Radiography of the Pharynx and Esophagus

Soft Tissue Neck Radiography

Soft Tissue Lateral: Most common image performed.
AP: Facility dependent.

Soft Tissue Neck Positioning

Positioned the same as AP & Lateral C-spine, use a soft tissue neck protocol.
An AP image may be performed, along with the lateral.
Patient should slowly breathe in during exposure to fill the airway with air.

Anatomical Structures and Indications

Structures:
- Trachea
- Hyoid bone
- Esophagus
- Adenoids
- Oropharynx
- Epiglottis
- Vocal Folds
- Aryepiglottic folds
- Nasopharynx
Indications:
- Assess the patency of the airway.
- Masses
- Foreign bodies
- Enlarged adenoids (kids)
- Epiglottitis (kids)
Technique is half that of a normal C-Spine.

Barium Swallow Procedure

Room Preparation:
- X-ray tube out of way
- Bucky to foot of table
- Footboard on table, ensure it is secure
- Lead apron on fluoro tower
- Move fluoro tower into place for fluoroscopy
- Move table to full upright position
- Position monitor appropriately
- Prepare barium in cups, label if necessary
Exam Procedure:
- Bring patient into the room, thoroughly explain the exam.
- Bring in the radiologist.
- Assist patient onto the footboard.
- Hand cups of barium as requested.
- Place and remove pillow as needed.
- Patient care is the primary responsibility of the technologist.

Explaining the Barium Swallow Procedure to the Patient

Inform patient of the different barium mixes they will be drinking.
Let them know to hold the drink in their mouth and not to swallow until instructed by the physician.
If a barium pill is used, inform the patient ahead of time.
Let them know the exam starts with them standing, and they will then be laid down.
Inform them the physician or RPA will be asking them to move into various positions to thoroughly assess the esophagus.

Table Controls

Table movement controls are duplicated on the fluoro tower.

Fluoroscope Parking

When the fluoroscope is not in use, it must be parked (Disengage and push carriage to the rear. Fluoro will not activate).
Handle to disengage.

Fluoroscopy Controls and Features

Locks
Compression Cone
Screen On Grid
5 min. Timer Reset
Flips image V. or H.
Table elevation
Exposure Single frame (spot )or cine
Exposure (left hand)
Collimators
Field of View (Mag. mode) 16 – 12 – 9 – 6 or 12 – 9 – 6 – 4.5
Longitudinal power assist
Fluoro On (Left hand)
Exposure
4-way motorized table movement
Fluoro On

Compression Cone

Compression lock & Longitudinal & lateral
A hollow plastic cone used to apply compression, primarily to separate loops of bowel.
Centered to the input screen, underneath the fluoro tower.
Button centers or retracts it.

Image Acquisition and Protocols

Fluoroscopy is typically found under exams of the gastrointestinal system (GI) and Angiograms (also called arteriograms or special procedures)

Pulsed Digital Fluoroscopy

Beam on only during acquisition.
AEC factors for frames
Framing rates of: 60, 30, 15 & 7.5 per sec.
Rates are synchronized to 60 Hz line current.

Fluoroscopy Features

(FNR: Fluoro Noise Reduction)
Spectral Filters
Last image hold (LIH / Store)
Pulsed Fluoro (*Optional)
FluoroStore (*Optional up to 15 sec.)

Last Image Hold

As the name of the feature implies, when fluoro goes off, the last image frame remains on the screen.
Pulsed fluoro: Beam is on only during acquisition of image, otherwise it is on all the time.
Fluoroscopy should be activated intermittently, for quick looks. Unless constant monitoring is necessary, last image hold is the same as keeping the beam on to study the image, without radiation.

AP/PA Esophagus

AP/PA, 40” SID, IR lengthwise
Tabletop bucky
Top of film 2 inches above shoulder
Center to MSP
Sponge, not a pillow
Position cup of barium appropriately for ease of drinking
Several large swallows before exposure
Must see entire thoracic and abdominal esophagus filled with barium
Marker placed on upper R of IR
Make sure it is moved in, so collimation will not cut it off.
100-110kVp @ 5-6mAs
High mA for short exposure

RAO Esophagus

RAO, 40” SID, IR lengthwise
Tabletop bucky
35-40 $^{\circ}$ rotation, straight spine
Center at level of T5-6, 2-3 inches left of spinous processes
Top of film 2 inches above shoulder
Sponge, not a pillow
Position cup of barium appropriately for ease of drinking
Must see entire thoracic and abdominal esophagus filled with barium
Abdominal portion most important, as upper part will be assessed with fluoroscopy
Marker placed on upper R of IR
Make sure it is moved in, so collimation will not cut it off.
Several large swallows before exposure
100-110kVp @ 9 mAs
High mA for short exposure

Right Lateral Esophagus

Right lateral, 40” SID, IR lengthwise
Tabletop bucky
Center to T5-6, at MCP
Top of film 2 inches above shoulder
Sponge, not a pillow
Position cup of barium appropriately for ease of drinking
CSP and TSP in line with each other
Arms forward or swimmers position
Marker placed on upper R of IR
Make sure it is moved in, so collimation will not cut it off.
Several large swallows before exposure
110-120kVp @ 12mAs
High mA for short exposure

Fluoroscopy Knowledge

Add patient
Start exam
Select fluoro on operators console
Energize fluoro tower
Place footboard, remove footboard
Place lead on tower
Elevate and lower table
Move bucky tray to proper position
Show fluoro on
Show spot fluoro image
Adjust Magnification factor
Adjust frame rates
Adjust collimation during fluoro
Adjust table position, show 5 min timer
Maneuver fluoro tower
Properly identify “lock” keys
Switch to overhead
Adjust fluoro images
Delete fluoro images
End exam

Anatomical landmarks of the Esophagus

Junction of esophagus with pharynx
Where esophagus is crossed by arch of aorta
Where esophagus is compressed by left main bronchus
Position of esophagus posterior to left atrium
At the esophageal hiatus
Diaphragm