2. Fluoroscopic Investigations Of The Gastrointestinal Tract
( Introduction)

3. Learning objectives
With the end of this lecture the student will be able to:
Describe the anatomy of the digestive system, to include the pharynx, esophagus ,stomach, , large intestine ,and accessory organs
Discuss the orientation of the stomach according to body habitus, physical position and respiration
Identify the function of each of the structures of the digestive system
Describe room preparation and identify supplies needed for the examinations of the digestive system
Identify methods of evaluating the digestive system
State the criteria to evaluate the digestive system radiographs in term of positioning ,image quality, radiographic anatomy ,and pathology
Explain different types of contrast media used in GIT exams
Explain pharmacological agents used in GIT exams
Differentiate between Retrograde and Antegrade GIT studies

4. References Websites http://www.e-radiography.net/
Radiographic procedures: By Stephen Chapman
Positioning in Radiography: By k.C.Clarke.
Text book of radiographic positioning and related anatomy; by
Kenneth L.Bontrager 6th edition.
Websites

5. Basic Anatomy The Digestive system Consists of: Mouth Pharynx
Oesophagus
Stomach
Small Intestine
Large Intestine
Rectum & Anus
Accessory organs include
Tongue and Teeth
Salivary glands
Pancreas
Liver
Gall bladder & biliary tract

6. Physiology of the digestive system
Ingestion
Digestion
Absorption
Elimination

7. Investigations of the digestive system
Plain film Investigation
Barium Investigations
Radionuclide Imaging
Computerized Tomography
Magnetic Resonance Imaging
Angiography
Ultrasound
Non- Radiographic Investigations (Endoscopy)

8. Barium Investigations
Wide range of investigations can be performed
Can incorporate plain film & fluoroscopic equipment
Involves the use of contrast media
Can involve the use of pharmacological agents
What is the role of the Radiographer?

9. Radiographic Contrast vs. Contrast Media
Difference between adjacent densities in a radiograph.
The films or images have different levels of density – different shades of gray
Short (high)
Long (low)
MAJOR DIFFERENCES
SLIGHT DIFFERENCES

10. Radiographic Contrast vs. Contrast Media
Contrast Media: Diagnostic agents that are instilled into body orifices or injected into the vascular system, joints, and ducts to enhance subject contrast in anatomic areas where there is low subject contrast.
CONTRAST
X-RAY DYE
DYE

11. Purpose of Contrast Media
To enhance subject contrast or render high subject contrast in a tissue that normally has low subject contrast.

12. Contrast Media Properties
able to show organ better
physiologically
no permanent alteration of organ
non toxic and able to be eliminated / excreted
Negative contrast
Radiolucent
e.g. AIR
Low atomic # material
Black on film
Positive contrast
Radiopaque
e.g. BARIUM
High atomic Number
White on film

13. Contrast Media for GIT Exams
Barium Sulfate: BaSO4
High atomic number
Not soluble in water = suspension
Used to coat the lining of organs
Supplied in different thicknesses
Used
Esophogram, UGI, Small Bowel, Large Bowel
Contraindications
perforations of GI tract
proximal to an obstructed bowel
Precautions
adequate hydration post examination

14. Contrast Media for GIT Exams
Why use Barium Sulphate?
It has a high atomic number (Z=56)
Non-toxic
Relatively cheap
body cannot metabolize BaSO4

15. Gastrografin or Hypaque
Contrast Media for GIT Exams
Gastrografin or Hypaque
High atomic #
Close to iodine
Water soluble
Similar usage as Barium
Water soluble, safe in the abdominal cavity
Safe to use if perforation is suspected

