usg templates

Sample Type / Medical Specialty: RadiologySample Name: Excretory Urogram - IVP

Description: Common Excretory Urogram - IVP template(Medical Transcription Sample Report)

A survey film of the abdomen shows no soft tissue abnormalities and no pathologic calcifications overlying the renal contours or bladder. Following intravenous infusion of appropriate contrast material, there is prompt symmetrical concentration as noted by nephrograms. No filling defects of the collecting systems are noted on the linear tomograms.

There is normal and symmetrical filling of the caliceal system. Subsequent films demonstrate that the kidneys are of normal size and contour bilaterally. The caliceal system and ureters are in their usual position and show no signs of obstruction or intraluminal defects. The postvoid films demonstrate normal emptying of the collecting system, including the urinary bladder.

IMPRESSION: Negative intravenous urogram.

Barium Swallow Study Evaluation

15

HISTORY: The patient is a 71-year-old female, who was referred for an outpatient

modified barium swallow study to objectively evaluate her swallowing function and

safety. The patient complained of globus sensation high in her throat particularly with

solid foods and with pills. She denied history of coughing and chocking with meals. The

patient’s complete medical history is unknown to me at this time. The patient was

cooperative and compliant throughout this evaluation.

STUDY: Modified barium swallow study was performed in the Radiology Suite in

cooperation with Dr. X. The patient was seated upright at a 90-degree angle in a video

imaging chair. To evaluate her swallowing function and safety, she was administered

graduated amounts of food and liquid mixed with barium in the form of thin liquids

(teaspoon x3. cup sip x4); thickened liquid (cup sip x3); puree consistency (teaspoon x3);

and solid consistency (1/4 cracker x1). The patient was given 2 additional cup sips of thin

liquid following the puree and solid food presentation.

ORAL STAGE: The patient had no difficulty with bolus control and transport. No spillage

out lips. The patient appears to have pocketing __________ particularly with puree and

solid food between her right faucial pillars. The patient did state that she had her tonsil

taken out as a child and appears to be a diverticulum located in this state. Further

evaluation by an ENT is highly recommended based on the residual and pooling that

occurred during this evaluation. We were not able to clear out the residual with

alternating cup sips and thin liquid.

PHARYNGEAL STAGE: No aspiration or penetration occurred during this evaluation. The

patient’s hyolaryngeal elevation and anterior movements are within the functional limits.

Epiglottic inversion is within functional limits. She had no residual or pooling in the

pharynx after the swallow.

CERVICAL ESOPHAGEAL STAGE: The patient’s upper esophageal sphincter opening is

well coordinated with swallow and readily accepted the bolus.

DIAGNOSTIC IMPRESSION: The patient had no aspiration or penetration occurred

during this evaluation. She does appear to have a diverticulum in the area between her

right faucial pillars. Additional evaluation is needed by an ENT physician.

PLAN: Based on this evaluation, the following is recommended:

1. The patient’s diet should consist regular consistency food with thin liquids. She needs

to take small bites and small sips to help decrease her risk of aspiration and penetration

as well as reflux.

2. The patient should be referred to an otolaryngologist for further evaluation of her oral

cavity particularly the area between her faucial pillars.

The above recommendations and results of the evaluation were discussed with the

patient as well as her daughter and both responded appropriately.

Thank you for the opportunity to be required the patient’s medical care. She is not in

need of skilled speech therapy and is discharged from my services.

Templates

X-ray Bone Fracture

Clinical History: [Pain]

Examination: [] views of the [] are submitted for review [ without priorradiographs available for comparison].

Findings: []

[There is no evidence of fracture or dislocation.]

Impression:

[No evidence of fracture or dislocation.]

X-ray Feldman

Clinical History: [Status post injury]

Examination: [] views of the [] are submitted for review. No priorradiograph is available for comparison.

Findings: []

[There is no evidence of bony or articular abnormality.]

Impression:

[No bony or articular abnormality.]

X-ray Cervical Spine

Clinical Information: [Motor vehicle accident]

Description: AP, lateral, and open-mouth views of the cervical spineare submitted for review.

[No evidence of fracture or malalignment is seen. Vertebral heights andintervertebral disc spaces are maintained. The prevertebral soft-tissues areunremarkable. There is no evidence of focal osteolytic or blastic lesion. ]

Impression:

[No evidence of fracture or malalignment.]

X-ray Thoracic Spine

Clinical information: [Back pain]

Description: AP and lateral views of the thoracic spine are submittedfor review.

[No evidence of fracture or malalignment is seen. Vertebral heights and

intervertebral disc spaces are preserved. There is no evidence of focalosteolytic or blastic lesion. Osseous mineralization is unremarkable.]

Impression:

[No evidence of osseous or articular abnormality.]

X-ray Lumbosacral Spine

Clinical information: [Back pain]

Description: AP, lateral, and coned down lateral views of thelumbosacral spine are submitted for review.

[No evidence of fracture or malalignment is seen. Vertebral heights andintervertebral disc spaces are preserved. There is no evidence of focalosteolytic or blastic lesion. Osseous mineralization is unremarkable.]

Impression:

[No evidence of osseous or articular abnormality.]

Body – CT, X-ray, GI, GU

X-ray abdomen

Clinical Information: []

Description: Supine and upright frontal views of the abdomen aresubmitted[.]

The bowel gas pattern is normal. There is no evidence of free intraperitonealair, pathologic calcification, or soft tissue mass.

The osseous structures are intact. The visualized portions of the lung basesare clear.

Impression:

[Unremarkable abdominal x-ray.]

X-ray feeding tube

Clinical information: [Feeding tube placement]

Description: A single frontal view of the abdomen is submitted for review[].

A feeding tube is seen with its distal tip in the [stomach].

The bowel gas pattern [appears nonobstructive]. [There is no evidence of free intraperitoneal air.] []

[The visualized portions of the lung bases are clear. ]

Impression:

[Feeding tube tip seen in] [stomach].

GI Upper GI


Description:

A scout supine frontal view of the abdomen demonstrates a normal bowel gaspattern, with no evidence of pathologic calcification, free intraperitonealair, or soft tissue mass. The osseous structures are intact.

A double-contrast upper GI series was performed. The esophagus is unremarkable,with no evidence of intraluminal filling defect or mucosal irregularity.

The stomach is unremarkable. There is no evidence of gastroesophageal reflux orhiatus hernia.

The duodenum is unremarkable.

Impression:

[Unremarkable upper GI series.]

GI Upper GI and Small Bowel Series


Description:

A scout supine frontal view of the abdomen demonstrates a normal bowel gaspattern, with no evidence of pathologic calcification, free intraperitonealair, or soft tissue mass. The osseous structures are intact.

A double-contrast upper GI series was performed. The the esophagus isunremarkable, with no evidence of intraluminal filling defect or mucosalirregularity.

The stomach is unremarkable. There is no evidence of gastroesophageal reflux orhiatus hernia.

A small bowel follow-through was performed. The small bowel contrasttransit time is normal.

The duodenum and jejunum are unremarkable, with no evidence of increase innumber or width of folds, intraluminal filling defect, or mucosal abnormality.

The ileum is unremarkable. The terminal ileum is well visualized, and is normalin appearance.

Impression:

[Unremarkable upper GI and small bowel series.]

GI Small Bowel Series


Description:

A scout supine frontal view of the abdomen demonstrates an unremarkable bowelgas pattern, with no evidence of free intraperitoneal air, soft tissue mass, orpathologic calcification.

A small bowel follow-through was performed. The small bowel contrast transittime is normal.

The duodenum and jejunum are unremarkable, with no evidence of increase innumber or width of folds, intraluminal filling defect, or mucosal abnormality.

The ileum is unremarkable. The terminal ileum is well visualized, and is normalin appearance.

Impression:

[Unremarkable small bowel follow through.]

GI Barium Enema


Description: A scout view of the abdomen, multiple fluoroscopic imagesafter the barium enema, and multiple radiographs in the PA and decubiti viewsof the abdomen are submitted for review.

There is no evidence of mass, stricture, diverticulum, or colonic polyps. Thearchitecture and mucosal surfaces of the colon appear normal. There is noevidence of colonic abnormality.

Impression:

[No evidence of mass, stricture, diverticulum, or colonic abnormality.]

GI Barium Swallow


Description:

A scout supine frontal view of the chest demonstrates clear lungs and normal cardiomediastinal borders.

A double-contrast esophogram was performed. The esophagus is unremarkable, with no evidence of intraluminal filling defect or mucosal irregularity.

There is no evidence of gastroesophageal reflux or hiatus hernia.

Impression:

[Unremarkable esophogram.]

GI Modified Barium Swallow – Aspiration

Clinical History: [Aspiration]

Description: [A modified barium swallow was performed in conjunctionwith the speech pathology service with thin barium and puree.

No evidence of penetration was seen.]

Impression: [

No evidence of penetration.]

GI Gastric Bypass

Clinical Information: [Status post gastric bypass]

Description:

A scout supine frontal view of the chest demonstrates clear lungs and normal cardiomediastinal borders.

A modified esophogram was performed with gastrograffin and thin barium. The esophagus is unremarkable, with no evidence of intraluminal filling defect or mucosal irregularity. No evidence of leak or obstruction is seen at the site of anastomosis

Gastroesophageal reflux is noted.

Impression:

[No evidence of leak or obstruction at the site of anastomosis.]

GI Defacography

Clinical History: [Constipation]

Description: [Defacography was performed in conjunction with the generalsurgery service. Contrast was injected into the rectum.]

The rectum is well visualized and the contours are unremarkable. Thecontrast was excreted with Valsava maneuver.

Impression:

Unremarkable defacography

GU IVP


Description:

A scout supine frontal view of the abdomen demonstrates a normal bowel gaspattern, with no evidence of free intraperitoneal air, pathologiccalcification, or soft tissue mass. The osseous structures are unremarkable.

Following the administration of intravenous contrast, prompt and symmetricbilateral nephrograms are identified. The kidneys are normal in size, contour,axis, and position.

Prompt excretion is noted bilaterally into normal renal collecting systems andureters, with no evidence of intraluminal filling defect or mucosalirregularity.

The bladder is smooth-walled, with no evidence of intraluminal filling defector mucosal abnormality. There is no significant post void residual.

Impression:

[Unremarkable excretory urogram.]

