Fluoroscopy

What is an Arthrogram?

An arthrogram is a type of imaging test used to look at a joint, such as the shoulder, knee, or hip. It may be done if standard X-rays do not show the needed details of the joint structure and function.

In arthrography, a long, thin needle is used to put contrast dye right into the joint.

An arthrogram may also use fluoroscopy, CT (computerized tomography), or MRI (magnetic resonance imaging) instead of X-rays to get better pictures of the joint.

While arthrography is most commonly used to examine the knee and shoulder joints, it may also be used to look at other joints, such as the wrist, ankle, hip, or elbow.

Why might I need an arthrogram?

An Arthrogram may be done on a joint when there has been persistent and unexplained pain, discomfort, loss of motion, and/or changes in the way the joint works. Other reasons to do this test may include:

• To find problems (such as tears) in the soft tissues of the joint, such as ligaments, tendons, cartilage, and joint capsules
• To check for damage from repeated dislocations of the joint
• To check prosthetic joints
• To look for loose bodies

There may be other reasons for your healthcare provider to recommend arthrography.

What are the risks of an arthrogram?

You may want to ask your healthcare provider about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your radiation exposure, such as previous CT scans and other types of X-rays, so that you can inform your healthcare provider. Risks linked with radiation exposure may be related to the cumulative number of X-ray exams and/or treatments over a long period.

If you are allergic or sensitive to medicines, contrast dyes, local anesthesia, iodine, or latex, tell your healthcare provider.

Some potential risks of arthrography include:

• Infection and bleeding at the needle site where the contrast dye is injected
• Allergic reaction to the contrast dye. This is rare with direct arthrography because the dye is not injected into a vein

Arthrography is not recommended for people with active arthritis or joint infections.

If you are pregnant or think you may be, tell your healthcare provider. Radiation exposure during pregnancy may lead to birth defects. If you must have an arthrography exam, special precautions will be taken to reduce the radiation exposure to the fetus.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I get ready for an arthrogram?

• Your healthcare provider will explain the procedure to you and you can ask questions.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if anything is not clear.
• There is no special restriction on diet or activity before arthrography.
• Be sure to tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, anesthetic agents (local and general), contrast dyes, and/or iodine.
• Tell your healthcare provider of all medicines (prescribed and over-the-counter) and herbal supplements that you are taking.
• Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the procedure.
• If you are pregnant or think you may be, tell your healthcare provider.
• Based on your medical condition, your healthcare provider may give you other instructions on what to do before the procedure.

What happens during an arthrogram?

Arthrography may be done on an outpatient basis or as part of your stay in the hospital. Procedures may vary depending on your condition and your healthcare provider's practices.

Generally, an arthrogram follows this process:

• You will be asked to remove any clothing, jewelry, or other objects that might get in the way. A bracelet with your name and an identification number may be put on your wrist. You may get a second bracelet if you have allergies.
• If you are asked to remove your clothing, you will be given a gown to wear.
• You will be positioned on an exam table in the procedure room.
• X-rays of the joint may be taken before the injection of the contrast dye for comparison with the pictures takenafter the dye is injected.
• The skin around the joint will be covered with sterile drapes and cleaned with an antiseptic solution.
• The area around the joint will be numbed by using a small needle to inject a local anesthetic (numbing medicine). You may feel burning before you feel a numbing sensation.
• The contrast dye will be injected into the joint using a long, thin needle. You may feel pressure as the needle is moved into the joint, but tell the healthcare provider if it hurts so more numbing medicine can be used. After this injection, you may be asked to move the joint so that the dye moves evenly throughout the joint. You may be asked to exercise the joint. For instance, in the case of knee arthrography, you may be asked to walk around for afew minutes.
• In most cases, you will get an MRI, or less commonly, a CT, after the arthrogram has been done.

While the arthrography procedure itself causes no pain, having to move or hold the joint still in certain positions might cause some discomfort or pain, particularly if you’ve recently had surgery or a joint injury. The technologist will use all possible comfort measures and complete the procedure as quickly as possible to minimize any discomfort or pain.

What happens after an arthrogram?

Your healthcare provider will give you specific instructions regarding movement of the joint, pain medicine care of the affected joint, symptoms to watch for, and any activity restrictions.

You may be asked to rest the joint for several hours right after the procedure.

