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Digestive system procedures
Esophagus
Barium Swallow
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Digestive system procedures
Stomach and Duodenum
S & D, UGI, Barium Meal
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Digestive system procedures
Small Intestine
Follow Through Enteroclysis
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Digestive system procedures
Large Intestine
Barium Enema
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Digestive system procedures
Salivary Glands
Sialogram
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Alimentary canal begins at
oral cavity, continues as the pharynx, esophagus, stomach, small intestine, large intestine and terminates as the anus
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Barium Swallow
Esophagus
Procedure
using contrast to visualize and evaluate the esophagus
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Barium Swallow
Esophagus
To investigate
lesions, esophageal varicies, foreign bodies, obstructions, strictures, size, shape, position, function
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Barium Swallow
Esophagus
Contrast
barium sulfate or Gastrografin (Do not use Gastrografin if suspected perforation in esophagus)
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Barium Swallow
Esophagus
Anterioposterior/Posteroanterior Projection
Patient Postion
Patient erect or recumbent
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Barium Swallow
Esophagus
Central Ray
CR: T5/T6 midsagittal plane
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Barium Swallow
Esophagus
Lateral View
Patient Postion
Patient erect or recumbent
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Barium Swallow
Esophagus
Lateral View
Structures
Structures seen are the lower neck to esophagastric junction
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Barium Swallow
Esophagus
Lateral View
Central Ray
CR: ┴ to T5/T6
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UGI, Barium Meal, S & D
Stomach+ Duodenum
Procedure
using contrast to visualize and evaluate the stomach and duodenum
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UGI, Barium Meal, S & D
Stomach+ Duodenum
To investigate
reflux, peptic ulcers, hiatus hernia, neoplasms, pyloric stenosis
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UGI, Barium Meal, S & D
Stomach+ Duodenum
Patient prep
NPO from midnight – decrease gastric juices that may dilute barium
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When would you book a diabetic patient for a UGI,Barium Meal,S&D?
Book patients with diabetes ASAP in am
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UGI, Barium Meal, S & D
Stomach+ Duodenum
Contrast: Single
used only for small children or very ill patients
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UGI, Barium Meal,
S & DStomach+ Duodenum
Contrast: Double
barium sulfate and gas pills (allows mucosal lining to be better visualized)
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What makes for a good exam when doing a UGI,Barium Meal,S&D Stomach
Patient communication and instruction from technologist is essential for a successful examination
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UGI, Barium Meal,S & D
Stomach+ Duodenum
Posteroanterior Projection
Greatest movement of stomach
is in asthenic patient (upright to prone)
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UGI, Barium Meal,
S & DStomach+ Duodenum
Posteroanterior Projection
Demonstrate
To demonstrate hiatal hernia perform in Trendelenburg position
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Salivary Glands
Sialography
Location of the Gland
Parotid Gland
inferior and anterior to EAM
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Salivary Glands
Sialography
Location of the Glands
Submandibular Gland
medial to the rami of the mandible
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Salivary Glands
Sialography
Location of the Gland
Sublingual Gland
underneath the tongue
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Salivary Glands
Sialography
Procedure
using contrast to visualize the salivary glands and ducts
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Salivary Glands
Sialography
Contrast
water soluble iodinated contrast – injected into the gland using a cannula
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Salivary Glands
Sialography
Demonstrates
lesions, tumors, fistulae, diverticulae, strictures, and calculi
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Salivary Glands
Sialography
Preliminary images
- taken to detect pathologies visible without contrast and establish optimum exposure technique
- * Lemon used as a secretory stimulant – given to patient prior to exam to open ducts and post exam to clear the duct of contrast media
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LargeIntestine
Barium Enema
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LargeIntestine
Barium Enema
Post Evacuation
AP / PA performed after patient empties their bowels
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LargeIntestine
Barium Enema
Left Lateral Decubitus
