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Sample Type / Medical Specialty: Radiology Sample 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 prior radiographs 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. radiograph is available for comparison.

No prior

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 spine are submitted for review. [No evidence of fracture or malalignment is seen. Vertebral heights and intervertebral disc spaces are maintained. The prevertebral soft-tissues are unremarkable. 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: for review.

AP and lateral views of the thoracic spine are submitted

[No evidence of fracture or malalignment is seen.

Vertebral heights and

intervertebral disc spaces are preserved. There is no evidence of focal osteolytic 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 the lumbosacral spine are submitted for review. [No evidence of fracture or malalignment is seen. Vertebral heights and intervertebral disc spaces are preserved. There is no evidence of focal osteolytic 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: submitted[.]

Supine and upright frontal views of the abdomen are

The bowel gas pattern is normal. There is no evidence of free intraperitoneal air, pathologic calcification, or soft tissue mass. The osseous structures are intact. bases are clear.

The visualized portions of the lung

Impression: [Unremarkable abdominal x-ray.]

X-ray feeding tube Clinical information: [Feeding tube placement] Description: review[].

A single frontal view of the abdomen is submitted for

A feeding tube is seen with its distal tip in the [stomach]. The bowel gas pattern [appears nonobstructive]. free intraperitoneal air.] []

[There is no evidence of

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

Impression: [Feeding tube tip seen in] [stomach].

GI Upper GI Clinical Information: [] Description: A scout supine frontal view of the abdomen demonstrates a normal bowel gas pattern, with no evidence of pathologic calcification, free intraperitoneal air, 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 or hiatus hernia. The duodenum is unremarkable. Impression: [Unremarkable upper GI series.]

GI Upper GI and Small Bowel Series Clinical Information: [] Description: A scout supine frontal view of the abdomen demonstrates a normal bowel gas pattern, with no evidence of pathologic calcification, free intraperitoneal air, or soft tissue mass. The osseous structures are intact. A double-contrast upper GI series was performed. The 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 or hiatus hernia. A small bowel follow-through was performed. The small bowel contrast transit time is normal. The duodenum and jejunum are unremarkable, with no evidence of increase in number or width of folds, intraluminal filling defect, or mucosal abnormality. The ileum is unremarkable. The terminal ileum is well visualized, and is normal in appearance. Impression:

[Unremarkable upper GI and small bowel series.]

GI Small Bowel Series Clinical Information: [] Description: A scout supine frontal view of the abdomen demonstrates an unremarkable bowel gas pattern, with no evidence of free intraperitoneal air, soft tissue mass, or pathologic calcification. A small bowel follow-through was performed. The small bowel contrast transit time is normal. The duodenum and jejunum are unremarkable, with no evidence of increase in number or width of folds, intraluminal filling defect, or mucosal abnormality. The ileum is unremarkable. The terminal ileum is well visualized, and is normal in appearance. Impression: [Unremarkable small bowel follow through.]

GI Barium Enema Clinical Information: [] Description: A scout view of the abdomen, multiple fluoroscopic images after the barium enema, and multiple radiographs in the PA and decubiti views of the abdomen are submitted for review. There is no evidence of mass, stricture, diverticulum, or colonic polyps. The architecture and mucosal surfaces of the colon appear normal. There is no evidence of colonic abnormality. Impression: [No evidence of mass, stricture, diverticulum, or colonic abnormality.]

GI Barium Swallow Clinical Information: [] 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 conjunction with 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 general surgery service. Contrast was injected into the rectum.] The rectum is well visualized and the contours are unremarkable. contrast was excreted with Valsava maneuver. Impression: Unremarkable defacography

GU IVP

The

Clinical Information: [] Description: A scout supine frontal view of the abdomen demonstrates a normal bowel gas pattern, with no evidence of free intraperitoneal air, pathologic calcification, or soft tissue mass. The osseous structures are unremarkable. Following the administration of intravenous contrast, prompt and symmetric bilateral nephrograms are identified. The kidneys are normal in size, contour, axis, and position. Prompt excretion is noted bilaterally into normal renal collecting systems and ureters, with no evidence of intraluminal filling defect or mucosal irregularity. The bladder is smooth-walled, with no evidence of intraluminal filling defect or 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 with the gynecology service. Contrast was injected into the uterus via a catheter.] The uterus was well visualized and is unremarkable. are patent bilaterally.

The fallopian tubes

Impression: Unremarkable hysterosalpingogram

Ultrasound US Lower Extremity Dopplers Clinical history: [Bilateral lower extremity swelling] Procedure: Gray scale ultrasound and color Doppler were utilized to evaluate the lower extremity deep venous systems. Findings: There is normal compression, augmentation and respiratory variation in the common femoral veins, superficial femoral veins and popliteal veins 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 evaluate the right lower extremity deep venous system. Findings: There is normal compression, augmentation and respiratory variation in the right common femoral vein, the right superficial femoral vein and 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 to evaluate the left lower extremity deep venous system. Findings: There is normal compression, augmentation and respiratory variation in the left common femoral vein, the left superficial femoral vein and 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 cystic and 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 no intrahepatic ductal dilatation. [There are no] gallstones. [No pericholecystic fluid, gallbladder wall thickening, or sonographic Murphy's sign is noted.] [There is no] extrahepatic ductal dilatation. The common duct is [] mm in size. The [tail] of the pancreas could not be visualized. The remainder of the pancreas is normal. The right kidney is [] cm in length. The left kidney is [] cm in length. No hydronephrosis 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 Clinical history: [] Procedure: Gray scale ultrasound[,] color Doppler[, and spectral Doppler] 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 no intrahepatic ductal dilatation. [There are no gallstones.] [There is no] extrahepatic ductal dilatation. The common duct is [] mm in size. The main portal vein, left portal vein and right portal vein are patent with normal waveforms. The hepatic veins are patent with normal waveforms. The hepatic artery is patent with normal waveforms. The [tail] of the pancreas could not be visualized. The remainder of the pancreas is normal. The right kidney is [] cm in length. The left kidney is [] cm in length. No hydronephrosis and no renal calculi. The spleen is normal in echotexture and size at [] cm in length. There is no ascites. Impression: []

US Renal Clinical history: [] Procedure: Grayscale ultrasound was utilized to evaluate the kidneys. [Color Doppler] [was] [utilized to assist evaluation of cystic and vascular structures.] 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 Doppler were utilized to evaluate the [] lower quadrant renal transplant. Findings: The [] lower quadrant transplant kidney is [] cm in length. There is [no / mild / mod / severe] hydronephrosis. There [are / are no] peritransplant collections. Resistive indices range from [0.xx] to [0.xx], which are [normal / in the indeterminate range / elevated, suggesting rejection or ATN]. The transplant artery and vein have normal waveforms. [The feeding iliac artery has 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, suggesting rejection or ATN].