GU Hysterosalpingogram

Clinical History: [Infertility]

Description: [A hysterosalpingogram was performed in conjunction withthe gynecology service. Contrast was injected into the uterus via a catheter.]

The uterus was well visualized and is unremarkable. The fallopian tubes arepatent bilaterally.

Impression:

Unremarkable hysterosalpingogram

Ultrasound

US Lower Extremity Dopplers

Clinical history: [Bilateral lower extremity swelling]

Procedure: Gray scale ultrasound and color Doppler were utilized toevaluate the lower extremity deep venous systems.

Findings: There is normal compression, augmentation and respiratoryvariation in the common femoral veins, superficial femoral veins and poplitealveins bilaterally.

Impression: []

[No evidence of deep venous thrombosis in either lower extremity. ]

US Right Lower Extremity Dopplers

Clinical history: [Right lower extremity swelling]

Procedure: Gray scale ultrasound and Doppler were utilized to evaluatethe right lower extremity deep venous system.

Findings: There is normal compression, augmentation and respiratoryvariation in the right common femoral vein, the right superficial femoral veinand the right popliteal vein.

Impression:

[No evidence of deep venous thrombosis in the right lower extremity.]

US Left Lower Extremity Dopplers

Clinical history: [Left lower extremity swelling]

Procedure: Gray scale ultrasound and color Doppler were utilized toevaluate the left lower extremity deep venous system.

Findings: There is normal compression, augmentation and respiratoryvariation in the left common femoral vein, the left superficial femoral veinand the left popliteal vein.

Impression:

[No evidence of deep venous thrombosis in the left lower extremity. ]

US Abdomen

Clinical history: []

Procedure: Gray scale ultrasound was utilized to evaluate the abdomen.Color Doppler and spectral Doppler were utilized to assist evaluation of cysticand vascular structures.

Findings: The liver is [normal in size] at [] cm in length. It is[normal] in echogenicity[.] There are no focal liver masses. There is nointrahepatic ductal dilatation.

[There are no] gallstones. [No pericholecystic fluid, gallbladder wallthickening, or sonographic Murphy's sign is noted.] [There is no] extrahepaticductal dilatation. The common duct is [] mm in size.

The [tail] of the pancreas could not be visualized. The remainder of thepancreas is normal.

The right kidney is [] cm in length. The left kidney is [] cm in length. Nohydronephrosis and no renal calculi are seen.

The spleen is normal in echotexture and size at [] cm in length.

There is no ascites.

Impression: []

US Abdomen – Dopplers


Procedure: Gray scale ultrasound[,] color Doppler[, and spectralDoppler] were utilized to evaluate the abdomen.

Findings: The liver is [normal in size] at [] cm in length. It is[normal] in echogenicity[] There are no focal liver masses. There is nointrahepatic ductal dilatation.

[There are no gallstones.] [There is no] extrahepatic ductal dilatation. Thecommon duct is [] mm in size.

The main portal vein, left portal vein and right portal vein are patent withnormal waveforms. The hepatic veins are patent with normal waveforms. Thehepatic artery is patent with normal waveforms.

The [tail] of the pancreas could not be visualized. The remainder of thepancreas is normal.

The right kidney is [] cm in length. The left kidney is [] cm in length. Nohydronephrosis and no renal calculi.

The spleen is normal in echotexture and size at [] cm in length.

There is no ascites.

Impression: []

US Renal


Procedure: Grayscale ultrasound was utilized to evaluate the kidneys.[Color Doppler] [was] [utilized to assist evaluation of cystic and vascularstructures.]

Findings:

The right kidney is [] cm in length. []

The left kidney is [] cm length. []

There is no hydronephrosis and there are no renal calculi in either kidney.

The urinary bladder is unremarkable.

Impression:

[Normal renal sonogram.]

US renal transplant

Clinical history: Status post renal transplant.

Procedure: Gray scale ultrasound, color Doppler and spectral Dopplerwere utilized to evaluate the [] lower quadrant renal transplant.

Findings: The [] lower quadrant transplant kidney is [] cm in length. Thereis [no / mild / mod / severe] hydronephrosis.

There [are / are no] peritransplant collections.

Resistive indices range from [0.xx] to [0.xx], which are [normal / in theindeterminate range / elevated, suggesting rejection or ATN].

The transplant artery and vein have normal waveforms. [The feeding iliac arteryhas a normal waveform.]

The urinary bladder is [unremarkable / decompressed at the time of the examination].

IMPRESSION:1. [No / Mild / Mod / Severe] hydronephrosis.2. There [are / are no] peritransplant collections.3. RI's which are [normal / in the indeterminate range / elevated, suggestingrejection or ATN].

US Upper Extremity Bilateral

Clinical history: [Bilateral upper extremity swelling]

Procedure: Gray scale ultrasound, color Doppler and spectral Dopplerwere utilized to evaluate the upper extremity deep venous systems.

Findings: There is normal color filling, compression and respiratoryvariation in the jugular veins bilaterally. There is normal color filling andrespiratory variation in the innominate veins, subclavian veins and axillaryveins bilaterally. The brachial veins have normal color filling and compressionbilaterally.

Impression:

[No evidence of deep venous thrombosis in either upper extremity.]

US Right Upper Extremity

Clinical history: [Right upper extremity swelling]

Procedure: Gray scale ultrasound, color Doppler and spectral Dopplerwere utilized to evaluate the right upper extremity deep venous system.

Findings: There is normal color filling, compression and respiratoryvariation in the right jugular vein. There is normal color filling andrespiratory variation in the right innominate vein, the right subclavian vein

and the right axillary vein. The right brachial vein has normal color fillingand demonstrates normal compression.

Impression:

[No evidence of deep venous thrombosis in the right upper extremity.]

US Left Upper Extremity Ultrasound

Clinical history: [Left upper extremity swelling]

Procedure: Gray scale ultrasound, color Doppler and spectral Dopplerwere utilized to evaluate the left upper extremity deep venous system.

Findings: There is normal color filling, compression and respiratoryvariation in the left jugular vein. There is normal color filling andrespiratory variation in the left innominate vein, the left subclavian vein andthe left axillary vein. The left brachial vein has normal color filling anddemonstrates normal compression.

Impression:

[No evidence of deep venous thrombosis in the left upper extremity.]

US Thyroid


Procedure: Gray scale ultrasound and color Doppler were utilized toevaluate the thyroid gland.

Findings: The right thyroid lobe is [] cm in size without focallesions.

The left thyroid lobe is [] cm in size without focal lesions.

Impression:

Normal thyroid sonogram.

US Thyroid Multinodular Goiter

Clinical history: [Multinodular goiter.]

Procedure: Gray scale ultrasound and color Doppler were utilized toevaluate the thyroid gland.

Findings: The right thyroid lobe is [] cm in size with multiple nodules,largest [] cm in the [] pole.

The left thyroid lobe is [] cm in size with multiple nodules, largest [] cm inthe [] pole.

Impression:

Multinodular goiter.

US Thyroid Biopsy

Clinical history: [] thyroid nodule.

Procedure: Gray scale ultrasound was utilized to localize the []thyroid nodule and, under sterile conditions, using local anesthetic, biopsywas subsequently performed.

Impression:

Ultrasound guided biopsy of [] thyroid nodule. The specimen slides were sent toCytopathology for microscopic evaluation.

US Scrotum


Procedure: Gray scale ultrasound, color Doppler and spectral Dopplerwere utilized to evaluate the scrotum.

Findings: The right testicle is [] cm in size without focal lesions. Theright epididymis is normal. []

The left testicle is [] cm in size without focal lesions. The left epididymisis normal. []

Impression:

[Normal scrotal sonogram.]

US Renal Biopsy

Clinical history: Renal failure.

Procedure: Ultrasound guidance was provided for biopsy of the []kidney, which was performed by the clinical service. There were no immediatecomplications.

Impression:

Ultrasound guidance for renal biopsy, performed by the clinical service,without immediate complication.

US Mark For Paracentesis

Clinical history: [Mark for paracentesis]

Procedure: A limited gray scale ultrasound was utilized to evaluateascites and mark the abdomen for paracentesis. Color Doppler and spectralDoppler were utilized to assist evaluation of cystic and vascular structures.

Findings: Massive ascites is seen in the abdomen. The skin of theright lower quandrant was marked for paracentesis where ascites is seen 2.5 cmfrom the skin.

Impression: [

Ascites marked in the right lower quadrant for paracentesis.]

Peds

Peds Voiding Cystourethrogram

HISTORY: [UTI]

DESCRIPTION: A voiding cystourethrogram was performed. Using aseptictechnique, urethral orifice was prepped with iodine. Pediatric catheter wascarefully inserted into the bladder, and nonionic contrast was administered.

Urinary bladder demonstrates no evidence of abnormal filling defects. The wallis smooth in contour. There is no evidence of ureteral reflux bilaterally.

During voiding, images of the urethra were obtained, and demonstrate noabnormalities.

Small postvoid residual was present.

IMPRESSION:

Unremarkable voiding cystourethrogram.

Peds Head Ultrasound

Clinical History: [Premature infant]

Description: [Sonogram of the head was performed.]

Findings:

[No evidence of hydrocephalus or intraventricular hemorrhage is seen.]

Impression: [

No evidence of hydrocephalus or intraventricular hemorrhage.]

Peds Hip Ultrasound

HIP ULTRASOUND: There are no comparison studies.

CLINICAL INDICATION: [] hip click.

FINDINGS: Bilateral ultrasonographic evaluation of the hips demonstratesnormal femoral heads without evidence of subluxation or dislocation.

IMPRESSION:

NORMAL HIP ULTRASOUND AS DESCRIBED.

Peds Upper GI

HISTORY: [Vomiting].

DESCRIPTION: Upper GI series was performed.

After administration of barium, images of the esophagus, stomach and upperabdomen were obtained. The scout view demonstrates no evidence of small bowelobstruction.

No evidence of gastroesophageal reflux was identified. Stomach and duodenumdemonstrate normal transit time. There is no evidence of malrotation.Proximal ileum is unremarkable.

IMPRESSION:

Unremarkable upper GI series.

Peds Scoliosis

Clinical information: [Scoliosis]

Technique: AP and lateral standing radiographs of the entire spine are submitted.

Findings:

[There is [mild thoracolumbar] scoliosis. No intrinsic vertebral anomalies are seen.]

