The optimal radiographic technique for operative and T-tube cholangiography

Optimal radiographic technique for T-tube and operative cholangiography requires an intimate knowledge of bile duct anatomy and the techniques that can be employed to demonstrate the biliary system. This article will review the anatomical considerations of the intra- and extrahepatic bile ducts that are important in direct cholangiography. The various radiographic techniques available for studying the biliary system will be reviewed. Based on several considerations, a high kVp and high-contrast agent concentration technique should produce better quality operative and T-tube cholangiograms than the currently recommended low kVp and low-contrast agent concentration technique. Results from our phantom and clinical studies will be presented to support this concept. The advantages and disadvantages of both types of techniques will be discussed, and recommendations will be made for performing the optimal radiographic evaluation for T-tube and operative cholangiography.