GI Radiology > Esophagus > Upper G.I.

Upper G.I. Tract Biphasic-Contrast Exam (cont.)

Method

Note that all patient positions described are in relation to the x-ray table.

  1. While the patient is lying supine on the x-ray table, slowly inject 0.2 mg of glucagon intravenously. (When you are just beginning to learn the procedure and are slow, consider using 0.3 mg.) 

  2. Raise the x-ray table to the upright position. The patient stands on the footrest with his back against the table top. (If patient cannot stand, elevate head of table 30°-45°.) Quickly scan the abdomen with the fluoroscope to check for contraindications to the study: free air beneath diaphragm or residual barium from a previous exam. 

  3. Immediately before using the chilled soda siphon, shake it vigorously and dispense “bubbly barium” into a 10 oz cup. Only fill the cup 1/2 full. Have the patient hold the cup of barium in the left hand. (Have the technologist hold the cup if patient is disabled.) 

  4. Rotate the patient into a left posterior oblique (LPO) position (to rotate the spine away from overlapping with the esophagus).

    1. Ask the patient to drink 1/2 cup of “bubbly barium” quickly and tell him not to belch. Scan the length of esophagus while the patient swallows. Obtain two double-contrast spots (2-on-1 film at 90 kVp)—one of the upper and one of the lower esophagus (including the cardia)—during maximal gas distention after all gas bubbles have disappeared.



  1. Then, take the empty cup from the patient and refill it 1/2 full with “bubbly barium”. Repeat the same films in the right posterior oblique (RPO) position while the patient holds the cup in his right hand and drinks an additional 1/2 cup of “bubbly barium”. Do not have the patient stop breathing or swallowing while making the exposures.

      

 

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