US Upper Extremity Bilateral Clinical history: [Bilateral upper extremity swelling] Procedure: Gray scale ultrasound, color Doppler and spectral Doppler were utilized to evaluate the upper extremity deep venous systems. Findings: There is normal color filling, compression and respiratory variation in the jugular veins bilaterally. There is normal color filling and respiratory variation in the innominate veins, subclavian veins and axillary veins bilaterally. The brachial veins have normal color filling and compression bilaterally. 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 Doppler were utilized to evaluate the right upper extremity deep venous system. Findings: There is normal color filling, compression and respiratory variation in the right jugular vein. There is normal color filling and respiratory variation in the right innominate vein, the right subclavian vein

and the right axillary vein. The right brachial vein has normal color filling and 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 Doppler were utilized to evaluate the left upper extremity deep venous system. Findings: There is normal color filling, compression and respiratory variation in the left jugular vein. There is normal color filling and respiratory variation in the left innominate vein, the left subclavian vein and the left axillary vein. The left brachial vein has normal color filling and demonstrates normal compression. Impression: [No evidence of deep venous thrombosis in the left upper extremity.]

US Thyroid Clinical history: [] Procedure: Gray scale ultrasound and color Doppler were utilized to evaluate the thyroid gland. Findings: The right thyroid lobe is [] cm in size without focal lesions. 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 to evaluate 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 in the [] 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, biopsy was subsequently performed. Impression: Ultrasound guided biopsy of [] thyroid nodule. The specimen slides were sent to Cytopathology for microscopic evaluation.

US Scrotum Clinical history: [] Procedure: Gray scale ultrasound, color Doppler and spectral Doppler were utilized to evaluate the scrotum. Findings: The right testicle is [] cm in size without focal lesions. The right epididymis is normal. [] The left testicle is [] cm in size without focal lesions. epididymis is normal. []

The left

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 immediate complications. 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 evaluate ascites and mark the abdomen for paracentesis. Color Doppler and spectral Doppler were utilized to assist evaluation of cystic and vascular structures.

Findings: Massive ascites is seen in the abdomen. The skin of the right lower quandrant was marked for paracentesis where ascites is seen 2.5 cm from 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 aseptic technique, urethral orifice was prepped with iodine. Pediatric catheter was carefully inserted into the bladder, and nonionic contrast was administered. Urinary bladder demonstrates no evidence of abnormal filling defects. The wall is smooth in contour. There is no evidence of ureteral reflux bilaterally. During voiding, images of the urethra were obtained, and demonstrate no abnormalities. 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 demonstrates normal 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 upper abdomen were obtained. The scout view demonstrates no evidence of small bowel obstruction. No evidence of gastroesophageal reflux was identified. Stomach and duodenum demonstrate 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. are seen.]

No intrinsic vertebral anomalies

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 [] is reviewed [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 abdomen performed 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: [No evidence of acute cardiopulmonary disease.]

Peds CT Chest, Abdomen, Pelvis Clinical statement: Procedure #1: comparison.

[[Lymphoma].

Rule out metastasis.]

CT scan of the chest.

Prior study [not] available for

Both lungs are clear. No evidence of mass or nodule is seen. No lymphadenopathy is noted. No evidence of pleural or pericardial effusion is seen. The heart appears unremarkable. Procedure #2: comparison.

CT scan of the abdomen.

Prior study [not] available for

The liver [is unremarkable.] The spleen, pancreas, and adrenal glands are unremarkable in appearance. Both kidneys appear unremarkable. There is no abdominal lymphadenopathy or ascites. The bowel demonstrates no evidence of obstruction or bowel wall thickening. [] Procedure #3: comparison.

CT scan of the pelvis.

Prior study [not] available for

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 Clinical information: [] Description: PA and lateral views of the chest are reviewed [without prior studies available for comparison]. Both lungs are clear. No focal consolidation, pleural effusion, pulmonary edema or pneumothorax is noted. The cardiomediastinal borders are unremarkable. The bony structures are unremarkable. Impression: [No evidence of acute cardiopulmonary disease.]

X-ray Chest AP Clinical information: [] Description: A single frontal view of the chest is reviewed [without prior studies available for comparison]. Both lungs are clear. No focal consolidation, pleural effusion, pulmonary edema or pneumothorax is noted. The cardiomediastinal borders are unremarkable. The bony structures are unremarkable. Impression: [No evidence of acute cardiopulmonary disease.]

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

Clinical information: [] Technique: 5 mm spiral CT images through the chest were obtained without 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. pleural or pericardial effusion. The airways are patent bilaterally. abdomen demonstrate no gross abnormality.

There is no evidence of

Visualized portions of the upper

Visualized bony structures demonstrate no evidence of focal blastic or lytic lesion. 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] nodule Physicians: [Resident], [Attending] Anesthesia: 1 % lidocaine SQ. Complications: None. Procedure Description: The risks, benefits, and alternatives of the procedure were fully explained to the patient. all questions were answered. Informed consent was obtained. The patient was placed supine on the CT table and preliminary 5 mm images of the lungs were obtained to localize the lesion. A [1.5] cm nodule in the [right lower lobe] was reidentified superior to the right hemidiaphragm. Using sterile technique, the skin was prepped and draped and an access window was localized and 1 % local lidocaine was administered SQ. CT fluoroscopy was used to guide a 19 gauge Temno introducer to the margin of the lesion. The position was confirmed using CT fluoroscopy and [two] coaxial core biopsies were obtained using a 20 gauge Temno needle. The specimens were sent to surgical pathology. The patient tolerated the procedure well. The follow-up CT scan demonstrated no evidence of pneumothorax and the patient left the department after one hour in the recovery room without immediate post procedure complications and was sent home with standard discharge instructions.

CT Chest Angio (Pulmonary Embolism) Clinical information: []

Technique: 2 mm spiral CT images through the chest and additional images 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. [pleural or] pericardial effusion. The airways are patent bilaterally. abdomen demonstrate no gross abnormality.