Impression:

[Mild] scoliosis

Peds Bone Age

Clinical information: [Short stature]

The [left] hand is submitted for evaluation of the patient's bone age. The patient's Chronological age is [age] years [six] months. The bone age corresponds best to the [male] standard in Greulich and Pyle of [] years.

IMPRESSION:

Within normal limits

Peds Chest X-ray

Clinical information: []

Description: A single frontal view of the chest performed at [] isreviewed [without prior studies available for comparison].

Both lungs are clear. No focal consolidation or pleural effusion is noted.

The cardiothymic borders are unremarkable.

Impression:

[No evidence of acute cardiopulmonary disease.]

Peds Chest X-ray ICU

Clinical information: [Respiratory distress]

Description: A single frontal view of the chest and upper abdomenperformed at [ ] is reviewed and compared with a prior study dated [12/16/2004].

[[Both lungs are clear. No focal consolidation or pleural effusion is noted.]The cardiothymic borders are unremarkable.]

Impression:


Peds CT Chest, Abdomen, Pelvis

Clinical statement: [[Lymphoma]. Rule out metastasis.]

Procedure #1: CT scan of the chest. Prior study [not] available forcomparison.

Both lungs are clear. No evidence of mass or nodule is seen. Nolymphadenopathy is noted. No evidence of pleural or pericardial effusion isseen. The heart appears unremarkable.

Procedure #2: CT scan of the abdomen. Prior study [not] available forcomparison.

The liver [is unremarkable.]

The spleen, pancreas, and adrenal glands are unremarkable in appearance. Bothkidneys appear unremarkable.

There is no abdominal lymphadenopathy or ascites.

The bowel demonstrates no evidence of obstruction or bowel wall thickening. []

Procedure #3: CT scan of the pelvis. Prior study [not] available forcomparison.

Evaluation of the pelvis reveals a normal appearing urinary bladder.

There is no pelvic lymphadenopathy or ascites.

[There are no suspicious lytic or blastic osseous lesions.]

Impression:

Chest:

[No evidence of metastatic disease in the chest.]

Abdomen:

[No evidence of metastatic disease in the abdomen.]

Pelvis:

[No evidence of metastatic disease in the pelvis.]

Chest

X-ray Chest PA and Lateral


Description: PA and lateral views of the chest are reviewed [withoutprior studies available for comparison].

Both lungs are clear. No focal consolidation, pleural effusion, pulmonaryedema or pneumothorax is noted. The cardiomediastinal borders areunremarkable. The bony structures are unremarkable.

Impression:


X-ray Chest AP


Description: A single frontal view of the chest is reviewed [withoutprior studies available for comparison].

Both lungs are clear. No focal consolidation, pleural effusion, pulmonaryedema or pneumothorax is noted. The cardiomediastinal borders areunremarkable. The bony structures are unremarkable.

Impression:


X-ray Chest ICU

Clinical History: []

Description: A single frontal portable chest radiograph is reviewed and compared with a prior study dated [5/25/2004].

[]

Impression: []

CT Chest


Technique: 5 mm spiral CT images through the chest were obtainedwithout intravenous contrast [without prior studies available for comparison].

Description: No evidence of masses or nodules is present.

No lymph node enlargement is noted in the chest. There is no evidence ofpleural or pericardial effusion.

The airways are patent bilaterally. Visualized portions of the upper abdomendemonstrate no gross abnormality.

Visualized bony structures demonstrate no evidence of focal blastic or lyticlesion.

Impression: []

[Unremarkable CT of the chest.]

CT Chest Biopsy

Clinical Information: [Right lower lobe] nodule

Procedure: C. T. guided core biopsy of [right lower lobe] nodulePhysicians: [Resident], [Attending]Anesthesia: 1 % lidocaine SQ.Complications: None.

Procedure Description:The risks, benefits, and alternatives of the procedure were fully explained tothe patient. all questions were answered. Informed consent was obtained.

The patient was placed supine on the CT table and preliminary 5 mm images ofthe lungs were obtained to localize the lesion. A [1.5] cm nodule in the [rightlower lobe] was reidentified superior to the right hemidiaphragm. Usingsterile technique, the skin was prepped and draped and an access window waslocalized and 1 % local lidocaine was administered SQ. CT fluoroscopy wasused to guide a 19 gauge Temno introducer to the margin of the lesion. Theposition was confirmed using CT fluoroscopy and [two] coaxial core biopsieswere obtained using a 20 gauge Temno needle. The specimens were sent tosurgical pathology.

The patient tolerated the procedure well. The follow-up CT scan demonstratedno evidence of pneumothorax and the patient left the department after one hourin the recovery room without immediate post procedure complications and wassent home with standard discharge instructions.

CT Chest Angio (Pulmonary Embolism)


Technique: 2 mm spiral CT images through the chest and additionalimages of the lower pelvis and thighs were obtained with intravenous contrast[without prior studies available for comparison].

Description: No evidence of pulmonary embolus or DVT is seen.

No evidence of masses or nodules is present.

No lymph node enlargement is noted in the chest. There is no evidence of[pleural or] pericardial effusion.

The airways are patent bilaterally. Visualized portions of the upper abdomendemonstrate no gross abnormality.

Visualized bony structures demonstrate no evidence of focal blastic or lyticlesion.

Impression: []

[No evidence of pulmonary embolus or DVT]

NM Bone Scan – Normal

Clinical information: [Prostate cancer], rule out metastatic disease.

Description:

After the intravenous administration of [20] millicuries of technetium 99m-HDP,whole body planar images were obtained in the anterior and posteriorprojections.

[There is no abnormal accumulation of radiotracer].

IMPRESSION:

No evidence of metastatic disease.

NM Bone Scan – Degenerative Changes

Clinical information: [Prostate] cancer, rule out metastatic disease.

Description:

After the intravenous administration of [20] millicuries of technetium 99m-HDP,whole body planar images were obtained in the anterior and posteriorprojections.

There is increased radiotracer activity in the [cervical spine, thoracic spine,lumbar spine, and knees,] which likely represent degenerative in etiology.Otherwise, there is no evidence of abnormal accumulation of radiotracer tosuggest metastatic disease.

IMPRESSION:

No evidence of metastatic disease. Probable degenerative changes as described.

NM Bone Scan – Compare, No Change

Clinical information: [Breast] cancer, rule out metastatic disease.

Description:

After the intravenous administration of [20.9] millicuries of technetium 99m-HDP, whole body planar images were obtained in the anterior and posteriorprojections. Comparison is made with prior bone scan of [10/24/2002].

There is increased radiotracer activity in the [thoracic spine], which islikely degenerative in etiology. Otherwise, there is no abnormal accumulationof radiotracer. There is only physiologic distribution of the radiotracer.

IMPRESSION:

NO EVIDENCE OF METASTATIC DISEASE. NO SIGNIFICANT CHANGE SINCE BONE SCAN OF [10/24/2002].

NM Brain

Clinical information: [].

Description: After the intravenous injection of [20.5] millicuries oftechnetium 99m-HMPAO, images of the brain were obtained.

There is [moderate heterogeneity]. [There is evidence for white matter diseaseand decreased cortical perfusion.]

Impression:

[Heterogeneous]. [Evidence for white matter disease and] decreased corticalperfusion. Differential diagnosis includes but not excluded to drugs,encephalitis, and vasculitis.]

NM Brain – Suggest Diamox

Clinical information: [73] year old [male] with history of [dementia andpersonality change] is referred for a brain SPECT to evaluate corticalperfusion.

Description: After the intravenous injection of [21.2] millicuries oftechnetium 99m-HMPAO, images of the brain were obtained. No other studies areavailable for correlation.

There is severe decreased bilateral cortical perfusion with extensive whitematter disease. The sensorimotor cortex is not preserved.

Impression:

Severe, global, cortical hypoperfusion including the white matter. Thispattern is atypical for Alzheimer's dementia, and a component of the decreasemay be age related. A possible etiology for the bilateral decreased perfusionis bilateral vascular disease. A repeat brain SPECT with Diamox can beobtained to assess vascular reserve.

NM Brain Lyme

Clinical information: [58] year old [female] with Lyme disease is referred fora brain SPECT to evaluate cortical perfusion.

Description: After the intravenous injection of [21] millicuries of technetium99m-HMPAO, images of the brain were obtained. No other studies are availablefor correlation.

There is [moderate], global, cortical hypoperfusion with heterogeneity. Thehypoperfusion involves the white matter.

Impression:

[Moderate], global, cortical hypoperfusion with heterogeneity. This perfusionpattern is consistent with encephalitis or vasculitis, such as from infections[e.g. Lyme disease], autoimmune causes or secondary to some medications.

NM Brain Lyme Comparison

Clinical information: [47] year old [female] with Lyme disease is referred fora brain SPECT to evaluate cortical perfusion.

Description: After the intravenous injection of [21.6] millicuries oftechnetium 99m-HMPAO, images of the brain were obtained. Comparison is madewith prior brain SPECT dated [12/28/99].

There is [moderate], global, cortical hypoperfusion with heterogeneity, whichhas [improved] since prior examination.

IMPRESSION:

[MODERATE], GLOBAL, CORTICAL HYPOPERFUSION WITH HETEROGENEITY, WHICH HAS[IMPROVED] SINCE PRIOR EXAMINATION OF [12/28/99]. THIS PERFUSION PATTERN ISCONSISTENT WITH ENCEPHALITIS OR VASCULITIS, SUCH AS FROM INFECTIONS [E.G. LYMEDISEASE], AUTOIMMUNE CAUSES OR SECONDARY TO SOME MEDICATIONS.

NM Brain Lyme with Depression

Clinical information: [54] year old [21.4] with Lyme disease is referred for abrain SPECT to evaluate cortical perfusion.

Description: After the intravenous injection of [21] millicuries of technetium99m-HMPAO, images of the brain were obtained. No other studies are availablefor correlation.

There is [moderate], global, cortical hypoperfusion with heterogeneity. Thehypoperfusion is more pronounced frontally. The hypoperfusion involves thewhite matter.

Impression:

[Moderate], global, cortical hypoperfusion with heterogeneity, which is morepronounced in the frontal regions. This perfusion pattern is consistent withencephalitis or vasculitis, such as from infections [e.g. Lyme disease],autoimmune causes or secondary to some medications. The frontal predominance ofthe hypoperfusion raises the possibility of an underlying component ofdepression.

