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21-10-2008

Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

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Barium Meal
by Dr Khursheed H. Awan
Radiology Dept, HMC Peshawar

21-10-2008

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Presentation Outline (Part 1)
Introduction Radiologic Anatomy Technique

21-10-2008

Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

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Introduction

21-10-2008

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. HMC Peshawar 5 . Awan. in many parts of the world. 21-10-2008 Presented by Dr Khurshid H. endoscopy has reduced the need for this examination.Introduction  Barium examination remains the basic technique for radiological investigation of the stomach although. Radiology Dept.

.Four basic techniques our  There are four basic techniques to the performance of this examination (A) (B) (C) (D) Distension Compression Mucosal relief Full column / barium filling (A) Each has specific advantages as well as limitations in evaluating the stomach. Awan. 21-10-2008 Presented by Dr Khurshid H. Radiology Dept. HMC Peshawar 6 .

. mucosal coating and proper projection. Radiology Dept. 21-10-2008 Presented by Dr Khurshid H. whereas the doubledoublecontrast examination utilizes these techniques to a limited degree. DoubleDouble-contrast technique combines the principles of distension. HMC Peshawar 7 . barium filling and mucosal relief. Awan.Four basic techniques (A) (B) The single-contrast upper gastrointestinal singleexamination emphasizes compression.

. Distention : increased barium => increased opacity. Awan. colonic flexures. and rectosigmoid are not easily accessible to palpation. in obese patients / those with recent surgery effective compression can not be achieved. many parts of the GI tract such as the gastric fundus and cardia. Radiology Dept. ¶ En-face· lesions lesions obscured by barium Encolumn. In addition. HMC Peshawar 8 . lesion in profile well visualized  Palpation and compression : Unfortunately.  21-10-2008 Presented by Dr Khurshid H.Why Double Contrast ?  SingleSingle-contrast studies have a number of limitations that may affect diagnostic accuracy.

Presented by Dr Khurshid H.. the contour of the bowel can be seen without losing the en face mucosal surface detail.Why Double Contrast ?    Increasing distention is achieved by gas rather than barium. regions of the GI tract that are inaccessible to palpation can be easily examined. Radiology Dept. Furthermore. Thus. Although compression is still useful with double contrast. it is certainly not as critical for the demonstration of lesions en face. Awan. HMC Peshawar 9 21-10-2008 .

Radiology Dept. Awan. HMC Peshawar 10 ..Barium examination of Stomach Single contrast examination Double contrast examination Biphasic examination    21-10-2008 Presented by Dr Khurshid H.

Radiologic Anatomy 21-10-2008 11 .

. Radiology Dept. HMC Peshawar 12 . Awan.Stomach : Anatomy 21-10-2008 Presented by Dr Khurshid H.

Stomach : Anatomy 21-10-2008 Presented by Dr Khurshid H.. Awan. HMC Peshawar 13 . Radiology Dept.

. HMC Peshawar 14 . Radiology Dept. Awan.Stomach : Anatomy Tracing of double contrast barium meal x-ray 21-10-2008 Presented by Dr Khurshid H.

Awan. HMC Peshawar 15 .. 21-10-2008 Presented by Dr Khurshid H. Radiology Dept.CT of normal stomach distended with positive contrast and air.

21-10-2008 Presented by Dr Khurshid H.CT of normal stomach distended with positive contrast and air. Radiology Dept. Awan.. HMC Peshawar 16 .

. Awan. 21-10-2008 Presented by Dr Khurshid H. Radiology Dept.CT of normal stomach distended with positive contrast and air. HMC Peshawar 17 .

HMC Peshawar 18 . 21-10-2008 Presented by Dr Khurshid H. Radiology Dept.. Awan.CT of normal stomach distended with positive contrast and air.

.CT of normal stomach distended with positive contrast and air. Awan. Radiology Dept. HMC Peshawar 19 . 21-10-2008 Presented by Dr Khurshid H.

Radiology Dept. Awan. 21-10-2008 Presented by Dr Khurshid H. HMC Peshawar 20 ..CT of normal stomach distended with positive contrast and air.

CT of normal stomach distended with positive contrast and air.. HMC Peshawar 21 . 21-10-2008 Presented by Dr Khurshid H. Awan. Radiology Dept.

Awan.. HMC Peshawar 22 .CT of normal stomach distended with positive contrast and air. 21-10-2008 Presented by Dr Khurshid H. Radiology Dept.

Awan. HMC Peshawar 23 .CT of normal stomach distended with positive contrast and air. Radiology Dept. 21-10-2008 Presented by Dr Khurshid H..

Radiology Dept. HMC Peshawar 24 .. Awan. 21-10-2008 Presented by Dr Khurshid H.CT of normal stomach distended with positive contrast and air.

