GI Tract positioning

Preparing the room, equipment, and contrast media prior to patient arrival, assisting with gowning/artifact removal/procedure explanation, obtaining history, acquiring a scout, communicating with the patient, and assisting the fluoroscopist

Radiographer Responsibilities

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

Route of contrast, Time of administration, Amount of contrast, Type of contrast, and Total fluoro time

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

The specific medical professional who retains sole authority to determine the alternative use of water-soluble iodinated media over barium sulfate

Radiologist

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

The average transit time required for contrast to travel from the stomach through the entire small intestine to the ileocecal valve

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

Washcloth, Drinking straw, Barium pill (or substitute), and 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

A dynamic videofluoroscopic procedure performed in direct conjunction with a speech therapist to evaluate swallowing mechanics

Modified Barium Swallow Study (MBSS)

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 centering landmark for the image receptor and central ray during an anteroposterior (AP) projection MBSS

At the level of 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

The precise central ray entry point and image receptor size for an AP or PA projection of the esophagus

Centered to the midsagittal plane at the level of T5-T6 using a 14 x 17 inch or 7 x 17 inch radiation field

The body rotation angle, patient position, and central ray entry point for an RAO esophagus projection

Recumbent right anterior oblique rotated 35 to 40 degrees with the central ray entering 2 inches lateral to the midsagittal plane at the level of T5-T6

The key anatomical placement criterion for a diagnostic RAO esophagus projection

Esophagus visualized clearly filled with barium between the vertebrae and the heart

The precise central ray alignment and patient positioning for a lateral esophagus projection

Central ray perpendicular to the midcoronal plane at the 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 Siphon 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, central ray placement, and breathing instructions for an AP scout image of an Upper GI

Patient supine or prone, centered to the midline of the body 3 inches above the iliac crest, with exposure made on suspended 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, central ray entry level, and structure shown for a PA oblique RAO stomach projection

Recumbent RAO rotated 40 to 70 degrees with the central ray at the level of L1-L2 to show the entire stomach, duodenal loop, and pyloric canal in profile

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

Recumbent LPO rotated 40 to 70 degrees (average 45) with the midline of the IR aligned halfway between the vertebrae and the left lateral border of the abdomen

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 a recumbent position and L3 for an upright position

The specific retrogastric spaces demonstrated on a right lateral stomach projection based on patient position

Right retrogastric space shown in recumbent right lateral; Left retrogastric space shown in upright left lateral

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

Orally, reflux filling via a large-volume barium enema, or 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

Body rotated 35 to 45 degrees with the central ray entering 1 to 2 inches lateral to the midsagittal plane on the elevated side at the level of the iliac crests

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

Entire colon, the right colic flexure (hepatic flexure), ascending colon, and cecum

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

Entire colon, the left colic flexure (splenic flexure), and descending colon

The precise central ray angling rules required to clearly demonstrate the axial rectosigmoid area without self-superimposition

Angled 30 to 40 degrees cephalad when the patient is supine, or angled 30 to 40 degrees caudal when the patient is prone

The proper patient positioning, central ray entry point, and breathing instructions for a lateral rectum radiograph

Left lateral recumbent position, central ray entering 1 inch below the ASIS, with respiration completely suspended

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 dynamic, functional 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 exact image receptor sizing and centering location used during the scout and active phases of a defecography exam

A 10 x 12 inch IR centered over the sigmoid colon for the AP view and over the rectal area for the lateral view

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