This document provides information about radiological procedures used to examine the gastrointestinal (GI) tract. It discusses various imaging modalities like fluoroscopy, upper and lower GI tests, ultrasound, CT, MRI and angiography. Specific procedures examined include barium swallow, upper GI series, small bowel series, and barium enema. Contrast agents used include barium sulfate and iodinated contrast. Safety, side effects, doses, and appropriate use of different contrast materials are outlined. Key anatomical planes and regions visualized by different procedures are also mentioned.

1. Radiological
procedure of GI
Tract -01
Presentor
Miss Kajal Jha
BSC MIT(2016 BATCH)
Moderator
Mr Ranjit Kr Jha
Assistant Professor,
BPKIHS Dharan

2. Sagital plane
Transumbilical
plane
Sub costal
plane
Intertubercular
plane
Mid clavicular
plane

4. WHERE ARE YOU???
Liver, gall bladder Stomach,spleen,left
colic flexure
Stomach,
duodenu
m,pancre
ase
Aorta,IV,
Coils of
SI,Stoma
ch
Rt kidney and
ureter and
decending
colon
Caecum,vermi
form
appendix
Urinary
bladde
r,coils
of
SI,enla
rged
Lt kidney and ureter ,
decending colon
Sigmoid
colon

5. What is Gastrointestinal(GI)
tract?
Gastrointestinal
= stomach and intestines.
Tract
=a collection of related
anatomic structures or a
series of connected body
organs.

6.  The complete human digestive system is made up of the
gastrointestinal tract (esophagus, stomach, and
intestines) and the accessory organs of digestion
(the tongue, salivary glands, pancreas, liver and
gallbladder).
 The tract is divided as
 Upper GI tract and
 Lower GI tract

7. On embryologic grounds, the GI tract should be divided
into-
 upper (mouth to major papilla in the duodenum),
 middle (duodenal papilla to mid-transverse colon),
and
 lower (mid-transverse colon to anus)
according to the derivation of these 3 areas from the
foregut, midgut, and hindgut, respectively.

11. What types of tests are used to
examine the gastrointestinal tract?
1. Fluoroscopy
2. Upper GI test
1. Types of Upper GI Tests
1. Barium swallow (esophagography)
2. Upper GI series
3. Small bowel series
3. Lower GI test
1. Types of Lower GI Tests
1. Air contrast barium enema (also called double contrast
barium enema)
2. Barium enema

12. 4. Ultrasound
 Transcutaneous
 Endosonography
5. CT
6. MRI
7. Angiography

13. 8. Radionuclide imaging
 Inflammatory bowel disease
 Gastro-oesophagel reflux
 Gastric emptying
 Bile reflux study
 Meckel’s scan(A Meckel's scan is an imaging test used to detect a Meckel's
diverticulum. This is a small, abnormal pocket that forms in the wall of your child's small
intestine)
 Gastrointestinal bleeding

15. Fluoroscopy
 Fluoroscopy is a type of X-ray that allows part
of the body to be studied in motion and
recorded on a video monitor.
 This type of X-ray is used to examine the
gastrointestinal (GI) tract (esophagus,
stomach, small intestine, large intestine
(colon) and rectum) so that your physician
can detect abnormalities in the size, shape,
position or functioning of these organs.

16. Upper GI test
 the patient drinks a contrast solution that
contains barium.
 The barium solution is sweetened and
flavored, but does taste chalky.
 As the barium passes through the digestive
tract, it provides an outline of the swallowing
process as well as the esophagus, stomach
and part of the small intestine.

17.  This test is used to diagnose –
 hiatal hernias (Hiatal hernia is a condition in which the upper portion of the stomach
protrudes into the chest cavity through an opening of the diaphragm called the esophageal hiatus.
This opening usually is only large enough to accommodate the esophagus)
 ulcers, tumors,
 Diverticulitis (medical condition that causes inflamed pouches in the lining of your intestine)
 esophageal varices (Esophageal varices are enlarged veins in the esophagus.
They're often due to obstructed blood flow through the portal vein, which carries blood from the
intestine, pancreas and spleen to the liver),
 obstruction, narrowing, or enteritis (inflammation of the small
intestine lining).

