p.1
Esophagography Procedure
What is esophagography or barium swallow?
A common radiographic procedure for examining the pharynx and esophagus using a radiopaque contrast medium.
p.8
Upper Gastrointestinal Series (UGIS)
What is administered if the patient is constipated before the procedure?
A non-gas-forming laxative.
p.8
Upper Gastrointestinal Series (UGIS)
What is the barium sulfate suspension concentration used in a single-contrast examination?
30% to 50% weight/volume.
p.7
Clinical Indications for Esophagography
What is Peptic Ulcer Disease?
Erosion of the stomach or duodenal mucosa due to various physiological or environmental conditions.
p.14
Patient Preparation for Esophagography
What is the patient preparation for Gastro-Jejunostomy?
The same as for patients who have not undergone surgery; NPO prior to examination is sufficient.
p.14
Positioning Techniques for Esophagography
What is the focus during imaging after barium ingestion in Gastro-Jejunostomy?
Concentrating at the anastomosis portion of the point of suture.
p.5
Positioning Techniques for Esophagography
What does the 45° RAO position reveal in the cardiac series?
The huge right atrium casting a triangular density behind the esophagus.
p.10
Upper Gastrointestinal Series (UGIS)
How do you determine the reference point using two planes?
Mark the intersection of the transpyloric plane and scapular spine, then measure 4 inches to the left.
p.6
Positioning Techniques for Esophagography
What is the effect of the right lateral recumbent position on the stomach?
The stomach swings forward, placing the body closer to the abdominal wall.
p.16
Clinical Indications for Esophagography
What is Malabsorption Syndrome?
A condition where the body cannot absorb nutrients properly.
p.3
Positioning Techniques for Esophagography
What is the central ray (CR) direction for the left lateral projection of the barium-filled esophagus?
Horizontal or perpendicular.
p.11
Positioning Techniques for Esophagography
What is the purpose of the spot film during stomach and duodenum imaging?
To capture a radiograph during the examination under fluoroscopic control.
p.3
Pathologies Demonstrated Radiographically
What is the primary projection for demonstrating esophageal carcinoma?
AP, PA, LAO, RAO, or lateral during the filling phase.
p.3
Pathologies Demonstrated Radiographically
What is the procedure for demonstrating a mediastinal mass?
Filling phase with continuous barium swallow, using fluoroscopic guidance.
p.5
Clinical Indications for Esophagography
What condition is indicated for a cardiac series?
Cardiomegaly - Enlargement of the heart.
p.4
Esophagography Procedure
What is the procedure for Hiatal Hernia?
Allow the patient to ingest the barium mixture before positioning.
p.4
Positioning Techniques for Esophagography
What positions are used for Hiatal Hernia?
Trendelenburg Position and Touch Toe Position.
What are the three sections of the small intestine?
Duodenum, Jejunum, Ileum.
p.5
Upper Gastrointestinal Series (UGIS)
What is the focus of the upper gastrointestinal series (UGIS)?
Radiographic examination of the distal esophagus, stomach, and duodenum.
p.13
Positioning Techniques for Esophagography
What is the purpose of the modifications described for the Trendelenburg position?
To apply greater intra-abdominal pressure for consistent results in radiographic demonstration of small sliding gastroesophageal hernias.
p.2
Breathing Exercises in Radiography
How is the Valsalva Maneuver performed?
The patient takes a deep breath while holding it in, forcing air against the closed glottis.
p.13
Positioning Techniques for Esophagography
What is the recommended angle for the patient in the Wolf Method?
40-50 degrees RAO position.
p.11
Upper Gastrointestinal Series (UGIS)
What is one method to produce air in the stomach during imaging?
Instruct the patient to sip the barium mixture using two straws.
p.6
Characteristics of the Esophagus
Where is the stomach located in the abdomen?
In the left upper quadrant (LUQ) below the diaphragm.
p.11
Upper Gastrointestinal Series (UGIS)
What is the central ray angle for Gordon's modification?
Projected 35-45 degrees cranially (cephalad).
p.11
Clinical Indications for Esophagography
What should be done after taking all projections in the study?
