This article continues our series of white papers on radiologic patient positioning techniques for x-ray examinations. Appearing each month on AuntMinnie.com, the series will explore each of the major modalities. If you'd like to comment on or contribute to this series, please e-mail Show
The esophagus may be examined by performing a single-contrast study in which only barium or another radiopaque contrast agent is used to fill the esophageal lumen. A double-contrast procedure also may be used. For this study, barium and carbon dioxide crystals (which liberate carbon dioxide) are the two contrast agents. No preliminary preparation of the patient is necessary. Single-contrast esophagram A single-contrast esophagram may be ordered for the following indications:
If an esophageal perforation is suspected, water-soluble contrast is used by convention.
Supplies and technical factors
Scout film: Not routinely obtained. Image receptor (IR) or cassette: 14 x 14 inches (35 x 35 cm); for a 3-on-1 or spot-film image kVp: 110 Table-top position: the table is declined to -20° to allow for a full esophageal distension
Patient positioning for a single-contrast esophagram
Double-contrast esophagram The performance of the double-contrast esophageal examination is similar to that of a single-contrast examination. For a double-contrast examination, free-flowing, high-density barium must be used. A gas-producing substance, usually carbon dioxide crystals, can be added to the barium mixture or taken by mouth immediately before the barium suspension is ingested. Spot radiographs are taken during the examination, and delayed images may be obtained on request. A double-contrast esophagram may be ordered for indications of early mucosal disease such as erosions, polyps, tumors, inflammation, or infection. It is contraindicated for the following conditions:
Supplies and technical factors
Scout film: Not obtained routinely IR or cassette: 14 x 14 inches (35 x 35 cm) for a 3-on-1 or spot-film image kVp: 90 Table-top position: vertical
Patient positioning for a double-contrast esophagram
Swallowing sequence and technique
Postfluoroscopy projections The three basic postfluoroscopy projections for the esophagram are the anteroposterior (AP) or posteroanterior (PA) projection; AP or PA oblique in the RPO or LPO position; and the lateral projection from the right or left position. Patient positioning for postfluoroscopy projections
Barium administration and respiration Thick barium: Two or three spoonfuls of thick barium should be ingested and the exposure made immediately after the last bolus is swallowed. (The patient generally does not breathe immediately after a swallow.) Thin barium: For complete filling of the esophagus with thin barium, the patient may need to drink through a straw to achieve continuous swallowing. The exposure is made after three or four swallows without suspending respiration, and using as short an exposure time as possible. For the demonstration of esophageal varices, instruct the patient to fully expirate and then to swallow the barium bolus -- avoid inspiration until the exposure has been made. Technical factors
Evaluation criteria for a good esophagram
By Dr. Naveed Ahmad Related Reading Dorsal and lateral decubitus patient positioning for abdominal x-ray exams, February 28, 2002 AP abdominal projection x-ray positioning techniques, January 16, 2002 Tips and techniques for decubitus and oblique chest x-rays, December 21, 2001 Mastering AP and lateral positioning for chest x-ray, November 20, 2001 Good positioning is key to PA chest x-ray exams, October 19, 2001 Copyright © 2002 AuntMinnie.com What is the recommended oblique projection and position for the best demonstration of the esophagus?The thoracic esophagus is best demonstrated in the right anterior oblique position.
What position best demonstrates a hiatal hernia?Caffey (1950) said that hiatus hernia can be best demonstrated with the patient in "semi-inverted positions". Astley and Carre (1954) use both a thin suspension and a thick barium meal, and examine the child in the recumbent position when the contrast medium passes through the oesophagus.
Which of the following Esophagram projections positions will project the majority of the esophagus over the spine?Unit test 1, 2, 3, & Midterm. What is the position of the stomach in a Hypersthenic patient?Heavily build hypersthenic individuals with short thorax and long abdomen are likely to have stomach that is placed in higher position and more transversally. In persons with a slender asthenic physique, the stomach is located lower and more vertical.
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