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RADIOLOGICAL ANATOMY

WITH BARIUM MEAL

CONTRAST MEDIA IN GIT


Earliest contrast medium
LIPIODOL
(Ethyl esters of iodized fatty acids of
poppyseed oil)

BARIUM SULPHATE
Non absorbable.
Insoluble in water / Lipid.
Inert to tissues.
Can be used for double contrast studies.

HIGH ATOMIC NUMBER


(56)HIGHLY RADIO

PHOTO ELECTRIC EFFECT

APPLICATION

GOOD

BAD

ADVANTAGES OF BaSO4
PREPARATION
NON-ABSORBABLE. Therefore barium does
not get degraded throughout the bowel
SUITABLE FOR DOUBLE CONTRAST
STUDIES As it coats the mucosa in a thin
layer, thus allows introduction of negative
contrast agents without significant degradation
ADV over water soluble contrast agent
Results in better coating --- better mucosal
detail
Low cost.

DISADVANTAGE
SUBSEQUENT ABDOMINAL CT is
rendered difficult to interpret
(May need to wait upto 2 weeks)
HIGH MORBIDITY associated with
barium in the peritoneal cavity

HIGH/LOW DENSITY BARIUM


Average particle size = 0.3 m to
12 m
Larger size = 12 m ,

BARIUM MEASURING
SYSTEMS
W/W Suspension

W/V Suspension

BARIUM REQUIREMENTS
BARIUM
SWALLOW

250 % W/V

100 ml

BARIUM MEAL

250 % W/V

135 ml

BARIUM MEAL
FOLLOW
THROUGH
SMALL BOWEL
ENEMA

60-100% W/V

300 ml

60-100% W/V

1500 ml

BARIUM ENEMA

115% W/V

500 ml

PREPARATIONS
MICROBAR
PASTE
MICROBAR
SUSPENSION
MICROBAR
HD
MICROBAR
for enema

100% w/v High viscosity,


high density paste for
pharynx and esophagus
95 % w/v Moderate density and
viscosity for esophagus, stomach
and small intestine
200 % w/v High density and low
viscosity in powder for double
contrast
1 and 5 Kg packs of powder :
Desired suspension can be made

ADDITIVES
CARBOXYL METHYL CELLULOSETo prevent settling. Rate of settling
should be less than 1/10 at the end
of 3 hours.
ANTACIDS- To prevent flocculations

SODIUM CITRATE, ALUMINIUM


HYDROXIDE, MAGNESIUM SULPHATE.

ADDITIVES
SODIUM META BI SULPHATE,
METHYL PARABEN Preservatives.
SIMETHICONE /
METHYLPOLYSILOXONE Antifoaming
agents
ERYTHROCIN Coloring agent
SACCHARINE, FRUIT ESSENCES
Sweetening agent

COMPLICATIONS
PERFORATION Into the peritoneal
cavity / mediastinum.
ASPIRATION Into bronchial tree.
INTRAVASATION embolism.
BARIUM INSPISSATION Colonic
obstruction to form hard stones.
Very rarely Barium encephalopathy

OTHER CONTRAST MEDIA


WATER SOLUBLE CONTRAST
AGENTS:
( IOHEXOL/ GASTROGRAFFIN)

20ml of contrast + 20 ml of normal saline + 2


drops of sorbitol

INDICATIONS:

SUSPECTED PERFORATION / FISTULA


H/O RECENT BIOPSY
SUSPECTED LOWER INTESTINAL
OBSTRUCTION
CORROSIVE POISONING
IMMEDIATE POST OPERATIVE STATUS

OTHER CONTRAST AGENTS


ORAL COCKTAIL:
Barium sulphate + Magnesium sulphate +
LOCM
(Absorb water into bowel and dissolve barium
moves very fast in GIT)
AIR/C02:
Double contrast studies
WATER:
To diagnose lipomatosis of colon
(Appears more lucent compared to the water column)

ANATOMY

DUODENUM (25cm)

5
cm

LI
L2

7.5
cm

L3
10 cm

2.5

BARIUM MEAL

INDICATIONS
Malignancies of gastro esophageal junction, stomach,
duodenum
Upper abdominal mass
Motility disorders
Gastric or duodenal obstruction
Systemic diseases like Tb (Affecting upper GIT)
GIT hemorrhage
SYMPTOMS WHICH PROMPTS BARIUM MEAL STUDY:
Epigastric pain suggestive of peptic ulceration/ Anorexia /
Weight loss / Vomiting / Anemia / Heart burn / Dyspepsia

IN CHILDREN
TO IDENTIFY A CAUSE FOR
VOMITING:
Gastro-oesophageal reflux
Pyloric obstruction
Malrotation

CONTRAINDICATIONS
SUSPECTED CASES OF GASTRODUODENAL PERFORATION
H/O OR SUSPICION OF ASPIRATION
LARGE BOWEL OBSTRUCTION
RECENT BIOPSY FROM GIT

PREPARATION
NPO for atleast 6 hours before
examination.
Abstain from-smoking

SINGLE
DOUBLE
LOW
CONTRAST
CONTRAST
BARIUM SUSPENSION
HIGHDENSITY
DENSITY(250%W/V),
LOW VISCOS

STANDARD VIEWS
SINGLE CONTRAST

DOUBLE CONTRAST

FUNDUS

SUPINE

ERECT WITH 2 VIEWS


90* TO EACH OTHER
OR PRONE RIGHT
SIDE DOWN

BODY

ERECT or PRONE

SUPINE WITH 60*


HEAD END ELEVATION

ANTRUM AND
PYLORUS

PRONE RIGHT SIDE


DOWN

SUPINE RIGHT SIDE


UP

D1 AND C Loop OF
DUODENUM

PRONE RIGHT SIDE


DOWN

SUPINE RIGHT SIDE


UP

D4 OF DUODENUM

SUPINE

PRONE RIGHT SIDE


DOWN

SINGLE CONTRAST
EXAMINATION

LOW DENSITY BARIUM = 80-100%W/V


MUCOSAL RELIEF RADIOGRAPH:
60-90 ml.
SUPINE AND PRONE FILMS.
GASTRIC FOLD PATTERNS.