Advise the patient to wait for the radiologist to confirm the radiographs.
p.7
Clinical Indications for Esophagography
What is a Bezoar?
A mass of undigested material trapped in the stomach, often made of hair or vegetable fibers.
p.4
Patient Preparation for Esophagography
What is the preparation for an esophagogram for infants?
Starve the patient for 2 to 3 hours before the examination.
p.9
Upper Gastrointestinal Series (UGIS)
What is the purpose of the hypotonic duodenography method?
To show duodenal anatomy without interference from peristaltic activity.
p.12
Positioning Techniques for Esophagography
What is the central ray direction for Gugliani's modification?
Directed at an angle of 20-25 degrees cranially (cephalad).
p.1
Phases of Esophageal Study
What are the two phases of studying the esophagus?
1. Mucosal Phase - demonstrates mucosal patterns with a barium preparation of 4:1. 2. Filling Phase - distends the lumen with a barium preparation of 2:1 or 3:1.
p.15
Upper Gastrointestinal Series (UGIS)
How is barium typically prepared for infants?
A milk barium mixture of 4 parts milk to 1 part barium.
p.9
Upper Gastrointestinal Series (UGIS)
What is the purpose of giving the patient a gas-forming substance?
To help expand the stomach and improve visualization.
p.9
Upper Gastrointestinal Series (UGIS)
What should the patient do to ensure even coating of the stomach walls?
Turn from side to side or roll over a few times.
What is the length of the duodenum?
Approximately 1 foot (12 inches).
p.6
Positioning Techniques for Esophagography
How does the stomach move in a prone position?
The stomach moves slightly downward.
p.16
Clinical Indications for Esophagography
What is Enteritis?
Inflammation of the small intestine.
p.8
Upper Gastrointestinal Series (UGIS)
What type of diet should the patient have before the examination?
Soft, low-residue diet for 2 days.
p.6
Upper Gastrointestinal Series (UGIS)
What is the purpose of studying the stomach radiographically?
To study the form and function of the distal esophagus, stomach, and duodenum, as well as to detect abnormal and functional conditions.
p.2
Breathing Exercises in Radiography
What does the Mueller Maneuver involve?
The patient exhales and then tries to inhale against the closed glottis.
p.10
Upper Gastrointestinal Series (UGIS)
What is the purpose of delayed radiographs in UGIS?
To ensure filling of the GI tract.
p.7
Clinical Indications for Esophagography
What are the two types of Peptic Ulcers?
Duodenal Ulcer and Gastric Ulcer.
p.8
Upper Gastrointestinal Series (UGIS)
What should be done after studying the rugae during the examination?
Instruct the patient to drink the rest of the barium mixture.
p.8
Upper Gastrointestinal Series (UGIS)
What can be determined using a single-contrast examination?
Size, shape, and position of the stomach.
p.1
Psychological Preparation for Patients
What is a psychological maneuver used during esophagography?
Giving the patient a mouthful of barium paste and having them swallow on the count of three, or instructing them to sip the barium mixture using a straw.
p.14
Positioning Techniques for Esophagography
What is the importance of double contrast in imaging?
It enhances the visibility of structures in the stomach.
p.16
Clinical Indications for Esophagography
What is Meckel’s Diverticulum?
A congenital defect in the small intestine that appears as a bulge or outpouching in the inner wall.
p.4
Positioning Techniques for Esophagography
What patient positions are used for infants during an esophagogram?
AP, Oblique, and Lateral using fast exposure.
p.11
Positioning Techniques for Esophagography
What is the initial step for esophagus imaging using fluoroscopy?
Ask the patient to swallow a barium mixture while in RPO upright position.
p.14
Pathologies Demonstrated Radiographically
What is Gastro-Jejunostomy?
A procedure where the jejunum is connected to the stomach after removing the duodenum and a portion of the distal stomach.
p.4
Positioning Techniques for Esophagography
What position is used for Chalasia?
Trendelenburg Position, where the head is lower than the feet.
p.7
Clinical Indications for Esophagography
What is a Hiatal Hernia?
A condition where a portion of the stomach herniates through the diaphragmatic opening.
p.7
Clinical Indications for Esophagography
What is Gastritis?
