66 CARE OF PATIENT IN DIAGNOSTIC RADIOGRAPHY

to which much of the efficacy of the examination will depend. The

alimentary tract is not inherently opaque to X-rays and cannot therefore
be directly examined. It becomes opaque upon the introduction of a
suitable contrast agent, barium sulphate, which fills the lumen of the tract
and thereby will reveal irregularities due to pathology: for example,
ulceration, neoplasia, or constrictive lesions.
It will readily by the student that on the administration
be appreciated
of a barium (sulphate) meal the radiological appearances can be reliable
only if the stomach is empty at the time the meal is taken. A misleading
impression of deformity may be received if the barium pattern is distorted
by the presence of food residues. It is a recognized truth that in a patient
whose stomach is obstructed by disease and contains an accumulation of
fluid, it may not be possible to make any adequate radiological examina
tion of the pylorus and duodenum : barium is prevented by the large
gastric residue from passing into the distal portions of the stomach. In this
case aspiration of the gastric contents may prove helpful.
Because of these physical principles it is essential that no patient who is
to have a barium meal should come to the X-ray department having
recently taken either food or drink. It is important that instructions on
this point should be specific: a patient told not to eat may well think that
the restriction does not apply to a glass of milk or an early morning cup
of tea. It is usual, if the X-ray examination is to be in the forenoon, to
instruct the patient to take nothing by mouth after the evening meal on
the previous night. This probably means that he has eaten last some
12 or 15 hours prior to taking the barium meal and of course this
is a starvation period of more than adequate margin.
Difficulty with this regimen, which is a very useful one, however, will
arise if the patient is working during the night or if the X-ray examination
has to be arranged for the afternoon. Both circumstances oblige him to
miss certainly two consecutive meals if he is to refrain from food after
the middle hours of the evening. It is better in this case for him to be told
specifically for how many hours he is required to starve.
On this point departmental routines vary to some extent. Some radio
logists prefer to tell the patient to take nothing by mouth for 6 hours
prior to examination. Others will forbid food or milk for 8 hours
but will allow non-milky drinks up to 4 hours before giving a
barium meal. The emptying rate of a normal stomach is generally
accepted as being from 4 to 6 hours. It is obviously impossible to give any
exact figure, since variations will arise from the nature and amount of the
food taken and individual differences in the subject of the time.