NM Lymphoscintigraphy

Clinical information: [53] year old woman with [left]-sided breast carcinoma.Lymphoscintigraphy is now requested as preoperative evaluation proceedingsentinel lymphadenectomy.

Description:

A total dose of 0.5 millicuries of technetium 99m-sulfa colloid was injectedjust lateral to the biopsy site. Imaging was then performed in the anteriorand lateral projections. The skin was marked overlying the sentinel lymph node.

IMPRESSION:

SCINTIGRAPHIC IDENTIFICATION OF SENTINEL LYMPH NODE.

NM Cisternography

Clinical History: [70 year old man with gait impairment. Possible NPH]

Description: [500] uCi of Indium-111 DTPA was administered intrathecally by theneurologist. Images were obtained at 6, 24, 48 hours in multiple projections.

[The study demonstrates that the ventricles are visualized at 6 hours. Howeverat 24 and 48 hours, activity is not appreciated in the ventricles. This is

consistent with atrophy.]

Impression:

[FINDINGS INCONSISTENT WITH NPH. MOST LIKELY REPRESENTS ATROPHY]

NM Gallium FUO

Clinical information: Fever of unknown origin.

Description:

[24][ and 48] hours after the intravenous injection of [1.8] millicuries ofgallium-67, whole body planar images were performed in the anterior andposterior projections. SPECT imaging was also performed of the [chest].

On the whole body images, there is [radiotracer accumulation in the anteriormediastinum]. [The location of this radiotracer uptake is confirmed on theSPECT imaging of the chest]. [The SPECT imaging of the chest is somewhatlimited secondary to patient motion].

Otherwise, there is physiologic distribution of the radiotracer.

Impression:

[Radiotracer accumulation in the anterior mediastinum].

NM Gastric Emptying, Egg

History: [] question of delayed gastric emptying.

Description:

After the oral administration of [500] uCi of technetium 99m radiolabeledsulfur colloid in an egg meal. Imaging over the abdomen was performed in theanterior and posterior projections. The halftime clearance of the radiotracerwas calculated using the geometric mean.

There is [no] evidence of gastroesophageal reflux. The clearance halftime iscalculated at [] minutes, which is [prolonged].

Impression:

1. [No evidence] of gastroesophageal reflux.2. [Prolonged] gastric emptying.

NM Hepatobiliary

CLINICAL INFORMATION: []

DESCRIPTION:

After the intravenous administration of [5.4] millicuries technetium-99mCholetec, imaging of the abdomen was performed. [Of note, after adequate

visualization of bowel structures, 2.5 mg morphine sulfate was administeredintravenously.]

There is prompt radiotracer uptake in the liver with subsequent excretion intothe intrahepatic and extrahepatic biliary system. Following administration ofmorphine sulfate there is prompt opacification of the gallbladder

IMPRESSION:

NO SCINTIGRAPHIC EVIDENCE FOR CHOLECYSTITIS.

NM I-123 Uptake

Clinical information: Toxic goiter.

Description:Twenty-four hours after the oral administration of [276] microcuries of iodine-123, a 24 hour uptake was calculated.

The 24 hour uptake of I-123 is calculated to be [71] percent which is[elevated].

IMPRESSION:

[MARKEDLY ELEVATED] UPTAKE OF I-123 OF [71] PERCENT.

NM I-111

Clinical information: Fever of unknown origin.

Description:

24 hours after the intravenous injection of 425 microcuries of indium 111tactic white blood cells, whole body planar images were performed in theanterior and posterior projections. SPECT imaging was also performed of thechest.

On the whole body images, there is radiotracer accumulation in the rightsubclavian region. The location of this radiotracer uptake is confirmed on theSPECT imaging of the chest.

Impression:

Radiotracer accumulation in the right subclavian region, which may representinfectious process at the site of the patient's subclavian central venouscatheter.

Liver Spleen

Clinical History: [72 year old male with history if idiopathicthrombocytopenia. Rule out remnant spleen.]

Description: Approximately [5.4] mCi of Tc-99m labeled sulfer colloid wasadministered intravenously. Images were then obtained in multipleprojections. No evidence of spleen.

Impression:

[NO EVIDENCE FOR AUXILLARY SPLEEN TISSUE.]

NM VQ quantitation

Clinical information: [pulmonary hypertension]

Description: After the inhalation of [10.3] millicuries of xenon-133 gas,signal breath, equilibrium, and washout images were performed of the lungs inthe anterior and posterior projections. After the intravenous injection of[0.5] millicuries of technetium 99m-MAA, perfusion images were obtained inmultiple obliquities. Regional quantitative ventilation and perfusion was thenperformed. Comparison is made with chest film of the same date.

There is relatively homogeneous distribution of the radiotracer on the singlebreath image which is maintained during equilibrium images. There is mildretention of the radiotracer at the right lung base on the washout images.

There is marked heterogeneous perfusion throughout both lungs on the perfusionimages. There is no significant left to right shunt.

Regional perfusion to thirds of the lungs as calculated by geometric mean fromanterior and posterior images are:

RIGHT LEFTUPPER [] []MIDDLE [] []LOWER [] []

TOTAL [] []

Regional ventilation to thirds of the lungs as calculated by geometric meanfrom anterior and posterior images are:

RIGHT LEFTUPPER [] []MIDDLE [] []LOWER [] []

TOTAL [] []

IMPRESSION:

[]

NM VQ Intermediate Probability

Clinical information: [60] year old [male] with [shortness of breath,]

Description: After the inhalation of [22 ]millicuries of technetium 99m-DTPA,ventilation images were obtained in multiple obliquities. Correspondingperfusion images were obtained after the intravenous administration of [4.5]millicuries of technetium 99m-MAA. Correlation is made with chest film of [thesame date].

On the ventilation images, [there is central deposition of the radiotracerwhich is consistent with airway disease].

There are matched perfusion/ventilation defects at [the right apex and rightposterior lung base]. [There are corresponding opacities on the chest film ofthe same date.] [The perfusion to the left lung is relatively homogeneous.]

Impression:

Intermediate probability for pulmonary embolism.

NM VQ Low Probability

Clinical information: [17] year old [female] with shortness of breath andchest pain.

Description: After the inhalation of [22] millicuries of technetium 99m-DTPA,ventilation images were obtained in multiple obliquities. Correspondingperfusion images were obtained after the intravenous administration of [4.5]millicuries of technetium 99m-MAA. Correlation is made with chest film of thesame date.

On the ventilation images, there is central deposition of the radiotracer whichis consistent with airway disease.

There is a small matched perfusion/ventilation defect at the right posteriorlung base. Otherwise, there relative homogeneous distribution of theradiotracer on the perfusion images.

Impression:

Low probability for pulmonary embolism.

NM VQ Low Probability, Airway

Clinical information: [17] year old [female] with shortness of breath andchest pain.

Description: After the inhalation of [22] millicuries of technetium 99m-DTPA,ventilation images were obtained in multiple obliquities. Corresponding

perfusion images were obtained after the intravenous administration of [4.5]millicuries of technetium 99m-MAA. Correlation is made with chest film of thesame date.

On the ventilation images, there is central deposition of the radiotracer whichis consistent with airway disease.

There is a small matched perfusion/ventilation defect at the right posteriorlung base. Otherwise, there relative homogeneous distribution of theradiotracer on the perfusion images.

Impression:


NM VQ Matched Defects Low Probability

Clinical information: [58] year old [female] with [shortness of breath andchest pain].

Description: After the inhalation of [25[ millicuries of technetium 99m-DTPA,ventilation images were obtained in multiple obliquities. Correspondingperfusion images were obtained after the intravenous administration of [5.1]millicuries of technetium 99m-MAA. Correlation is made with chest film of thesame date.

There is a small matched perfusion/ventilation defect in the [periphery of theright mid lung], without corresponding chest x-ray abnormality. Otherwise,there relative homogeneous distribution of the radiotracer on the perfusion andventilation images.

Impression:


NM VQ Negative

Clinical information: [44] year old [male] with shortness of breath , rule outpulmonary embolism.

Description: After the inhalation of [25] millicuries of technetium 99m-DTPA,ventilation images were obtained in multiple obliquities. Correspondingperfusion images were obtained after the intravenous administration of [5.4]millicuries of technetium 99m-MAA. Correlation is made with chest film of thesame date.

On the ventilation images, there is uniform distribution of the radiotracer.

On the perfusion images, there is relative homogeneous distribution of theradiotracer.

Impression:

No evidence for pulmonary embolism.

NM Meckels

Clinical information: [3-year-old girl with anemia]. Rule out Meckel'sdiverticulum.

Description: After injection of [4.5] millicuries of technetium 99m-pertechnetate, sequential imaging of the abdomen was performed for 30 minutes.

[There was no abnormal radiotracer uptake]. There was [] only physiologicuptake was observed.

IMPRESSION:

[No evidence of Meckel's diverticulum].

NM Neuroblastoma Negative I-131

Clinical information: Neuroblastoma[, stage 3, off therapy for nine to tenmonths].

Description: 24 hours after the intravenous administration of [4.4]microcuries of I-131 MIBG, whole body planar images were obtained in theanterior and posterior projections. Comparison is made with prior MIBG scans,the most recent dated [2-14-01].

There is physiologic distribution of the radiotracer. No abnormal foci of theradiotracer accumulation is noted.

Impression:

No evidence for recurrent/residual neuroblastoma.

NM Neuroblastoma I-123

Clinical information: Neuroblastoma[, stage 3, off therapy for nine to tenmonths].

Description: 24 hours after the intravenous administration of [4.4]millicuries of I-123 MIBG, whole body planar images were obtained in theanterior and posterior projections. Comparison is made with prior MIBG scans,the most recent dated [2-14-01].

There is physiologic distribution of the radiotracer. No abnormal foci of the

radiotracer accumulation is noted.

Impression:

No evidence for recurrent/residual neuroblastoma.

NM Octreotide

Clinical Information: [Carcinoid syndrome]

Description: After injection of [7.2] mCi of Indium 111-Octreotide, imageswere whole body views, axial, coronal, and sagittal images were obtained.

There is normal visualization of the liver, spleen, and kidneys. There is noabnormal uptake visualized.

Impression:

No evidence of metastatic disease.

NM Parathyroid Subtraction, Negative

CLINICAL INFORMATION: Elevated calcium and parathyroid hormone.