– AP / PA Projection
- Double contrast
- Raise patient onto sponge if necessary
- Horizontal beam
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LargeIntestine
Barium Enema
Left lateral Decubitus
-AP/PA Projection
Central Ray
CR: ┴ to iliac crest at the midline
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LargeIntestine
Barium Enema
Left Lateral Decubitus
– AP / PA Projection
Demonstrates Right side
Demonstrates the lateral side of the ascending colon (right side)
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LargeIntestine
Barium Enema
Left Lateral Decubitus
– AP / PA Projection
Demonstrates Left side
Demonstrates the medial side of the descending colon (left side)
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LargeIntestine
Barium Enema
Rectum ▼
Lateral View
Central Ray
CR: ┴ at level of ASIS on midcoronal plane
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LargeIntestine
Barium Enema
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LargeIntestine
Barium Enema
Rectum
Lateral View
Demonstrates
Demonstrates rectum and distal sigmoid portion of colon
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LargeIntestine
Barium Enema
Sigmoid ▼
Anteroposterior Projection /
Posteroanterior Projection
Central Ray
- CR ▼
- •AP 30-40° cephalad enter 2” below ASIS
- •PA 30-40° caudad exit at ASIS
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LargeIntestine
Barium Enema
Sigmoid ▼
Anteroposterior Projection /
Posteroanterior Projection
Demonstrates
Demonstrates the rectosigmoid area
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Large Intestine
Barium Enema
Right Posterior Oblique View /Left Anterior Oblique View
Patient Position
Rotate patient 35-45°
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Large Intestine
Barium Enema
Right Posterior Oblique View
/Left Anterior Oblique View
Central Ray
•CR: ┴ level of the iliac crest, 1-2” lateral from midline on the elevated side
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Large Intestine
Barium Enema
Right Posterior Oblique View/
Left Anterior Oblique View
Demonstrates
Demonstrates left colic flexure, desending colon
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Large Intestine
Barium Enema
Left Posterior Oblique View
/Right Anterior Oblique View
Patient Position
Rotate patient 35-45°
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Large Intestine
Barium Enema
Left Posterior Oblique View
/Right Anterior Oblique View
Central Ray
•CR: ┴ level of the iliac crest, 1-2” lateral from midline on the elevated side
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Large Intestine
Barium Enema
Left Posterior Oblique View
/Right Anterior Oblique View
Demonstrates
•Demonstrates right colic flexure, asending colon, cecum, sigmoid
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Large Intestine
Barium Enema
Left Posterior Oblique View/
Right Anterior Oblique View
•Valsalva
- whether at the nose and mouth or at the glottis Increases both intrathoracic and intraabdominal pressure
- Dysphagia Aspiration
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Large Intestine
Barium Enema
Tip Insertion:
- Place the patient in Sim’s position
- Communication with patient is essential
- Lubricate the tip heavily
- Instruct patient to exhale slowly
- Insert tip 3-4” past anal sphincter in an anterior then superior direction.
- Do not ever FORCIBLY PUSH the tip in against resistance.
- •Inflate balloon now if required (to hold tip in rectum)
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Large Intestine
Barium Enema
Procedure
using contrast to visualize and evaluate the large bowel
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Large Intestine
Barium Enema
To investigate
neoplasms, ulcerative colitis, diverticulosis, crohn’s, polyps, volvulus, intusseption
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Large Intestine
Barium Enema
Patient Prep
NPO 8-9hrs, low residue diet, laxatives, cleansing enema (when necessary)
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Large Intestine
Barium Enema
Contrast
single, barium (thinner mix) double, air and barium (thicker mix)
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Large Intestine
Barium Enema
Preliminary image
to clean bowel, contraindications
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Large Intestine
Barium Enema
Contraindications
gross bleeding, perforated bowel, obstruction/stricture or severe diarrhea
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SmallIntestine
Enteroclysis,Small Bowel Enema
- This radiographic procedure involves contrast media being injected directly into the duodenum under fluoroscopic control to exam the small intestine
- A Nasoenteric tube is used for this type of exam, inserted via nose or mouth
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SmallIntestineEnteroclysis,
Small Bowel Enema
3 phases of swallowing
Oral phase
moving the food/liquid to the back of the mouth
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SmallIntestineEnteroclysis
Small Bowel Enema
3 Phase of swallowing
Pharyngeal phase
moving the food/liquid over the back of the tongue and down to the pharynx or throat
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SmallIntestineEnteroclysis
