Contrast Studies

Question 1

What is peristalsis?

Answer 1

The term applied to the contraction waves by which food is propelled toward the rectum

Question 2

How many peristalic waves occur in the stomach?

Answer 2

3-4 waves per minute

Question 3

What is the average emptying time of a normal stomach?

Answer 3

2-3 hours

Question 4

Where is peristalsis the greatest in the intestines?

Answer 4

Greatest in the upper part of the canal and decreases in the lower portion

Question 5

How long does it take barium to reach the ileocecal valve?

Answer 5

First part in 2-3 hours
Last part in 4-5 hours

Question 6

What is the radiographer responsible for in fluoro exams of the alimentary canal?

Answer 6

• Preparing the room, equiptment and contrast
• Preparing the paitent
• Obtaining a patient history
• Taking a scout image
• Ongoing communication with the patient
• Assisting the doctor

Question 7

What is barium sulfate?

Answer 7

An artificual water-insoluble contrast medium

Question 8

What forms does barium sulfate come in?

Answer 8

Dry powder or liquid

Question 9

What other contrast media are used for the alimentary canal?

Answer 9

Water-soluble, iodinated contrast

Question 10

What is the main difference between iodinated contrast and barium?

Answer 10

Iodinated move through faster, can clear stomach in 1-2 hours and fill colon in 4

Question 11

What is an advantage of water-soluble contrast?

Answer 11

They can be easily removed from the body by aspiration before surgery and has no effect if leaked into the body

Question 12

What is a disadvantage to iodinated contrasts?

Answer 12

They have a bitter taste

Question 13

Where is the highest degree of motion in the digestive tract?

Answer 13

Stomach and proximal part of small intestine

Question 14

What should fluoro exposure times be based on?

Answer 14

• body habitus
• pathological changes
• narcotic pain meds
• body position
• respiration

Question 15

What exposure time should be used for upright esophagus?

Answer 15

0.1 second or less

Question 16

How does full inspiration affect barium move time in esophagus?

Answer 16

It moves very slow when swallowed at the end of inspiration

Question 17

When does barium rate of passage increase?

Answer 17

When swallowing during modeate inspiration

Question 18

What happens to barium during expiration?

Answer 18

Barium is delayed for several seconds when swallowed at the end of expiration

Question 19

What is the exposure time that should be used for stomach and small intestine?

Answer 19

0.2 seconds for patients with normal peristalic activity and never longer than 0.5

Question 20

When should exposures be taken of stomach and intestine?

Answer 20

At the end of expiration

Question 21

What two contrast procedures can be done for the esophagus?

Answer 21

• Full column, single contrast
• Double contrast

Question 22

What is a single contrast exam?

Answer 22

When only barium or water soluble contrast is used to fill the esophagus

Question 23

What is a double contrast procedure?

Answer 23

When barium and carbon dioxide crytals are used to fill the esophagus

Question 24

What patient prep is needed for esophageal exams?

Answer 24

No patient prep

Question 25

What type of barium should be used with single contrast studies?

Answer 25

Low density 60% weght/volume

Question 26

What type of barium should be used with double contrast studies?

Answer 26

High density 210% weight/volume

Question 27

What are the steps for a single contrast esophagus exam?

Answer 27

- Start the fluoro and spot imaging with pt upright - After the fluoro exam of heart and lungs, have patient take cup in left hand to drink the barium - Patient then swallows multiple mouthfuls under various breathing techniques

Question 28

What are the steps for a double contrast esophagus exam?

Answer 28

Almost same as single, but crystals are given by mouth immediately before barium suspension

Question 29

What are UGI tract images used to evaluate?

Answer 29

The distal esophagus, stomach and some/all of small intestine

Question 30

What does a UGI series include?

Answer 30

- KUB image - Fluoro images or combo of fluoro and radiographic images of contrast - Small intestine study when requested

Question 31

What are the patient prep steps for stomach fluoro?

Answer 31

Stomach needs to be empty and colon free of gas/fecal matter

Question 32

When should the patient stop eating for an exam of the stomach?

Answer 32

After midnight

Question 33

When should the patient stop eating for a small intestine exam?

Answer 33

Food and fluid withheld after evening meal

Question 34

What else should be avoided as part of patient prep the night before UGI imaging?

Answer 34

- Smoking - Chewing gum

Question 35

What contrast medium is generally used in routine GI exams?

