procedures

• peristalsis

  -wave contractions, digestive tube pushes contents towards rectum

  -peristalsis affected by body habitus, pathology, use of narcotic pain medicine, body position, and aspiration.

  -greatest in stomach and duodenum
• considerations for all digestive fluoro procedures

  -3-4 waves per minute happen in the filled stomach (peristalsis)
• average emptying time for the stomach?


  2-3 hours
• average transit time to ileocecal valve ?

  2-3 hours
• contrast media

  -barium sulfate is best used for alimentary canal 

  -iodinated contrast travels faster through the GI tract than barium sulfate (clears the stomach in 1-2 hours)

  -iodinated sulfate does not stick to the esophageal mucosa like barium sulfate can 

  -iodinated is best used for the stomach, duodenum, and large intestine 
• esophagus (examination)

  -can use single or double contrast

  Single: barium or water soluble iodine 

  Double: barium or carbon dioxide crystals 

  -1st part of the exam is rad tech fluoroing patient while swallowing  
• 3 functions of digestive system

  -ingestion/ digestion: oral cavity, pharynx, esophagus, stomach, and small intestine

  -absorption: of water, vitamins, and minerals by small intestine

  -elimination: of material by large intestine
• double contrast techniques

  -used to enhance diagnosis of diseases and conditions in upper GI series

  -use both barium sulfate (radiopaque)/room air or CO2 gas (radiolucent)
• esophagus views 


  RAO (35-40 degrees)

  AP/PA

  Left lateral

  LAO
• esophagus RAO

  patient position: recumbent (preferred bc it cover all of esophagus) or erect

  part position: 35-40 prone

  CR: centered T6, 2-3 inches inferior to jugular notch

  respiration: suspend
• what position

  main anatomy?

  A) RAO esophagus

  
• what image is this

  
• what image is this

  what anatomy

  A) Lateral esophagus

  
• what position is this?

  anatomy?

  A) AP esophagus

  
• what position

  anatomy?

  A) LAO esophagus

  
• what is this

  what anatomy

  A) AP esophagus

  
• upper GI (RAO)


  patient position: recumbent

  part position: prone 40-70 degrees

  CR: L1

  respiration: suspend respiration, expose on expiration
• what procedure is this

  what anatomy

  A) RAO upper GI

  
• what position is this

  what anatomy ?

  A) PA upper GI

  
• what position

  patient position: recumbent

  part position: true lateral, IR at level of iliac crests

  CR: L1

  respiration: suspend respiration, expose after expiration

  A) right lateral upper GI

  
• what position?

  patient position: recumbent

  part position: 30-60 supine

  CR: L1 IR: level of iliac crests

  respiration: suspend respiration, expose after expiration

  A) LPO upper GI

  
• what position is this?

  patient position: prone

  part position: no body rotation

  CR: L1

  respiration: suspend respiration, expose on expiration

  A) PA upper GI

  
• what position:

  patient position: recumbent

  part position: prone 40-70

  CR: L1

  respiration: suspend respiration, expose after expiration

  A) RAO upper GI

  
• what position

  patient position: supine

  part position: IR at level of iliac crests

  CR: L1

  respiration: suspend respiration and expose on expiration

  A) AP upper GI

  
• small bowel series 


  AP or PA

  -barium or other opaque contrast are administered in 3 ways:

  1. orally (most common)
  2. reflux filling via large volume barium enema
  3. direct injection via tube in small bowel (called enteroclysis)
• patient prep for small bowel series

  -soft/ low residue for 2 days

  -no food/ fluid after evening meal the day before

  -cleaning enema for. colon may be used
• oral method (small bowel notes)


  supine used: to improve visualization of duodenum and jejunum

  prone: to compress abdomen and increase image quality

  -1st image taken with3in 15 minutes of taking barium

  -next interval is 15-30 minutes

  -examination is complete after barium reaches cecum
• PA or AP small intestine

  patient position: prone or supine

  part position:

  -for 30 minute interval: center IR at T2

  -for delayed images: center IR at iliac crests

  respiration: at end of expiration
• what procedure is this?

  -entire small intestine is viewed

  A) AP/PA small intestine

  
• what special procedure is this?

  -part of small intestine series

  A) PA ileocecal spot

  
• what position is this

  patient position: supine/prone

  CR: at level of iliac crests

  respiration: suspend respiration and expose on expiration

  image eval: transverse colon filled by barium

  A) PA contrast enema

  
• what position is this?

  patient position: semiprone, 35-45 RAO

  part position : pelvis and trunk have 35-45 degree

  CR: level of iliac crests

  respiration: suspend respiration, expose on expiration

  image Eval: right colic flexure and ascending/ sigmoid colon are "open"

  A) RAO contrast enema

  
• what procedure is this

  patient position: rotated into 35-45 degree *blank*

  part position: check pelvis and trunk for proper rotation

  image evaluation: left colic flexure is "open"

  A) LAO contrast enema

  
• what procedure is this ?

  patient position: semisupine, 35-45 obliques

  CR: center IR at level of iliac crests

  respiration: exposure on expiration

  A) LPO contrast enema

  
• what procedure is this?

  identify

  A) RPO contrast enema

  
• what procedure is this?

  CR: level of ASIS

  A) left lateral rectum

  
• what position is this?

  identify

  A) right lateral decubitus

  
• what position ?

  identify

  A) left lateral decubitus