GI system positioning / tipping

The specific five elements that must be permanently documented in the patient's chart following any fluoroscopic procedure

1. Route of contrast

2. Time of administration

3. Amount of contrast

4. Type of contrast

5. Total fluoro time

What are the 2 breathing exercises used in fluro?

1. Valsalva maneuver

2. Modified valsalva maneuver

The specific healthcare professional responsible for ensuring that an inpatient has strictly complied with all pre-examination preparation orders

Nursing Staff

The direct method by which a radiographer verifies pre-examination preparation compliance for an outpatient

Asking the patient directly as a core part of taking their history

The dynamic imaging tools obtained prior to contrast administration specifically to evaluate the effectiveness of the patient's bowel preparation

Scout Radiographs

An inert, water-insoluble positive contrast medium that does not dissolve in water but instead mixes with it to form a suspension

Barium Sulfate

The thickest physical form of barium sulfate, specifically utilized during specialized swallowing evaluation studies

Paste Form

Water-soluble iodinated compound solutions such as Gastrografin or Oral Hypaque used when standard barium is strictly contraindicated

Iodinated Media

The four distinct clinical scenarios where standard barium sulfate is strictly contraindicated and water-soluble iodinated contrast must be used instead

1. Impending abdominal surgery

2. Suspected perforation

3. High risk of barium impaction

4. Neonatal patients

The two primary clinical risks or body complications associated with administering water-soluble iodinated contrast media to a patient

Severe dehydration and Aspiration complications

The specific anatomical or structural abnormality during an esophageal examination where water-soluble iodinated contrast is explicitly contraindicated

Suspected Fistula

Malignant tumor arising from the lining of the esophagus

Carcinoma of esophagus

A negative contrast agent that increases the visibility of the mucosal lining by increasing image density in double-contrast studies

Air Contrast

An injected intravenous drug used to relax the GI tract, slow down peristalsis, and effectively reduce patient abdominal cramping during an exam

Glucagon

The involuntary contraction waves by which the digestive tube propels its internal contents toward the rectum

Peristalsis

The average number of peristaltic contraction waves that naturally occur per minute within a completely filled stomach

Three to Four Waves

The average physiological emptying time required for a standard, healthy adult stomach to completely clear

2 to 3 Hours

What patient position is this?

Supine

3 structures shown for a PA oblique RAO stomach

1. Entire stomach

2. Duodenal loop

3. Pyloric canal

What patient position is this?

Prone

What patient position is this?

Erect

Average transit time to ileocecal valve is

2 to 3 Hours

The four miscellaneous supplies that should always be proactively gathered in the room specifically for an Esophagogram or Upper GI series

1. Washcloth

2. Straw

3. Barium pill (or substitute)

4. Bucky slot shield

The specific action a radiographer must take regarding the fluoroscopy table and Bucky tray layout during preliminary room setup

Bring the radiographic table to a fully vertical position and ensure the Bucky tray is moved completely out of the way

The fundamental clinical rule regarding gonadal shielding during digestive system radiographic imaging

Shielding should be used on all children and adults of reproductive age whenever smaller IR are used- or per site protocol

The two alternative medical names used interchangeably within clinical facilities for a Modified Barium Swallow Study

Swallowing Dysfunction Study or Videofluoroscopic Swallow Study (VFSS)

The specific clinical team required to be physically present to conduct a diagnostic Modified Barium Swallow Study

Speech therapist, Radiologic technologist, and Radiologist

The proper patient and part positioning for a lateral view MBSS

Seated or standing in a true lateral position with shoulders depressed and the midcoronal plane perpendicular to the image receptor

The required collimation radiation field boundaries for a diagnostic lateral view MBSS

From the level of the external acoustic meatus (EAM) down to the jugular notch

The specific anatomical structures that must be clearly shown on a diagnostic lateral view MBSS image

Contrast-filled mouth, pharynx, and cervical esophagus

The CR for AP projection MBSS

At the level or just below the laryngeal prominence

The main diagnostic purpose of obtaining an AP view during an MBSS evaluation

Demonstrating unilateral structural or functional abnormalities

The preliminary patient preparation or dietary restriction required before starting a standard esophagogram