Inflammation of the lining or mucosa of the stomach.
p.5
Upper Gastrointestinal Series (UGIS)
What is the purpose of the preliminary (scout) radiograph in UGIS?
To delineate the organs of the abdomen and detect any calcifications or tumor masses.
p.15
Small Bowel Series (SBS) and Patient Preparation
What should be done to prepare for a Small Bowel Series (SBS)?
Light evening meal, laxatives before bedtime, and NPO on the day of the examination.
p.16
Clinical Indications for Esophagography
What is Adynamic/Paralytic Ileus?
Intestinal blockage in the absence of a physical obstruction, often due to foreign bodies.
p.16
Clinical Indications for Esophagography
What should be used instead of Barium Sulfate in certain patients?
Water-soluble iodinated contrast media, with caution for allergic reactions.
p.3
Positioning Techniques for Esophagography
What is the significance of the left lateral position in esophagography?
It minimizes the magnification of the heart.
p.14
Pathologies Demonstrated Radiographically
What is Partial Gastrectomy?
A surgical procedure where the pathologic portion of the stomach is removed.
p.2
Breathing Exercises in Radiography
What is the Modified Valsalva Maneuver?
The patient pinches off the nose, closes the mouth, and tries to blow the nose, expanding the cheeks outward.
p.1
Clinical Indications for Esophagography
What is achalasia?
A condition involving abnormal constriction of the lower portion of the esophagus.
p.10
Upper Gastrointestinal Series (UGIS)
How does fluoroscopy affect the length of the examination?
It considerably reduces the length of time of the examination.
p.10
Upper Gastrointestinal Series (UGIS)
What is the first step in determining the reference point for the stomach using scout film?
Trace the shadow of the stomach from the fundus down to the pylorus.
p.11
Upper Gastrointestinal Series (UGIS)
What is one way to produce air in the stomach using medication?
By giving the patient gas-producing tablets like 'GASTROLUFT'.
p.6
Positioning Techniques for Esophagography
What happens to the stomach when a person is in a supine position?
The stomach moves up to maximum, superiorly towards the diaphragm.
p.7
Clinical Indications for Esophagography
What should be communicated to the patient regarding UGIS?
Inform the patient about how long the procedure is going to take.
p.16
Clinical Indications for Esophagography
What are the two types of Ileus?
Adynamic/Paralytic Ileus and Mechanical Ileus.
p.12
Positioning Techniques for Esophagography
What is the best projection to demonstrate the greater and lesser curvature of the stomach for hypersthenic patients?
The projection that shows the antral portion of the stomach, pyloric canal, and duodenal bulb.
p.12
Positioning Techniques for Esophagography
What structures are demonstrated using Poppel's method?
The right angle view of the stomach and the retrogastric space, as well as pancreatic pathologies.
p.13
Positioning Techniques for Esophagography
What is the patient position for the Wolf Method?
The patient is placed in a prone position on the radiographic table.
p.6
Characteristics of the Esophagus
What shape is the stomach described as?
J-shaped portion of the digestive tract.
p.2
Positioning Techniques for Esophagography
What is the purpose of the RPO projection?
To demonstrate the entire length of the esophagus free from superimposition with adjacent structures.
p.2
Positioning Techniques for Esophagography
How is the RAO projection performed if the patient cannot stand?
The patient is placed in a supine position and elevated approximately 45 degrees.
p.5
Positioning Techniques for Esophagography
What is observed in the left lateral position during the cardiac series?
The barium-filled esophagus pushed by the poststenotic dilation of the descending aorta.
p.6
Positioning Techniques for Esophagography
How does the stomach position change when a person is upright?
The stomach goes down for about 3 to 6 inches due to gravity.
p.7
Clinical Indications for Esophagography
Why should the barium mixture be prepared in advance?
To minimize the unpalatable taste for the patient.
p.4
Esophagography Procedure
What methods can be used to introduce contrast for infants?
By feeding bottle or by pressure or gravity method via catheter inserted through the nose.
p.16
Clinical Indications for Esophagography
What are the contraindications for using Barium Sulfate?
Presurgical patients, patients with perforated hollow viscus, and possible large bowel obstruction.
p.12
Positioning Techniques for Esophagography
What is the purpose of Hampton's modification?