Small Bowel Enema
3 Phases of swallowing
Esophageal phase
the food/liquid enters the esophagus
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SmallIntestine
Enteroclysis
Small Bowel Enema
Exam is suited for patients with
complains of swallowing, choking or regurgitating, or for patients who have had past episodes of pneumonia which have yet to be diagnosed
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SmallIntestine
EnteroclysisSmall
Bowel Enema
Identifies problems
- that occur in the mouth, at the base of the tongue, in the pharynx, or in the esophagus
- •Also provides information about tongue motion and coordination and timing of the swallow
- •Provides info on how material is managed orally just prior to the swallow and evaluates the mechanical aspects of the swallowing mechanism including airway protection and how well the material moves through the different phases of swallowing
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SmallIntestine
Follow Through,Small Bowel Series
Anteroposterior Projection /
Posteroanterior Projection
Patient Position
Patient supine or prone
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SmallIntestineFollow Through,Small Bowel Series Anteroposterior Projection / Posteroanterior Projection
Images taken after
15 to 30 minute intervals, use time markers
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SmallIntestineFollow Through,Small Bowel Series Anteroposterior Projection / Posteroanterior Projection
Demonstrates
•Demonstrates small intestine progressively filling with barium until it reaches the ileocecal valve
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SmallIntestineFollow Through,Small Bowel Series Anteroposterior Projection / Posteroanterior Projection
Trendelenburg positoin
•Trendelenburg position used to unfold loops of iliem in the asthenic patient
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SmallIntestineFollow Through,Small Bowel Series Anteroposterior Projection / Posteroanterior Projection
Central Ray
•CR: ┴ to iliac crest (centering will change as barium moves down)
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SmallIntestine
Follow Through,
Small Bowel series
Procedure
using contrast to visualize and evaluate the function of the small bowel
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SmallIntestine
Follow Through,
Small Bowel series
To investigate
Crohn’s, tumors, malabsorption disorder, ulcers, obstructions, FB, strictures
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SmallIntestine
Follow Through,
Small Bowel series
Patient Prep
NPO midnight onward – same as S&D
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SmallIntestine
Follow Through
,Small Bowel series
Contrast
Barium sulfate (or gastrografin if questioning perforations)
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UGI, Barium Meal, S & D
Stomach+ Duodenum
Right Anterior Oblique View
Patient Position
Patient prone and rotated 40-70°
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UGI, Barium Meal, S & D
Stomach+ Duodenum
Right Anterior Oblique View
Central Ray
- CR:Sagittal plane – ½ way between spine and left lateral border at L1/L2
- Hypersthenic patients – more rotation
- Gastric peristalsis more active in this position
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UGI, Barium Meal, S & D
Stomach+ Duodenum
Posteroanterior Projection
Greatest movement of stomach in
- asthenic patient (upright to prone)
- To demonstrate hiatal hernia perform in Trendelenburg position
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UGI, Barium Meal, S & D
Stomach+ Duodenum
Contrast▼
•Single
used only for small children or very ill patients
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UGI, Barium Meal, S & D
Stomach+ Duodenum
Contrast▼
Double
barium sulfate and gas pills (allows mucosal lining to be better visualized)
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UGI, Barium Meal, S & D
Stomach+ Duodenum
Contrast▼
Patient communication and instruction from technologist is essential
for a successful examination
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UGI, Barium Meal, S & D
Stomach+ Duodenum
Procedure
using contrast to visualize and evaluate the stomach and duodenum
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UGI, Barium Meal, S & D
Stomach+ Duodenum
To investigate
reflux, peptic ulcers, hiatus hernia, neoplasms, pyloric stenosis
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UGI, Barium Meal, S & D
Stomach+ Duodenum
Patient prep
- NPO from midnight – decrease gastric juices that may dilute barium
- * Book patients with diabetes ASAP in am
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UGI, Barium Meal, S & D
Stomach+ Duodenum
When should you book patient who have diabetes
first thing in the am
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What is the protection/ view
Anteriorposterior projection
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What projection or view
Right Anterior Oblique View
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What projection or view
Left Posterior Oblique View
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