18.  It may also be used to determine the causes
of swallowing problems, reflux, abdominal
pain, diarrhea, unexplained vomiting or
weight loss or bleeding

19. Contrast materials
 used to improve pictures of the inside of the
body produced by x-rays, computed
tomography (CT), magnetic resonance (MR)
imaging, and ultrasound
 allow the radiologist to distinguish normal
from abnormal conditions.
 are not dyes that permanently discolor
internal organs.

20.  are substances that temporarily change the
way x-rays or other imaging tools interact
with the body
 help distinguish or "contrast" selected areas
of the body from surrounding tissue. By
improving the visibility of specific organs,
blood vessels or tissues, contrast materials
help physicians diagnose medical conditions.

21.  Barium-sulfate is the most common contrast
material taken by mouth, or orally.
 It is also used rectally and is available in
several forms, including:
 powder, which is mixed with water before
administration
 liquid
 paste
 tablet

22.  used to enhance x-ray and CT images of the
gastrointestinal (GI) tract, including:
 pharynx
 esophagus
 stomach
 the small intestine
 the large intestine (colon)

23. How safe are contrast
materials?
 Contrast materials are safe drugs; adverse
reactions ranging from mild to severe do
occur but severe reactions are very
uncommon.
 While serious allergic or other reactions to
contrast materials are rare, radiology
departments are well-equipped to deal with
them.

24. Side effects and adverse and
allergic reactions
 tell your doctor if these mild side effects of
barium-sulfate contrast materials become
severe or do not go away
 stomach
 cramps
 diarrhea
 nausea
 vomiting
 constipation

25.  Tell your doctor immediately about any of
these symptoms:
 hives
 itching
 red skin
 swelling of the throat
 difficulty breathing or swallowing
 hoarseness
 agitation
 Confusion
 fast heartbeat
 bluish skin color

26. You are at greater risk of an adverse reaction
to barium-sulfate contrast materials if:
 you have a history of asthma, hay fever, or other
allergies, which will increase your risk of an allergic
reaction to the additives in the barium-sulfate agent.
 you have cystic fibrosis, which will increase the risk of
blockage in the small bowel.
 you are severely dehydrated, which may cause severe
constipation.
 you have an intestinal blockage or perforation that could
made worse by a barium-sulfate agent

27. BARIUM
 Barium suspension is made up of barium
sulphate.
 (barium carbonate is poisonous)
 BaSO4 is an ionic salt of barium (Ba), a
metallic chemical element with atomic
number 56.

28.  Unlike barium and many of its other salts,
barium sulfate is insoluble in water and
therefore very little of the toxic barium metal
is absorbed into the body.

29. Indications
It is the preferential contrast agent for
gastrointestinal (GI) examinations due to:
 high attenuation of x-rays
 lack of absorption from the gut into the body
 lack of toxicity (in the gut)

30. Contraindications
 known or strongly suspected gastrointestinal perforation
 may be used in evaluation for possible esophageal
perforations
 large volume aspiration risk
 prior allergic reaction (rare)
 left-sided colonic obstruction (relative contraindication)
 if the barium cannot exit the colon, it has the potential
to become inspissated and very hard, leading to a
quite problematic constipation

31. Complications
 may cause a peritonitis if they leak into the
peritoneal space.
 Barium migration into the bloodstream,
known as intravasation is a serious and rare
complication
 recent research suggests that these concerns
are unfounded and no case reports of
clinically-significant barium-induced
pleural/mediastinal inflammation exist.

32. Ba as Contrast agent
 A non ionic suspension is used(for otherwise
the barium particles would aggregate into
clumps)
 Ba particle size must be small(0.1-3
micrometer)
 The resultant solution has the PH of 5.3
which makes it stable in gastric acid.

