GASTROINTESTINAL GASTROINTESTINAL SYSTEM PROCEDURES GASTROINTESTINAL SYSTEM PROCEDURES SYSTEM PROCEDURES. Similarities. Variables.

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1 GASTROINTESTINAL SYSTEM PROCEDURES Gary D. Morrison, M.Ed., R.T.(R) Associate Professor, Radiologic Sciences Midwestern State University GASTROINTESTINAL SYSTEM PROCEDURES Similarities Comparable densities requires use of contrast media. Require use of fluoroscopy. Technologist also uses overhead tube to produce plain films. Variables Structures vary greatly in shape, size, and location depending on body habitus. Great variation in normal function. GASTROINTESTINAL SYSTEM PROCEDURES Contrast Media Positive Barium Sulfate (BaSO 4 ). Most common Can not be used with perforation Suspension not solution Non-injectible, water-soluble Iodine (Oral) - generally used when barium is contraindicated. Negative Normally air or CO 2. Used to give double-contrast.

2 GASTROINTESTINAL SYSTEM PROCEDURES Contrast Media Mixing of Barium Thin Used for UGI & SBS Moves faster - actual speed depends on suspending media temperature, consistency, & condition of GI tract Thick Used to coat (barium swallow & BE) Moves slowly Barium must be stirred before use Exact thickness will be determined by the radiologist & dept. protocol GASTROINTESTINAL SYSTEM PROCEDURES Contrast Media Contraindications/Alternates The use of barium is contraindicated in the following: Perforated viscous Pre-op When barium is contraindicated, use noninjectible, water-soluble Iodine (Oral) contrast Gastrografin Oral Hypaque Barium can cake in GI tract Force fluids Use laxatives & enemas as necessary GASTROINTESTINAL SYSTEM PROCEDURES

3 ESOPHAGRAM (BARIUM SWALLOW) Examination of Pharynx (distal 2/3) Esophagus Looks at Anatomical structure Swallowing function Patient Preparation No prep Pt. removes clothing, jewelry, glasses, & dentures ESOPHAGRAM (BARIUM SWALLOW) Room Preparation Room clean Barium mixed - thick & thin Fluoro set up Spot film cassettes/cameras ready Table in upright position with foot board in place ESOPHAGRAM (BARIUM SWALLOW) Fluoro Routine General survey of chest & abdomen Deglutition observed Upright PA/AP Obliques Recumbent Optional Trendelenburg Valsalva Water test Toe-touch

4 ESOPHAGRAM (BARIUM SWALLOW) Overhead Routine Use thick Barium Upright or recumbent Standard positions RAO PA/AP Lt. Lateral ESOPHAGRAM (BARIUM SWALLOW) RAO MSP to film CR 2 lat. Of MSP ESOPHAGRAM (BARIUM SWALLOW) PA/AP Center MSP to film Arms at side Turn head slightly

5 ESOPHAGRAM (BARIUM SWALLOW) Lt. Lateral Arms forward Center MSP to film CR - T5-T6 CARDIAC SERIES To Determine the Size & Shape of the Heart. No Fluoro Thick Barium 72 FFD - Erect Four (4) Positions PA Lt.. Lateral 45 o RAO 60 o LAO UPPER GI SERIES (UGI) Examination of Distal Esophagus, Stomach, & Duodenum Patient Preparation NPO for 8-12 hours No smoking No gum chewing For exam, patient must remove clothing, jewelry, glasses, & dentures Room Preparation - As Previously Discussed

6 UPPER GI SERIES (UGI) Fluoro Routine - Generally Starts As for the Barium Swallow & Then Progresses According to Radiologist & Dept. Protocol Overhead Routine - Completed After Fluoro According to Radiologist & Dept. Protocol RAO PA Rt. Lateral LPO UPPER GI SERIES (UGI) RAO Varies with size, shape, & position of stomach UPPER GI SERIES (UGI) PA CR-mid-way between spine & Lt. lat. border at level of L1-L2