There is no evidence of

Visualized portions of the upper

Visualized bony structures demonstrate no evidence of focal blastic or lytic lesion. 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 99mHDP, whole body planar images were obtained in the anterior and posterior projections. [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 99mHDP, whole body planar images were obtained in the anterior and posterior projections. 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 to suggest 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 99mHDP, whole body planar images were obtained in the anterior and posterior projections. Comparison is made with prior bone scan of [10/24/2002]. There is increased radiotracer activity in the [thoracic spine], which is likely degenerative in etiology. Otherwise, there is no abnormal accumulation of radiotracer. There is only physiologic distribution of the radiotracer. IMPRESSION: NO EVIDENCE OF METASTATIC DISEASE. OF [10/24/2002].

NO SIGNIFICANT CHANGE SINCE BONE SCAN

NM Brain Clinical information:

[].

Description: After the intravenous injection of [20.5] millicuries of technetium 99m-HMPAO, images of the brain were obtained. There is [moderate heterogeneity]. disease and decreased cortical perfusion.]

[There is evidence for white matter

Impression: [Heterogeneous]. [Evidence for white matter disease and] decreased cortical perfusion. 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 and personality change] is referred for a brain SPECT to evaluate cortical perfusion. Description: After the intravenous injection of [21.2] millicuries of technetium 99m-HMPAO, images of the brain were obtained. No other studies are available for correlation. There is severe decreased bilateral cortical perfusion with extensive white matter disease. The sensorimotor cortex is not preserved.

Impression: Severe, global, cortical hypoperfusion including the white matter. This pattern is atypical for Alzheimer's dementia, and a component of the decrease may be age related. A possible etiology for the bilateral decreased perfusion is bilateral vascular disease. A repeat brain SPECT with Diamox can be obtained to assess vascular reserve.

NM Brain Lyme Clinical information: [58] year old [female] with Lyme disease is referred for a brain SPECT to evaluate cortical perfusion. Description: After the intravenous injection of [21] millicuries of technetium 99m-HMPAO, images of the brain were obtained. No other studies are available for correlation. There is [moderate], global, cortical hypoperfusion with heterogeneity. The hypoperfusion involves the white matter. Impression: [Moderate], global, cortical hypoperfusion with heterogeneity. This perfusion pattern 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 for a brain SPECT to evaluate cortical perfusion. Description: After the intravenous injection of [21.6] millicuries of technetium 99m-HMPAO, images of the brain were obtained. Comparison is made with prior brain SPECT dated [12/28/99]. There is [moderate], global, cortical hypoperfusion with heterogeneity, which has [improved] since prior examination. IMPRESSION: [MODERATE], GLOBAL, CORTICAL HYPOPERFUSION WITH HETEROGENEITY, WHICH HAS [IMPROVED] SINCE PRIOR EXAMINATION OF [12/28/99]. THIS PERFUSION PATTERN IS CONSISTENT WITH ENCEPHALITIS OR VASCULITIS, SUCH AS FROM INFECTIONS [E.G. LYME DISEASE], 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 a brain SPECT to evaluate cortical perfusion. Description: After the intravenous injection of [21] millicuries of technetium 99m-HMPAO, images of the brain were obtained. No other studies are available for correlation. There is [moderate], global, cortical hypoperfusion with heterogeneity. The hypoperfusion is more pronounced frontally. The hypoperfusion involves the white matter. Impression: [Moderate], global, cortical hypoperfusion with heterogeneity, which is more pronounced in the frontal regions. This perfusion pattern is consistent with encephalitis or vasculitis, such as from infections [e.g. Lyme disease], autoimmune causes or secondary to some medications. The frontal predominance of the hypoperfusion raises the possibility of an underlying component of depression.

NM Lymphoscintigraphy Clinical information: [53] year old woman with [left]-sided breast carcinoma. Lymphoscintigraphy is now requested as preoperative evaluation proceeding sentinel lymphadenectomy. Description: A total dose of 0.5 millicuries of technetium 99m-sulfa colloid was injected just lateral to the biopsy site. Imaging was then performed in the anterior and 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 the neurologist. Images were obtained at 6, 24, 48 hours in multiple projections. [The study demonstrates that the ventricles are visualized at 6 hours. However at 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 of gallium-67, whole body planar images were performed in the anterior and posterior projections. SPECT imaging was also performed of the [chest]. On the whole body images, there is [radiotracer accumulation in the anterior mediastinum]. [The location of this radiotracer uptake is confirmed on the SPECT imaging of the chest]. [The SPECT imaging of the chest is somewhat limited 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 radiolabeled sulfur colloid in an egg meal. Imaging over the abdomen was performed in the anterior and posterior projections. The halftime clearance of the radiotracer was calculated using the geometric mean. There is [no] evidence of gastroesophageal reflux. is calculated at [] minutes, which is [prolonged].

The clearance halftime

Impression: 1. 2.

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

NM Hepatobiliary CLINICAL INFORMATION: [] DESCRIPTION: After the intravenous administration of [5.4] millicuries technetium-99m Choletec, imaging of the abdomen was performed. [Of note, after adequate

visualization of bowel structures, 2.5 mg morphine sulfate was administered intravenously.] There is prompt radiotracer uptake in the liver with subsequent excretion into the intrahepatic and extrahepatic biliary system. Following administration of morphine 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 iodine123, 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 111 tactic white blood cells, whole body planar images were performed in the anterior and posterior projections. SPECT imaging was also performed of the chest. On the whole body images, there is radiotracer accumulation in the right subclavian region. The location of this radiotracer uptake is confirmed on the SPECT imaging of the chest. Impression: Radiotracer accumulation in the right subclavian region, which may represent infectious process at the site of the patient's subclavian central venous catheter.

Liver Spleen Clinical History: [72 year old male with history if idiopathic thrombocytopenia. Rule out remnant spleen.]

