Esophagram/barium Swallow

Question 1

Position RAO Esophagram

Answer 1

Recumbent prone or erect
Patient rotated so MSP is 35-40 degrees from grid device.
Pillow under head.
Right side touching IR
If recumbent, right arm is by side and left knee is flexed
Have patient drink thin barium while you are going back to take image
Recumbent adds to reflux; barium stays in esophagus longer.

Question 2

Position for Right Lateral esophagram

Answer 2

Recumbent or erect
Pillow under head
Arms abducted up away from body.
Shoulder and hips in true lateral.
Recumbent adds to reflux; barium stays in esophagus longer.
Have patient drink while you are going back to take image.

Question 3

Position for AP esophagram

Answer 3

Recumbent or erect
Ensure that shoulders and hips are not rotated.
Recumbent adds to reflux; barium stays in esophagus longer.
Have patient turn head to drink barium, while you are going back to take image.

Question 4

Routine for Esophagram

Answer 4

RAO
Right lateral
AP

Question 5

Where is the top of IR for the Esophagram routine?

Answer 5

At level of mouth; 2” above top of shoulder.

Question 6

CR for RAO esophagram

Answer 6

Directed perpendicular to level of T5-6.
CR centered midway between upside, side and lateral border of ribs.
Collimate side to side

Question 7

Film size for esophagrams

Answer 7

14 x 17 LW

Question 8

Structures for RAO esophagram

Answer 8

Unobstructed view of the entire esophagus located between the vertebral column and the heart.

Question 9

Structures seen in Right Lateral esophagram

Answer 9

Esophagus located between the vertebral column and the heart. Esophagus is more posterior.

Question 10

CR for Right Lateral Esophagram

Answer 10

Directed perpendicular to the level of T5-6

Center more posterior to mid-coronal plane.

Question 11

CR for AP esophagram

Answer 11

Directed perpendicular to level of T5-6

Question 12

Structures seen in AP esophagram

Answer 12

Frontal image of the esophagus. Much of the esophagus with barium will be superimposed over the spine.

Question 13

Name 6 pathologies for esophagrams.

Answer 13

Anatomical anomalies
Esophageal Reflux/GERD
Esophageal Varices 
Foreign body obstruction
Difficulty swallowing
Diverticuli

Question 14

Rapid sequence means

Answer 14

Take more images per second
Usually for impaired swallowing mechanism
Focus is on upper esophagus

Question 15

Make sure of what, on the esophagram images?

Answer 15

There is a column of barium in esophagus on images

Question 16

Step of Esophagram

Answer 16

Table erect to start.
Shield patient from the back.
Thick barium in a cup.
Thin barium while lying down, with a straw.
Then after fluoro, do overhead x-Rays.

Question 17

3 optional positions for esophagram

Answer 17

Swimmers
LAO
Soft Tissue Lateral

Question 18

What are you looking for, if you do LAO Esophagram?

Answer 18

Esophagus/heart relationship
Looking if heart (cardiomegly) is impacting the esophagus
If patient has Heart on the opposite side

Question 19

Why do a soft tissue lateral esophagram?

Answer 19

If patient has Difficulty swallowing.

Question 20

Position for Soft Tissue Lateral esophagram

Answer 20

True lateral
Extend chin, shoulders down and back
CR at C6
72” SID

Question 21

Which position is routinely used to show variceal distentions and why?

Answer 21

Recumbent bc Varices are best filled by having the blood flow against gravity.

Question 22

What is the valsalva maneuver?

Answer 22

Is performed by forcible exhalation against a closed glottis.

Question 23

Thick barium

Answer 23

Is blue
Add 65cc of water
No straw

Question 24

Thin barium

Answer 24

Fill to top of label with water.

Put straw in it.