The Lateral Decubitus Position in Cholecystography

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THE value of the lateral decubitus position during cholecystography has been long established. Its use as a routine procedure is recommended and can be accomplished with little additional effort, resulting in greater diagnostic accuracy.

For this view the patient is positioned on a mobile table, with his right side directly over a well in the table top. A horizontal x-ray beam is employed, traversing the gallbladder area in a posteroanterior direction. An upright Bucky holds the cassette in a position against the patient's right upper abdomen (fig. 1).

In our routine cholecystographic examination at the Cleveland Clinic, each patient has a posteroanterior lateral decubitus film and an ordinary posteroanterior prone film. These are developed and the wet films studied. If these two films are diagnostic, no other films are exposed. If, in the opinion of the roentgenologist, these two films do not constitute a diagnostic examination, fat meal, pitressen, or a second dose of dye are given, or oblique and upright films may be taken. By following this procedure, less than 20 per cent of the patients need more than the two original films.

One of the main objections to routine prone views of the gallbladder is the great frequency with which the gallbladder shadow will be obscured by gas or fecal shadows present in the hepatic flexure of the colon, duodenal bulb or small intestine. These may be identified incorrectly as calculi or may obscure the presence of calculi in the portion of the gallbladder over which they are. . .



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