Some mild swelling and fullness may be noted in or around the joint. Your healthcare provider may suggest that you apply ice if swelling happens. If swelling continues or increases after a day or two, contact the healthcare provider.

Take a pain reliever for soreness as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines.

After a knee arthrogram, the affected knee may be wrapped with an elastic bandage for several days. You will be shown how to apply the bandage and remove it for bathing and dressing.

You may notice some clicking or cracking noises with movement of the joint for a few days after the procedure. This is normal, and should resolve within a few days.

Tell your healthcare provider if you have any of the following:

• Fever
• Redness, swelling, bleeding, or other drainage from the injection site
• Increased pain around the injection site

You may resume your normal diet unless your healthcare provider tells you differently.

Your healthcare provider may give you other instructions after the procedure, depending on your particular situation.

What is a Barium Enema?

A barium enema is a radiographic (X-ray) examination of the lower gastrointestinal (GI) tract. The large intestine, including the rectum, is made visible on X-ray film by filling the colon with a liquid suspension called barium sulfate (barium). Barium highlights certain areas in the body to create a clearer picture.

Fluoroscopy is often used during a barium enema. Fluoroscopy is a study of moving body structures — similar to an X-ray "movie." In a barium enema, fluoroscopy allows the radiologist to see the movement of the barium through the large intestine as it is instilled through the rectum.

Why is barium used with X-rays?

Barium is a dry, white, chalky, powder that is mixed with water to make barium liquid. Barium is an X-ray absorber and appears white on X-ray film. When instilled via the rectum, barium coats the inside wall of the large intestine. This allows for visualization of the inner wall lining, as well as the size, shape, contour, and patency of the colon. This process shows differences that might not be seen on standard X-rays. Barium is used only for diagnostic studies of the GI tract.

The use of barium with standard X-rays contributes to the visibility of various characteristics of the large intestine. Some abnormalities of the large intestine that may be detected by a barium enema include tumors, inflammation, polyps (growths), diverticula (pouches), obstructions and changes in the intestinal structure.

After the instillation of barium into the rectum, the radiologist may also fill the large intestine with air. Air will appear black on X-ray film, contrasting with barium's white image. The use of the two substances, barium and air, is called a double contrast study.

The purpose of using two contrast substances is to achieve an enhancement of the inside wall lining of the large intestine. As the air expands the large intestine (like blowing up a balloon), a barium coating is formed on the inner surface of the colon wall. This technique enhances visualization by sharpening the outline of the inner surface layer of the large intestine. The benefit of this technique is to show smaller surface abnormalities in the large intestine.

What are the reasons for a barium enema?

A barium enema may be performed to diagnose structural or functional abnormalities of the large intestine, including the rectum. These abnormalities may include, but are not limited to:

• Ulcerative colitis - Ulcerations and inflammation of the large intestine.
• Crohn's disease - Ulcerations and inflammation occurring in any part of the GI tract (mouth to anus).
• Obstructions and polyps (growths)
• Cancer
• Unusual bloating or lower abdominal pain
• Unexplained weight loss
• Irritable bowel syndrome
• Changes in bowel movements, such as chronic diarrhea or constipation, or passing of blood, mucus, and/or pus.

There may be other reasons for your doctor to recommend a barium enema.

What are the risks of a barium enema?

You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It's a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of X-rays, so that you can inform your health care provider. Risks associated with radiation exposure may be related to the cumulative number of X-ray examinations and/or treatments over a long period of time.

If you're pregnant or suspect that you may be pregnant, you should notify your doctor. Radiation exposure during pregnancy may lead to birth defects.

Patients who are allergic to or sensitive to medications, contrast media, iodine, or latex should notify their health care provider.

Constipation or fecal impaction may occur if the barium isn't completely eliminated from the body. Risks of barium enema may include, but are not limited to:

• Colon perforation
• Constipation or fecal impaction

Contraindications for a barium enema include, but are not limited to:

• Suspected bowel perforation
• Severe ulcerative colitis
• Pregnancy
• Toxic megacolon
• Acute abdominal pain

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Certain factors or conditions may interfere with the accuracy of a barium enema procedure. These factors include, but are not limited to:

• Recent barium swallow or upper GI procedure that may interfere with the X-ray exposure of the lower GI area
• Colon spasm
• Stool in the bowel

How do I prepare for a barium enema?

PRECAUTIONS: If you are pregnant or suspect that you may be pregnant, you should notify your doctor. Notify the radiologist if you've had a recent barium swallow or upper GI procedure, as this may interfere with obtaining an optimal X-ray exposure of the lower GI area.