Description: Approximately [5.4] mCi of Tc-99m labeled sulfer colloid was administered intravenously. Images were then obtained in multiple projections. 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 in the anterior and posterior projections. After the intravenous injection of [0.5] millicuries of technetium 99m-MAA, perfusion images were obtained in multiple obliquities. Regional quantitative ventilation and perfusion was then performed. Comparison is made with chest film of the same date. There is relatively homogeneous distribution of the radiotracer on the single breath image which is maintained during equilibrium images. There is mild retention of the radiotracer at the right lung base on the washout images. There is marked heterogeneous perfusion throughout both lungs on the perfusion images. There is no significant left to right shunt. Regional perfusion to thirds of the lungs as calculated by geometric mean from anterior and posterior images are: UPPER MIDDLE [] LOWER

RIGHT [] [] []

LEFT []

TOTAL

[]

[]

[]

Regional ventilation to thirds of the lungs as calculated by geometric mean from anterior and posterior images are: UPPER MIDDLE [] LOWER

RIGHT [] [] []

LEFT []

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 99mDTPA, 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 [the same date]. On the ventilation images, [there is central deposition of the radiotracer which is consistent with airway disease]. There are matched perfusion/ventilation defects at [the right apex and right posterior lung base]. [There are corresponding opacities on the chest film of the same date.] [The perfusion to the left lung is relatively homogeneous.] Impression: Intermediate probability for pulmonary embolism.

NM VQ Low Probability Clinical information: chest pain.

[17] year old [female] with shortness of breath and

Description: After the inhalation of [22] millicuries of technetium 99mDTPA, 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 the same date. On the ventilation images, there is central deposition of the radiotracer which is consistent with airway disease. There is a small matched perfusion/ventilation defect at the right posterior lung base. Otherwise, there relative homogeneous distribution of the radiotracer on the perfusion images. Impression: Low probability for pulmonary embolism.

NM VQ Low Probability, Airway Clinical information: chest pain.

[17] year old [female] with shortness of breath and

Description: After the inhalation of [22] millicuries of technetium 99mDTPA, 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 the same date. On the ventilation images, there is central deposition of the radiotracer which is consistent with airway disease. There is a small matched perfusion/ventilation defect at the right posterior lung base. Otherwise, there relative homogeneous distribution of the radiotracer on the perfusion images. Impression: Low probability for pulmonary embolism.

NM VQ Matched Defects Low Probability Clinical information: chest pain].

[58] year old [female] with [shortness of breath and

Description: After the inhalation of [25[ millicuries of technetium 99mDTPA, ventilation images were obtained in multiple obliquities. Corresponding perfusion images were obtained after the intravenous administration of [5.1] millicuries of technetium 99m-MAA. Correlation is made with chest film of the same date. There is a small matched perfusion/ventilation defect in the [periphery of the right mid lung], without corresponding chest x-ray abnormality. Otherwise, there relative homogeneous distribution of the radiotracer on the perfusion and ventilation images. Impression: Low probability for pulmonary embolism.

NM VQ Negative Clinical information: out pulmonary embolism.

[44] year old [male] with shortness of breath , rule

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

On the ventilation images, there is uniform distribution of the radiotracer. On the perfusion images, there is relative homogeneous distribution of the radiotracer. Impression: No evidence for pulmonary embolism.

NM Meckels Clinical information: diverticulum.

[3-year-old girl with anemia].

Rule out Meckel's

Description: After injection of [4.5] millicuries of technetium 99mpertechnetate, sequential imaging of the abdomen was performed for 30 minutes. [There was no abnormal radiotracer uptake]. There was [] only physiologic uptake was observed. IMPRESSION: [No evidence of Meckel's diverticulum].

NM Neuroblastoma Negative I-131 Clinical information: months].

Neuroblastoma[, stage 3, off therapy for nine to ten

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

No abnormal foci of

Impression: No evidence for recurrent/residual neuroblastoma.

NM Neuroblastoma I-123 Clinical information: months].

Neuroblastoma[, stage 3, off therapy for nine to ten

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

No abnormal foci of

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, images were whole body views, axial, coronal, and sagittal images were obtained. There is normal visualization of the liver, spleen, and kidneys. no abnormal uptake visualized.

There is

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 I123, imaging of the neck was performed. Subsequently, [22] mCi Tc 99m sestamibi was injected intravenously and imaging of the neck was performed. Iodine counts were then subtracted from the sestamibi counts. [Of note, the patient moved during imaging, rendering the subtraction images uninterpretable]. [The patient then underwent two hour delayed sestamibi imaging.] There is physiologic distribution of radiotracer. There is no focus of radiotracer uptake to suggest parathyroid adenoma. IMPRESSION: NO SCINTIGRAPHIC EVIDENCE FOR PARATHYROID ADENOMA.

NM PET Lymphoma Clinical information: [Non-Hodgkin's] lymphoma status post [chemotherapy] is referred 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 the neck, chest, abdomen and pelvis was performed. Comparison is made with [prior PET 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 new hypermetabolic activity.] There is only physiologic distribution of the radiotracer 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.] NO EVIDENCE OF MALIGNANCY AT THIS TIME.

NM Prostascint Clinical information: Prostate cancer, status post RRP 5 years ago with rising PSA: Rule out metastatic disease. Description: After the intravenous injection of [6.0] millicuries of indium-111 labeled Prostascint, triplanar SPECT imaging was performed of the chest, abdomen, and pelvis at both 30 minutes and 96 hours. Additionally, whole body planar images was 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. Subsequent dynamic and static images of the kidneys were obtained in the posterior projection. Ten minutes after radiotracer injection, [20] mg Lasix was administered intravenously. Following adequate aortic bolus of radiotracer there is good perfusion to both kidneys followed by normal cortical localization. There is subsequent prompt excretion of radiotracer bilaterally and normal clearance from the collecting systems. [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 STENOSIS 2. 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 labeled vitamin B12, and an oral dose of 0.5 microcuries of cobalt-58 labeled vitamin B12 with intrinsic factor. Then after one hour, an intermuscular injection of 1000 micrograms of unlabeled vitamin B12 was given to the patient. The patient was given a container, and instructed to collect [his] urine for 24 hours, to be returned to the department of nuclear medicine the next day. The 24 hour urine volume was measured to be [1100] ml. The fraction of excreted radiolabeled cobalt 57 vitamin B12 was measured as [5.0] percent, which is less than normal limits of 8-34%. The fraction of excreted radiolabeled cobalt 58 vitamin B12 was measured as [3.7] percent, which is also lower than normal range of 9-33%. Impression: [FINDINGS CONSISTENT WITH A MALABSORPTION SYNDROME, NOT CAUSED BY LACK OF INTRINSIC FACTOR].