DESCRIPTION:

Approximately 24 hours after the oral administration of [305] microcuries I-123, imaging of the neck was performed. Subsequently, [22] mCi Tc 99msestamibi was injected intravenously and imaging of the neck was performed.Iodine counts were then subtracted from the sestamibi counts. [Of note, thepatient moved during imaging, rendering the subtraction imagesuninterpretable]. [The patient then underwent two hour delayed sestamibiimaging.]

There is physiologic distribution of radiotracer. There is no focus ofradiotracer uptake to suggest parathyroid adenoma.

IMPRESSION:

NO SCINTIGRAPHIC EVIDENCE FOR PARATHYROID ADENOMA.

NM PET Lymphoma

Clinical information: [Non-Hodgkin's] lymphoma status post [chemotherapy] isreferred for follow-up PET scan to assess residual/recurrent disease.

Description: Approximately 50 minutes after the intravenous administration of[9.68] millicuries of Fluorine-18-FDG, a transmission corrected PET scan of theneck, chest, abdomen and pelvis was performed. Comparison is made with [priorPET scan dated 1-30-01 as well as prior CT scan of the neck, chest, abdomen and

pelvis dated 5-2-01].

[There has been interval resolution of the hypermetabolic activity in the neck,chest, abdomen, pelvis, and extremities. There is no evidence for newhypermetabolic activity.] There is only physiologic distribution of theradiotracer in the neck, chest, abdomen and pelvis.

IMPRESSION:

[INTERVAL RESOLUTION OF THE HYPERMETABOLIC ACTIVITY IN THE NECK, CHEST,ABDOMEN, PELVIS AND EXTREMITIES SINCE PRIOR PET SCAN OF 12/30/2002.] NOEVIDENCE OF MALIGNANCY AT THIS TIME.

NM Prostascint

Clinical information: Prostate cancer, status post RRP 5 years ago withrising PSA: Rule out metastatic disease.

Description:

After the intravenous injection of [6.0] millicuries of indium-111 labeledProstascint, triplanar SPECT imaging was performed of the chest, abdomen, andpelvis at both 30 minutes and 96 hours. Additionally, whole body planar imageswas carried out at 96 hours in the anterior posterior projections.

IMPRESSION:

[]

NM Renal Mag 3

CLINICAL INFORMATION: []

DESCRIPTION:

Following adequate hydration and shortly after the IV administration of [1.25]mg Vasotec, [5.2] mCi Tc 99m labeled MAG 3 was administered IV. Subsequentdynamic and static images of the kidneys were obtained in the posteriorprojection. Ten minutes after radiotracer injection, [20] mg Lasix wasadministered intravenously.

Following adequate aortic bolus of radiotracer there is good perfusion to bothkidneys followed by normal cortical localization. There is subsequent promptexcretion of radiotracer bilaterally and normal clearance from the collectingsystems.

[No evidence of obstruction was seen.]

Time activity curves were calculated revealing time to peak and T1/2 clearance[within normal limits bilaterally.]

IMPRESSION:

1. NO SCINTIGRAPHIC EVIDENCE FOR RENAL ARTERY STENOSIS2. NO EVIDENCE OF OBSTRUCTION

NM Schilling’s

Clinical information: [Celiac disease].

Description:The patient was given an oral dose of 0.5 microcuries of cobalt-57 labeledvitamin B12, and an oral dose of 0.5 microcuries of cobalt-58 labeled vitaminB12 with intrinsic factor. Then after one hour, an intermuscular injection of1000 micrograms of unlabeled vitamin B12 was given to the patient. The patientwas given a container, and instructed to collect [his] urine for 24 hours, tobe returned to the department of nuclear medicine the next day.

The 24 hour urine volume was measured to be [1100] ml. The fraction ofexcreted radiolabeled cobalt 57 vitamin B12 was measured as [5.0] percent,which is less than normal limits of 8-34%. The fraction of excretedradiolabeled cobalt 58 vitamin B12 was measured as [3.7] percent, which is alsolower than normal range of 9-33%.

Impression:

[FINDINGS CONSISTENT WITH A MALABSORPTION SYNDROME, NOT CAUSED BY LACK OFINTRINSIC FACTOR].

NM Sestamibi Whole Body

Clinical information: Thyroid cancer

Description: After the intravenous administration of 22 millicuries oftechnetium 99m SESTAMIBI, whole body images were obtained in the anterior andposterior projections. Delayed whole body images as well as imaging over theneck wer also performed.

On the initial whole body images, there are several foci of increasedradiotracer accumulation within the liver. These foci appear to be in bothlobes of the liver. They do not persist on the delayed images. Otherwise,there is physiologic distribution of the radiotracer.

Impression:

Several foci of abnormal radiotracer accumulation within the liver on theinitial whole body images. These foci are suspicious for metastatic disease.

NM therapy, samarium

Clinical information: Metastatic [prostate] cancer. [He] is referred for

treatment with Samarium-153 for palliative therapy of intractable bone pain.

Description: The risks of therapy with Samarium-153 were discussed with thepatient [and his wife], which included but were not limited to, bone marrowsuppression and failure of response. Potential benefits were also discussed.Informed consent was obtained from the patient.

After the patient's identity was confirmed with two forms of identification,one with photograph, reliable intravenous access was obtained, andapproximately 500 ml of saline was infused. A total dose of [73.3] millicuriesSamarium-153 was administered intravenously without incident. The patientremained in the nuclear medicine suite for approximately six hours thereafter,during which time [his] urine was collected and disposed of properly.

The patient was informed to follow up with [his urologist].

Impression:

INTRAVENOUS ADMINISTRATION OF [83] MILLICURIES OF SAMARIUM-153 FOR PALLIATIVETHERAPY OF INTRACTABLE BONE PAIN FROM METASTATIC [PROSTATE] CANCER.

NM Three Phase Bone Scan, Osteomyelitis

Clinical information: [Left knee] pain, rule out osteomyelitis.

Description:After the intravenousadministration of [dose] millicuries of technetium 99m-HDP, blood flow, blood pool, and delayed images were performed of the [knees].Correlation is made with plain films of the [] dated [].

On the blood flow imaged, blood pool images, and delayed images, there isincreased radiotracer activity in the [].

Impression:

Increased radiotracer accumulation about the [left knee] on all three phaases,in the absence of fracture, these findings are consistent with osteromyelitis.

NM Three Phase Bone Scan, Negative

Clinical information: Diabetic with [fever and] [right foot] pain, rule outosteomyelitis.

Description:

After the intravenous administration of [22] millicuries of technetium 99m-HDP,blood flow, blood pool, and delayed images were performed of the feet.

Correlation is made with plain films of the [right] foot dated [6/25/01].

On the blood flow imaged, blood pool images, and delayed images, there is noevidence of increased radiotracer activity in the [feet].

IMPRESSION:

NO EVIDENCE OF OSTEOMYELITIS OF THE [RIGHT FOOT].

NM Thyroid Therapy

CLINICAL INFORMATION: [86 old woman with hyperthyroidism.]

DESCRIPTION:

The risks and benefits of radioactive iodine therapy were discussed, thepatient's identity was confirmed, and appropriate informed consent wasobtained.

A dose of [20] mC I 131 was subsequently administered orally, without incident.

The patient was informed of appropriate precautions and restrictions, and wastold to follow up with her physician in a 4-6 weeks.

IMPRESSION:

ORAL ADMINISTRATION OF [20] MILLICURIES I 131 FOR TREATMENT OF HYPERTHYROIDISM.

NM Thyroid Therapy (bis)

CLINICAL INFORMATION: [Hyperthyroidism]

DESCRIPTION:

The risks and benefits of radioactive iodine therapy were discussed, thepatient's identity was confirmed, and appropriate informed consent wasobtained.

A dose of [20] mC I 131 was subsequently administered orally, without incident.

The patient was informed of appropriate precautions and restrictions, and wastold to follow up with her physician in a 4-6 weeks.

IMPRESSION:

ORAL ADMINISTRATION OF [20] MILLICURIES I 131 FOR TREATMENT OF HYPERTHYROIDISM.

NM Thyroid I-131

Clinical information: Thyroid cancer.

Description:

48 hours after the oral administration of [276] microcuries of iodine-131,whole body imaging was performed in the anterior and posterior projections.

There is physiologic distribution of the radiotracer. [No abnormalaccumulation of radiotracer is noted].

IMPRESSION:

[NO EVIDENCE OF METASTATIC DISEASE].

NM Thyroid I-123 Uptake

Clinical information: Toxic goiter.

Description: Twenty-four hours after the oral administration of [267]microcuries of iodine-123, a 24 hour uptake was calculated.

The 24 hour uptake of I-123 is calculated to be [40] percent which is[elevated].

IMPRESSION:

[ELEVATED] UPTAKE OF I-123 OF [40] PERCENT.

NM Testicular Torsion, Abnormal

History: [3 month-old male with swollen right testicle.] Rule out torsion.

Description: After injection of [5] millicuries of technetium 99mpertechnetate, flow and blood pool images were obtained.

Blood pool images showed photopenia in the area of the [right] testicleconsistent with torsion.

Impression:

Probable [right] testicular torsion

Interventional Radiology

IR CT Abscess Drainage

Pre procedure diagnosis: []

Post-Procedure diagnosis: []

Procedure:1. Non contrast CT of the abdomen/pelvis.2. Placement of 12 french drainage catheter under CT guidance.

Physicians: [], [] (Attending present for entire procedure)

Anesthesia: 1 % lidocaine SQ, versed and fentanyl IV with nursing supervision.

Complications: None.

Contrast: None.

Procedure Description:The risks, benefits, and alternatives of the procedure were fully explained tothe patient. Informed consent was obtained.

The patient was placed supine on the CT table and limited images of the abdomenand pelvis were obtained to localize the fluid collection. An access windowwas localized and 1 % local lidocaine was administered SQ. Using trocartechnique, a 12 french multipurpose drainage catheter was placed within thecollection. The catheter was locked in position and placed to gravitydrainage. Approximately 40 cc of dark brown material was aspirated and sentfor culture and sensitivity and bilirubin.

The patient tolerated the procedure well and left the department withoutimmediate post procedure complications.

Procedure Findings:

[The initial CT scan demonstrated a multiloculated gas containing fluidcollection anterior to the left lobe of the liver in the left epigastriumextending along the anterior abdominal wall into the pelvis. This wassuccessfully drained with an 12 french multipurpose drain,as described.]