16. Pharmacological agents
Buscopan
Glucagon
Maxalon
Carbex
Methyl cellulose
Why are they given?

17. Pharmacological agents
Purpose
Buscopan (20mg iv)
Relax smooth muscles (Useful in barium enema examinations)
Glucagon (0.3mg iv)
Relax smooth muscles ( Used for patients with glaucoma & cardiovascular disease) Useful in barium enema examinations
Maxalon (20mg iv/oral)
Increases gastric peristalsis (useful in follow through examinations)
Carbex ( Tablets)
Gas producing Agent ( For double contrast Ba Meal)
Methyl cellulose ( Syrup)
For small bowel double contrast exams

18. GI Contrast Studies Antegrade studies (with the normal flow)
esophagus, stomach, small bowel
Contrast (Barium / barium + air /Oral iodine solution
BaSO4 Only
BaSO4 + Air

19. GI Contrast Studies Retrograde studies (against the flow)
Colon ( Large Bowel)
Contrast barium / barium + air
Barium + Air
Barium Only

20. GI Contrast Studies (Supplies)
Esophagus
Contrast media
Straw and spoon
Cotton balls
Emesis basin
Small bowel
Contrast media ( 2 large glasses)
Straw
Gas producing substance ( carbonated drink )
Emesis basin
Timer
pharmacological agents
Upper GIT
Contrast media
Straw and spoon
Gas producing substance ( carbonated drink )
Emesis basin
pharmacological agents
Barium enema
Contrast filled enema bag
Enema tip
Lubricant
Disposable gloves
Towels
Sheets/blankets
compression paddle
pharmacological agents

21. GI Contrast Studies (Preparation)
Common patient preparation aspects for barium investigations
What would you check?
Identification, request form.
Pregnancy check (10 day rule)
Review of previous examinations
Allergy check
Abdominal preparation
?Diabetic patients (adjustment in appointment time & preparation prior to examination)
Psychological preparation for examination

22. GI Contrast Studies (Preparation)
Summary of abdominal preparation ( Adults)
Esophagus
No preparation needed
Small bowel
NPO after evening meal
low residue diet 1-2 days prior to exam
Cleaning enema
Empty bladder
Upper GIT
NPO after midnight ( At least 8 hours prior to
exam
No gum chewing
No smoking
Barium enema
low residue diet 2-3 days prior to exam
Increased fluid intake 2-3 days prior to exam
Cleared liquid diet 24 hours prior to exam
Cathartic the afternoon before the examination
Cleaning enema
Empty bladder

23. GI Contrast Studies (Preparation)
Summary of abdominal preparation ( Paediatrics)
Esophagus and Upper GIT
NPO 3-4 hours prior exam
0-2 years
NPO 6 hours prior exam
> 2 years
Esophagus and Upper GIT
No preparation
0-2 years
Low residue diet evening meal
Mild laxative with water at bed time
2-10 years
As for 2-10 years patients with doubling the
dose of laxative
> 10 years

24. GI Contrast Studies (Breathing Instructions)
To reduce the stress of the abdomen that could lead to involuntary motion,
all radiographs are obtained during suspended respiration.
Special breathing techniques are used to increase the Intrathoracic and
intra abdominal pressure
Valsalva maneuver
While holding the breath on deep inspiration , the patients bears down as if trying to move the bowels

25. GI Contrast Studies Equipment consideration
Tilting table (+/-90 degrees)
Rapid film recording facilities
Special feeding accessories
Fluoroscopic unit (normally digital)
Additional over couch tube
Lead aprons and gloves
Sponges and other supports

26. GI Contrast Studies (Radiation protection)
ALARA principle (Minimise dose to patient /staff)
Utilise pulsed fluoroscopy where appropriate
Record patient dose & imaging times
Record any faults with equipment / regular QA
Practical collimation
Adhere to clinical protocols (minimum no of films / dose)
Always read patient history / notes

27. GI Contrast Studies (Plain Films)
Before barium Studies Plain Films are required To Assess:-
Trauma
Small / Large Bowel Obstruction
Constipation
Palpable Mass
Acute Gastro-intestinal Bleeding
Perforation (include. Chest radiograph)

28. GI Contrast Studies(Plain Films)
Plain films showing Obstruction

29. THANK YOU