33. Barium Studies For GI Tract
s/no Type of study Proprietary
name
Density(W/V) Volume
(ml)
Parts to be examined
1 Barium
swallow
E-Z HD 250% 100 Oesophagus
2 Barium Meal E-Z HD 250% 135 Stomach
3 Barium follow
through
E-Z Paque 60-100% 300 Small bowel
4 Small bowel
enema
E-Z Paque 60% 1500 Small bowel
5 Barium enema Polibar 115% 500 Rectum,sigmoid
colon,decening,transve
rse and acending
colon,caecum

35. Doses and concentration of
Barium Sulphate used
S/NO STUDY TYPE CONCENTRATION
(W/V)
APPROX.QUA
NTITY (ml)
1 Barium Swallow Single contrast 100% varriable
Double contrast
250%
varriable
2 Upper GIT study Single contrast 82-100% 300-350
Double contrast 200-250% 200
50% 500-600
3 Ba MFT
Enteroclysis
Single contrast 20% 800-1200
Double contrast 85% 200
4 Barium enema Single contrast 15-20% Varriable
Double contrast 60-110% varriable
5 CT Abdomen 1-5% 800-1000

36. Choice of contrast media
 Non ionic contrast media are the prefered
agents in almost all contrast rdiographic
studies:
 Low osmolarity
 Higher radiographic density
 Lower incidence of idiosyncreatic and nin
iodiosyncreatic reactions

37.  The only limiting factor in their widepread use
is their cost.
 The current trend is to weight the cost benefit
of use of various contrast media.

38. s/no study indication Agent used Comments
1 IVP Routine Ionic water soluble
contrast
Low cost
Congestive heart
failure in eldery
children
Non ionic water
soluble contrast
agents
Low osmolarity,
therefore less
hemodynamic impact.
Less water loss
through kidney
Atropy,asthama,p
revious drug or
contrast reaction
Non ionic water
soluble
Low incednce of
idiosyncrar=tic
reaction as compared
to ionic contrast agent
2 GIT
STUDIES
Routine single
contrast
95% w/v BaSo4
suspension
Routine double
contrast
250% w/v BaSo4
suspension

39. s/no study indication Agent used Comments
2
(contd)
Ba
Swallow
H/O aspiration in
child Non ionic
water
soluble
contrast
Because of its high osmolarity
ionic contrast agents draw
water into alveoli if aspirated,
causing sever pulmonary
odema. Therefore ionic
contrast agents are totally
contraindicated in these
conditions,and non ionic
agents are used
Suspected tracheo-
oesophageal fistula
Oesophageal
perforation
Ionic or non
ionic
contrast
agents
Leakage of BaSo4 into
mediastinum can lead to
mediastinal fibrosis
3 Ba Meal
or Ba
Enema
Routine BaSo4
suspension
•Abdominal trauma
•Perforation
peritonitis
•Post operative
Water
soluble
contrast
agent
Ionic or non ionic agents may
be used as BaSo4
suspension. Leakage can
cause peritoneal adhesion and
uretric or bowel obstruction

40. s/no study indication Agent used Comments
3 Ba Meal or Ba
Enema
Pre operative Water soluble
contrast agent
Study with BaSo4
suspension will
preclude any abdominal
surgery for 7 days
Meconium ileus Ionic contrast
agent
Because of their high
osmolarity these agents
draw water into bowel
lumens and can soften
the meconium and
relive obstruction.

41. s/no study indication Agent
used
Comments
4 Follow
through
examination
Suspected
large bowel
obstruction
Water
soluble
contrast
BaSo4 suspension can cause
impaction because of water
resorption in colon. Ideally in these
conditions a barium enema or
colonscopic examination must be
done. If, however , an oral follow
through contrast examination is
indicated a water soluble contrast
agent should be used.
5 angiography Cerebral
angiograph
y routine
Non ionic
contrast
media
•Non ionic contrast media are more
comfortable in a conscious patient
as they cause less vasodialation
•Na+ containing ionic contrast
agents are toxic to vascular
endothelium and may cause
disruption of BBB and cerebral
odema. So if ionic contrast are used
meglumine salts are prefered over
Na+.