IR Aortoiliac Run-off (AIRO)

HISTORY: []

PROCEDURE:1. Fluoroscopy.2. Abdominal aortogram.3. Pelvic arteriogram.4. Bilateral lower extremity runoff.

POST PROCEDURE DIAGNOSIS:1. []

PHYSICIANS: [], []. The attending was present for the entire procedure.

COMPLICATIONS: None.

CONTRAST: Visipaque.

MEDICATIONS: Intravenous conscious sedation, one percent lidocaine.

PROCEDURE DESCRIPTION:Following description of risks, benefits and alternatives to the procedureinformed consent was obtained. Patient was placed on the angiography table andboth groins were sterilely prepped and draped. Under ultrasound guidance, a 21gauge micropuncture needle was advanced into the left common femoral artery andfollowing arterial return, and 018 Cope Mandrell wire was advanced. The needle

was exchanged for a 5 French dilator. The inner dilator and guide wire wereremoved, and a 35 Newton 15J guide wire was advanced into the upper abdominalaorta. Over the guide wire, a 5 French racket catheter was placed in the upperabdominal aorta and abdominal aortogram was performed. The catheter was thenplaced above the iliac bifurcation and pelvic arteriograms were performed.From this position, bilateral lower extremity runoffs were performed using amultistation technique. The catheter was then removed and following manualcompression, hemostasis was achieved. Patient tolerated procedure withoutdifficulty.

FINDINGS:ABDOMINAL AORTA: [Bilateral single patent renal arteries are identified.There are symmetric bilateral nephrograms. The celiac axis and superiormesenteric artery are opacified. There is moderate to narrowing of the distalabdominal aorta at the bifurcation.]

PELVIS: [A high-grade stenosis of the proximal right common iliac artery ispresent. There is mild post stenotic dilatation of the common iliac artery.The distal common iliac artery, right external iliac artery and right commonfemoral artery are all patent, however they are diffusely small in caliber.The left common iliac artery, external iliac artery and common femoral arteryare all patent, and are also diffusely small in caliber.]

RIGHT LOWER EXTREMITY: [The right profunda femoral artery, superficial femoralartery and popliteal artery are widely patent. The right anterior tibialartery is continuous with the dorsalis pedis artery. The tibioperoneal trunk,peroneal artery and posterior tibial artery are all widely patent. The rightposterior tibial artery continuous as the medial malleolar artery.]

LEFT LOWER EXTREMITY: [The left profunda femoral artery, superficial femoralartery, popliteal artery are widely patent. The left anterior tibial artery iscontinuous with the dorsalis pedis artery. The left posterior tibial artery iscontinuous with the medial malleolar artery. The tibioperoneal trunk andperoneal artery are also patent.]

IR Biliary Change

Preprocedure diagnosis: Status post liver transplant with poorly functioninginternal/external biliary drainage catheter.

Post procedure diagnosis:1. Poorly functioning internal/external biliary drainage catheter exchangedfor a new custom-designed 7 French Dawson Mueller catheter.

Procedure performed:1. Catheter cholangiogram.2. Internal/External biliary drainage catheter exchange.

Physicians: [],[](Attending physician present for entire procedure)

Complications: none.

Contrast:Visipaque.

Anesthesia: none.

Procedure description: The risks, benefits and alternatives of the procedurewere discussed with the patient's mother. All questions were answered andinformed written consent was obtained.

The patient was brought to the angiography suite and placed supine. The siteof her biliary drainage catheter was prepped and draped sterling. Contrast wasinjected and the tube was manipulated.

Given the findings, the catheter was exchanged over a 0.035 Newton J wire forany new custom-designed 7 French Dawson Mueller drainage catheter. Repeatcontrast injection was performed.

The catheter was secured at the skin and left to gravity drainage.

Procedure findings:

The initial cholangiogram reveals filling of the jejunum without evidence ofintrahepatic biliary ductal filling. With tube manipulation at the scan, therewas demonstration of intrahepatic biliary ducts. However, adequate drainagewas not seen.

Following replacement of the catheter with a newer version containing largerholes over a longer segment, improved intrahepatic bilary ductal filling anddrainage was noted.

IR Biliary Stricture Dilatation

Preprocedure diagnosis: Patient with living related liver transplant forbiliary atresia now with obstructive liver function tests.

Post procedure diagnosis: Same.

Procedure performed:1. Percutaneous transhepatic cholangiogram.2. Biliary enteric stricture dilatation.3. Internal and external biliary drainage.

Physicians: [], [](Attending physician present for entire procedure)


Contrast: Visipaque.

Anesthesia: Subcutaneous one percent lidocaine; intravenous versed andfentanyl with nursing supervision.

Procedure description: The risks, benefits and alternatives of the procedurewere discussed with the patient. All questions were answered and informedwritten consent was obtained.

The patient was placed supine on the angiography table. Intravenous Rocephinwas administered. The right side of the abdomen was prepped and drapedsterilely. Sonographic evaluation of the right upper quadrant was performed.An appropriate puncture site in the right axillary line was selected and theskin anesthetized. Through a small dermatotomy, several passes with a 21 gaugeAccustick needle were made in an attempt to allow opacification of the biliaryducts. Eventually a central biliary duct was entered and a cholangiogram wasperformed. Several passes using a second 21 gauge Accustick needle to access amore peripheral duct via the same dermatotomy were unsuccessful. A second,more anterior and superior puncture was made and a more peripheral posteriorright biliary duct was entered. A 0.018 inch Microvena guide wire was passedmore centrally and the Accustick set of nested dilators was then exchanged forthe needle. Utilizing a 0.035 inch Terumo glide wire and a four French Kumpecatheter the biliary enteric anastomosis was cannulated. The guide wire wasthen exchanged for a 0.035 Amplatz wire.

Serial dilatation of the anastomotic stricture was performed utilizing, first a4 x 20 mm balloon then a 5 x 40 mm balloon. In a 25 French biliary drainagecatheter with additional side holes was fashioned and placed across this regionwith its locking loop of centrally within the jejunum. The catheter was theninjected with contrast to demonstrate appropriate function. The catheter wassecured at the skin and left to gravity drainage.

Procedure findings:1. Completely obstructed right biliary ducts secondary to a tight stricture of the biliary enteric anastomosis.2. Successful balloon dilatation of biliary anastomotic stricture to 5 mm.3. 8.5 French internal to external biliary drainage catheter placement, as described.

IR Chemoembolization

Preprocedure diagnosis: [Hepatoma]

Post procedure diagnosis: same.

Procedure performed:1. Visceral arteriograms (celiac and superior mesenteric arteries).2. Hepatic chemo embolization.

Physicians: [],[](Attending physician present for entire procedure)


Contrast: Visipaque


Procedure description:The risks, benefits, and alternatives to the procedure were discussed with thepatient. Written informed consent was obtained. Preprocedure medications wereadministered including cephazolin, metronidazole, odansetron, decadron, anddiphenhydramine intravenously.

The patient was brought into the angiography suite and placed supine.Following standard prepping and draping, the [right OR left] common femoralartery was punctured. An 035 wire was advanced into the abdominal aorta andthen a 5 French sheath was placed.

A C2 catheter was used to identify the superior mesenteric artery.Arteriography was performed. The catheter was repositioned within the celiacartery and repeat arteriography was performed. [Additional subselectiveangiograms of the []arteries were performed.] Chemo embolization wasundertaken utilizing, cisplatin, doxorubicin, mitomycin, lipiodol and PVA.This was performed until near stasis in the tumor vessels.

The patient tolerated the procedure well and was transferred to the recoveryroom in stable condition.

Procedure Findings:

Visceral arteriogram:Injection of the superior mesenteric artery demonstrated normal arterialbranches with a patent portal vein.

Injection of the celiac artery demonstrated patent splenic, left gastric,common and proper hepatic, and gastroduodenal arteries. The left hepatic artery[]. The right hepatic artery [].

Hepatic chemo embolization:The tumor vasculature in the [right OR left] lobe of the liver was successfullychemo embolized to near complete stasis.

IR Gastrojejunostomy

Preprocedure diagnosis: 6 month old boy with congenital spinal atrophy andaspiration risk requiring long term gastric feeding.


Procedure performed: Fluoroscopically guided percutaneous gastrojejunostomytube placement.

Physicians: [], [] (Attending physician present for entire procedure)


Contrast: Conray.

Anesthesia: Subcutaneous one percent lidocaine; general anesthesia supervision.

Procedure description: The risks, benefits and alternatives of the procedurewere discussed with the patient's mother with the aid of a translator. Allquestions were answered and informed written consent was obtained.

The patient was brought to the Babies operating room and placed supine. Theupper abdomen was evaluated with ultrasound and then prepped and drapedsterilely. Air was then insufflated into the patient's NG tube. Selection ofan appropriate puncture site over the gastric body/antral junction wasperformed. Care was made to avoid the colon and liver. A 19 gauge double wallneedle was advanced into the stomach pointing towards the antrum. Next twocope anchoring devices were deployed and an 0.035 inch guide wire was passedeasily into the stomach. The stomach was retracted to the anterior abdominalwall. The wire was directed into the jejunum with the aid of an angledcatheter. Over a stiff 0.038" guide wire a 12 French Shetty transgastricjejunostomy tube was placed with its distal tip in the proximal jejunum. Thelocking loop was appropriately positioned within the stomach. Contrast wasadministered to demonstrate appropriate position.

The gastrojejunostomy tube was secured to the skin and a sterile dressing wasapplied. The patient on the procedure without complication.

Procedure findings:1. Status post successful placement of 12 French Shetty percutaneousgastrojejunostomy tube, as described.

Plan:1. Gastrojejunostomy tube to gravity drainage for 24 hours.

IR GI Bleed Embolization

Preprocedure diagnosis: History of bright red blood per rectum and mouth frombleeding pseudoaneurysm s/p embolization 12 hours ago now with question ofrebleed. Followup study.

Post procedure diagnosis: No evidence of active bleeding.

Procedure performed:1. left transfemoral aortic catheterization.2. celiac trunk arteriogram.3. second order splenic arteriogram.4. second order left gastric arteriogram.5. embolization of the left gastric artery.6. superior mesenteric arteriogram.7. second order replaced right hepatic arteriogram.8. arteriotomy closure with Perclose device.

