PHARYNGOGRAPHY

• Pharyngography involves a thick, creamy mixture of water and barium sulfate (50% - 50%)
• Special Notations:

  • Usually carried out using fluoroscopy with spot-film images only
  • Synchronized with a rapid exposure with the shortest exposure time
  • May use fluoroscopic equipment with spot radiography / videotape / cine film
• Procedure:

  1. Scout film to be taken in AP / LAT

  2. Ask the patient to hold the barium sulfate bolus in the mouth until signaled and then to swallow the bolus in one movement (Full distention – tablespoon)

  3. Exposure made during deglutition

  4. If a mucosal study is to be attempted, ask the patient to refrain from swallowing again

  5. Take mucosal study during the modified Valsalva’s maneuver for double-contrast delineation
• • Lateral Convex: Sitting/Standing laterally in front of VCH/VGD: Coronal plane just anterior TMJ to coincide with MLL of cassette; neck slightly extended Horizontally 72” TMJ Coronal plane at laryngeal prominence (C3 – C4)
  • Templeton & Kredel: Action of CM is rapid that exposure be made as soon as anterior movement is noted
• Projection/Method/View Specific Points/Structure Positioning Context Position & CRD Direction Special Consideration:

  • AP Convex: Sitting/Standing in front of VCH/VGD: MSP of neck to coincide with MLL of cassette 8 x 10 – Longitudinal in VCH/VGD MSP at laryngeal prominence (C3 – C4)
  • Gunson Method: Tie a dark-colored shoestring snugly around the patient’s throat above the thyroid cartilage - displacement coincides with the anterior and superior movement of the cartilage
• • Inspiratory phonation/reverse phonation/aspirate or aspirant maneuver by Powers, Holtz, & Ogura: Image shows adducted vocal cords, moved inferiorly and balloons the ventricle for clear delineation
  • Valsalva’s maneuver: Image shows complete closure of the glottis; tests the elasticity & functional integrity of the glottis
  • Modified Valsalva’s maneuver: Image shows the glottis closed and the laryngeal pharynx and piriform recesses distended with air; tests the elasticity of the laryngeal pharynx (hypopharynx) and the piriform recesses
• Negative Laryngography:

  • Contrast Medium (CM): AIR
  • Indication: Alterations in normal anatomy and physiology of laryngopharyngeal structures
  • Procedure for specific indications: Made with AP projections; selected maneuver should be explained & demonstrated
  • Quiet Inspiration image shows abducted cords, with uninterrupted column of air from laryngeal vestibule to trachea
  • Normal (Expiratory) Phonation image shows adducted cord
• Thyroid Gland Examination:

  • Radiographic exams not performed regularly because this is effectively evaluated using CT, Nuc Med or Ultrasound
  • Indication: Goiter (enlargement) – diffuse or nodular; may be confined to the neck or a portion may protrude into the superior thoracic cavity behind the sternum - intrathoracic/retrosternal/substernal goiter; any compression or displacement of the trachea; presence of any calcium deposits
• Projection/Method/View Specific Points/Structure Positioning Context Position & CRD Direction Special Consideration:

  • AP: Upright Head extended enough – prevent superimposition of the mandibular shadow on larynx; Adjust the patient to place the thyroid mass tangent to the IR 8 x 10 Horizontal to MSP at the level of the larynx
  • Lateral: Used to demonstrate intrathoracic extension of the goiter when shoulders cannot be rotated posteriorly enough to clear the superior mediastinum 8 x 10- 36” – 40”- Horizontally at laryngeal prominence
  • Oblique: Only obtained when nodular enlargement is present
• The pharynx is the passageway between the nasal cavity, oral cavity, larynx, esophagus, and trachea.
• It has three parts: nasopharynx, oropharynx, and laryngopharynx.
• The nasopharynx extends from the posterior nares to the soft palate.
• The nasopharynx extends from the base of the skull to the soft palate.
• The oropharynx extends from the soft palate to the epiglottis.
• Pharyngography is used to evaluate the structure and function of the pharynx.
• Pharyngography is an imaging technique used to visualize the structures within the pharynx.
• Pharyngography involves a thick, creamy mixture of water and barium sulfate (50% - 50%)
• Special Notations:

  • Usually carried out using fluoroscopy with spot-film images only
  • Synchronized with a rapid exposure with the shortest exposure time
  • May use fluoroscopic equipment with spot radiography / videotape / cine film
• Procedure:

  1. Scout film to be taken in AP / LAT

  2. Ask the patient to hold the barium sulfate bolus in the mouth until signaled and then to swallow the bolus in one movement (Full distention – tablespoon)

  3. Exposure made during deglutition

  4. If a mucosal study is to be attempted, ask the patient to refrain from swallowing again

  5. Take mucosal study during the modified Valsalva’s maneuver for double-contrast delineation
• Projection/Method/View Specific Points/Structure Positioning:

  • AP Conventional: Sitting/standing in front of VCH/VGD
  • Lateral Conventional: Sitting/standing laterally in front of VCH/VGD
  • Negative Laryngography uses air as contrast medium for alterations in normal anatomy and physiology of laryngopharyngeal structures
  • Techniques include quiet inspiration, normal (expiratory) phonation, inspiratory phonation/reverse phonation/aspirate or aspirant maneuver, Valsalva’s maneuver, and modified Valsalva’s maneuver
• Tomolaryngography involves air & iodised oil as contrast medium for alterations in normal anatomy and physiology of laryngopharyngeal structures

  • Only made in AP/frontal plane
  • Techniques include quiet inspiration, normal (expiratory) phonation, and stress maneuvers as indicated
• Positive Laryngography uses iodised oil/thin barium as contrast medium to determine exact site, size, and extent of tumor masses

  • Techniques include fluoroscopy with spot radiographs &/cineradiographic recordings
  • Procedure involves specific instructions to the patient, cautioning against coughing and swallowing after CM introduction, and slow CM administration
• Thyroid Gland Examination:

  • Radionic exams not regularly performed; evaluated using CT, Nuc Med, or Ultrasound
  • Indications include goiter (enlargement), compression or displacement of the trachea, and presence of calcium deposits
  • Techniques include AP and lateral projections, with special considerations for positioning and direction