THIS CONTAINS THEORY AS WELL AS IMAGES FOR BETTER UNDERSTANDING.

3. Miodified and cookie swallow

4.  Indication
 Dysphagia and obstruction
 Pain during swallowing
 Assessment of mediastinal masses
 Pre assessment of carcinoma bronchus
 Motility disorders of oesophagus e.g. aclasia
and diffuse oesophageal spasm, scleroderma
 Assessment of site of perforation

5.  Zenker’s diverticulum and cricoid webs. In these
cases water soluble contrast media are used.
E.g. Gastrograffin or dinosial aqueous
 Relative contraindications-
 Tracheo oesophageal fistula
 perforation
 Contrast-
 100% barium sulphate paste
 80% barium sulphate suspension
 30% barium sulphate suspension for high kv
technique
 200-250% high density, low viscosity for
double contrast study

6.  Pharynx-
 One mouthful( 10-15 ml) of contrast media
(barium sulphate paste) is given and
fluoroscopic observation of act of deglutition
is observed in frontal and lateral view with
patient erect.
 To get optimum distension of the pharynx,
exposure is triggered at the time when hyoid
bone is at highest point during swallowing.

7.  For this , a string is tied just above the level
of larynx. The rotor is kept running and
patient is asked to swallow.
 Exposure is released when larynx comes
above the string.
 Lateral film is taken erect and front film in
supine position.

8.  One mouthful of contrast media ( barium
sulphate paste) is given to patient and
patient is instructed to swallow once and
stop swallowing thereafter.
 Spot films are taken in frontal and lateral
projection.
 Patient performs valsalva maneuver in erect
position with nose closed.
 Frontal and lateral spots are taken to show
distended pyriform sinuses and vallecullae.

9.  Oesophagus-
 Single contrast- multiple mouthful of 80%
W/V barium suspension are given.
 Follow the barium bolus down the
oesophagus and observe the peristalsis
always in supine position.
 Films are exposed in erect position – RAO,
LAO, frontal and lateral views when the
oesophagus is well distended.
 The escape of contrast at the level of the
diaphragmatic hiatus should not be confused
for reflux.

10.  Mucosal film is taken in RAO after the
oesophagus is empty.
 Then fundus of stomach and GO junction are
assessed with spot film in different obliquities
in erect and recumbent position.
 Double contrast-
 Barium contrast should be high density, low
viscosity(200-250%).
 15-20 ml barium is given in the mouth and
patient is asked to swallow.
 Then , effervescent powder is given with
another mouthful of barium.

11.  In erect position , gas tends to stay up,
resulting in adequate distension which stays
foe longer time as compared to supine
position.
 Prone position also retains more gas within
the esophagus and gives adequate
distension.
 Hypotonia using Buscopan or glucagon
keeps the oesophagus keeps the
oesophagus distended for longer time .
 Filming is done in frontal , lateral, RAO, and
LAO.

12.  Introduction of gas for double contrast
studies can also be done through a tube
passed into upper oesophagus.
 Specific Condition –
 Dysphagia for both solids and liquid.
 Pharyngeal web
 Foreign body impaction ( marsh mallow
coated with barium is swallowed as whole).
The passage of marsh mallow will be
hindered at the level of obstruction

13.  In carcinoma ( high viscosity, normal density
liquid barium is given).
 Achlasia – the oesophagus should be
cleaned thoroughly( aspirate and wash) so
that secondary achlasia due to ca
oesophagus not be missed.
 Barium 80% W/V is used and patient is
studied in erect position .
 To differentiate achlasia, from other condition
showing abnormal peristalsis , mecholyl test
is done.

14.  Hiatus hernia- high abdominal pressure
required .
 Patient is asked to lie down , straighten legs
and then raise them up.
 Stomach should be well distended,
otherwise hiatus hernia may not be
demonstrated.
 Gastro – oesophageal reflux

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