thick barium 3-4:1(3 or 4 tbsps of barium against one cup of water)
what are the contraindications to barium
it sohuld not be used if the patient has a history of perforations or lacerations in the body (viscus)
if the patient is pre surgical for surgery
or if they are allergic to barium
what should be used if the patient is allergic to barium
what happens if they allergic to iodine
water soluble iodine contrast
if allergic idoine do not use a water soluble iodine contrast
does barium dissolve in water or is it water soluble
no
when should you not use water soluble iodinated contrast
if the patient is allergic to iodine and has a history of dehydration
what is an example of an iodinated contrast media
MD-gastroview
what is the purpose of a double contrast UGI
to visualize gastric mucosa
where is the most amt of radiation when flouoring
at the patients head and feet are
where must the bucky be when doing the fluoro
must be moved all the way to the head end of the table
what is the purpose of a charged couple device
it changes an analog signal intoa digital signal
Fluoroscopy exposure patterns are aka
isodose curves
what three positions visualize barium in the pylorus region of the stomach
which position is best to view the duodenal bulb filled w/barium
ap rao and right lateral
RAO = best or RT lateral
what is the patient prep for an upper GI
the patient must be ___
do not eat drink smoke or chew gum the midnight before the exam
any antispasmodic medications should be discontinued 24 before the exam
NPO 8 hrs prior
what is the patient prep for an esophagram
there is no prep for the patient except during the exam the patient must wear a hospital gown and remove all metal from the waist up
how should we begin the introduction for an esophagram exam and what is the room prep
introduce yourself (what exam is about)
get history allergies and pregnancy
explain the exam
scout films
Room:
should be clean
Fluoro timer set to 5 mins
lead aprons available for everyone
bucky tray at the end of the table
foot rest test for security
tissue towels emesis basins straws and a waste receptacle if needed
what is the scout film for a Upper gi and esophogram
upper gi: ap abdomen
esophagram: pa chest
what are the instructions for administering a double contrast agent to the patient how should we do it
First have the barium in one cup already mixed with water
then have the patient drink the gas crystals first mix the gas crystals w/2tbsps of water and pour crystals in cup and give to patient immediately to drink
then give the pt the barium cup
then lie patient in an ap
what are the routine positions for the UGI
what is the special position for the UGI
AP LPO PA RAO RT Lateral
Ap trendelenberg
how much kv do we need for an esophagram, STL, UGI
double and single contrast
esophagram:
Single:100-125
double:100-125
STL: 60-70
UGI
single:100-125
double: 80-100
In an RAO prone of the UGI the air is in the _____ and the barium is filled where
fundus
barium is in pylorus region and barium filled in the duodenal bulb
what size cassette do we use for a PA UGI
when would you need a 14x17
10x12 or 11x14
if the small bowel is to be included
the breathing technique for all UGI positions is what
suspend respiration on expiration
how would you do a pa if you had a hypersthenic patient and their stomach was more transverse and higher in position
angle the tube 35-45 deg cephalad
where is the CR for all positions of the UGI except the right lateral
at level of 1 (2 inches above lower lateral rib margin & 1 inch to the left of the vertebral column
where is the CR for a right lateral UGI
still centered at l1 (2 inches above lower lateral rib margin) & 1.5 in anterior to midcoronal plane
why do you need less kvp in double contrast examination
because there is less barium and it is mixed with air so it is not as thick and needs less penetration
what is the degree of obliquity for an RAO UGI
if the patient was hypersthenic, asthenic or average what is the degree of obliquity for each
40-70 degrees for anterior obliques
hypersthenic = 70
asthenic = 40
average (sthenic) =45
what is the rule of thumb when obliquing the patient in and RAO or LPO position of the UGI in regards to body habitus (hypersthenic and asthenic)
if the patient is hypersthenic the pt needs more oblique rotation
if the patient is asthenic (really thin long) the pt needs less oblique rotation
what is the degree of obliquity for an LPO UGI if the patient was hypersthenic asthenic or average list the obliquity for each
30-60 deg oblique for posterior obliques
hypersthenic 60 deg
asthenic 30 deg
average 45 deg
in any position of the UGI where would you center if the patient was either hypersthenic (broad short or fat) or asthenic (tall skinny)
hypersthenic: 2'' higher around level of t12 because there stomach is more transverse
asthenic: 2'' lower at level of L2 because there stomach extends downwards towards the bladder because of the height
what is the only position of the stomach where you see the pyloric region posterior to the stomach
RT lateral UGI
with most positions of the UGI the bottom of the cassette can be place where when centering
at the crests
when would you use the alternative trendelenberg position on an AP UGI
when it is necessary to fill the fundus with barium on a thin asthenic patient
the jejunum has an appearance of what
feathery apperance with barium in it
what position is this
pa
what position is this
RAO prone b/c notice obliquity of the spine
what position is this
ap barium in the fundus air in pylorus regions
what position is this
LPO b/c the barium is in the fundus and the spine is rotated indicating it is not an ap and air is filled in the duodenal bulb and pylorus regions
what position is this
right lateral b.c of position of spine and barium in the pyloric and duodenal regions air in the fundus
what is the choice of barium for a UGI
thin barium mainly but you can use thick
what is the choice of barium for an esophagram
thick and thin barium
what is AIDET
A - acknowledge patient
I -introduce yourself
D - discuss duration of procedure
E - explain procedure
T -thank the patient
a full trendelenberg position when doing an upper GI is used to demonstrate what pathology