This document provides an overview of gastrointestinal tract imaging procedures using barium as a contrast agent. It describes the characteristics and uses of barium sulfate for outlining GI structures. Various GI imaging techniques are outlined, including barium swallow, barium meal, barium follow through, and barium enema. Patient preparation, contrast agents, positioning, and film techniques are discussed for each procedure. Potential complications are also briefly mentioned.

1. Gastrointestinal Tract
Special Procedure
BY
Roshan shah
B.Sc.MIT 2nd year
3rd Batch

2. Definition:-
 It is an x-ray examination of the
esophagus, stomach, duodenum,
small intestine & large intestine.
 Diagnostic test
- GI-series
- CT-scan
- MRI
- Endoscopy
- Endoscopic USG etc.

3. Contrast examination:-
 Barium sulphate is the best CM for demonstrating the GI-tract.
- Single CM is used to outline the structure.
- Double CM is used for detail viewing of the mucosal
pattern.
 Water soluble CM is used in some cases such as perforation, small
bowel obstruction, pediatric patient.

4. Characteristic of barium:-
 High density with low viscosity.
 Particles size 0.1 to 0.3 µm
 pH = 5.3
 Inert compound with no adverse reaction
Route: Orally & Rectally
Method: Single contrast & double contrast

5. Difference?
Single contrast
medium
Double contrast
medium
Only barium is given. 60-100%
w/v
Barium with gas producing agent
is given. 200-250% w/v
To outline the structures, lumen
and large abnormalities.
For detail viewing of the mucosal
pattern, making it easier to see
narrowed areas (strictures),
diverticula or inflammation.

6. Cont…

7. GI-series:-
1. Barium swallow
2. Barium meal
3. Barium follow-through
4. Small bowel enema
5. Barium enema

8. Barium swallow
 Indication:-
1. dysphagia
2. anaemia
3. pain
4. assessment of tracheo-oesophageal fistula
5. assessment of site of perforation
 Patient preparation:-
-NPO for 6 hours prior to the examination.
-Smoking should be avoided on the day of examination.
- Muscle relaxants before the procedure
 Contrast medium:-
-Double contrast 200-250%w/v, 100ml/ more according to need.
-Water soluble contrast agent if perforation is suspected (Gastrograffin).
-LOCM(approx 300 mgI /ml) incase of aspiration.

9. Technique:-
 AP or PA Projection:-
• Pt. supine or prone
• Center midsagittal plane to
cassette
• Bottom of cassette should be
placed just below tip of
xiphoid
• Pt. drinks contrast before
exposure and continues
drinking during exposure.
• Shield!

10. Cont..,
 RAO or LAO Positions:-
• To throw the esophagus clear
of the spine.
• Pt should be rotated 35 - 40
degrees
• Center about 2 inches lateral
to MSP
• Bottom of cassette below
xiphoid.

11. Cont…
 Lateral projection:-
• Place pt in lateral position.
• Center midcoronal plane to
cassette.
• Bottom of cassette below
xiphoid process.
• Pt must drink continuously
before and during exposure.
• Use shielding!

12. Cont…

13. Barium meal
 indication:-
-dyspepsia
-weight loss
-upper abdominal mass
-partial obstruction
-GI hemorrhage
 Contraindication:-
-complete large bowel obstruction
 Patient preparation;-
-Pt. should follow a low residue diet for 2 days prior to exam
-NPO for 6 hours prior to the examination.
 Contrast medium:-
-E-Z HD 250%w/v, 135ml

14. Technique:-
• A gas producing agent is
swallowed. The patient drinks
barium while lying on the left
side.
• The patient then lies supine &
slightly on the right side .
• Ask to roll onto the right side &
then quickly over in a complete
circle, to finish in an RAO
position.

15. Single vs double contrast:-
 Single contrast:-
• Shows size, shape, and
position of stomach.
• Examines changing
contour of stomach during
peristalsis.
• Observe filling and
emptying of duodenal
bulb.
 Double contrast:-
• Mucosal lining is well
visualized
• Small lesions are less
easily obscured

16. Compare Single and Double Contrast:-

17. Compare AP & PA projection:-

18. LATERAL PROJECTION:-
 Position:-
• Lateral recumbent - right side
 CR:-
• Level of L1-L2
• Between midcoronal and anterior
of abdomen

19. Film technique:-
• RAO: to demonstrate antrum & greater curve
• Supine: antrum & body
• LAO: lesser curve
• Left lateral tilted, head up: fundus
 From the left lateral position the patient returns to a supine position
& then rolls onto the left side & over into a prone position.
-Prone
-RAO
-Supine
-LAO

20. Barium follow-through:-
 Methods:-
-single contrast.
-with the addition of an effervescent agent.
-with the addition of a pneumocolon technique.
 Indication:-
-Diarrhoea
-Anaemia
-Partial obstruction
-Malabsorption
-Abdominal mass
 Contraindication:-
-Complete obstruction
-Suspected perforation

21. Cont…
 Contrast medium:-
-E-Z paque 100% w/v 300ml
 Patient preparation:-
-Low residue diet for 2 days prior when possible
-NPO after midnight before exam.
-Metoclopramide (maxolon) 20 mg orally may be given before or
during the examination.

22. Technique:-
 Prone PA film of the abdomen
are taken every 15-20min
during the first hour.
 And subsequently every 20-30
min until the colon is reached.
 Spot film of the terminal ileum
are taken in supine.

23. Film series:-
Immediate 15 minutes

24. Cont…
30 minutes 1 hour

25. Aftercare:-
The patient should be warned that his bowel
motion will be white for a few days after the
examination and may be difficult to flush away.
The patient should be advised to eat and drink
normally to avoid barium impaction. Laxative may
be taken if required.
The patient must not leave the department until
any blurring of vision produced by the Buscopan
has resolved.

26. Complications:-
• Leakage of barium from an unsuspected
perforation.
• Aspiration of stomach content due to the Buscopan.
• Conversion of partial obstruction into a complete
obstruction by the impaction of barium.
• Barium appendicitis, if barium impact in the
appendix.