42. s/no study indication Agent
used
Comments
5 angiogr
aphy
Renal
arteriography
Non ionic
contrast
media
Ionic contrast media can causse renal
tubular damage and therefore best
avoided for this application.
Coronary
arteriography
Nonionic
contrast
media
•They have safe hemodynamics and
myocardial profile.
•Experimental research suggests that
addition of Na + to these agents reduce
the risk of arrhythmias associated with
the procedures.
Ionic
contrast
agents
•If use, these agents should have
physiological level of Na+ which reduces
the risk of arrhythmias.
•Pure solutions of both meglumine and
Na+salts is cardiotoxic, therefore a
combination of the two should be used.
•Should have Ca++ binding property,
therefore Ca++ EDTA is used as a
stablising agent instead of Na+EDTA.

43. s/no study indication Agent used Comments
5 angiography Peripheral
arteriography
routine
Non ionic
contrast
agent
Prefered as they cause less pain,
warmth and discomfort and obviate
the need of general anethesia.
Ionic dimer
agent(Hexa
brix)
Second best to non ionic contrast
agents, but have toxicity for vascular
endothelium because of Na+
content.
If used, meglumine containing salts
are prefered as Na + containing
salts are toxic to vascular
endothelium and cause more pain
Ionic
monomers
Angiography
with
angioplasty
Ioxaglate(H
exabrix):
It is preferred agent for angiography
because of its antip;atelet and
antithrombotic action.
Ionic dimer Bacause of its Na+ content, it
maintains physiological level of Na+
and therefore preferred in coronary
interventions.

44. s/no study indication Agent
used
Comments
5 Angiograph
y
Peripheral
angiography
in patient with
previous
sever
contrast
reaction
CO2 CO2 has been used as a negative
contrst for peripheral angiography using
digital substraction unit with varriable
results.
Renal or
peripheral
angiography
ina a patient
with renal
failure
Gadolini
um
chelates
Radiodensity of Gd is less than iodine
and their cost is high. But theoritically
Gd chelated can be used in patients
with renal failures, because of their safe
profile in such patients.
6 CT Routine
abdominal
scanning
Iodinate
d
contrast
agent 2-
5 % w/v
Poor taste and acceptance by the
patiens.
Because of osmotic movement of water
across the bowel mucosa, there is
dilution of contrast at the interphase of
mucosa and bowel lumen. Therefore
mucosal delineation is less clear
compared to BaSO4 suspension.

45. s/no study indication Agent used Comments
6 CT
Routine
abdominal
scanning
BaSO4 suspension 1-
3%
Gives better delineation
of mucosa than
iodinated water soluble
agents.
water Gives excellent bowel
wall details when used
with intravascular
contrast enhancement
in high resolution fast
scanning syatem

46. Pharynx and oesophagus

47.  Pharynx, (Greek: “throat”) cone-shaped
passageway leading from the oral and nasal
cavities in the head to
the esophagus and larynx.
 The pharynx chamber serves both
respiratory and digestive functions.
 Extends from base of the skull to the T6.

48.  The anterior portion is the nasal pharynx, the
back section of the nasal cavity.
 The nasal pharynx connects to the second
region, the oral pharynx, by means of a
passage called an isthmus.
 The oral pharynx begins at the back of
the mouth cavity and continues down the throat to the
epiglottis, a flap of tissue that covers the air passage
to the lungs and that channels food to the esophagus

49.  The third region is the laryngeal pharynx,
which begins at the epiglottis and leads down
to the esophagus.
 Its function is to regulate the passage of air to the
lungs and food to the esophagus.