To demonstrate a leaf-like pattern of the pylorus and the duodenal bulb.
p.14
Pathologies Demonstrated Radiographically
What is Sub-total Gastrectomy?
A procedure where only half of the stomach is removed.
p.13
Positioning Techniques for Esophagography
What is the Sommer-Feegelle Method?
It uses a specially constructed 34-degree angle board to place the patient in a Trendelenburg position.
p.2
Positioning Techniques for Esophagography
What is the AP projection positioning for esophagography?
Patient is placed in PA position, centered to the midline of the table with RP at T6.
p.8
Upper Gastrointestinal Series (UGIS)
What is the main advantage of a double-contrast examination?
Small lesions are less easily obscured and the mucosal lining can be more clearly visualized.
p.6
Characteristics of the Esophagus
What is the cardiac orifice?
The upper opening at the junction of the esophagus, located at the level of the seventh left costal cartilage.
What is the length of the small intestine?
Approximately 21 feet (252 inches).
p.4
Esophagography Procedure
How are foreign bodies examined in the esophagus?
Use cotton balls soaked with barium mixture and allow the patient to swallow it.
p.7
Clinical Indications for Esophagography
What is the recommended barium mixture for preparation?
A 2:1 (60 to 66%) or 3:1 (70 to 80%) barium mixture.
What is the function of the ileocecal valve?
It prevents retrograde flow from the ileum to the cecum of the colon.
p.9
Upper Gastrointestinal Series (UGIS)
What is the disadvantage of the Double Meal Method?
Superimposition between the filling of the small intestine and the stomach.
p.16
Upper Gastrointestinal Series (UGIS)
What is the barium preparation volume for adults?
600-1,200 ml of barium sulfate.
p.12
Positioning Techniques for Esophagography
What is the positioning for Poppel's method?
The patient is positioned supine after ingesting contrast media, with two exposures taken: one horizontal and one vertical.
p.12
Positioning Techniques for Esophagography
What is the reference point for the second exposure in Poppel's method?
4 inches to the left of the pylorus, centered to the midline of the table.
p.7
Clinical Indications for Esophagography
What are some clinical indications for esophagography?
Ulcer, Hiatal Hernia, Acute or Chronic Gastritis, Tumor, carcinoma, Diverticulae, Bezoars.
p.7
Clinical Indications for Esophagography
Where are Duodenal Ulcers frequently located?
In the second or third aspect of the duodenum.
p.5
Positioning Techniques for Esophagography
What does the PA projection show in the cardiac series?
A barium-filled esophagus and the level of aortic coarctation.
p.2
Positioning Techniques for Esophagography
What is the significance of taking exposure at the count of three after swallowing?
It ensures that the barium mixture is properly positioned for imaging.
p.9
Upper Gastrointestinal Series (UGIS)
What is the biphasic examination?
Both single-contrast and double-contrast examinations performed on the same day.
p.16
Positioning Techniques for Esophagography
What is the purpose of the Supine position during SBS?
To avoid abdominal pressure and prevent overlapping of intestinal loops.
p.13
Positioning Techniques for Esophagography
What is the Wolf Method used for in radiographic demonstration?
It involves a semi-cylindrical compression device to increase intra-abdominal pressure and ensure adequate contrast filling of the esophagus.
p.1
Characteristics of the Esophagus
What are the characteristics of the esophagus?
It is a collapsible fibromuscular tube, posterior to the trachea and heart, beginning at C6 and connecting to the stomach around T10, approximately 9.7 inches (25 cm) long.
p.14
Pathologies Demonstrated Radiographically
What is Total Gastrectomy?
A surgical procedure where the whole stomach is removed.
p.6
Characteristics of the Esophagus
What are the main parts of the stomach?
Cardia, Fundus, Body, and Pylorus.
p.6
Characteristics of the Esophagus
What is the pyloric orifice?
The lower opening of the stomach that communicates with the duodenum.
p.10
Upper Gastrointestinal Series (UGIS)
What is Addison's Plane in relation to UGIS?