No Prep Required

The standard weight-to-volume percentage of low-density barium used during a single-contrast esophagogram

60% Weight/Volume

The standard weight-to-volume percentage of high-density barium used in conjunction with carbon dioxide crystals for a double-contrast esophagogram

210% to 250% Weight/Volume

CR and IR size for an AP or PA projection of the esophagus

MSP at T5-T6 using a 14x17 or 7x17

The patient position, body rotation, and CR for an RAO esophagus projection

Rotated 35 to 40 degrees with CR entering 2 inches lateral to the MSP at level of T5-T6

The key anatomical placement criterion for a diagnostic RAO esophagus projection

Esophagus filled with barium between the vertebrae and the heart

The precise CR and patient positioning for a lateral esophagus projection

CR perpendicular to MCP at level of T5-T6 with the patient in a right or left lateral position and arms moved forward away from the body

The four diagnostic testing methods or maneuvers used during fluoroscopy to actively detect esophageal reflux

1. Breathing exercises (Valsalva)

2. Water test

3. Compression technique

4. Toe-touch maneuver

The maneuver where a patient takes a deep breath and bears down as if trying to move the bowels to induce reflux

Valsalva Maneuver

The maneuver performed by having the patient close their mouth, pinch their nose closed, and try to blow out against the resistance

Modified Valsalva Maneuver

The diagnostic reflux test performed with the patient in a slight LPO position swallowing water to observe the esophagogastric junction under fluoroscopy

Water Test

The reflux detection method where an inflated paddle is placed under the stomach with the patient in a prone position to apply localized pressure

Compression Technique

A dual-purpose maneuver that is highly effective for radiographically demonstrating both gastric reflux and a hiatal hernia

Toe-Touch Test

A diagnostic evaluation of the distal esophagus, stomach, and small intestine using ingested contrast media

Gastrointestinal Series (GI Series / UGI)

The strict pre-examination dietary instructions required of a patient prior to an Upper GI series

NPO after midnight or for at least 8 hours before the exam

The two common habits that are strictly restricted prior to an Upper GI series because they stimulate unwanted gastric secretions

Smoking and chewing gum

An evaluation that combines both single-contrast and double-contrast methods during the exact same Upper GI procedure

Biphasic Examination

The proper patient positioning, CR, and breathing instructions for an AP scout image of an Upper GI

Supine or prone, centered to MSP 3 inches above the iliac crest, on expiration

The specific anatomical areas demonstrated on a diagnostic PA projection of the stomach

Barium-filled stomach and duodenal loop, detailing size, shape, and position

The specific anatomical areas demonstrated on a diagnostic AP projection of the stomach

Contrast-filled fundus, delineation of the body/pylorus/duodenum, retrogastric portion of the duodenum/jejunum, and diaphragmatic herniations

The body rotation range and CR for a PA oblique RAO stomach

Rotated 40 to 70 degrees with CR at level of L1-L2

The precise part alignment and body rotation details for an AP oblique LPO stomach projection

Recumbent LPO rotated 40 to 70 degrees (average 45) , centered between xiphoid process and lower rib margin

In a lateral stomach, the right retrogastric space shown in _______

Recumbent right lateral

In a lateral stomach, the left retrogastric space shown in _______

upright left lateral

The specific anatomical regions highlighted on an AP oblique LPO stomach projection

Fundic portion of the stomach, duodenal bulb, and C-loop

The required central ray centering level for a right lateral stomach projection in both recumbent and upright positions

Centered at L1-L2 for recumbent position, L3 for upright position

The three administration routes used to introduce contrast media into the small intestine

1. Orally

2. Reflux filling via a large-volume barium enema

3. Direct injection via a tube (Enteroclysis)

The most common clinical method utilized to perform a standard small bowel series

Oral Method

The strict dietary and mechanical prep required before a small bowel series

NPO after the evening meal, a low-residue diet for 1 to 2 days prior, a cleansing enema, and emptying the bladder immediately before the exam

The exact image receptor centering adjustments required for a timed small bowel series based on the time interval

Centered 3 inches above the iliac crest for the 30-minute interval image, and centered directly at the iliac crest for all subsequent delayed images

The technical definition and visual marker that signifies the completion of a small bowel series

Opaque contrast reaches the ileocecal valve and visualizes progressive filling of the cecum

