Discussion on Cholecystography

(1) No branch of radiology requires more careful attention to technique and detail than gall-bladder radiology.—(2) The X-ray examination should always include ( a) a preliminary examination, ( b) cholecystography, ( c) barium meal, in this sequence.—(3) A number of gall-stones can be shown on the preliminary radiograph, and a further number on the cholecystograph, but there still remains a proportion which cannot be seen by X-ray examination. The greater the care taken in technique, the smaller will be the number of gall-stones not indicated.—(4) The radiographic demonstration of gall-stones does not necessarily mean that the lesion causing the patient's illness has been discovered. Gall-stones may exist without causing marked symptoms. They may produce symptoms which are atypical.—(5) The dye can be administered (i) by the mouth, (ii) intravenously. The former is now the best routine method of examination, though the latter still remains the more accurate.—(6) Non-filling of the gall-bladder in about 96% of cases indicates a pathological condition of the gall-bladder, often accompanied by stones, though these may not be shown on the radiograph.—(7) Poor filling of the gall-bladder on repeated examination also indicates a pathological condition of the gall-bladder. (8) A good gall-bladder shadow, which is normal in shape, size and position, uniform in outline and density, which contracts after a meal to a much smaller size, in a high percentage of cases indicates a normal gall-bladder. A small proportion of such gall-bladders may be diseased, and may even contain a small collection of stones.—(9) Any abnormality in the area of the gall-bladder before or after it has been filled with dye should be investigated by further radiographs taken according to the type of abnormality seen. (10) It has been demonstrated that a large collection of gall-stones in the gall-bladder can be passed into the intestine by way of the ducts.—(11) Complete gall-bladder radiology enables us to give a fairly accurate opinion as to the condition of the gall-bladder.