Biliary Microlithiasis

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Biliary Microlithiasis - Rapid Patient Rotation Protocol

The Patient Rotation technique requires a voluntary patient rotation as rapid as possible with instantaneous visualization of the gallbladder immediately at the end of a rotation.  Rotations are listed in order of effectiveness:

  1. The patient is held stationary in a steep RLD position (the body right side down at 90°to the table) for up to 2 minutes or more. Patient is then rapidly rotated 180˚ to end in the steep LLD position (the body left side down at 90˚ to the table).  80% effective.
  2. Starting in the prone position, the patient is turned slowly in a small arc from left to right with resting periods in between, intermittently rolling back and forth while remaining essentially prone for up to 5 minutes. Following this the patient is rapidly rotated 270˚ from the prone position to end in the steep LLD position.
  3. The patient is stationary in the steep LLD position for up to 2 minutes or more and is then rapidly rotated 180º to end in a steep RLD position or alternatively rotated 270˚ to end supine.
  4. From a supine position for up to 2 or more minutes, the patient is rapidly rotated up to or beyond 360˚ to end supine or in a right or left anterior oblique position.

Voluntary patient rotation is as rapid as possible to agitate the gallbladder bile causing particles to fall from the dependant wall where they can be observed in suspension “freefalling” within the bile of the gallbladder.  Detection and imaging of foci requires immediate visualization of the gallbladder the instant a patient rotation ends. Cine loop is used to record particles because they disappear very quickly.

We believe intraluminal gallbladder echogenic foci seen using this technique are the same biliary microlithiasis particles detected in ERCP aspirates.