Before starting barium enema preparation, please discuss with your physician if:

• You are diabetic and require insulin
• You have an inflammatory condition such as Chron's disease or ulcerative colitis
• You have any additional questions regarding the procedure

CLOTHING: You must completely change into a patient gown. Please remove all piercings and leave all jewelry and valuables at home.

EAT/DRINK: Follow the directions below to ensure your colon is properly cleansed and free of waste matter or feces prior to the procedure. Based on your medical condition, your health care provider may request other specific preparation.

For two days prior to the exam:

Have only clear liquids for the entire day. Drinking lots of clear liquids is a very important part of the preparation. Clear liquids include:

• Water
• Clear juices - no pulp (apple, white grape, white cranberry)
• Bouillon soup or clear broth
• Plain Jell-O (no cream, fruit or other additive)
• Coffee or tea without milk or creamer

On the day before the exam:

Continue consuming only clear liquids listed above.

At 5 p.m. drink a 10 ounce bottle of magnesium citrate. Have additional clear fluids throughout the evening. Drink a minimum of four eight ounce glasses of clear liquid. Magnesium citrate is available over the counter at any pharmacy.

The day of the exam:

Continue to follow clear liquid diet until the examination is complete.

What happens during a barium enema?

A barium enema may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.

Generally, a barium enema will follow this process:

• You'll be asked to remove any jewelry, eye glasses, or other metal objects that may interfere with the procedure.
• You will be asked to remove your clothing, and you'll be given a gown to wear.
• You will be positioned horizontally on the examination table in a side-lying position. A lubricated rectal tube will be inserted into the rectum to allow the barium to flow into the intestine.
• The barium will be allowed to flow slowly into the intestine. You may experience cramping in the lower abdominal area as the barium is instilled. To lessen the discomfort, it may be helpful to take slow deep breaths.
• You may feel the need to have a bowel movement. It will be important to resist the urge to prevent the barium from leaking back out. At the appropriate time, you'll be given a bedpan or assisted to the bathroom as needed.
• During the procedure, the machine and examination table will move and you may be asked to assume various positions as the X-rays are being taken.
• The radiologist will take single pictures, a series of X-rays, or a video (fluoroscopy [LINK]) as the barium moves through the intestine.
• If a double contrast study is ordered, air is injected via the rectum in order to expand the large intestine, and more X-rays will be taken.
• Once all required X-rays have been taken, you'll be assisted from the table.

What happens after a barium enema?

Following the examination, some barium will be expelled immediately. You'll be assisted to the bathroom or given a bedpan.

You may resume your normal diet and activities after a barium enema, unless your doctor advises you differently.

Barium may cause constipation or possible impaction after the procedure if it isn't completely eliminated from your body. You will be advised to drink plenty of fluids to expel the barium from the body.

Since barium isn't absorbed into the body but passes through your entire gastrointestinal tract, your bowel movements may be lighter in color until all the barium has been excreted.

The long and rigorous bowel preparation prior to the procedure may cause fatigue afterward. You should rest as needed.

You may experience soreness of the anus and rectum due to the bowel preparation. Your doctor may recommend the application of a soothing ointment to the area.

Notify your health care provider to report any of the following:

• Difficulty with bowel movements or inability to have a bowel movement
• Pain and/or distention of the abdomen
• Stools that are smaller in diameter than normal
• Fever
• Rectal bleeding

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

What is a Barium Swallow?

A barium swallow is a radiographic (X-ray) examination of the upper gastrointestinal (GI) tract, specifically the pharynx (back of mouth and throat) and the esophagus (a hollow tube of muscle extending from below the tongue to the stomach). The pharynx and esophagus are made visible on X-ray film by a liquid suspension called barium sulfate (barium). Barium highlights certain areas in the body to create a clearer picture. A barium swallow may be performed separately or as part of an upper gastrointestinal (UGI) series, which evaluates the esophagus, stomach, and duodenum (first part of the small intestine).

Fluoroscopy [LINK] is often used during a barium swallow to study moving body structures — similar to an X-ray "movie." In barium X-rays, fluoroscopy allows the radiologist to see the movement of the barium through the pharynx and esophagus as a person drinks.

What are the reasons for a barium swallow?