50.  The oesophagus is a fibromuscular tube,
approximately 25cm in length, that transports food
from the pharynx to the stomach.
 It originates at the inferior border of the cricoid
cartilage (C6) and extends to the cardiac orifice of
the stomach (T11).
 The oesophagus passed via a hole in the
diapgragm called oesophageal hiatus which is
situated at the level of the 10th thoracic vetebra

51.  Oesophageal Sphincters
 There are two sphincters present in the
oesophagus, known as the upper and lower
oesophageal sphincters.
 They act to prevent the entry of air and the
reflux of gastric contents respectively.

52.  Upper Oesophageal Sphincter
 The upper sphincter is an anatomical, striated muscle
sphincter at the junction between the pharynx and
oesophagus.
 Normally, it is constricted to prevent the entrance of air into
the oesophagus.
 Lower Oesophageal Sphincter
 The lower oesophageal sphincter is a physiological
sphincter located in the gastro-oesophageal
junction (junction between the stomach and
oesophagus)..

53. Recommended imging
procedures
 Ba examination/endoscopy (most common)
 Radionuclide imaging(to acess gastro-
oesophageal reflux)
 Ct and MRI (to determine the extent of
oesophageal carcinoma and for radiotherapy
planning)

54. Barium swallow
Normal Ba Swallow
Barium swallow showing
esophageal dilatation and
beaking
Ba swallow showing
cervical stricture

55.  Indication
 Dysphagia (most common)
 Carcinoma of oesophagus
 Oesophageal strictures, varices and ulceration
 Hiatus hernia
 Oesophageal reflux
 Anaemia
 Pain
 Assessment of tracheo-oesophageal fistulae
 Assessment of site of perforation

56. Contraindication
 Oesophageal perforation esulting in leakage
into mediastinal,pleural or periotenal cavities
 In such case it is normal to commene the
examination using a water based ionic contrast
agent.

57. Preliminary film
 A control film is advised prior to a water
soluble study if perforation is suspected.

58. Imaging technique
 The patient is in the erect, right anterior
oblique (RAO) position to throw the
oesophagus clear of the spine.
 An ample mouthful of barium is swallowed,
and spot films of the upper and lower
oesophagus are taken.
 Oesophageal varices are better seen in the
prone, right posterior oblique (RPO) position,
as they will be more distended.

59.  the patient is turned prone and placed in
the right anterior oblique position with a
bolster under the rib cage.
 The patient is observed drining barium via
straw to demonstrate the presense of hiatus
hernia.
 A hiatal hernia is when your stomach bulges up into your
chest through an opening in your diaphragm, the muscle
that separates the two areas. The opening is called
the hiatus, so this condition is also called a hiatus hernia.

60. Complications
1. Leakage of barium from an unsuspected
perforation
2. Aspiration.

61. Stomach and small bowel
 the stomach lies between the oesophagus
and the duodenum (the first part of the small
intestine). It is in the left upper part of
the abdominal cavity.
 The four main sections of the stomach are
the cardia, fundus, body, and pyloric part.

63.  The small intestine (small bowel) lies
between the stomach and the large intestine
(large bowel) and includes the duodenum,
jejunum, and ileum.
 The small intestine is so called because its lumen
diameter is smaller than that of the large intestine,
although it is longer in length than the large
intestine.

64.  The duodenum continues into the jejunum at
the duodenojejunal junction or flexure, which
lies to the left of L2 vertebra and is fixed to
the retroperitoneum by a suspensory
ligament of Treitz.
 The inferior mesenteric vein (IMV) lies to the
left of the duodenojejunal junction.

66.  From proximal (at the stomach) to distal,
these are the duodenum, jejunum, and ileum
 The shortest region is the 25.4-cm (10-
in) duodenum, which begins at the pyloric
sphincter.
 subdivided into four segments: the superior,
descending, horizontal, and ascending
duodenum.

67.  The jejunum is about 0.9 meters (3 feet)
long (in life) and runs from the duodenum to
the ileum.
 The ileum is the longest part of the small
intestine, measuring about 1.8 meters (6 feet)
in length.