NM Sestamibi Whole Body Clinical information:

Thyroid cancer

Description: After the intravenous administration of 22 millicuries of technetium 99m SESTAMIBI, whole body images were obtained in the anterior and posterior projections. Delayed whole body images as well as imaging over the neck wer also performed. On the initial whole body images, there are several foci of increased radiotracer accumulation within the liver. These foci appear to be in both lobes 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 the initial 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 the patient [and his wife], which included but were not limited to, bone marrow suppression 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, and approximately 500 ml of saline was infused. A total dose of [73.3] millicuries Samarium-153 was administered intravenously without incident. The patient remained 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 PALLIATIVE THERAPY 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 99mHDP, 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 is increased 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 out osteomyelitis. Description: After the intravenous administration of [22] millicuries of technetium 99mHDP, 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 no evidence 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, the patient's identity was confirmed, and appropriate informed consent was obtained. A dose of [20] mC I 131 was subsequently administered orally, without incident. The patient was informed of appropriate precautions and restrictions, and was told 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, the patient's identity was confirmed, and appropriate informed consent was obtained. A dose of [20] mC I 131 was subsequently administered orally, without incident. The patient was informed of appropriate precautions and restrictions, and was told 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. accumulation of radiotracer is noted].

[No abnormal

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: torsion.

[3 month-old male with swollen right testicle.]

Rule out

Description: After injection of [5] millicuries of technetium 99m pertechnetate, flow and blood pool images were obtained. Blood pool images showed photopenia in the area of the [right] testicle consistent 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 to the patient. Informed consent was obtained. The patient was placed supine on the CT table and limited images of the abdomen and pelvis were obtained to localize the fluid collection. An access window was localized and 1 % local lidocaine was administered SQ. Using trocar technique, a 12 french multipurpose drainage catheter was placed within the collection. The catheter was locked in position and placed to gravity drainage. Approximately 40 cc of dark brown material was aspirated and sent for culture and sensitivity and bilirubin. The patient tolerated the procedure well and left the department without immediate post procedure complications. Procedure Findings: [The initial CT scan demonstrated a multiloculated gas containing fluid collection anterior to the left lobe of the liver in the left epigastrium extending along the anterior abdominal wall into the pelvis. This was successfully 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:

[], [].

COMPLICATIONS: CONTRAST:

The attending was present for the entire procedure.

None.

Visipaque.

MEDICATIONS:

Intravenous conscious sedation, one percent lidocaine.

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

was exchanged for a 5 French dilator. The inner dilator and guide wire were removed, and a 35 Newton 15J guide wire was advanced into the upper abdominal aorta. Over the guide wire, a 5 French racket catheter was placed in the upper abdominal aorta and abdominal aortogram was performed. The catheter was then placed above the iliac bifurcation and pelvic arteriograms were performed. From this position, bilateral lower extremity runoffs were performed using a multistation technique. The catheter was then removed and following manual compression, hemostasis was achieved. Patient tolerated procedure without difficulty. FINDINGS: ABDOMINAL AORTA: [Bilateral single patent renal arteries are identified. There are symmetric bilateral nephrograms. The celiac axis and superior mesenteric artery are opacified. There is moderate to narrowing of the distal abdominal aorta at the bifurcation.] PELVIS: [A high-grade stenosis of the proximal right common iliac artery is present. There is mild post stenotic dilatation of the common iliac artery. The distal common iliac artery, right external iliac artery and right common femoral artery are all patent, however they are diffusely small in caliber. The left common iliac artery, external iliac artery and common femoral artery are all patent, and are also diffusely small in caliber.] RIGHT LOWER EXTREMITY: [The right profunda femoral artery, superficial femoral artery and popliteal artery are widely patent. The right anterior tibial artery is continuous with the dorsalis pedis artery. The tibioperoneal trunk, peroneal artery and posterior tibial artery are all widely patent. The right posterior tibial artery continuous as the medial malleolar artery.] LEFT LOWER EXTREMITY: [The left profunda femoral artery, superficial femoral artery, popliteal artery are widely patent. The left anterior tibial artery is continuous with the dorsalis pedis artery. The left posterior tibial artery is continuous with the medial malleolar artery. The tibioperoneal trunk and peroneal artery are also patent.]

IR Biliary Change Preprocedure diagnosis: Status post liver transplant with poorly functioning internal/external biliary drainage catheter. Post procedure diagnosis: 1. Poorly functioning internal/external biliary drainage catheter exchanged for 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 procedure were discussed with the patient's mother. All questions were answered and informed written consent was obtained. The patient was brought to the angiography suite and placed supine. The site of her biliary drainage catheter was prepped and draped sterling. Contrast was injected and the tube was manipulated. Given the findings, the catheter was exchanged over a 0.035 Newton J wire for any new custom-designed 7 French Dawson Mueller drainage catheter. Repeat contrast 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 of intrahepatic biliary ductal filling. With tube manipulation at the scan, there was demonstration of intrahepatic biliary ducts. However, adequate drainage was not seen. Following replacement of the catheter with a newer version containing larger holes over a longer segment, improved intrahepatic bilary ductal filling and drainage was noted.

IR Biliary Stricture Dilatation Preprocedure diagnosis: Patient with living related liver transplant for biliary 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)

Complications: Contrast:

none.

Visipaque.

Anesthesia: Subcutaneous one percent lidocaine; intravenous versed and fentanyl with nursing supervision. Procedure description: The risks, benefits and alternatives of the procedure were discussed with the patient. All questions were answered and informed written consent was obtained. The patient was placed supine on the angiography table. Intravenous Rocephin was administered. The right side of the abdomen was prepped and draped sterilely. Sonographic evaluation of the right upper quadrant was performed. An appropriate puncture site in the right axillary line was selected and the skin anesthetized. Through a small dermatotomy, several passes with a 21 gauge Accustick needle were made in an attempt to allow opacification of the biliary ducts. Eventually a central biliary duct was entered and a cholangiogram was performed. Several passes using a second 21 gauge Accustick needle to access a more peripheral duct via the same dermatotomy were unsuccessful. A second, more anterior and superior puncture was made and a more peripheral posterior right biliary duct was entered. A 0.018 inch Microvena guide wire was passed more centrally and the Accustick set of nested dilators was then exchanged for the needle. Utilizing a 0.035 inch Terumo glide wire and a four French Kumpe catheter the biliary enteric anastomosis was cannulated. The guide wire was then exchanged for a 0.035 Amplatz wire. Serial dilatation of the anastomotic stricture was performed utilizing, first a 4 x 20 mm balloon then a 5 x 40 mm balloon. In a 25 French biliary drainage catheter with additional side holes was fashioned and placed across this region with its locking loop of centrally within the jejunum. The catheter was then injected with contrast to demonstrate appropriate function. The catheter was secured 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: Post procedure diagnosis:

[Hepatoma] same.