. Awan. as if looking at your own CT from above) CT of normal stomach distended with positive contrast and air. 21-10-2008 Presented by Dr Khurshid H.Turn image so that patient left side is to your left . HMC Peshawar 25 . Radiology Dept.

Radiology Dept.CT of normal stomach distended with positive contrast and air. HMC Peshawar 26 . Awan. 21-10-2008 Presented by Dr Khurshid H..

HMC Peshawar 27 . 21-10-2008 Presented by Dr Khurshid H.CT of normal stomach distended with positive contrast and air. Radiology Dept. Awan..

21-10-2008 Presented by Dr Khurshid H. HMC Peshawar 28 . Radiology Dept. Awan..

Radiology Dept.. Awan.1 Air rises up Ba settles down 21-10-2008 Presented by Dr Khurshid H. HMC Peshawar 29 .4.

1 Gastric Antrum Left posterior oblique 21-10-2008 Presented by Dr Khurshid H. HMC Peshawar 30 . Awan. Radiology Dept.4..

1 Gastric Antrum Left posterior oblique (LPO) 21-10-2008 Presented by Dr Khurshid H. HMC Peshawar 31 . Radiology Dept. Awan..4.

Radiology Dept.2 yGastric body. inferior portion yPatient Supine (AP) 21-10-2008 Presented by Dr Khurshid H. HMC Peshawar 32 ..4. Awan.

Awan. inferior portion yPatient Supine (AP) 21-10-2008 Presented by Dr Khurshid H.2 yGastric body. HMC Peshawar 33 ..4. Radiology Dept.

Radiology Dept. Awan. HMC Peshawar 34 .2 Gastric body. inferior portion yPatient Supine (AP) 21-10-2008 Presented by Dr Khurshid H..4.

Awan. HMC Peshawar 35 .. Radiology Dept.4.3 yFundus yRight Lateral (RL) 21-10-2008 Presented by Dr Khurshid H.

. Awan. HMC Peshawar 36 .4. Radiology Dept.3 yFundus yRight Lateral (RL) 21-10-2008 Presented by Dr Khurshid H.

4.. HMC Peshawar 37 . Radiology Dept.3 yFundus yRight Lateral (RL) 21-10-2008 Presented by Dr Khurshid H. Awan.

4. Awan..3 yFundus yRight Lateral (RL) 21-10-2008 Presented by Dr Khurshid H. Radiology Dept. HMC Peshawar 38 .

superior portion yRight Posterior Oblique (RPO) 21-10-2008 Presented by Dr Khurshid H. HMC Peshawar 39 .. Awan.4. Radiology Dept.4 Gastric body.

Awan. superior portion yRight Posterior Oblique (RPO) 21-10-2008 Presented by Dr Khurshid H. HMC Peshawar 40 .4 yGastric body..4. Radiology Dept.

HMC Peshawar 41 .4 yGastric body.4. superior portion yRight Posterior Oblique (RPO) 21-10-2008 Presented by Dr Khurshid H.. Radiology Dept. Awan.

Technique Double Contrast examination 21-10-2008 42 .

Take four DC spots (4-on-1 film format) in the (4-onfollowing sequence from the distal to the proximal end of the stomach (90 kVp) 21-10-2008 Presented by Dr Khurshid H. HMC Peshawar 43 .. Radiology Dept. Awan.

HMC Peshawar 44 . Awan.1 3 2 4 21-10-2008 Presented by Dr Khurshid H. Radiology Dept..

HMC Peshawar 45 .1 Antrum Left posterior oblique (LPO) Body & Duodenal bulb also seen with double contrast. 21-10-2008 Presented by Dr Khurshid H.. Awan. Radiology Dept.4.

Awan. HMC Peshawar 46 . Radiology Dept. Note: Fine transverse antral folds 21-10-2008 Presented by Dr Khurshid H.4.2 Gastric body and antrum Supine (AP) In this case there is early filling of the duodenum..

3 Fundus. 21-10-2008 Presented by Dr Khurshid H. broad-based extrinsic impression from the spleen is present. Awan. Right Lateral (RL) In this patient smooth.. cardia. Radiology Dept.4. HMC Peshawar 47 .

Awan.4 Gastric body. Superior portion Right Posterior Oblique (RPO) Note:..Areae gastricae demarcated by barium-filled grooves which are normal mucosal features. Radiology Dept.4. 21-10-2008 Presented by Dr Khurshid H. HMC Peshawar 48 . are depicted in this image.

HMC Peshawar 49 . Radiology Dept..Thank you End of Part 1 21-10-2008 Presented by Dr Khurshid H. Awan.