Physicians: [], []. (Attending physician present for entire procedure)



Anesthesia: Subcutaneous one percent lidocaine; Fentanyl and versed conscioussedation with radiology nursing supervision.

Procedure description: The risks, benefits and alternatives were discussedwith the patient. All questions were answered and informed consent was thenobtained.

The patient was brought to the angiography suite and placed supine. The leftgroin was prepped and draped sterilely. Utilizing a 19 gauge single wallneedle, the left common femoral artery was entered. A 0.035 inch guide wirepassed easily into the abdominal aorta. Utilizing a series of nested dilators,this wire was exchanged for a 0.035 inch 15 J wire. Over this a 5 French longsheath was placed in the groin. A 5 French C2 Cobra glide catheter and 035glide wire were used to canulate the celiac trunk and angiogram was performed.Next, the catheter was position in the splenic artery over a wire and anarteriogram is performed. Next, catheter was exchanged over a wire for a fourFrench C2 catheter. A woman's loop was formed at the aortic arch, and thecatheter withdrawn into the celiac trunk which was then used to catheterize theleft gastric artery. An arteriogram was performed. Next, embolization usinggelfoam slurry was performed until near stasis was achieved. Repeat are twograms then performed.

The catheter was then withdrawn and the Waltman loop undone and used tocannulate the superior mesenteric artery. An arteriogram was performed. Overa wire, the replaced right hepatic artery was then cannulated and anarteriogram was performed. Given the findings, a coaxial microcatheter wasadvanced into the right hepatic artery across the pseudoaneurysm, and multiplemicrocoils were deployed proximal, at, and distal to the pseudoaneurysm. The

catheter then exchanged over a wire for the 5 French glide Cobra catheter, andadditional larger coils were then deployed until stasis was achieved within thereplaced right hepatic order. Repeat arteriogram was performed.

The catheters and wires were then removed and the the arteriotomy site closedwith a Perclose device successfully. The patient tolerated the procedure,there were no complications.

The patient was transferred to the ICU without immediate complication in stablecondition.

Procedure findings:

Large approximately 2.5 cm pseudoaneurysm within the replaced right hepaticartery successfully treated and occluded with multiple coils.

No additional bleeding sides were identified within the celiac axis andsuperior mesenteric arteries. The patient is status post Whipple's procedureconsistent with the findings of absence of the gastroduodenal artery.

The left gastric artery was empirically embolized with gelfoam slurry to nearstasis.

IR IVC Filter (Greenfield Groin)

Preprocedure diagnosis: [DVT]

Post procedure diagnosis: same, status post infrarenal IVC filter placement.

Procedure:1. Left transfemoral catheterization of the IVC.2. Inferior Venacavagram.3. Infra-renal Greenfield IVC filter placement.

Physicians: [], []. The attending was present for the entire procedure.

Anesthesia: 1% Lidocaine SQ.



Procedure Description: The risks, beneftis and alternatives of the procedurewere fully discussed with the patient . All questions were answered andinformed consent obtained from the patient.

The patient was placed in the supine position and the [left] groin was preppedand draped in a sterile manner. The [left] common femoral vein was puncturedwith a 19 gauge needle. An 035 Newton J guide wire was passed easily into the

inferior vena cava. Over this, a 5 French pigtail catheter was placed at theiliac venous confluence. An inferior venocavagram was obtained.

The pigtail catheter was exchanged over the 035 guidewire for the filterdelivery device. The inner dilator and wire were removed and the Greenfield IVCfilter was advanced to the end of the delivery device. The IVC filter wasdeployed in the infrarenal IVC filter. The sheath was then removed and pressureheld at the left groin until hemostasis was achieved. The patient tolerated theprocedure without immediate complications and was discharged from thedepartment in stable condition.

Procedure Findings:

1. Patent inferior vena cava without anomalies. T2. Successful infrarenal Greenfield IVC filter placement.

IR AV Shunt Widely Patent

Preprocedure diagnosis: Left arm dialysis AV graft follow-up for IMPRA study


Procedure performed:1. Left upper extremity dialysis fistulagram.2. Central venogram.

Physicians: [], [](Attending physician present for entire procedure).



Anesthesia: Subcutaneous one percent lidocaine.

Procedure description: The risks, benefits and alternatives to the procedurewere discussed with the patient. Informed written consent was obtained.

The patient was placed supine on the angiography table. After standardsurgical prepping and draping, the left extremity dialysis graft was puncturedusing a 21 G needle. A 0.018" guide wire was easily advanced toward the venousanastamosis. The needle was removed and exchanged for the inner 3 Frenchdilator from the micropuncture kit. Contrast evaluation of the venousanastomoses was performed. Additional central venograms were also performed.

The dilator was removed and hemostasis was obtained with manual compression.The patient was transferred to the recovery room and discharged home in stablecondition.

Procedure findings:

1. Patent left AVG with strong pulse and thrill.2. Impra stent widely patent, measureing 7.1 cm. The venous limb measures 7.0 cm. The axillary vein just central to the anastomosis measures 11.1 cm.3. Patent central veins.

Plan: 4 month follow up.

IR AVF Venous Dilatation

Preprocedure diagnosis: Left arm dialysis AV graft with poor flows.


Procedure performed:1. Left upper extremity dialysis fistulagram.2. Venous anastamotic angioplasty.

Physicians: Duwe, Rundback (Attending physician present for entire procedure).



Anesthesia: Subcutaneous one percent lidocaine.

Procedure description: The risks, benefits and alternatives to the procedurewere discussed with the patient. Informed written consent was obtained.

The patient was placed supine on the angiography table. After standardsurgical prepping and draping, the left extremity dialysis graft was puncturedusing a 21 G needle. A 0.018" guide wire was easily advanced toward the venousanastamosis. A series of nested micropuncture dilators were advanced and theinner dilator and wire removed. Contrast evaluation of the arterial andvenous anastomoses was performed. Additional central venograms were alsoperformed.

Given the venous anastamotic stricture, a 6 Fr sheath was placed and the lesionwas crossed with a 0.035" Terumo glide wire and a 5 Fr Kumpe catheter. Thewire was then exchanged for a 0.035" Rosen. Over this wire, the stricture wasdilated to 7 and then 8mm using 7 and 8 x 40 mm balloons. Follow up venographywas performed. The sheath was removed and hemostasis was obtained with manualcompression. The patient was transferred to the recovery room and dischargedhome in stable condition.

Procedure findings:1. Patent left brachial artery to basilic vein PTFE AVG.2. Hemodynamically significant venous anastamotic stricture status post successful dilatation to 8mm.3. Patent central veins and arterial anastamosis.

Plan: 3 month follow up.

IR Nephrostomy

HISTORY: []

PROCEDURE:1. Fluoroscopy.2. Ultrasound guided right percutaneous nephrostomy placement.

POST PROCEDURE DIAGNOSIS:1. [Right hydronephrosis].2. No significant left hydronephrosis.3. Ultrasound and fluoroscopically guided right 8.5 French 25 cm multipurpose pigtail catheter nephrostomy placement.

PHYSICIANS: [], []. The attending was president for entire procedure.

CONTRAST: Visipaque.


MEDICATIONS: Intravenous conscious sedation, one percent lidocaine.

PROCEDURE DESCRIPTION:Following discussion of risks, benefits and alternatives of the procedure,informed consent was obtained. The patient was placed on fluoroscopy table inprone position and both kidneys were studied with ultrasound. The flanks weresterilely prepped and draped. Under ultrasound guidance, an accustick needlewas advanced into the right renal collecting system and following urine return,contrast was gently injected to opacify the renal pelvis and calyces underfluoroscopic visualization. Air was also injected to outline a suitableposterior calix. Under fluoroscopic guidance, an Accustick needle was thenadvanced towards the posterior calix. Following aspiration of urine, an .018guide wire was advanced into the collecting system. The needle was exchangedout for the Accustick dliator/stylet system. The .018 guidewire was left inplace, and an .035 180 cm Rosen wire was advanced into the renal pelvis. TheAccustick system was removed and 6, 7, and 8 French dilators were seriallyadvanced. After tract dilation, an 8.5 Fr 25 cm multipurpose pigtail catheterwas advanced and the distal pigtail was locked within the renal pelvis vialocking suture. The catheter was secured to the skin with a Percu-stayadhesive device and left to gravity bag drainage externally. Next, attempts toaccess the left renal collecting system were made unsuccessfully, due to lackof hydronephrosis. Sterile dressings were applied and the patient leftfluoroscopy suite in satisfactory condition.

FINDINGS:Preprocedure ultrasound demonstrates moderate right hydronephrosis and no

collecting system dilatation on the left. And 8.5 French 25 cm multipurposepigtail drainage catheter was successfully placed on the right side, with thedistal catheter in the renal pelvis. Placement of left percutaneousnephrostomy tube was unsuccessful.

IR Nephrostomy Exchange

HISTORY: History of chronic left distal ureteral obstruction of unclearetiology at. Left nephrostomy tube was displaced accidentally.

PROCEDURE:1. Antegrade nephrostogram.2. Exchange of nephrostomy tube3. Fluoroscopic guidance.

POST PROCEDURE DIAGNOSIS:1. Distal left ureteral obstruction.2. Misplaced left nephrostomy tube which was exchanged for a new 8.5 French tube now in good position.

PHYSICIANS: [], []. The attending was president for entire procedure.

CONTRAST: Conray.


MEDICATIONS: one percent lidocaine.

PROCEDURE DESCRIPTION:The patient was placed on fluoroscopy table in prone position.The left flankwas sterilely prepped and draped. The percutaneous site was anesthetized withone percent lidocaine. Contrast was injected into the left nephrostomy tube andmultiple images were obtained.

Using an 035 guide wire, the nephrostomy tube was exchanged for new 8.5 Frenchmultipurpose pigtail catheter coiled in the renal pelvis. The catheter wassecured to the skin and left to gravity bag drainage externally.

FINDINGS:The antegrade nephrostogram demonstrated the existing catheter to be coiledwithin a renal calix. There was no evidence of leakage however. Followingexchange of the 8.5 French percutaneous nephrostomy tube within the renalpelvis, contrast injection revealed appropriate tube function.

PLAN:1. External drainage.

IR Nephrostomy to Nephroureterostomy

HISTORY: History of distal ureteral obstruction secondary to prostate cancer.Follow-up study secondary to leaking around the nephrostomy tube.

PROCEDURE:1. Antegrade nephrostogram.2. Exchange of nephrostomy tube for a nephroureterostomy tube.