A plane drawn transversely midway between the manubrial notch and the upper border of the symphysis pubis.
p.4
Patient Preparation for Esophagography
What is the barium preparation for infants?
Milk barium mixture, 4 parts water milk and 1 part barium.
p.5
Upper Gastrointestinal Series (UGIS)
What additional study may be performed during UGIS?
A small intestine study consisting of radiographs obtained at frequent intervals.
p.9
Upper Gastrointestinal Series (UGIS)
What is the most frequently employed method of study in UGIS?
Overhead or Conventional Method.
p.2
Breathing Exercises in Radiography
What is the purpose of various breathing exercises?
To increase both intra thoracic and intra abdominal pressure.
p.3
Pathologies Demonstrated Radiographically
How is thyroid gland enlargement demonstrated radiographically?
Using AP or PA for lateral displacement and lateral for anterior or posterior displacement.
p.15
Clinical Indications for Esophagography
What is a common clinical indication for UGIS in infants?
Obstruction, possibly due to foreign bodies or pathology.
p.5
Clinical Indications for Esophagography
What is the primary purpose of the cardiac series radiographic examination?
To study heart size and configuration.
p.1
Clinical Indications for Esophagography
What is dysphagia?
A clinical indication for esophagography characterized by difficulty in swallowing.
p.9
Upper Gastrointestinal Series (UGIS)
What types of contrast media are used in the study?
Both positive and negative contrast media.
p.11
Upper Gastrointestinal Series (UGIS)
What is Gordon's modification in UGIS?
The patient is placed in a prone position with specific adjustments to the body and central ray.
p.1
Clinical Indications for Esophagography
What is a hiatal hernia?
An abnormal protrusion of an organ through an aperture, where part of the fundus enters the esophagus or forces the diaphragm above.
p.1
Psychological Preparation for Patients
How should a patient be psychologically prepared for esophagography?
By explaining the taste of the barium mixture, its importance, and how to drink it, using a well-modulated voice and clear instructions.
Where is the jejunum primarily located?
In the Left Upper Quadrant (LUQ) of the abdomen.
p.5
Upper Gastrointestinal Series (UGIS)
What type of studies are included in the UGIS examination?
Fluoroscopic and serial radiographic studies using ingested contrast material.
p.16
Phases of Esophageal Study
What is peristalsis?
Contraction waves that propel contents through the digestive tube towards the anus.
p.3
Positioning Techniques for Esophagography
What is the recommended patient position for the left lateral projection of the esophagus?
The patient is placed in the left lateral position, either recumbent or erect.
p.4
Esophagography Procedure
What is the procedure for Chalasia?
Exposure is taken after contrast media has passed through the gastroesophageal junction, and the patient should ingest the barium mixture first.
p.13
Positioning Techniques for Esophagography
When should the exposure be made during the Sommer-Feegelle Method?
During the Muller/Valsalva Maneuver.
p.13
Pathologies Demonstrated Radiographically
What structures are demonstrated in the radiographic study of hiatal hernias?
The relationship of the stomach to the diaphragm.
p.9
Upper Gastrointestinal Series (UGIS)
What medications may be given to the patient before the procedure?
Glucagon or other anti-cholinergic medications.
p.10
Upper Gastrointestinal Series (UGIS)
What imaginary line is used to find another reference point for the stomach?
An imaginary line passing at the level of the elbow joint and the right mammary line.
p.15
Small Bowel Series (SBS) and Patient Preparation
What is the purpose of a Small Bowel Series (SBS)?
To study the form, function, anatomy, and physiology of the small bowel and detect any abnormal conditions.
p.16
Clinical Indications for Esophagography
What is Mechanical Ileus?
Obstruction caused by another pathological condition, such as tumors or masses.
p.14
Positioning Techniques for Esophagography
What position is best for demonstrating the body, pylorus, and duodenal bulb in hypersthenic patients?
Left lateral recumbent position.
p.6
Positioning Techniques for Esophagography
What occurs to the stomach in a left lateral upright position?
The body of the stomach swings backward, moving closer to the spine.
p.16
Positioning Techniques for Esophagography
What is the purpose of the Prone position during SBS?
To compress abdominal contents for better radiographic quality and visibility of bowel loops.
