Contrast Media Reaction 400
Local Anaesthetic Toxicity 402

Appendix I Average effective dose equivalents for some

common examinations 403
Appendix II Dose limits – the Ionising Radiation Regulations
1999 405
Appendix III The Ionising Radiation (Medical Exposure)
Regulations 2000 with the Ionising Radiation (Medical
Exposure) (Amendment) Regulations 2006 and the Ionising
Radiation (Medical Exposure) (Amendment) Regulations
2011 407
Schedule 1 416
Schedule 2 417

Index 421
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