Babeh Edi

GIT	Barium Meal Double Contrast

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Basic Anatomy

Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London

Indications
Dyspepsia
Unexplained weight loss
Abdominal masses
Upper GI tract haemorrage or iron deficiency anaemia
Assessment of perforation and or post surgery
Gastrointestinal reflux
Contraindications
Large bowel obstruction
Immediately impending gastric/abdominal surgery
Contrast Media and drugs. (Typical Examples, See Contrast / Drugs Section for more information)
EZEM HD 250%  100 - 150 ml
Baritop 100% w/v  100 - 150 ml
Gas producing mixtures,
Buscopan / Glucagon 
Equipment
Fluoroscopy with spot film capability 10 frames/second
Fluoroscopy table with 90/20 tilt.
Special "feeding" equipment may be required, i.e. straws and feeding cups.
Injection administration equipment.
Patient Preparation
Patient Identification, Check Pregnancy state,
General psychological preparation and examination outline.
Nil by mouth for 6 hours before the examination*
* Note special preparation may be needed for diabetic patients.
Check sensitivity to drugs used.
Technique
The patient  takes the gas producing agent and is requested not to burp.
The patient is then positioned lying supported on the left side and drinks the barium mixture.
The patient lies supine left side raised and trendelenberg tilted to induce reflux.
A smooth muscle relaxant is administered.
Then a series of fluoroscopically guided films is taken in a variety of positions to demonstrate the stomach, duodenal cap and first part of duodenum.
Typical Film Series 

Position	Demonstrates
Supine RAO	Antrum and greater curve
Supine	Antrum and body
Supine LAO	Lesser curve
Supine Left Lateral	Fundus
Prone	Duodenal loop
Prone,RAO,Supine,LAO Erect RAO, LAO	Duodenal Cap series
Erect	Fundus

Typical Film from Image Series

Radiation Protection
Define strict referral criteria to exclude clinically unhelpful examinations
Minimise fluoroscopy time and current
Introduce QA programme to make regular checks on and to optimise staff and equipment performance
Collimate X-ray beam to minimise size
Shield sensitive organs when possible
Install modern image intensifiers with sensitive (e.g. CsI) photocathodes and digital image processing
Use video recorder instead of cine camera during fluoroscopy wherever possible
Use spot film photofluoroscopy with modern image intensifier and 100mm camera instead of radiography whenever appropriate
Use pulsed systems with image storage devices in fluoroscopy.
Aftercare
Record volumes and descriptions of contrast media and drugs administered.
General patient psychological aftercare
Ensure the patient understands the procedure for collecting the results.
Warn the patient of the possibilities of constipation and appropriate counter measures
Check for any side effects of drugs used, i.e. blurred vision from muscle relaxants.
Complications
Aspiration of barium mixture
Leakage of barium into the peritoneum with and unsuspected perforation
Barium impaction and large bowel obstruction
Barium induced appendicitis
Side effects of drugs used
Other Imaging Techniques
Flexible endoscopy
CT