1. Performing a Barium meal
Department of Diagnostic Radiology
23 March 2012
M. Pieters

2. Anatomy of the stomach
J-shaped
Varies in size and shape

3. Stomach in situ

4. Anatomy of the stomach

5. Anatomy of the stomach

6. Layers of the stomach
Three muscle layers, three mucosal layers

7. Arterial supply
Coeliac artery
Common hepatic artery

8. Posterior relations

9. Posterior relations

10. Anterior relations

11. Lesser sac

12. Venous drainage

13. Lymph drainage of the stomach

14. Stomach innervation

15. Barium meal

16. Indications Dyspepsia Weight loss GIT haemorrhage
Failed upper GIT endoscopy
Assessment of perforation site
Upper abdominal mass
Unexplained iron deficiency anaemia
Partial obstruction

17. Contra-indications
Complete large bowel obstruction

18. Complications
Aspiration
Intra-peritoneal leakage
Ba appenticites

19. Contrast agents
Barium Sulphate eg. E-Z HD 250%
Carbex granules

20. Patient preparation NPO 6hrs prior
History – no pharmacological contra-indications

21. Technique (Double contrast)
Position
Film
Action
Reasoning
Visualization
Erect/sitting -
Pt drinks fizzing agent
To distend the stomach
On left side
Screen
Pt drinks barium
Delays passage to duodenum
Greater curve
Supine, tilted to the right side
Cough or swallow H2O
Ba flows to GE-junction
Observe for reflux
Unchanged
IV muscle relaxant
Roll to right, complete circle, end supine, left tilt
Coating of the gastric mucosa
*RAO = Pt supine and slightly tilted to the left.
** When arae gastrica in the antrum are visible, good coating has been achieved.

22. Technique (Stomach Spot Films)AP
Position
Film
Action
Reasoning
Visualization
Supine, tilted to the left
RAO -
Antrum and greater curve
Supine PA
Antrum and body
Supine, tilted to the right
LAO
Lesser curve en face
On right side, head up 45o
Left lateral
Fundus
** When arae gastrica in the antrum are visible, good coating has been achieved.
!!!! ALSO ADD PICS of MODEL and EXAMPLES of IMAGES
@ Would happen if pt turned on right side then prone

23. Technique (Duodenal Spot Films)
Position
Film
Action
Reasoning
Visualization
Return to supine, on left side, then prone AP
Pt on compression pad
Avoid Ba flooding duodenal loop
AP of the Duodenal loop
Roll to right side, supine, then supine tilted to the left
RAO -
RAO of the Duodenal cap
Turn supine (shortest route) PA
PA of the Duodenal cap
Lie supine and tilted to the right
LAO
LAO of the Duodenal cap
** When arae gastrica in the antrum are visible, good coating has been achieved.
!!!! ALSO ADD PICS of MODEL and EXAMPLES of IMAGES
@ Would happen if pt turned on right side then prone

24. Technique (Erect Views)
Fundal lesion suspected
Position
Film
Visualization
Erect PA
Fundus
RAO
Duodenal cap and Fundus
LAO
** When arae gastrica in the antrum are visible, good coating has been achieved.
!!!! ALSO ADD PICS of MODEL and EXAMPLES of IMAGES
@ Would happen if pt turned on right side then prone

25. Technique (Oesophageal views)
Barium swallow to conclude exam
Either spot films or dynamic screening
Position
Film
Visualization
Erect
RAO
Oesophagus
** When arae gastrica in the antrum are visible, good coating has been achieved.
!!!! ALSO ADD PICS of MODEL and EXAMPLES of IMAGES
@ Would happen if pt turned on right side then prone

26. Bibliography
A Guide to Radiological Procedures 5th ed - Aitchison
Diagnostic and Surgical Imaging Anatomy: Chest.Abdomen.Pelvis - Federle
Anatomy for Diagnostic Imaging 3rd ed – Ryan
Atlas of Human Anatomy 5th ed – Netter
Atlas of anatomy – Gilroy
Web references:
/ugi/frame_set.htm