A barium swallow may be performed to diagnose structural or functional abnormalities of the pharynx and esophagus. These abnormalities may include, but are not limited to:

• Cancers of the head, neck, pharynx, and esophagu
• Tumors
• Hiatal hernia, an upward movement of the stomach, either into or alongside the esophagus
• Structural problems such as diverticula, strictures, or polyps (growths)
• Esophageal varices (enlarged veins)
• Muscle disorders (pharyngeal or esophageal) such as dysphagia (difficulty swallowing) or spasms (pharyngeal or esophageal)
• Achalasia, a condition in which the lower esophageal sphincter muscle doesn't relax and allow food to pass into the stomach
• Gastroesophageal reflux disease (GERD) and ulcers

There may be other reasons for your doctor to recommend a barium swallow.

What are the risks of a barium swallow?

You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It's a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of X-rays, so that you can inform your doctor. Risks associated with radiation exposure may be related to the cumulative number of X-ray examinations and/or treatments over a long period of time.

If you're pregnant or suspect that you may be pregnant, you should notify your doctor. Radiation exposure during pregnancy may lead to birth defects.

Patients who are allergic to or sensitive to medications, contrast dyes, iodine, or latex should notify their doctor.

Constipation or fecal impaction may occur if the barium isn't completely eliminated from the body.

Contraindications for a barium swallow may include, but are not limited to:

• Esophageal or bowel perforation
• Bowel obstruction or severe constipation
• Pregnancy
• Severe swallowing difficulty such that aspiration (entry of substances into the lungs) of barium is likely

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

How do I prepare for a barium swallow?

PRECAUTIONS: If you are pregnant or suspect that you may be pregnant, you should notify your doctor. Notify the radiologist if you've had a recent barium swallow or upper GI procedure, as this may interfere with obtaining an optimal X-ray exposure of the lower GI area.

Before starting barium enema preparation, please discuss with your physician if:

• You are diabetic and require insulin
• You have an inflammatory condition such as Chron's disease or ulcerative colitis
• You have any additional questions regarding the procedure

CLOTHING: You must completely change into a patient gown. Please remove all piercings and leave all jewelry and valuables at home.

EAT/DRINK: Follow the directions below to ensure your colon is properly cleansed and free of waste matter or feces prior to the procedure. Based on your medical condition, your health care provider may request other specific preparation.

FOR TWO DAYS BEFORE THE APPOINTMENT

Drink ONLY clear liquids. Meals may include clear broth, strained fruit juices, tea and coffee without milk, carbonated beverages, or Jell-o. Do not eat solid food or milk. Drink lots of water throughout day At 6 p.m., take 2 Dulcolax pills.

ON THE DAY BEFORE YOUR APPOINTMENT

Continue liquid diet. At 10 a.m., take 2 Dulcolax pills. At 2 p.m., take 2 Dulcolax pills and drink 8 oz. of Miralax. Drink lots of water throughout day. Nothing to eat or drink after midnight the night before exam

What happens after a barium swallow?

You may resume your normal diet and activities after a barium swallow, unless your doctor advises you differently.

Barium may cause constipation or possible impaction after the procedure if it isn't completely eliminated from your body. You may be advised to drink plenty of fluids to expel the barium from the body. You may also be given acathartic or laxative to help expel the barium.

Since barium isn't absorbed into the body but passes through the entire intestinal tract, your bowel movements may be lighter in color until all of the barium has been excreted.

Notify your doctor to report any of the following:

• Difficulty with bowel movements or inability to have a bowel movement
• Pain and/or distention of the abdomen
• Stools that are smaller in diameter than normal

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

What is a Modified Barium Swallow?

During a modified barium swallow, you ingest foods and liquids containing barium sulfate, a contrast dye that sharply outlines your mouth, throat, and esophagus on x-ray film. Using real-time x-rays, or fluoroscopy, a physician and a speech pathologist observe the movement of the barium through these structures on a television monitor. Modified barium swallow is specifically aimed at evaluating the swallowing process in individuals who have difficulty speaking or swallowing food without inhaling, or aspirating, it into the windpipe.

Purpose of the Modified Barium Swallow

• To identify the cause of difficult or impaired swallowing (dysphagia).
• To help determine the most appropriate treatment or management techniques for swallowing problems.

Before the Modified Barium Swallow

• Tell your doctor if you are or could be pregnant.