The maximum temperature to which a barium enema mixture may be warmed to prevent thermal injury to the bowel mucosa

Body Temperature (never warm above this)

The primary and most crucial patient preparation requirement before performing a retrograde barium enema examination

The colon must be exceptionally clean and entirely free of residual fecal material

A full dietary and mechanical bowel preparation regimen required of an outpatient the days leading up to a barium enema

Low-residue diet and increased fluids for 2-3 days, clear liquids for 24 hours, a cathartic the afternoon before, NPO for 8 hours minimum, and a cleansing enema the morning of the exam

The maximum fluid volume capacity of a standard disposable barium enema bag

3 Quarts (3000 mL)

The crucial radiation safety rule regarding the inflation of a retention catheter balloon tip during a barium enema

The balloon must be inflated using fluoroscopy just before the exam, limited to one complete squeeze of the inflator (approx. 90 mL)

The immediate dual-step action a radiographer must take after all barium enema radiographs have been successfully acquired

Deflate the retention balloon completely first, then carefully remove the enema tip

The precise central ray alignment, image receptor placement, and air-contrast orientation for a lateral decubitus large intestine projection

Horizontal central ray perpendicular to a 14 x 17 inch IR centered to the level of the iliac crests with the side of interest positioned "up"

The specific colon walls demonstrated on a right lateral decubitus position of the large intestine

Medial side of the ascending colon and the lateral side of the descending colon

The specific colon walls demonstrated on a left lateral decubitus position of the large intestine

Lateral side of the ascending colon and the medial side of the descending colon

The body rotation angle and central ray entry point for AP/PA oblique projections of the large intestine

Rotated 35 to 45 degrees, CR centered 2 inches lateral to MSP at level of elevated iliac crest

The 5 specific colon anatomy and flexure demonstrated by the LPO/RAO oblique large intestine projections

1. Entire colon

2. Right colic flexure (hepatic flexure)

3. Ascending colon

4. Cecum

5. Sigmoid colon

The 3 specific colon anatomy and flexure demonstrated by the RPO/LAO oblique large intestine projections

1. Entire colon

2. Left colic flexure (splenic flexure)

3. Descending colon

The CR angling required to clearly demonstrate the axial rectosigmoid area

Angled 30 to 40 degrees cephalad when the patient is supine, angled 30 to 40 degrees caudal when the patient is prone, at MSP on level of ASIS

The proper patient positioning and CR for a lateral rectum radiograph

Left lateral recumbent position, central ray entering 1 inch below the ASIS

A specialized radiographic exam where barium is carefully administered through a patient's stoma using a cone-shaped tip or small catheter to evaluate healing or new lesions

Colostomy Study (Loopogram)

A fluoroscopic study of the anus and rectum performed during the rest, strain, and evacuation phases of defecation

Defecography

The specialized patient preparation and high-density contrast media rules required for a defecography procedure

No advance bowel preparation required; uses a very high-density barium sulfate mixture sometimes mixed with potato starch

The five key discharge instructions that must be explained to a patient following any diagnostic barium GI study

1. Explain that stools will be white

2. drink lots of fluids

3. increase dietary fiber

4. take a mild laxative

5. Notify a physician if no bowel movement occurs within 24 hours to 3 days

The general respiratory instruction rule applied to all digestive system radiographs, with one specific procedural exception

All radiographs are taken on complete expiration, except for the RAO esophagus

What position was this patient in?

Prone (PA)

Which position was this patient in?

Supine (AP)

What view is this?

AP MBS

What is this?

Carcinoma of esophagus

What is this?

AP/PA esophagus

What is this?

Oblique esophagus

What is this?

Lateral esophagus

What is this?

Diverticulum in duodenum

What view is this?

PA Stomach

What view is this?

AP Stomach

What view is this?

PA Oblique RAO stomach

What view is this?

AP Oblique LPO stomach

What view is this?

Lateral stomach

What view is this

AP/PA small bowel

What view is this?

Right lateral decub large intestine

When doing stomach exams, is it more common to do left lateral or right laterals?

Right lateral

What is this?

Left lateral decub large intestine

What view is this? Is patient in RAO or LAO?

PA oblique RAO large intestine