POST PROCEDURE DIAGNOSIS:1. Left UVJ obstruction.2. Retracted left nephrostomy tube which was exchanged for a new 8.5 French nephroureterostomy in good position.

PHYSICIANS: [], [](Attending present for entire procedure).

CONTRAST: Conray.


MEDICATIONS: one percent lidocaine and conscious sedation with radiologynursing supervision.

PROCEDURE DESCRIPTION:The patient was placed on fluoroscopy table in prone position.The left flankwas sterilely prepped and draped. The percutaneous site was anesthetized withone percent lidocaine. Contrast was injected into the left nephrostomy tube andmultiple images were obtained.

Using an 035 guide wire, the nephrostomy tube was exchanged for a long sixFrench sheath. Using a 5 French Kumpy catheter and an angled Terumo glidewire, access was made into the urinary bladder through the distal UVJ severestenosis. The wire was then exchanged for an Ultra stiff Amplatz 035 wire.The catheter and sheath were then removed and exchanged for a 26 cmnephroureterostomy tube with the distal aspect curled within the urinarybladder and the proximal coils within the renal pelvis. Repeat contrastinjection was then performed through the tube and images obtained including thepatient in the reversed Trendelenberg position. The catheter was secured to theskin with pink tape and 0-0 silk sutres and left to gravity bag drainageexternally.

FINDINGS:The antegrade nephrostogram demonstrated the existing catheter to be coiledwithin a renal calix. The percutaneous nephrostomy tube was exchanged for a 26cm nephroureterostomy tube which was passed across the UVJ obstruction from thepatient's known prostate cancer. This tube was placed to external drainage.

PLAN:1. External drainage.

IR Non-tunnel Dialysis Catheter

History: []

Procedure:

1. Ultrasound guided puncture of [right] internal jugular vein.2. Placement of non-tunneled central venous catheter.3. Fluoroscopic localization of catheter tip.

Post-Procedure diagnosis:

1. Successful placement of 15 cm 11.5 French straight double lumen cathetervia [right] internal jugular vein with tip in the RA. Catheter is ready foruse.

Attending radiologist: []

Assistant radiologist: [], []

Anesthesia: Local


Contrast: None.

Description of procedure:

The risks, benefits, and alternatives of the procedure were fully explained tothe patient. The patient understood and witnessed, signed, informed consentwas obtained.

The patient was placed supine on the fluoroscopic table and the neck and upperchest were prepped and draped in the usual sterile fashion. Using ultrasoundguidance and a 21 gauge needle access into the [right] internal jugular veinwas achieved and exchange was made over wire for the 5 French micropuncturekit. Following this the 5 French dilator was exchanged over a wire for an 11French dilator. The catheter was then inserted over wire.

The catheter flushed and aspirated easily. The catheter was secured to theskin with 2-0 surgipro. Sterile dressings were applied, and the catheter washeparinized.

Patient tolerated the procedure well and left the department without immediatepost procedure complications.

Findings:The [right] internal jugular vein is patent and compressible. Successfulplacement of non tunneled central venous catheter with tip in the RA. Catheteris ready for use.

IR Permacath Removal

History:

End Stage Renal Diasese with infected permacath.

Procedure:

Removal of a Permacath

Post procedure diagnosis: same

Attending radiologist: []

Assistant radiologist: []

Anesthesia: Local

Contrast: None.


Patient was placed in supine position. 1 % lidocaine was given for localanesthetic. The Permacath was removed, and hemostasis was obtained. There wereno complications. The tip of the catheter was sent for culture andsensitivity.

IR Portacath

Preprocedure diagnosis: Breast cancer requiring chemotherapy.


Procedure performed: Right internal jugular tunneled Bard 6.6 Fr single lumenport placement.



Contrast: none.


Procedure description: The risks, benefits, and alternatives of the procedurewere fully explained to the patient. The patient understood and informedconsent was obtained.

The patient was given her standing order of Zosyn on the floor at 6am today.The patient was placed supine on the fluoroscopic table and the neck and upperchest were prepped and draped in the usual sterile fashion. Using ultrasoundguidance and a 21 gauge needle access into the right internal jugular vein wasachieved and exchange was made over wire for the micropuncture kit. A 5Frdilator was placed through which a 0.035 in Rosen wire was advanced to theIVC. The site on the right upper chest was anesthetized with lidocaine with

epinephrine and a dermatotomy was made to accommodate the port. A pocket forthe port was bluntly dissected in the subcutaneous tissues. The distal end ofthe catheter was connected to the tunneling device and this was used to bringthe catheter through from the pocket to the internal jugular puncture site.Following this the 5 French dilator was exchanged over a wire for an 7 Frenchdilator/ peel away sheath. The inner dilator and wire were removed and thecatheter was inserted into the peel away sheath. The proximal end of thecatheter was cut to length and afixed to the port. The port was positioned inthe pocket and sutured at two ends to the deep tissues with 4-0 nylon sutures.The incision site for the port was sutured with interrupted subcutaneous andsubcuticular absorbable sutures. The port was accessed through the skin. Theport flushed and aspirated easily. The port was heparinized.

The patient tolerated the procedure well and left the department withoutimmediate post procedure complications.

Procedure findings:1. Successful placement of right internal jugular 6.6 Fr single lumen chest port with tip at junction of SVC/RA junction.2. Patent right internal jugular vein.

IR Ileal Conduit Stent Study

Preprocedure diagnosis: Patient with ileal conduit formation followingcystectomy, one week postoperative evaluation.

Post procedure diagnosis:1. Bilaterally patent ureters without evidence of ureteral injury orobstruction.2. Ileal conduit.

Procedure performed:1. Bilateral antegrade nephrostograms.



Contrast: Conray.


Procedure description: The risks, benefits and alternatives of the procedurewere discussed with the patient. All questions were answered and informedconsent was obtained.

The patient was brought to the angiography suite and placed supine havingreceived preprocedural antibiotics. The patient's ureteral stents extending

from the ostomy site were catheterized and contrast was injected.The ureteralstents were then removed over a 035 Bentson guide wire.

The patient tolerated procedure without complication.

Procedure findings:

The nephrostograms demonstrated no evidence of contrast extravasation orcollecting system dilatation. Contrast is seen flowing easily around theureteral stents into the ileal conduit.

IR TDC Exchange

Pre procedure diagnosis: End Stage Renal Diasese with infected permacath.


Procedure:Permacath exchange over a wire.

Physicians: [], []. (The attending was present for the entire procedure).

Anesthesia: Intravenous versed and fentanyl and radiology nursing supervision,and subcutaneous lidocaine with epinephrine.

Contrast: None.


Procedure description: The risks, benefits and alternatives of the procedurewere discussed with the patient. Informed consent was obtained.

The patient was placed supine on the angiography table and the right sidedcatheter site over the upper chest was prepped and draped sterilely.

The tract along the catheter was anesthetized copiously. Blunt dissection wasperformed to release the cuff. At this point, two stiff 035 Glide wires wereadvanced via the catheter lumen throught the right atrium, IVC and into theright external iliac veins.

The catheter was withdrawn over the wires and a new 19 cm catheter was placedwith its distal tip at the RA/SVC junction.The catheter was secured at the skinsite and a bandage was applied. The catheter was heparinized.

The patient tolerated procedure without immediate complication.

Procedure findings: Status post successful exchange of tunneled dialysiscatheter, as described The catheter is ready for immediate use.

IR T-Tube Post Transplant

Preprocedure diagnosis: One week status post living related liver transplant.

Post procedure diagnosis: Widely patent biliary anastomosis without evidenceof leak or obstruction.

Procedure performed: T-tube cholangiogram.




Anesthesia: none.

Procedure description: The risk benefits and alternatives of the procedurewere discussed with the patient. Informed consent was obtained. The patientwas placed supine on the angiography table. A scout radiograph was obtainedfollowed by opacification of the patient's biliary tree via a percutaneous T-tube. Delayed images were obtained five minutes after tube capping.

Procedure findings: The scout radiograph demonstrates surgical clips, drainsand skin staples over the right upper quadrant with an appropriately positionedT-tube. Following contrast injection, the anastomosis of the right intrahepaticducts to the common bile plaque is patent. Contrast fills unremarkableintrahepatic biliary ducts. Adjacent to the T-tube in the common bile duct is asmall amount of debris. No contrast extravasation or obstruction to flow wasidentified. Delayed iimages demonstrated adequate drainage into the duodenum.

IR Tunnel Dialysis Catheter

Pre procedure diagnosis: ESRD with failed graft requiring hemodialysis.


Procedure:1. Ultrasound guided puncture of [right] internal jugular vein.2. Placement of tunneled hemodialysis catheter.3. Fluoroscopic localization of catheter tip.

Physician: [], [] (Attending was present for the entire procedure).

Anesthesia: Intravenous conscious sedation with radiology nursing supervision.Patient received IV fentanyl and Versed and local lidocaine with 1:100,000epinepherine.


Contrast: None.

Procedure Description:The risks, benefits, and alternatives of the procedurewere fully explained to the patient. The patient understood and witnessed,signed, informed consent was obtained.

The patient was placed supine on the fluoroscopic table and the neck and upperchest were prepped and draped in the usual sterile fashion. Using ultrasoundguidance and a 21 gauge needle access into the [right] internal jugular veinwas achieved and exchange was made over wire for the micropuncture kit. A capwas placed on the 5 French dilator and the site on the right upper chest wasanesthetized with lidocaine and a small dermatotomy was made. The catheter wasconnected to the tunneling device and this was used to bring the catheterthrough the internal jugular puncture site. Following this the 5 Frenchdilator was exchanged over a wire for an 11 French dilator. Then exchange wasmade for the 15 French peel away sheath. The inner dilator and wire wereremoved and the catheter was inserted into the peel away sheath and the peelaway removed. Under fluoroscopic guidance the catheter tip was localized.

The catheter flushed and aspirated easily. The catheter was secured to theskin with 2-0 surgipro. The puncture site was closed with 4-0 polysorb andsteri-strips. Sterile dressings were applied. The catheter was heparinized.

Patient tolerated the procedure well and left the department without immediatepost procedure complications.

Procedure Findings:The [right] internal jugular vein is patent andcompressible. Successful placement of tunneled hemodialysis catheter with tipat the SVC/RA junction. Catheter is ready for use.

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