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.