What You Experience

• You may be seated in a special chair designed for this exam.
• You will consume barium containing product of different consistencies The consistency of the items vary, ranging from thin liquid to semisolid foods (for example, pudding) or solid foods (such as a cookie).
• As you swallow different amounts of the items, the examiners use fluoroscopic imaging to observe the swallowing process on a television screen in order to determine which foods are difficult for you to swallow and which structures are responsible for the problem. The swallowing process may be observed at normal speed or in slow motion.
• Other than chewing and swallowing, you must remain still during the procedure.
• A speech pathologist is present during the test to evaluate your swallowing ability and, if possible, to suggest some possible corrective actions.
• The test usually takes 30 minutes depending on the findings.

After the Modified Barium Swallow

• You may leave the testing facility immediately and resume your normal diet and activities, unless instructed differently by the speech pathologist.
• Drink plenty of fluids to help eliminate the barium from your system.
• Your stool will be chalky and light-colored initially, but it should return to normal color after 1 to 3 days.

Results

• Your physician will receive a copy of the radiologists final report.

• If possible, the speech pathologist will recommend specific corrective actions to help you resolve the swallowing problem during the test and no further testing or treatment is needed.

What is Hysterosalpingography?

Hysterosalpingography is an x-ray examination of a woman's uterus and fallopian tubes that uses a special form of x-ray called fluoroscopy and a contrast material.

Fluoroscopy is a special x-ray technique that makes it possible to see internal organs in motion. During a hysterosalpingogram, the uterus and fallopian tubes are filled with a contrast material and the radiologist/physician is able to use fluoroscopy to view and assess their anatomy and function.

What are some common uses of the procedure?

Hysterosalpingography is primarily used to examine women who have difficulty becoming pregnant by allowing the radiologist to evaluate the shape and structure of the uterus, the openness of the fallopian tubes, and any scarring within the uterine or peritoneal (abdominal) cavity.

The procedure can be used to investigate repeated miscarriages that result from congenital or acquired abnormalities of the uterus and to determine the presence and severity of these abnormalities, including:

• Tumor masses
• Adhesions
• Uterine fibroids

Hysterosalpingography is also used to evaluate the openness of the fallopian tubes, and to monitor the effects of tubal surgery, including:

• Blockage of the fallopian tubes due to infection or scarring
• Tubal ligation
• The closure of the fallopian tubes in a sterilization procedure and a sterilization reversal
• The re-opening of the fallopian tubes following a sterilization or disease-related blockage

How should I prepare?

The hysterosalpingography procedure is performed within the first 10 days after the start of menstruation but before ovulation to make certain that you are not pregnant during the exam.

This procedure should not be performed if you have an active inflammatory condition. You should notify your physician or technologist if you have a chronic pelvic infection or an untreated sexually transmitted disease at the time of the procedure.  

Prior to the procedure, you may be given a mild sedative or over-the-counter medication to minimize any potential discomfort. Some physicians prescribe an antibiotic prior to and/or after the procedure.

You should inform your physician of any medications being taken and if there are any allergies, especially to iodinated contrast materials. Also inform your doctor about recent illnesses or other medical conditions.  

You will be asked to remove some of your clothes and wear a gown during the exam. You may also be asked to remove jewelry, removable dental appliances, eye glasses and any metal objects or clothing that might interfere with the x-ray images.

Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby.  

How is the procedure performed?

This examination is usually done on an outpatient basis.

The procedure is like a gynecological exam. The patient is positioned on her back on the exam table, with her knees bent or her feet held placed at the end of the table and a speculum is inserted into the vagina. The cervix is then cleansed, and a catheter is inserted into the cervix. The patient is carefully positioned underneath the fluoroscopy camera. The contrast material then begins to fill the uterine cavity, fallopian tubes and peritoneal cavity through the catheter and fluoroscopic images are taken.

In some cases, if certain abnormalities are encountered, the patient will be asked to rest and wait up to 30 minutes so that a delayed image can be obtained. This delayed image may provide clues to a patient's condition that the original images with contrast material do not. On occasion, an x-ray will be taken the next day to ensure that there is no scarring surrounding the ovaries.

When the procedure is complete, the catheter will be removed and the patient will be allowed to sit up.

The hysterosalpingogram is usually completed within 30 minutes.

What will I experience during and after the procedure?

This exam should cause only discomfort.  

