4. • Barium carbonate is toxic
•Properties
• High atomic number-56 highly radiopaque
• Non absorbable, non toxic
• Insoluble in water
• Inert to tissues
• high specific gravity of 4.25 to 4.50, resulting in its name, taken from the Greek "barys,"
meaning "heavy."
• Since the barium atom is large and heavy, it absorbs X-rays quite well. Since the sulfate also
possesses no toxicity, it is used as a radio-opaque or radio-contrast agent in gastrointestinal
testing
5. • Commercially prepared barium formulations in india by
ESKAYEF FINE CHEMICALS LTD.
• Microbar paste :
• 100% high viscocity paste
• High density, high viscosity – pharynx and
osophagus
• Microbar suspension
6. • 95% moderate density and viscosisty –osophagus stomach and small
intestine
• Microbar HD
• 200% high density, low viscosity- in powder form
• 70ml water added
• Sachets of gas producing powder are supplied
with the pack
• Ideal for double contrast
• Additives
7. • Carboxymethyl cellulose- decrease settling – hygroscopic
• Sodium citrate- prevents flocculation- makes alkaline
• Simethicone – anti foaming
• Erythrocin – color
• Saccharin –palatable, sweet taste
Barium swallow
• From oral cavity to fundus of stomach
• Contrast
8. • 100% barium sulphate paste
• 80% barium sulphate suspension
• High density, low viscosity for double contrast study
• Preparations
• 6 hrs of fasting
• Technique
• Pharynx
• One mouthful of thick barium sulphate
9. • Pateint instructed to swallow once and stop there after
• Spot films are taken when patients say eee..eee..or Valsalva
maneuver
• Frontal and lateral view are taken
• Osophagus
• Multiple mouthfuls of 80% w/v barium suspension
• Observe peristalsis
• Films – frontal, RAO and lateral- well distended osophagus
10. • Double contrast – high density, low viscosity barium(10-15ML) , then
effervescent powder
• Buscopan or glucagon for hypotonia
11.
12.
13.
14.
15.
16. Barium meal
• Osophagus to proximal jejunum
• Preparations
• 6 hrs fasting
• Patient should restrain from smoking
• In patients with GOO prolonged fasting reqiured
• Single contrast –low density barium sulaphate is used
• Double contrast – high density , low viscosity barium suspension
17. • 10-15ml of 80-100% barium suspension
• The patient lying supine is rotated in clockwise direction from the foot
end of patient
• Mucosal relief is obtained.
• The patient in supine and about 100-250ml of barium is given
• The patient turned prone oblique right dependent- the barium enters
the duodenum.
• More barium may be given to distend stomach
• Standard films taken
18. •Double contrast
• Dry fluid free stomach is essential
• High density (200-250%) low viscosity barium sulphate
• Antifoaming agents used in barium suspension prevent air bubble
formation.
• Sodium bicarbonate and citric acid are given –carbon dioxide is
formed.
• Standard films taken
• Biphasic study
19. • combining the both single and double contrast technique
• Good anatomic and physiologic information
• Both mucosal delineation and full column distension
20.
21.
22.
23. Single contrast Double contrast
Fundus Supine Erect with two views 90 degree to
each other or prone right side
down
Body Prone Supine with 60 degree head end
elevation
Antrum and pylorus Prone right side down Supine right side up
D1 and C loop of duodenum Prone right side down Supine right side up
D4 of duodenum Supine Prone right side up
24. endoscopy Barium meal
High diagnostic accuracy 100% Low diagnostic accuracy 83%
For erosive ulcers, small recurrent ulcers, early
detection of tumor and biopsy
To study the physiology-peristalsis and gastric
emptying
25.
26.
27. Barium meal follow through
• Jejunum to ileaoceacal junction
• SMALL BOWEL FOLLOW THROUGH
• DEDICATED SMALL BOWEL FOLOW THROUGH
• Peroral pneumocolon
• Contrast Media
• medium density barium 50-60%w/v is used .
• High density cause fold thickening and clumping.
28. • Alikine –improves the coating of valvulae conniventes.
• Acid –spasm, enlarged folds and dilatation.
• Preperation
• A low roughage diet and high fluid intake -48 hrs • 12 hrs fasting
• Small bowel follow through
• Following barium meal – 200 ml of 20-25%- to decrease the high
density
• Followed by 250ml of barium 40-45% is given.
29. • Overhead radiographs obtained –half hourly till ileocaecal
junction.
• Dedicated small bowel follow through
• 600ml of barium 50% is administered
• After 15-20 min a film is taken in prone position
• Subsequent films taken at 15-30 min till ileocaecal junction.
positioning Purpose
First Right side down
dependent
To aid gastric emptying
30. Second prone To separate the bowel
loops
third Right side up To visualize the IC junction
Advantages of prone position
• Better separation of bowel loops
• More uniform x ray penetration is obtained.
• Ilieum migrate cephalad and becomes less compacted.
Overlap in the pelvis overcome by
• Table head down
31. • 30 degree caudal angled view of pelvis
• Always empty urinary bladder prior to spot films.
• Peroral pnuemocolon
• Done at the end of barium meal follow through
• To evaluate the distal ileum
• When barium reached the right and proxiximal transverse colon
• Air is inflated into the rectum and refluxed into the ileacaecal
valve.
• Appearances of jejunum and ileum on barium study
32. jejunum ileum
Upper left and periumbilical region Lower right hypogastric and pelvic region
Proximal 2/5th
of small bowel Diatal 3/5th
of small bowel
Feathery appearances Featureless
Max diameter- 3cm 2cm
No. of folds 4-7 per inch 3-5 per inch
33.
34.
35.
36.
37. Barium enema
• Large bowel examination
• Preparation • Tab Dulcolax 2hs -2days.
• Water enema on previous night
• Low residue diet -2days
• Overnight fasting
• Preparation not required in
• Diarrhoea
• Total obstruction
• Paralytic ileus
38. • children
•Double contrast
• High density 75-95%-slow flowing better coating
• Patient in prone postioning –left side down oblique barium is
passed
• When splenic flexure is reached – air is introduced.
• Air should push the barium and never pass beyond the column.
• Frontal and lateral films of rectum taken.
• Oblique right side down –rectosigmoid junction.
• Now patient in prone right side dependent – air is pumped
• Barium in transverse colon turn the patient left side up.
39. • Barium reach right side clon and IC junction
• Right side up – air is pumped - till IC junction outlines.
• Spot films of flexures, IC junction, full films
40.
41.
42. • Single contrast
• Low density 15-20% w/v.
• Tube is paced in rectum – left lateral position.
• The height of enema should not be more than 1 metre above
the table top.
Part of the bowel SCBE
Rectum and presacral space Left lateral frontal- prone
Rectosigmoid Prone right side down oblique
Splenic flexure Prone left side down oblique
