William H. Stewart

Sources of Error in Oral Cholecystography, with Suggested Methods of Correction

A Satisfactory oral Graham series requires more attention to detail than any other type of x-ray examination. To overlook any one of many essentials in performing the test may ruin the entire examination. While certain standardization is helpful, there must be variation in technic if the full value of the method is utilized. There are certain errors in cholecystography which are due, first, to the patient, second, to the technic, and—last and most important—due to misinterpretation. These will be dealt with in their order and an effort made to outline corrections. First, Errors due to the Patient.—An individual may be unable to co-operate fully on account of illness, or he may misunderstand the instructions so that he does not do as directed. Completely suspending respiration is very difficult for some patients, especially should they be suffering from cardiac lesions or ascites. Much can be gained by taking sufficient time properly to instruct the patient before any films are exposed. It is surprising to...

Where is the Diaphragm

IN the normal chest the position of the diaphragm is well known and its shadow and mobility are characteristic, but in many disease processes of both thorax and abdomen the diaphragm may be so altered, either temporarily or permanently, that its exact location may be difficult to state. As a matter of medical diagnostic interest and especially if operative measures are deemed necessary, the localization of the diaphragm may become of great importance to the surgeon. This paper comments on some of the roentgenographic findings in diseases of the chest and abdomen in which the position of the diaphragm may be uncertain, and discusses the problem of exact localization by the roentgen ray. The diaphragm by virtue of its median position between chest and abdomen is of interest to the roentgenologist, not so much because of its intrinsic disease processes as because of its abnormalities, in cases in which there is pathologic involvement of thoracic or abdominal viscera. Abnormal variations in the position, the ...

Oral Cholecystography of To-day1

INTERPRETATION of cholecystographic findings is entirely dependent on the technic of conducting the examination and there still exists a lamentable lack of standardization or uniformity in this technical procedure and conduct of the examination. We do not mean to imply that there is only one correct way in which to make the examination, but there are certain all-important fundamentals which must be acknowledged in the management, especially of the “faint” and “no shadow” cases. Our experience has been that the majority of films (75 per cent) submitted here for examination from other laboratories where a cholecystographic examination has been performed and a diagnosis made, are of inferior quality, usually almost black, on which a report of “no shadow” and pathologic gall bladder has been made. The impression is prevalent that a Graham test is a Graham test however performed, and that if a few films result in no gall-bladder outline being discernible, then the gall bladder must consequently be diseased. On...

Recent Advancements in Cholecystography1

THE February, 1924, issue of the Journal of the American Medical Association contained an article entitled, “A Preliminary Report on the Roentgenographic Examination of the Gall Bladder; A New Method Utilizing the Intravenous Injection of Tetrabromphenolphthalein Sodium Salt,” by Drs. E. A. Graham, W. H. Cole and G. H. Copher of St. Louis. While investigating tests to ascertain the function of the liver, the discovery was made that when certain drugs were administered intravenously the bile became opaque to the X-ray, causing the outline of the gall bladder to be clearly defined. Different dyes were used experimentally, the outcome being that the tetrabromphenolphthalein sodium salt was found to be the most practical for routine use. This discovery was received with enthusiasm by all the roentgenologists throughout the world. Up to this time the roentgen diagnosis of gall-bladder lesions had not been satisfactory. In a fair percentage of cases, if special attention were paid to technic, gallstones, pathol...