RADIOLOGIC CONTRAST EXAMINATION

SPECIAL RADIOGRAPHIC EXAMINATIONS

GASTROINTESTINAL TRACT
UPPER GASTROINTESTINAL TRACT SYSTEM
ALIMENTARY CANAL BEGINS AT THE:
 Oral cavity
 Pharynx
 Esophagus
 Small intestine
 Large intestine, which terminates at the;
 Anus
ACCESSORY ORGAN OF DIGESTION
 Salivary Gland
 Pancreas
 Liver
 Gallbladder
FUNCTIONS OF DIGESTIVE SYSTEM
 Intake and/or digestion of food
 Absorb digested food particles
 Eliminate any unused material in the form of semi-solid waste product.

SIALOGRAPHY
 Radiologic examination of the salivary glands and ducts using water-soluble iodinated contrast
media
 To demonstrate salivary glands and calculi in their ducts
 Indications:
 Inflammatory lesions (obstructed or not obstructed)
 Pain or swelling in the area
 Palpable mass
 Calculi
 Strictures
 Tumor
 Infection
 Dryness of mouth & eyes
 Extent of salivary fistulae
 Sialography involves the following steps:
 Inject the radiopaque medium into the main duct.
 Obtain preliminary radiographs to detect any condition demonstrable without the use of a
contrast medium and to establish the optimum exposure technique.
  About 2 or 3 minutes before the sialographic procedure, give the patient a secretory
stimulant to open the duct for ready identification of its orifice and for easier passage of a
cannula or catheter.
 Take a radiograph about 10 minutes after the procedure to verify clearance of the contrast
medium, if needed.
THREE (3) PAIRS OF SALIVARY GLANDS
1. Parotid Gland (with Stensen’s duct)
 PAROTID: largest, from zygoma to the angle of mandible about 5 cm or 2” long
2. Submandibular/submaxillary Gland (with Wharton’s duct)
 SUBMANDIBULAR: situated beneath the mucous membrane, extends posterior from a point
below the first molar almost to the angle of mandible.
3. Sublingual Gland (with Bartholin’s duct)
 SUBLINGUAL: group of smaller glands, narrow and elongated in form / located in the floor
of the mouth beneath the sublingual fold.

PAROTID GLAND
Procedure:
TANGENTIAL PROJECTION
 Position of Patient
 Place the patient in either a recumbent or seated position
 Because the parotid gland lies midway between the anterior and posterior surfaces of the
skull, obtain the tangential projection of the glandular region from either the posterior or
the anterior direction
 Position of Part
 Supine body position
 With the patient supine, rotate the head slightly toward the side being examined so
that the parotid area is perpendicular to the plane of the image receptor
  Center the image receptor to the parotid area
 With the patient’s head resting on the occiput, adjust the head so that the
mandibular ramus is parallel with the longitudinal axis of the image receptor
 Prone body position
 With the patient prone, rotate the head so that the parotid area being examined is
perpendicular to the plane of the image receptor
 Center the image receptor to the parotid region
 With the patient’s head resting on the chin, adjust the flexion of the head so that
the mandibular ramus is parallel with the longitudinal axis of the image receptor
 When the parotid (Stensen’s) duct does not have to be demonstrated, rest the
patient’s head on the forehead and nose.
 Shield gonads
 Central ray
 Perpendicular to the plane of the image receptor, directed along the lateral surface
of the mandibular ramus

PAROTID AND SUBMANDIBULAR GLAND

Procedure:
LATERAL PROJECTION
 Position of Patient
 Place the patient in a semiprone or seated and upright position
 Position of Part
 Parotid Gland
 With the affected side closest to the image receptor, extend the patient’s neck so
that the space between the cervical area of the spine and the mandibular rami is
cleared
 Center the image receptor to a point approximately 1 inch (2.5cm) superior to the
mandibular angle
 Adjust the head so that the midsagittal plane is rotated approximately 15 degrees
toward the image receptor from a true lateral positon
 Submandibular Gland
  Center the image receptor to the inferior margin of the angle of the mandible
 Adjust the patient’s head in a true lateral position
 Central ray
 Perpendicular to the center of image receptor and directed at:
 at a point 1 inch superior to the mandibular angle to demonstrate the parotid
gland
 at the inferior margin of the mandibular angle to demonstrate the
submandibular gland
 SUBMANDIBULAR AND SUBLINGUAL GLAND
Procedure:
AXIAL PROJECTION (INTRAORAL METHOD)
 Position of Patient
 Elevate the patient’s thorax on several firm pillows
 Flex the patient’s knees to relax the abdominal muscles and thereby allow full extension of
the neck
 Adjust the shoulders to lie in the same transverse plane
 Position of Film
 Tape a side marker (R or L) on one corner of the exposure surface of the occlusal film
packet
 Place the film in the mouth with the long axis directed transversely
 Center the packet to the midsagittal plane, and gently insert it far enough that it is contact
with the anterior borders of the mandibular rami
 Instruct the patient to gently close the mouth (to hold the packet in position)
 After placement of the occlusal film, fully extend the patient’s neck and rest it on the vertex
with the midsagittal plane vertical
 Shield gonads
 Respiration: Suspend
 Central ray
 Perpendicular to the plane of the film and directed to the intersection of the midsagittal
plane and a coronal plane passing through the second molars
 PHARYNGOGRAPHY
 To identify abnormalities during the active progress of deglutition
 Opaque studies of the pharynx are made with an ingestible contrast medium, usually a thick,
creamy mixture of water and barium sulfate.
 Functions:
 Acts as passageway of food
 Air passage from nasal cavity of mouth to larynx
 Resonating chamber for the sounds produced in the larynx
 it extends from the base of the skull to the cricoid cartilage and situated behind the
nose, the mouth and upper part of the throat
3 Parts of the Pharynx
1. Nasopharynx
– lies behind the nose and above the soft palate
2. Oropharynx
– lies behind the mouth and extends from the soft palate to the epiglottis, it is
common to both respiratory and alimentary tracts
3. Laryngopharynx
– extends from the upper border of the epiglottis to the lower border of the cricoid
cartilage where it continues to the esophagus.
– Connects with the oropharynx above and the esophagus below
DEGLUTITION
 The shortest exposure time possible must be used for studies made during deglutition. The
following steps should be observed:
 Ask the patient to hold the barium sulfate bolus in the mouth until signaled and then to
swallow the bolus in one movement.
 If a mucosal study is to be attempted, ask the patient to refrain from swallowing again.
 Take the mucosal study during the modified Valsalva's maneuver for double contrast
delineation.
 Indications:
 Demonstrate tumor
 Demonstrate abscess
 Demonstrate presence of Foreign Bodies

