Question

For this week's discussion assignment. You are the technologist who is working in the fluoroscopy suite. A patient's doctor has called you informing you of the following:

Ms. Smith has the following studies for the day. However, the physician on the phone wants to know from you which exam/procedure to do first, second, third, etc. The sequencing of these exams are important because if performed out of order will result in left over contrast residue for the remaining exams.

Ms. Smith Procedures

1. Barium Enema
2. Small Bowl Follow Through (SFBT)
3. Esophogram (Modified Barium Swallow)
4. CT of the abdomen, using IV COntrast
5. Upper GI Study
6. Cystourtherogram

Provide an explanation and rationale for your each of exam/procedure.

Answer 1

Barium enema:

Barium enema is an X-ray procedure where fluid which contains metallic substance ( barium) is introduced in to rectum with small tube

This liquid containing metallic substance will coat the intestine and in X- ray relatively clear images of colon can be obtained

Before this procedure the colon should be emptied, and this procedure typically takes 30- 60 minutes

Rationale

This procedure is performed for the conditions like

• Abdominal pain
• Rectal bleeding
• Abnormal polyps
• Irritable bowel disease
• Persistent constipation or diarrhoea
• Unexplained weight loss
• Changes in bowel habits

Small bowel follow through:

Small bowel follow through procedure uses a form of real time X-ray called fluroscopy and a barium based contrast material to produce images of stomach and upper part of small intestine

Barium is a liquid that is swallowed and appears white on X-ray images

You are not allowed to drink or eat after the midnight of day before procedure

Rationale:

• It is used to identify bowel disease
• Polyps and cancers
• Obstruction
• Ulcers
• Inflammation

Esophogram:

It is a modified barium swallow test often referred as videofluroscopic swallowing study. which takes X-ray pictures of esophagus after barium is swallowed, this will outline and coat the walls of esophagus and helps to visualise including inner lining of GI and swallowing motion

Rationale:

• Painful swallowing
• Pharyngeal dysphagia
• Hiatal hernia
• Laryngeal abnormalities
• Progressive neurological disease
• Esophageal cancer
• Reflux disease

CT of the abdomen using IV contrast:

CT with intravenous contrast used to highlight blood vessels, organs and other structures. Iodine based dye is injected intravenously

Patient should be asked for allergies to iodine or barium, as it is a modern contrast IV dye, there is less likely for reactions, or else patient shall be premeditated with steroid medication if there is a risk of reaction.

Patient should be on empty stomach for this procedure and no metallic clips should be on body.

Rationale:

• Abdominal pain
• Mass in the abdomen
• Kidney stones
• Unexplained weight loss
• To check for intestinal obstruction
• Crohn's disease
• Injuries following trauma
• Cancer

Upper GI study:

Upper GI series study is performed by using X-ray, fluroscopy and a chalky liquid called barium to view upper GI, barium will produce more clear X-rays

Rationale:

• Nausea and vomiting
• Abdominal pain
• Difficulty in swallowing
• Unexplained weight loss
• Abnormal growth such as cancer
• Esophagvarivarices
• Hiatal hernia
• Ulcers
• GERD

Cystourethrogram:

Cystourethrogram is performed with x-ray to take the pictures of bladder and urethra while your bladder is full and while urinating

A thin flexible catheter will be introduced in to bladder through urethra and a contrast material will be introduced in to bladder and X-rays will be taken

Rationale:

• Urinary tract infections
• Injuries to the bladder and urethra
• Urinary incontinence
• Structural abnormalities of urethra and bladder
• Stritcture of urethra
• Vesicourethral reflex