68. Recommended studies
 Barium meal (to investigate the stomach and the proximal
portion of the small bowel.
 Hypotonic duodenography can provide
additional information where lesions of the
duodenogram are suspected including
lesions of the head of pancrease.
 Small bowel enema and barium follow
through( to examine the small bowel in its entirety)

69.  Fibreoptic endoscopy (examination of the upper GI Tract and
used particularly in the assessment of the gastric wall and assiociated
viscera)
 Radionuclied imaging(assess the rate of gastric
emptying.also in Mickel’s diverticulum and inflammatory bowel
disease)
 CT (to investigate mass lesion of assiociated structures such as
pancrease.)
 USG (can be used in the case of pyloric stenosis to measure the
antral wall thickness but isnot the modality of choice.)

70. BARIUM MEAL
 Methods
1. Double contrast – the method of choice to
demonstrate mucosal pattern.
2. Single contrast – uses:
 a. children – since it usually is not necessary
to demonstrate mucosal pattern
 b. to demonstrate gross pathology only

71. Indications
 1. Failed upper gastrointestinal endosocpy
 2. Dyspepsia
 3. Weight loss
 4. Upper abdominal mass
 5. Gastrointestinal haemorrhage (or unexplained iron-deficiency
 anaemia)
 6. Partial obstruction
 7. Assessment of site of perforation – it is essential that a
watersoluble
 contrast medium, e.g. Gastrografin or LOCM, is used.

72. Contraindications
 Complete large-bowel obstruction

73. Patient preparation
 1. Nil orally for 6 h prior to the examination
 2. It should be ensured that there are no
contraindications to the
 pharmacological agents used.
 Preliminary film
 None.

75.  The double contrast method:
 1. A gas-producing agent is swallowed.
 2. The patient then drinks the barium while
lying on the left side,supported by the elbow.
 This position prevents the bariumfrom reaching
the duodenum too quickly and so obscuring the
greater curve of the stomach.
Technique

76.  3. The patient then lies supine and slightly on
the right side, to bring the barium up against
the gastro-oesophageal junction.
 This manoeuvre is screened to check for reflux,
which may be revealed by asking the patient to
cough or to swallow water while in this position.
 The significance of reflux produced by tipping the
patient’s head down is debatable, as this is an
unphysiological position.
 If reflux is observed, spot films are taken to record
the level to which it ascends.

77.  4. An i.v. injection of a smooth muscle
relaxant (Buscopan 20mg or glucagon 0.3mg) is given.
 The administration of Buscopan has been shown not
to affect the detection of gastrooesophageal reflux or
hiatus hernia.
 5. The patient is asked to roll onto the right
side and then quickly over in a complete
circle, to finish in an RAO position.
 This roll is performed to coat the gastric mucosa
with barium. Goodcoating has been achieved if
the areae gastricae in the antrum are visible.

81.  From the left lateral position the patient
returns to a supine position and then rolls
onto the left side and over into a prone
position.
 This sequence ofmovements is required to
avoid barium flooding into the duodenal loop,
which would occur if the patient were to roll
onto the right side to achieve a prone
position.

82.  2. Spot film of the duodenal loop (lying):
 a. Prone – the patient lies on a compression
pad to prevent barium from flooding into the
duodenum.
 An additional view to demonstrate the
anterior wall of the duodenal loop may be
taken in an RAO position

83.  3. Spot films of the duodenal cap (lying):
 a. Prone
 b. RAO – the patient attains this position from
the prone position by rolling first onto the left
side, for the reasons mentioned above
 c. Supine
 d. LAO.

84.  4. Additional views of the fundus in an erect
position may be taken at this stage, if there is
suspicion of a fundal lesion.
 5. Spot films of the oesophagus are taken,
while barium is being swallowed, to complete
the examination

85. Aftercare
 1. The patient should be warned that his
bowel motions will be white for a few days
after the examination and may be difficult to
flush away.
 2. The patient should be advised to eat and
drink normally to avoid barium impaction.
Laxatives may be taken if required.
 3. The patient must not leave the department
until any blurring of vision produced by the
Buscopan has resolved.

