ESOPHAGRAMhttp://www.auntminnie.com/index.aspx?Sec=sup&Sub=xra&Pag=dis&ItemId=52930 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
Post-fluoroscopy projections The three basic post-fluoroscopy 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 post-fluoroscopy 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
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