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

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

Complications: Contrast:

none.

Visipaque

Anesthesia: Subcutaneous one percent lidocaine; intravenous versed and fentanyl with nursing supervision. Procedure description: The risks, benefits, and alternatives to the procedure were discussed with the patient. Written informed consent was obtained. Preprocedure medications were administered including cephazolin, metronidazole, odansetron, decadron, and diphenhydramine intravenously. The patient was brought into the angiography suite and placed supine. Following standard prepping and draping, the [right OR left] common femoral artery was punctured. An 035 wire was advanced into the abdominal aorta and then 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 celiac artery and repeat arteriography was performed. [Additional subselective angiograms of the []arteries were performed.] Chemo embolization was undertaken 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 recovery room in stable condition. Procedure Findings: Visceral arteriogram: Injection of the superior mesenteric artery demonstrated normal arterial branches 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 successfully chemo embolized to near complete stasis.

IR Gastrojejunostomy

Preprocedure diagnosis: 6 month old boy with congenital spinal atrophy and aspiration risk requiring long term gastric feeding. Post procedure diagnosis: Procedure performed: gastrojejunostomy tube placement.

Same.

Fluoroscopically guided percutaneous

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

none.

Conray.

Anesthesia: Subcutaneous one percent lidocaine; general anesthesia supervision. Procedure description: The risks, benefits and alternatives of the procedure were discussed with the patient's mother with the aid of a translator. questions were answered and informed written consent was obtained.

All

The patient was brought to the Babies operating room and placed supine. The upper abdomen was evaluated with ultrasound and then prepped and draped sterilely. Air was then insufflated into the patient's NG tube. Selection of an appropriate puncture site over the gastric body/antral junction was performed. Care was made to avoid the colon and liver. A 19 gauge double wall needle was advanced into the stomach pointing towards the antrum. Next two cope anchoring devices were deployed and an 0.035 inch guide wire was passed easily into the stomach. The stomach was retracted to the anterior abdominal wall. The wire was directed into the jejunum with the aid of an angled catheter. Over a stiff 0.038" guide wire a 12 French Shetty transgastric jejunostomy tube was placed with its distal tip in the proximal jejunum. The locking loop was appropriately positioned within the stomach. Contrast was administered to demonstrate appropriate position. The gastrojejunostomy tube was secured to the skin and a sterile dressing was applied. The patient on the procedure without complication. Procedure findings: 1. Status post successful placement of 12 French Shetty percutaneous gastrojejunostomy 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 from bleeding pseudoaneurysm s/p embolization 12 hours ago now with question of rebleed. 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) Complications:

none.

Contrast: Visipaque. Anesthesia: Subcutaneous one percent lidocaine; Fentanyl and versed conscious sedation with radiology nursing supervision. Procedure description: The risks, benefits and alternatives were discussed with the patient. All questions were answered and informed consent was then obtained. The patient was brought to the angiography suite and placed supine. The left groin was prepped and draped sterilely. Utilizing a 19 gauge single wall needle, the left common femoral artery was entered. A 0.035 inch guide wire passed 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 long sheath was placed in the groin. A 5 French C2 Cobra glide catheter and 035 glide 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 an arteriogram is performed. Next, catheter was exchanged over a wire for a four French C2 catheter. A woman's loop was formed at the aortic arch, and the catheter withdrawn into the celiac trunk which was then used to catheterize the left gastric artery. An arteriogram was performed. Next, embolization using gelfoam slurry was performed until near stasis was achieved. Repeat are two grams then performed. The catheter was then withdrawn and the Waltman loop undone and used to cannulate the superior mesenteric artery. An arteriogram was performed. Over a wire, the replaced right hepatic artery was then cannulated and an arteriogram was performed. Given the findings, a coaxial microcatheter was advanced into the right hepatic artery across the pseudoaneurysm, and multiple microcoils were deployed proximal, at, and distal to the pseudoaneurysm. The

catheter then exchanged over a wire for the 5 French glide Cobra catheter, and additional larger coils were then deployed until stasis was achieved within the replaced right hepatic order. Repeat arteriogram was performed. The catheters and wires were then removed and the the arteriotomy site closed with a Perclose device successfully. The patient tolerated the procedure, there were no complications. The patient was transferred to the ICU without immediate complication in stable condition. Procedure findings: Large approximately 2.5 cm pseudoaneurysm within the replaced right hepatic artery successfully treated and occluded with multiple coils. No additional bleeding sides were identified within the celiac axis and superior mesenteric arteries. The patient is status post Whipple's procedure consistent with the findings of absence of the gastroduodenal artery. The left gastric artery was empirically embolized with gelfoam slurry to near stasis.

IR IVC Filter (Greenfield Groin) Preprocedure diagnosis: [DVT] Post procedure diagnosis: placement.

same, status post infrarenal IVC filter

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. Contrast:

Visipaque.

Complications: none. Procedure Description: The risks, beneftis and alternatives of the procedure were fully discussed with the patient . All questions were answered and informed consent obtained from the patient. The patient was placed in the supine position and the [left] groin was prepped and draped in a sterile manner. The [left] common femoral vein was punctured with 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 the iliac venous confluence. An inferior venocavagram was obtained. The pigtail catheter was exchanged over the 035 guidewire for the filter delivery device. The inner dilator and wire were removed and the Greenfield IVC filter was advanced to the end of the delivery device. The IVC filter was deployed in the infrarenal IVC filter. The sheath was then removed and pressure held at the left groin until hemostasis was achieved. The patient tolerated the procedure without immediate complications and was discharged from the department in stable condition. Procedure Findings: 1. Patent inferior vena cava without anomalies. T 2. Successful infrarenal Greenfield IVC filter placement.

IR AV Shunt Widely Patent Preprocedure diagnosis: study

Left arm dialysis AV graft follow-up for IMPRA

Post procedure diagnosis: same. Procedure performed: 1. Left upper extremity dialysis fistulagram. 2. Central venogram. Physicians: [], [](Attending physician present for entire procedure). Complications: Contrast: Anesthesia:

none.

Visipaque. Subcutaneous one percent lidocaine.

