Newer Developments in Cholecystography
Since the introduction of cholecystography by Graham and his coworkers in 19241,2, its importance in the diagnosis of dysfunction or disease of the gallbladder has become well established, but the technique of this procedure has not yet become standardized. After countless discussions relative to the merits of the intravenous versus the oral method of administering the dye, the oral method has been adopted generally. The newer developments have been regarded with keen interest and the clinician as well as the roentgenologist, in judging the reliability of a cholecystographic examination, now insists on knowing the details of the method used. In attempting to standardize the procedure we believe the following features should be considered:
The administration of multiple doses of the dye produces greater density in the visualized gallbladder than does the single dose, and it makes non-visualization of greater significance, without harming the patient.
The administration of large amounts of sugar and other carbohydrates preceding and during the examination facilitates the excretion of the dye by the liver, thereby adding greater significance to the cholecystographic findings.
One ounce or less of a mixture of egg yolk, lecithin, and glycerine, as recommended by Levyn3, has been found to be as efficacious as the fat meal in emptying the gallbladder, and it has not interfered with the roentgen examination of the stomach and small intestine on the same day that the cholecystograms are made. Figure 1 shows a small opaque calculus in the gallbladder area, which, at this time. . .