GUNSON METHOD
 Synchronizing the exposure with the height of the swallowing act in deglutition studies of the
pharynx and superior esophagus.
 Tying a dark colored shoestring snugly around the patient’s throat above the thyroid cartilage.
 Anterior and superior movements of the larynx are then shown by the elevation of the shoestring
as the thyroid cartilage moves anteriorly and immediately thereafter by the displacement of the
shoestring as the cartilage passes superiorly.
ESOPHAGOGRAPHY/BARIUM SWALLOW
 demonstrate pharynx and esophagus
 indirectly investigate suspected lesions of the heart and great vessels
ESOPHAGUS
 Length measures 10 inches or 25-30 cm.
 It is located posterior to the trachea and pharynx & anterior to the vertebral column
 It passes through the diaphragm in front of the aorta to enter the stomach
 Three (3) Segments of the esophagus
 Cervical segment
 Thoracic segment
 Intra-abdominal segment
 INDICATIONS:
 Dysphagia
 Barrett's esophagus / syndrome
 stricture in the distal esophagus
 developed peptic ulcer in the distal
 Thyroid gland enlargement
 Esophageal carcinoma – cancer of the esophagus
 Mediastinal mass
 Chalasia
 It is a condition of abnormal relaxation of the gastro-esophageal junction
 It results to heart burn, retrosternal pain, regurgitation and eructation (an oral
ejection of gas or air from the stomach; belching)
 Achalasia
 A condition of abnormal constriction of the Gastroesophageal junction
 Hiatal hernia
 A protrusion of the stomach through the wall of the diaphragm
 Cardiomegaly
 Foreign Bodies
 CONTRAINDICATION:
 Suspected leakage from the esophagus into the mediastinum or pleural or peritoneal
cavities.
 Aspiration into the bronchial tree
2 Phases employed in CM Administration
1. Filling phase
 to distend the lumen of the esophagus
 ratio 2:1 or 3:1
2. Mucosal phase
 demonstrate the mucosal pattern of the esophagus
 4:1 ratio
Procedures performed to detect ESOPHAGEAL REFLUX:
 Breathing exercises - Valsalva maneuver
 Mueller maneuver - The patient exhale and tries to inhale against a closed glottis
 Water test - Swallow a mouthful of water through a straw
 Compression technique - The patient is in prone position with compression paddle
 Toe – touch maneuver - To study the possibility of regurgitation into the esophagus from the
stomach
- Can show if the patient has esophageal reflux and/or hiatal hernia/s
PROCEDURE:
AP/PA PROJECTION
LATERAL PROJECTION
RPO – esophageal varices are better seen
 Demonstrate esophageal varices
 The patient will exhale fully and then follow ingestion of the contrast media (avoid inhaling
until the exposure has been made)
 Demonstrate the entire esophagus
RAO – to throw the esophagus clear of the spine
 BODY HABITUS (Classification)
HYPERSTHENIC
 A body of one massive build which represent the upper extreme.
 Stomach & Gallbladder occupy high, almost horizontal in position
 Only 5% fits into this category
 The level of the stomach is approximately T9 to T12
 The duodenal bulb is at the level of T11 to T12
STHENIC
 A predominant type
 50% of patient fits into this category
 Stomach is at the level from T10 to T11 to L2
 Duodenal bulb is at the level of L2
ASTHENIC
 Extremely slender build type
 Stomach and gallbladder are low vertical and near the midline
 Represent lower extreme about 10% fits in this category
 Stomach is at the level of T11 to L4
 Duodenal bulb is at the level of L3
HYPOSTHENIC
 Modification of extreme asthenic
 35% of the population fits in this category
 Stomach is approximately T11 to L5 or even lower
 Duodenal bulb is at the level of L3 or L4
UPPER GASTROINTESTINAL SERIES
(UGIS) OR BARIUM MEAL
Radiographic examination of the Gastrointestinal Tract and its function, including the:
 Distal esophagus
 Stomach
 Duodenum