There may be slight discomfort and cramping when the catheter is placed and the contrast material is injected, but it should not last long. There may also be slight irritation of the peritoneum, the lining of the abdominal cavity, causing generalized lower abdominal pain, but this should also be minimal and not long lasting. Most women experience vaginal spotting for a few days after the examination, which is normal.

Who interprets the results and how do I get them?

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you.

Follow-up examinations may be necessary. Your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if a finding is stable or changed over time.

What is a Small Bowel Follow Through?

A small bowel follow-through, also called small bowel series, is a radiologic examination of the small intestine. The small intestine begins at the duodenum (just past the stomach) and ends at the ileocecal valve (at the junction with the large intestine/colon).

What is the prep for the SBFT?

Nothing to eat or drink from midnight the day before the exam if the appointment time is in the morning. If the appointment time is in the afternoon, nothing to eat or drink for at least 8 hours prior to the appt time.

How is the procedure done?

The study is done while you are drinking barium. The barium appears white on X-rays and shows the outline of the internal lining of the small bowel. An X-ray is taken every 20-30 minutes tracking the progression of the barium. It will be necessary to drink two cups of barium at the beginning of the exam, however, the patient may be asked to drink more as the exam progresses. Once the barium has entered the large intestine, you will be taken to the fluoroscopy room and a few more X-rays are taken of the ileocecal valve. This is one of the most common places for pathology of the bowel to be found; therefore imaging of this structure is crucial.

The amount of barium varies from patient to patient. The bowel motility also varies from patient to patient; the average test length is approximately 2-4 hours.

The barium is non-toxic and passed out normally as stool, although the appearance may be paler than usual.

When may I resume my normal diet?

As soon as the study is complete, you may resume your normal diet. You should drink plenty of fluids to avoid becoming constipated.

What is an Upper Gastrointestinal Series?

An upper gastrointestinal series (UGI) is a radiographic (X-ray) examination of the upper gastrointestinal (GI) tract. The esophagus, stomach, and duodenum (first part of the small intestine) are made visible on X-ray film by a liquid suspension. This liquid suspension may be barium or a water-soluble contrast. If only the pharynx (back of mouth and throat) and esophagus (a hollow tube of muscle extending from below the tongue to the stomach) are examined with barium, the procedure is called a barium swallow.

Fluoroscopy is often used during an upper GI series. Fluoroscopy is a study of moving body structures — similar to an X-ray “movie."  A continuous X-ray beam is passed through the body part being examined and is transmitted to a TV-like monitor so that the body part and its motion can be seen in detail. In an upper GI series, fluoroscopy allows the radiologist to see the movement of the barium through the esophagus, stomach, and duodenum as a person drinks.

Why is barium used with X-rays?

Barium is a dry, white, chalky powder that is mixed with water to make a thick, milkshake-like drink. Barium is an X-ray absorber and appears white on X-ray film. When swallowed, a barium drink coats the inside walls of the upper GI tract organs so that the swallowing motion, inside wall lining, function, size, and shape of these organs are visible on X-ray. This process shows differences that might not be seen on standard X-rays. Barium is used only for diagnostic studies of the GI tract.

The use of barium with standard X-rays contributes to the visibility of various characteristics of the esophagus, stomach, and duodenum. Some abnormalities of the upper GI tract that may be detected with an upper GI series include tumors, ulcers, hernias, diverticula (pouches), strictures (narrowing), inflammation, and swallowing difficulties.

In addition to barium, the radiologist may use a gas, such as air or a carbonated substance. You may be given a powder, tablet, or carbonated beverage that produces gas when swallowed. Alternately, you may drink the barium through a perforated straw so that you swallow air with the barium. Air or gas will appear black on X-ray film, contrasting with the barium’s white image. The use of the two substances, barium and gas, is called a double contrast study. The radiologist may use the water-soluble contrast if you have a perforation (tear or hole) of the bowel or esophagus, or for other reasons determined by your doctor.

The purpose of using two contrast substances is to achieve an enhancement of the inside wall lining of the esophagus, stomach, and duodenum. As the gas expands the organs (like blowing up a balloon), a barium coating is formed on the inner surface of the organs. This technique enhances visualization by sharpening the outline of the inner surface layer of the esophagus, stomach, and/or duodenum, and is useful in diagnosing structural and tissue abnormalities.

Other related procedures that may be used to diagnose upper GI problems are barium swallow and esophagogastroduodenoscopy (EGD).

What are the reasons for an upper GI series?