7 UPPER GI SERIES (UGI) Rt. Lateral CR - midway between MCP & ant. Border at level of L1-L2 UPPER GI SERIES (UGI) LPO - 45 (30-60 ) CR-mid way between spine & Lt. lat. border at level of L1-L2 SMALL BOWEL SERIES To Study Radiographically the Structure & Function of the Three Parts of the Small Intestine & to Detect Abnormalities Patient Preparation Light meal night before NPO for 8-12 hours No smoking or gum chewing Laxative or enema (optional) For exam, patient must remove clothing - including underwear

8 SMALL BOWEL SERIES Indications Enteritis - inflammation of the mucousal & submucousal tissues of the intestines Neoplasms - a new & abnormal formation of tissue which serves no useful function Benign Malignant Various malabsorption syndromes Ileus - obstruction Adynamic/Paralytic Mechanical SMALL BOWEL SERIES Contraindications Perforation Pre-op Large intestine obstruction May Be Performed As Small bowel series only UGI with small bowel follow-through Accelerated small bowel - cold saline Small bowel enema (enteroclysis) Retrograde small bowel - reflux method SMALL BOWEL SERIES Imaging Overheads films at 30 min. intervals until barium reaches ileocecal valve (usually 2 hrs.) CR - MSP at level of L2 for early films, iliac crest for delayed films Fluoro & spot films optional when barium reaches the ileocecal valve

9 To Study the Structure & Function of the Large Intestines & Detect Abnormalities Indications Appendicitis Colitis - inflammation of the colon Diverticulosis/itis - outpouching of bowel wall/with inflammation Intussusception - collapse of bowel into itself Neoplasm - benign or malignant Volvulus - twisting of bowel on itself Patient Preparation Same as UGI, plus Laxative - mandatory Types Irritant - castor oil Saline-based magnesium citrate or magnesium sulfate Contraindications GI bleeding Diarrhea Obstruction Inflammatory lesions Cleansing enema - optional Contrast Media Single - Positive, usually Barium Double Used to show small growths such as polyps Positive & negative, usually Barium & Air Contrast Media Administration Closed-bag system Self-contained Disposable Allows mixing of Barium Allows for drainage

10 Contrast Media Administration Open system Reusable Blood-body fluid hazard Spill hazard Enema tips & rectal tubes Straight - disposable Retention tip - disposable Rectal catheter with balloon - reusable Room Preparation Table horizontal - footboard optional Bucky tray at foot of table Barium mixed according to protocol Fluoro tower set up with overhead tube out of the way Spot film cassettes/camera ready Good supply of gloves & towels Mop & bucket General Routine Prepare the patient Explain the exam Encourage relaxation Deep breaths through mouth Have pt. change - everything Scout Insert enema tip Explain Sims position Lubricate tip

11 Fluoro Routine Maintain tension on enema tip Communicate Turn barium on & off Change spot films Fluoro routine will vary with radiologist & institution Overhead Routine Single contrast BE - completed after fluoro AP/PA projection RAO position LAO position AP/PA axial projection OPTIONAL - Rt. &/or Lt. Lateral Post-evacuation AP/PA projection AP/PA Projection CR - MSP at level of iliac crest

12 RAO CR lat. to midline on elevated side at level of iliac crest LAO CR lat. to midline on elevated side at level of iliac crest AP/PA Axial AP - CR cephalad at MSP & ASIS PA -CR caudal at MSP & ASIS

13 Lateral Rectum CR - MCP at level of ASIS Post-evacuation Same as AP/PA WITH AIR Overhead Routine BE with air (double contrast) - completed after fluoro for instillation of air Repeat all or part of single-contrast routine, plus AP/PA projection - both Rt. Lateral Decubitus position Lt. Lateral Decubitus position

14 WITH AIR Rt. Lat. Decubitus Horizontal CR at MSP & iliac crest WITH AIR Rt. Lat. Decubitus Horizontal CR at MSP & iliac crest

X-ray (Radiography), Lower GI Tract

Scan for mobile link. X-ray (Radiography), Lower GI Tract What is Lower GI Tract X-ray Radiography (Barium Enema)? Lower gastrointestinal (GI) tract radiography, also called a lower GI or barium enema,