a. This is a radiographic procedure, which will allow visualization of the lymph
nodes and lymphatic channels by the use of contrast media. The lymph vessels and
nodes of the extremities as well as the retroperitoneal areas can be visualized by this
b. The examiner injects 6 cc Ethiodol (ethyl ester of iodized poppyseed oil
containing 37 percent iodine) in the upper extremity or 12 cc into the lymphatic vessels
of the lower extremities. For infants and children, the total amount injected is one-third
to two-thirds that for adults. At the completion of the injection, the exposures are made.
For lymphangiograms of the lower extremities, AP projections are taken of the legs,
thighs, pelvis, abdomen, and chest. For the upper extremities, AP projections include
the forearm, arm, shoulder, and chest.
Section III. THE CENTRAL NERVOUS SYSTEM
The central nervous system consists of the brain and spinal cord. Because there
is insufficient difference in densities of the tissues to allow for satisfactory visualization
of the various structures of the central nervous system by conventional radiography,
specialized radiographic techniques must be used. The attending physician and the
radiologist determine the specific method.
Ventriculography is a diagnostic procedure whereby several radiographs are
made of the head in various positions following the removal of all or a certain portion of
the cerebrospinal fluid and its replacement with a suitable contrast medium. The
ventricles are reached with hollow needles through small trephine openings in the skull.
a. Patient Preparation and Scheduling. Except in emergency, the
examination is scheduled. Usually, the patient is sedated the evening before and again
on the morning of the examination according to the directions of the responsible
clinician. Breakfast is withheld on the morning of the examination.
b. Preliminary Procedure.
(1) The patient is taken to the designated operating room, where he is
placed in a sitting position with his chin resting on a suitable support. After aseptic
preparation and administration of local anesthetic, two small openings are made with a
trephine in the skull, 6.5 cm to 7 cm above the occipital protuberance, and 3 cm lateral
to the midline. A needle or cannula is introduced into each of the trephine openings,
and then advanced into the ventricular cavities. A mercury manometer is used to