Answer 35

Barium sulfate mixed with water

Question 36

What types of barium administration are used in UGI exams?

Answer 36

- Single contrast - Double contrast - Biphasic (combo of single and double contrast)

Question 37

What are the 3 methods of barium administration for the small intestine?

Answer 37

1. By mouth 2. Reflux filling through a barium enema 3. Direct injection into the bowel (enterclysis)

Question 38

When are the latter two barium administration procedures done for small intestine?

Answer 38

Only when oral administration fails

Question 39

What is the patient prep for small intestine contrast exams?

Answer 39

- Low residue diet for 2 days before - Food witheld after evening meal the day before the exam - Cleansing enema administered morning of - Bladder empty also recommended

Question 40

What is the radiographic examination of the small intestine called?

Answer 40

Small bowel series because identical images are taken at timed intervals

Question 41

How are the images in a small bowel series identified?

Answer 41

Through the use of a time marker on each image

Question 42

What body positions are used for small bowel series?

Answer 42

Supine or prone position

Question 43

What is the supine position used for?

Answer 43

1. to take advantage of the superior and lateral shift of the stomach for better visualization of retrogastric portions of the intestine 2. Prevent compression of the overlapping loops

Question 44

What is the prone position used for?

Answer 44

To compress abdominal contents

Question 45

When is the first exposure in a small bowel series taken?

Answer 45

at 15 minutes after the patient drinks barium

Question 46

How much time is between the next intervals of the small bowel series?

Answer 46

15-20 minutes depending on transit time of barium

Question 47

What can be given to patients with hypermotilty to stimulate peristalsis?

Answer 47

A glass of ice water

Question 48

What are the steps of a complete reflux small bowel exam?

Answer 48

- Patient is given glucagon to relax the intestine - Retention enema tip is inserted into the patient - Patient is placed supine and barium suspension administered until it reaches the duodenal bulb - Enema bag is then lowered to drain it before images are taken

Question 49

What are the steps for an enteroclysis small bowel procedure?

Answer 49

Contrast is injected through a specially designed catheter (Bilbao or Sellink) directle into the duodenal area

Question 50

What is gastrointestinal intubation?

Answer 50

A procedure in which a tube is inserted through the nose and passed into the stomach, where its then carried via peristalic waves

Question 51

What is gastrointestinal intubation used for?

Answer 51

Therapeutic or diagnostic purposes

Question 52

How is therapeutic gastrointestinal intubation done?

Answer 52

The tube is connected to a suction system to siphone gas and fluids out of the GI tract

Question 53

What are the two radiographic methods for examining the large intestine?

Answer 53

- Single contrast enema - Double contrast enema

Question 54

What is the patient prep for large intestine imaging?

Answer 54

Large intestine needs to be completely emptied of its contents

Question 55

What happens with retained fecal matter in large intestine?

Answer 55

When coated with barium they look similar to small masses

Question 56

What do the preliminary steps include for large intestine procedures?

Answer 56

- Clear liquid diet only - Complete intestinal tract cleansing kits - Cleansing enema

Question 57

What type of catheter should be used in patients with hemorrhoids, fissures, etc?

Answer 57

Soft rubber rectal catheter

Question 58

What are the features of a retention tip?

Answer 58

Double lumen tube with a thin balloon at the distal end

Question 59

What is the standard capacity of an enema bag?

Answer 59

3000 ml

Question 60

How much liquid do most BE exams need?

Answer 60

1000-2000 ml of premixed barium

Question 61

How should the enema tip be inserted?

Answer 61

- Turn patient on their left side and have them roll forward in the Sims position - ADjust IV pole no higher than 24 inches - Direct the tube no more than 1.5 inches initiall and follow the angle of the anal canal - Continue insertion until tube is up to 4" inserted - Stabalize the tube and turn patient to supine or prone position

Question 62

How is the air/barium distributed in the stomach in the supine position?

Answer 62

Barium up in the fundus of the stomach Air down in the pyloric region

Question 63

How is the air/barium distributed in the stomach in the prone position?

Answer 63

Air up in the very top of the fundus Contrast down in the body and pyloric region

Question 64

How is the air/barium distributed in the stomach in the erect position?

Answer 64

Air up in the entire fundus and upper body Barium down in the lower body and pylorus