SINGLE CONTRAST :
100 to 250 ml
Prone , RAO, LPO, R LATERAL
Wall rigidity, contour abnormalities
Lesions/Filling defects

ADVANTAGE
Optimal for patients
who are immobile
Filling defects due to
large masses in
pyloric and duodenal
region are more easily
identifiable

DISADVANTAGE

Lack of sensitivity in
detecting small
erosion, linear ulcer,
superficial gastric
carcinoma

DOUBLE CONTRAST STUDY


100 to 150 ml of high density barium
(250% w/v)
300 to 500 ml of effervescent
Hypotonic agent Buscopan(hyoscine
butyl bromide,20 mg i.v) or 0.1-0.2 mg
i.v glucagon is injected intravenously
-relax stomach and suspend peristalsis.
Supine, RAO, LPO, R Lateral, ERECT

ADVANTAGE
Highly accurate
detecting
abnormalities
following gastric
surgery, bile reflex
gastritis, marginal
ulceration, recurrent
carcinomas

DISADVANTAGE

Misses some polyp,


ulcers, erosion ,
superficial carcinoma

BIPHASIC STUDY
To have both mucosal delineation
in double contrast phase and full
column distension in single
contrast phase.
CONTRAST MEDIUM:
60 -100 % low viscosity , 200 250 ml of barium
is given orally with gas forming powder in the last
few mouthfuls.

FILMING
PRONE OBLIQUE, RT SIDE
DOWN

DUODENAL CAP, C-Loop

SUPINE WITH RIGHT SIDE UP


OBLIQUE

DUODENUM

ERECT

GASTRC FUNDUS

SUPINE WITH 60* HEAD UP

UPPER BODY OF STOMACH

SUPINE

LOWER BODY OF STOMACH,


PYLORIC ANTRUM

SUPINE WITH RT SIDE UP


OBLIQUE

PYLORIC ANTRUM & CANAL

HAS TO BE PERFORMED QUICKLY , WITHOUT


WASTING TIME

AFTERCARE
The patient should be warned that his
bowel motions will be white for a few
days after the examination.
The patient should be advised to eat
and drink normally to avoid barium
impaction.
The patient must not leave the
department until any blurring of vision
produced by the Buscopan has resolved

SC (RAO) : Stomach and C-loop of the


duodenum with duodenal bulb in profile

Normal stomach. Double-contrast spot image of stomach with


patient supine shows distal gastric body (B) and antrum (A). Greater
curvature (white arrows) and lesser curvature (black arrows) are coated
by barium. Rugal fold on posterior wall of gastric body is depicted as
tubular, slightly undulating, radiolucent filling defect (black
arrowheads) in shallow barium pool. Dense barium pool outlines
contour (white arrowheads) of gastric fundus (F). Mucosal surface and
folds in fundus are obscured by barium pool, and antrum is devoid of

Double-contrast spot
image of gastric fundus with
patient in right-side-down
position shows normal gastric
cardia with smooth folds
radiating to central point
(white arrow) at closed
gastroesophageal junction,
also known as cardiac rosette.
Long, straight fold
(arrowheads) extends
inferiorly from cardia along
lesser curvature. Black arrows
denote normal extrinsic
impression by adjacent spleen

Double-contrast spot image of stomach with patient in left posterior


oblique position shows normal areae gastricae pattern in antrum as 2
3-mm polygonally shaped radiolucent tufts of mucosa outlined by
barium in grooves. Areae gastricae are slightly larger in distal gastric
body than in antrum.

OBLIQUE
VIEW

COMPARISON OF BARIUM WITH


ENDOSCOPY
ENDOSCOPY

BARIUM MEAL

PROCEDURE OF CHOICE
DIAGNOSTIC ACCURACY IS VERY
HIGH (100%)

LOW DIAGNOSTIC ACCURACY


(83%) DONE WHEN ENDOSCOPY
IS CONTRAINDICATED

IDEAL FOR EROSIVE ULCERS AND


EARLY DETECTION OF TUMOR
AND BIOPSY CAN BE TAKEN FROM
THE LESION

IDEAL WHEN ENDOSCOPY IS


CONTRAINDICATED.
IT IS THE MODALITY TO STUDY
THE PHYSIOLOGY (i.e) peristalsis
and gastric emptying

SUMMARY
KNOW WHY BARIUM IS USED
LOW/HIGH DENSITY BARIUM
BARIUM MEASUREMENT SYSTEMS
BARIUM MEAL
INDICATIONS, CONTRA
INDICATIONS, PREPARATION,
AFTERCARE,FILMING
RADIOLOGICAL ANATOMY

ATOMIC NUMBER OF
BARIUM???
45
56
58
54

WHICH OF THE FOLLOWING


INTERACTION IS RQUIRED
COHERENT SCATTERING
PHOTOELECTRIC EFFECT
PAIR PRODUCTION
COMPTONS SCATTERING

Double-contrast spot image of


gastric fundus with patient in rightside-down position

NAME THE PARTS