Procedure description: The risks, benefits and alternatives to the procedure were discussed with the patient. Informed written consent was obtained. The patient was placed supine on the angiography table. After standard surgical prepping and draping, the left extremity dialysis graft was punctured using a 21 G needle. A 0.018" guide wire was easily advanced toward the venous anastamosis. The needle was removed and exchanged for the inner 3 French dilator from the micropuncture kit. Contrast evaluation of the venous anastomoses 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 stable condition. Procedure findings:

1. 2. 7.0 cm. 3.

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

Plan: 4 month follow up.

IR AVF Venous Dilatation Preprocedure diagnosis:

Left arm dialysis AV graft with poor flows.

Post procedure diagnosis: same. Procedure performed: 1. Left upper extremity dialysis fistulagram. 2. Venous anastamotic angioplasty. Physicians: Duwe, Rundback (Attending physician present for entire procedure). Complications: Contrast: Anesthesia:

none.

Visipaque. Subcutaneous one percent lidocaine.

Procedure description: The risks, benefits and alternatives to the procedure were discussed with the patient. Informed written consent was obtained. The patient was placed supine on the angiography table. After standard surgical prepping and draping, the left extremity dialysis graft was punctured using a 21 G needle. A 0.018" guide wire was easily advanced toward the venous anastamosis. A series of nested micropuncture dilators were advanced and the inner dilator and wire removed. Contrast evaluation of the arterial and venous anastomoses was performed. Additional central venograms were also performed. Given the venous anastamotic stricture, a 6 Fr sheath was placed and the lesion was crossed with a 0.035" Terumo glide wire and a 5 Fr Kumpe catheter. The wire was then exchanged for a 0.035" Rosen. Over this wire, the stricture was dilated to 7 and then 8mm using 7 and 8 x 40 mm balloons. Follow up venography was performed. The sheath was removed and hemostasis was obtained with manual compression. The patient was transferred to the recovery room and discharged home 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: CONTRAST:

[], [].

The attending was president for entire procedure.

Visipaque.

COMPLICATIONS: MEDICATIONS:

None. 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 in prone position and both kidneys were studied with ultrasound. The flanks were sterilely prepped and draped. Under ultrasound guidance, an accustick needle was advanced into the right renal collecting system and following urine return, contrast was gently injected to opacify the renal pelvis and calyces under fluoroscopic visualization. Air was also injected to outline a suitable posterior calix. Under fluoroscopic guidance, an Accustick needle was then advanced towards the posterior calix. Following aspiration of urine, an .018 guide wire was advanced into the collecting system. The needle was exchanged out for the Accustick dliator/stylet system. The .018 guidewire was left in place, and an .035 180 cm Rosen wire was advanced into the renal pelvis. The Accustick system was removed and 6, 7, and 8 French dilators were serially advanced. After tract dilation, an 8.5 Fr 25 cm multipurpose pigtail catheter was advanced and the distal pigtail was locked within the renal pelvis via locking suture. The catheter was secured to the skin with a Percu-stay adhesive device and left to gravity bag drainage externally. Next, attempts to access the left renal collecting system were made unsuccessfully, due to lack of hydronephrosis. Sterile dressings were applied and the patient left fluoroscopy 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 multipurpose pigtail drainage catheter was successfully placed on the right side, with the distal catheter in the renal pelvis. Placement of left percutaneous nephrostomy tube was unsuccessful.

IR Nephrostomy Exchange HISTORY: History of chronic left distal ureteral obstruction of unclear etiology at. Left nephrostomy tube was displaced accidentally. PROCEDURE: 1. Antegrade nephrostogram. 2. Exchange of nephrostomy tube 3. 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: CONTRAST:

[], [].

The attending was president for entire procedure.

Conray.

COMPLICATIONS:

None.

MEDICATIONS: one percent lidocaine. PROCEDURE DESCRIPTION: The patient was placed on fluoroscopy table in prone position.The left flank was sterilely prepped and draped. The percutaneous site was anesthetized with one percent lidocaine. Contrast was injected into the left nephrostomy tube and multiple images were obtained. Using an 035 guide wire, the nephrostomy tube was exchanged for new 8.5 French multipurpose pigtail catheter coiled in the renal pelvis. The catheter was secured to the skin and left to gravity bag drainage externally. FINDINGS: The antegrade nephrostogram demonstrated the existing catheter to be coiled within a renal calix. There was no evidence of leakage however. Following exchange of the 8.5 French percutaneous nephrostomy tube within the renal pelvis, 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.

COMPLICATIONS:

None.

MEDICATIONS: one percent lidocaine and conscious sedation with radiology nursing supervision. PROCEDURE DESCRIPTION: The patient was placed on fluoroscopy table in prone position.The left flank was sterilely prepped and draped. The percutaneous site was anesthetized with one percent lidocaine. Contrast was injected into the left nephrostomy tube and multiple images were obtained. Using an 035 guide wire, the nephrostomy tube was exchanged for a long six French sheath. Using a 5 French Kumpy catheter and an angled Terumo glide wire, access was made into the urinary bladder through the distal UVJ severe stenosis. The wire was then exchanged for an Ultra stiff Amplatz 035 wire. The catheter and sheath were then removed and exchanged for a 26 cm nephroureterostomy tube with the distal aspect curled within the urinary bladder and the proximal coils within the renal pelvis. Repeat contrast injection was then performed through the tube and images obtained including the patient in the reversed Trendelenberg position. The catheter was secured to the skin with pink tape and 0-0 silk sutres and left to gravity bag drainage externally. FINDINGS: The antegrade nephrostogram demonstrated the existing catheter to be coiled within a renal calix. The percutaneous nephrostomy tube was exchanged for a 26 cm nephroureterostomy tube which was passed across the UVJ obstruction from the patient's known prostate cancer. This tube was placed to external drainage. PLAN: 1. External drainage.

IR Non-tunnel Dialysis Catheter History: [] Procedure:

1. 2. 3.

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

Post-Procedure diagnosis: 1. Successful placement of 15 cm 11.5 French straight double lumen catheter via [right] internal jugular vein with tip in the RA. Catheter is ready for use. Attending radiologist: [] Assistant radiologist: [], [] Anesthesia: Local Complications: Contrast:

None.

None.

