Imaging of Bariatric Surgery

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after April 6, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 3.25
Procedures: 3.25
Abdomen and Pelvis: 3.25

Radiography: 4.50
Patient Care: 1.25
Patient Interactions and Management: 1.25
Procedures: 3.25
Thorax and Abdomen Procedures: 3.25

Registered Radiologist Assistant: 4.50
Procedures: 4.50
Abdominal Section: 4.50

Outline

1. Introduction
2. Laparoscopic Roux-en-Y Gastric Bypass
   1. Surgical Anatomy
   2. Normal Imaging Findings
   3. Complications
3. Laparoscopic Adjustable Bandind
   1. Surgical Anatomy
   2. Normal Imaging Findings
   3. Complications
4. Laparoscopic Sleeve Gastrectomy
   1. Surgical Anatomy
   2. Normal Imaging Findings
   3. Complications

Objectives

Upon completion of this course, students will:

1. describe steps that health care facilities have taken to address the growing bariatric patient population
2. define body mass index (BMI)
3. know which medical imaging modalities play a role both pre and post-operative diagnostic studies of bariatric patients
4. know the most common bariatric surgical procedures performed in the U.S.
5. describe the limitations of each imaging modality with bariatric patients
6. be familiar with the pre and post-surgical anatomy that occurs with a laparoscopic Roux-en-Y gastric bypass
7. understand radiographic and fluoroscopic customization to produce high quality images of a bariatric patient
8. know the proper radiographic and fluoroscopic positions of a UGI series, including exposure settings as well as the fluoroscopic and overhead components
9. understand the components of a CT scanner and how those factors may need to be adjusted to better facilitate bariatric patient
10. describe the use of various radiographic techniques and accessory items that may be helpful in performing conventional radiography on a bariatric patient
11. be familiar with radiation safety principles such as ALARA and dose rates for exams in which bariatric patients may have serial studies such as UGI and CT
12. understand the anatomy post surgically of a Roux-en-Y gastric bypass that may be visualized on a UGI series or CT abdominal scan
13. be familiar with the artifacts that may be seen on a CT scan of bariatric patient
14. be familiar with the contrast agents used for an abdominal CT for a bariatric patient
15. be familiar with both oral contrast agents used for an UGI series for a bariatric patient
16. understand the complications that may occur after a Roux-en-Y gastric bypass procedure
17. understand the medical imaging techniques used after a Roux-en-Y gastric bypass procedure and their role in visualizing potential complications
18. describe what additional radiographic projections or views are used to image complications that may occur post a Roux-en-Y gastric bypass procedure
19. be familiar with the radiographic appearance of complications post a Roux-en-Y gastric bypass procedure
20. understand the ABC classification of small bowel obstructions and how it relates to potential post-surgical complications of a Roux-en-Y gastric bypass procedure
21. be familiar with the appearance of small bowel obstructions and how they are imaged with barium studies and or CT
22. describe the effects that a gastric suture line disruption have when this occurs as a complication post a Roux-en-Y gastric bypass procedure
23. know what barium studies reveal when performing the imaging study on a gastric staple line disruption as a complication of a Roux-en-Y gastric bypass procedure
24. describe the advantages of barium studies over CT to visualize internal hernias
25. differentiate the radiographic appearance of chronic and acute ischemia of the Roux limb on a barium study
26. know which year the Food and Drug Administration (FDA) approved the use of laparoscopic adjustable gastric banding procedures as an option for bariatric treatment
27. know which type of bariatric surgery is currently the most popular in the U.S. and applicable to what type of bariatric patient population
28. know what are the two most common type of gastric banding procedures that have been utilized in the U.S.
29. know which disease processes or conditions may exclude a patient from being a candidate for a gastric banding procedure
30. describe the anatomy visualized after a patient undergoes a laparoscopic adjustable gastric banding procedure
31. describe what radiographic appearance the gastric band has that is part of a laparoscopic adjustable gastric banding procedure
32. describe what the phi angle is and the normal degree of angles
33. be familiar with the radiographic projections that best visualize the stoma component of a gastric band
34. know what the normal measurements of the stoma are at the level of the gastric pouch for a adjustable gastric banding procedure
35. know what medical imaging protocols and exams are beneficial in evaluating any post-operative complications after a adjustable gastric banding procedure
36. be familiar with the normal diameter of the gastric pouch after a adjustable gastric banding procedure
37. understand what other imaging studies may help show a gastric band leak if a UGI and CT are not definitive
38. know which CT projections are of assistance to visualize the gastric band and pouch post operatively of a laparoscopic adjustable gastric banding procedure
39. know which medical imaging modality can facilitate visual access to the gastric port in difficult cases or to identify a fluid leak, tube disconnection, or asymmetric band inflation post a gastric band procedure
40. know how often gastric perforation occurs as a complication after a gastric band procedure
41. know when the sleeve gastrectomy was introduced and what percentage of patients have this procedure
42. describe what type of bariatric surgery a sleeve gastrectomy is and the pre and post-operative anatomy that it encompasses
43. describe which medical imaging studies play a role either pre or post operatively on patients who have had a sleeve gastrectomy performed
44. know how much of the stomach is removed during a sleeve gastrectomy procedure
45. name the complications that may occur post a sleeve gastrectomy procedure