86. Complications
 1. Leakage of barium from an unsuspected
perforation
 2. Aspiration of stomach contents due to the
Buscopan
 3. Conversion of a partial large bowel
obstruction into a complete obstruction by the
impaction of barium
 4. Barium appendicitis, if barium impacts in
the appendix (exceedingly rare)
 5. Side-effects of the pharmacological agents
used.

87. BARIUM FOLLOW-THROUGH
 Methods
 1. Single contrast
 2. With the addition of an effervescent agent
 3. With the addition of a pneumocolon technique.
 Indications
 1. Pain
 2. Diarrhoea
 3. Anaemia/gastrointestinal bleeding
 4. Partial obstruction
 5. Malabsorption
 6. Abdominal mass.

88.  Contraindications
 1. Complete obstruction.
 2. Suspected perforation (unless a water-soluble
contrast medium is used).

89.  Patient preparation
 Metoclopramide 20mg orally may be given before
or during the examination.
 Preliminary film
 Plain abdominal film is used if small bowel
obstruction is thought possible.

90. Technique
 The aim is to deliver a single column of
barium into the small bowel.
 This is achieved by laying the patient on his right
side afterthe barium has been ingested.
 Metoclopramide enhances the rate of gastric
emptying. If the transit time through the small
bowel is found to be slow, the addition of an
osmotic water-soluble contrast agent may help to
speed it up.

91.  If a follow-through examination is combined
with a barium meal, glucagon is used for the
duodenal cap views rather than Buscopan
because it has a short length of action and
does not interfere with the small-bowel transit
time.

92.  Films
 1. Prone PA films of the abdomen are taken every
15–20 min during the first hour, and subsequently
every 20–30 min until the colon is reached.
 The prone position is used because the pressure on
the abdomen helps to separate the loops of small
bowel.
 2. Spot films of the terminal ileum are taken
supine, using a compression pad.

93.  Additional films
 1. To separate loops of small bowel:
 a. compression with fluoroscopy
 b. obliques
 c. with X-ray tube angled into the pelvis
 d. with the patient tilted head down.
 2. To demonstrate diverticula: erect film – this
position will reveal any fluid levels caused by
contrast medium retained within the diverticula.

94.  Barium meal follow-through in the 70-year-old
patien

95. Lets ponder!!!
1. Preliminary film in any examination is taken
for:
I. To make adjustments in exposure factors
II. To check patient position
III. To demonstrate, identify and localise opacities
IV. All of above

96. II. Indication for water soluble contrast media
is:
a) Suspected perforation
b) Ileocaecal TB
c) Constipation
d) Gastroesophageal reflux disease

97. 3) Buscopan is contraindicated in all except:
1. Myasthenia gravis
2. Paralytic ileus
3. Pyloric stenosis
4. Open angel glaucoma

98.  Water insoluble contrast media is used in all
except:
1. Barium meal folloe through
2. Barium swallow
3. Sinogram
4. Barium eneme

99.  The method of choice to demonstrate
mucosal pattern in Ba studies is:
1. Single contrast
2. Non contrast
3. Double contrast
4. intravenous

100.  In Ba meal sequence antrum and body of
stomach are visualised in the position:
1. Supine
2. Left ant obq
3. Right post obq
4. Left lateral

101. Reference
 A guide to radiological procedures.
 Research gates
 Radiopedia
 Clark’s Special procedure in diagnostic imaging.
 Satish Bhargabhawa
 Radiology refrense articles
 BD Chaurasya anatomy book
 NCBI book Self
 MCQs in Radiology for Residents and Technologists-
Sumeet Bhargava and Satish K Bhargava

102. AIR AND FEELINGS ARE NOT ONLY THE
POWERFUL THINGS YET INVISIBLE. WE
HAVE SOMETHING MORE TO IT. NAME IT
X-RAY.
-Kajal Jha