Description of procedure: The risks, benefits, and alternatives of the procedure were 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 upper chest were prepped and draped in the usual sterile fashion. Using ultrasound guidance and a 21 gauge needle access into the [right] internal jugular vein was achieved and exchange was made over wire for the 5 French micropuncture kit. Following this the 5 French dilator was exchanged over a wire for an 11 French dilator. The catheter was then inserted over wire. The catheter flushed and aspirated easily. The catheter was secured to the skin with 2-0 surgipro. Sterile dressings were applied, and the catheter was heparinized. Patient tolerated the procedure well and left the department without immediate post procedure complications. Findings: The [right] internal jugular vein is patent and compressible. Successful placement of non tunneled central venous catheter with tip in the RA. Catheter is 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. Complications: None. Patient was placed in supine position. 1 % lidocaine was given for local anesthetic. The Permacath was removed, and hemostasis was obtained. There were no complications. The tip of the catheter was sent for culture and sensitivity.

IR Portacath Preprocedure diagnosis: Post procedure diagnosis: Procedure performed: lumen port placement. Physicians:

Same.

Right internal jugular tunneled Bard 6.6 Fr single

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

Complications: Contrast:

Breast cancer requiring chemotherapy.

none.

none.

Anesthesia: Subcutaneous one percent lidocaine; intravenous versed and fentanyl with nursing supervision. Procedure description: The risks, benefits, and alternatives of the procedure were fully explained to the patient. The patient understood and informed consent 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 upper chest were prepped and draped in the usual sterile fashion. Using ultrasound guidance and a 21 gauge needle access into the right internal jugular vein was achieved and exchange was made over wire for the micropuncture kit. A 5Fr dilator was placed through which a 0.035 in Rosen wire was advanced to the IVC. The site on the right upper chest was anesthetized with lidocaine with

epinephrine and a dermatotomy was made to accommodate the port. A pocket for the port was bluntly dissected in the subcutaneous tissues. The distal end of the catheter was connected to the tunneling device and this was used to bring the 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 French dilator/ peel away sheath. The inner dilator and wire were removed and the catheter was inserted into the peel away sheath. The proximal end of the catheter was cut to length and afixed to the port. The port was positioned in the 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 and subcuticular absorbable sutures. The port was accessed through the skin. The port flushed and aspirated easily. The port was heparinized. The patient tolerated the procedure well and left the department without immediate 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 following cystectomy, one week postoperative evaluation. Post procedure diagnosis: 1. Bilaterally patent ureters without evidence of ureteral injury or obstruction. 2. Ileal conduit. Procedure performed: 1. Bilateral antegrade nephrostograms. Physicians: [], [] Complications:

(Attending physician present for entire procedure)

none.

Contrast: Conray. Anesthesia: Subcutaneous one percent lidocaine; intravenous versed and fentanyl with nursing supervision. Procedure description: The risks, benefits and alternatives of the procedure were discussed with the patient. All questions were answered and informed consent was obtained. The patient was brought to the angiography suite and placed supine having received preprocedural antibiotics. The patient's ureteral stents extending

from the ostomy site were catheterized and contrast was injected.The ureteral stents 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 or collecting system dilatation. Contrast is seen flowing easily around the ureteral stents into the ileal conduit.

IR TDC Exchange Pre procedure diagnosis:

End Stage Renal Diasese with infected permacath.

Post procedure diagnosis: same. 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. Complications: None. Procedure description: The risks, benefits and alternatives of the procedure were discussed with the patient. Informed consent was obtained. The patient was placed supine on the angiography table and the right sided catheter site over the upper chest was prepped and draped sterilely. The tract along the catheter was anesthetized copiously. Blunt dissection was performed to release the cuff. At this point, two stiff 035 Glide wires were advanced via the catheter lumen throught the right atrium, IVC and into the right external iliac veins. The catheter was withdrawn over the wires and a new 19 cm catheter was placed with its distal tip at the RA/SVC junction.The catheter was secured at the skin site and a bandage was applied. The catheter was heparinized. The patient tolerated procedure without immediate complication. Procedure findings: Status post successful exchange of tunneled dialysis catheter, as described The catheter is ready for immediate use.

IR T-Tube Post Transplant

Preprocedure diagnosis: transplant. Post procedure diagnosis: evidence of leak or obstruction. Procedure performed: Physicians:

One week status post living related liver Widely patent biliary anastomosis without

T-tube cholangiogram.

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

Complications:

none.

Contrast: Visipaque. Anesthesia:

none.

Procedure description: The risk benefits and alternatives of the procedure were discussed with the patient. Informed consent was obtained. The patient was placed supine on the angiography table. A scout radiograph was obtained followed by opacification of the patient's biliary tree via a percutaneous Ttube. Delayed images were obtained five minutes after tube capping. Procedure findings: The scout radiograph demonstrates surgical clips, drains and skin staples over the right upper quadrant with an appropriately positioned T-tube. Following contrast injection, the anastomosis of the right intrahepatic ducts to the common bile plaque is patent. Contrast fills unremarkable intrahepatic biliary ducts. Adjacent to the T-tube in the common bile duct is a small amount of debris. No contrast extravasation or obstruction to flow was identified. Delayed iimages demonstrated adequate drainage into the duodenum.

IR Tunnel Dialysis Catheter Pre procedure diagnosis: ESRD with failed graft requiring hemodialysis. Post procedure diagnosis: Same. 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 1:100,000 epinepherine. Complications: Contrast:

None.

None.

Procedure Description:The risks, benefits, and alternatives of the procedure were 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 upper chest were prepped and draped in the usual sterile fashion. Using ultrasound guidance and a 21 gauge needle access into the [right] internal jugular vein was achieved and exchange was made over wire for the micropuncture kit. A cap was placed on the 5 French dilator and the site on the right upper chest was anesthetized with lidocaine and a small dermatotomy was made. The catheter was connected to the tunneling device and this was used to bring the catheter through the internal jugular puncture site. Following this the 5 French dilator was exchanged over a wire for an 11 French dilator. Then exchange was made for the 15 French peel away sheath. The inner dilator and wire were removed and the catheter was inserted into the peel away sheath and the peel away removed. Under fluoroscopic guidance the catheter tip was localized. The catheter flushed and aspirated easily. The catheter was secured to the skin with 2-0 surgipro. The puncture site was closed with 4-0 polysorb and steri-strips. Sterile dressings were applied. The catheter was heparinized. Patient tolerated the procedure well and left the department without immediate post procedure complications. Procedure Findings:The [right] internal jugular vein is patent and compressible. Successful placement of tunneled hemodialysis catheter with tip at the SVC/RA junction. Catheter is ready for use.