An upper GI series may be performed to diagnose structural or functional abnormalities of the esophagus, stomach, and duodenum. These abnormalities may include, but are not limited to:

• Ulcers may be gastric (stomach) or enteric (duodenum)
• Gastroesophageal reflux disease (GERD)
• Inflammation (esophagitis, gastritis, or duodenitis) or infection
• Benign tumors. Nonmalignant
• Cancer
• Structural problems. Such as diverticula, strictures, or polyps (growths)
• Hiatal hernia. Upward movement of the stomach, either into or alongside the esophagus
• Dysphagia or difficulty swallowing
• Motility disorders. Difficulty moving foods through the pharynx or esophagus
• Chest and/or abdominal pain
• Unexplained vomiting and/or indigestion
• Bloody bowel movements

There may be other reasons for your doctor to recommend an upper GI series.

What are the risks of an upper GI series?

You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It's a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of X-rays, so that you can inform your doctor. Risks associated with radiation exposure may be related to the cumulative number of X-ray examinations and/or treatments over a long period of time.

If you're pregnant or suspect that you may be pregnant, you should notify your doctor. Radiation exposure during pregnancy may lead to birth defects.

Patients who are allergic to or sensitive to medications, contrast dyes, iodine, or latex should notify their doctor.

Constipation or fecal impaction may occur if the barium isn't completely eliminated from the body.

Contraindications for an upper GI series include, but are not limited to:

• Bowel or esophagus perforation
• Bowel obstruction or severe constipation
• Pregnancy
• Severe swallowing difficulty such that aspiration (entry of substances into the lungs) of barium is likely

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

How do I prepare for an upper GI series?

PRECAUTIONS: If you are pregnant or think you may be pregnant, you should notify your doctor. Notify the radiologist if you have had a recent barium X-ray or any gastrointestinal surgical procedure, as this may interfere with obtaining an optimal X-ray exposure of the upper GI series.

CLOTHING: You must completely change into a patient gown. A locker will be provided to secure your personal belongings. Please remove all piercings and leave all jewelry and valuables at home.

EAT/DRINK: The night before your exam, do not eat or drink anything after midnight until the exam is over.

Based on your medical condition, your doctor may request other specific preparation.

What happens during an upper GI series?

An upper GI series may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary, depending on your condition and your doctor’s practices.

Generally, an upper GI series follows this process:

• You'll be asked to remove any clothing, jewelry, or other objects that may interfere with the procedure.
• If you're asked to remove clothing, you'll be given a gown to wear.
• You will be positioned on an X-ray table that can tilt you from a horizontal to an upright position. You may be asked to change positions (for example, lying on your side, back, or stomach) at intervals during the procedure.
• The radiologist will ask you to take a swallow of a thickened contrast drink. The contrast is usually flavored, although it may not be very pleasant tasting.
• As you swallow the contrast, the radiologist will take single pictures, a series of X-rays or a video (fluoroscopy) to observe the contrast moving through the pharynx.
• If you're having a procedure with barium, you'll be given a thinner barium drink to swallow. X-rays and/or fluoroscopy will be used to observe the barium’s passage down the esophagus. You may also be asked to swallow a barium tablet, which can help to visualize certain structural problems of the esophagus.
• The radiologist may press on your abdomen during the examination to help visualize the stomach and aid in coating of the stomach wall.
• If you're having a double contrast study, you may be asked to swallow a powder, tablet, or carbonated beverage. Alternately, you may be asked to drink the barium through a perforated straw. Because the gas that's produced will expand and enhance the visualization of the inner surface of the upper GI organs, it will be important not to burp.
• Once all required X-rays have been taken, you'll be assisted from the table.

What happens after an upper GI series?

You may resume your normal diet and activities after an upper GI series unless your doctor advises you differently.

Barium may cause constipation or possible impaction after the procedure if it isn't completely eliminated from your body. You may be advised to drink plenty of fluids to expel the barium from the body. You may be given a laxative to help expel the barium.

Since barium isn't absorbed into the body but passes through your entire gastrointestinal tract, your bowel movements may be lighter in color until all of the barium has been excreted.

Notify your doctor to report any of the following:

• Difficulty with bowel movements or inability to have a bowel movement
• Pain and/or distention of the abdomen
• Stools that are smaller in diameter than normal

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

All fluoroscopy exams must be scheduled. Please call 304.526.2125 for scheduling.