RADIOLOGICAL ANATOMY WITH BARIUM MEAL

…Dr.Janani.A.V

CONTRAST MEDIA IN GIT

Earliest contrast medium – LIPIODOL (Ethyl esters of iodized fatty acids of poppyseed oil)

BARIUM SULPHATE

Non absorbable.Insoluble in water / Lipid.Inert to tissues.Can be used for double contrast studies.

HIGH ATOMIC NUMBER (56)- HIGHLY RADIO OPAQUE ?

PHOTO ELECTRIC EFFECT

APPLICATION …

Does not produce scatter radiation and it enhances tissue contrast

Patient receives more radiation

GOOD

BAD

ADVANTAGES OF BaSO4 PREPARATION

NON-ABSORBABLE. Therefore barium does not get degraded throughout the bowel

SUITABLE FOR DOUBLE CONTRAST STUDIES –As it coats the mucosa in a thin layer, thus allows introduction of negative contrast agents without significant degradation

ADV over water soluble contrast agent – Results in better coating --- better mucosal detail

Low cost.

DISADVANTAGE

SUBSEQUENT ABDOMINAL CT is rendered difficult to interpret

(May need to wait upto 2 weeks)HIGH MORBIDITY associated with barium in

the peritoneal cavity

HIGH/LOW DENSITY BARIUM

Average particle size = 0.3 µm to 12 µm

0.3 – 3 µm

More stable in suspension

Larger size = 12 µm , Heterogenous size

HIGH DENSITY + LOW VISCOSITY Ba suspension

Good mucosal coating - Used in double contrast barium studies

BARIUM MEASURING SYSTEMS

W/W Suspension

Specified weight of BaSo4 is used and enough water is then added to obtain a total weight

Eg: 30% W/W --- 30g of BaSo4 + 70 g of H2O = 100g

W/V Suspension

Specified weight of BaSo4 is determined and enough water is then added to obtain a certain volume

Eg: 80% W/V --- 80g of BaSo4 + H2O = 100 ml

BARIUM REQUIREMENTSBARIUM SWALLOW 250 % W/V 100 ml

BARIUM MEAL 250 % W/V 135 ml

BARIUM MEAL FOLLOW THROUGH

60-100% W/V 300 ml

SMALL BOWEL ENEMA

60-100% W/V 1500 ml

BARIUM ENEMA 115% W/V 500 ml

PREPARATIONS

MICROBAR PASTE 100% w/v – High viscosity, high density paste for pharynx and esophagus

MICROBAR SUSPENSION

95 % w/v – Moderate density and viscosity for esophagus, stomach and small

intestine

MICROBAR HD 200 % w/v – High density and low viscosity in powder for double contrast

MICROBAR for enema

1 and 5 Kg packs of powder : Desired suspension can be made

ADDITIVES

• CARBOXYL METHYL CELLULOSE- To prevent settling. Rate of settling should be less than 1/10 at the end of 3 hours.

• ANTACIDS- To prevent flocculations – SODIUM CITRATE, ALUMINIUM HYDROXIDE,

MAGNESIUM SULPHATE.

ADDITIVES

• SODIUM META BI SULPHATE, METHYL PARABEN – Preservatives.

• SIMETHICONE / METHYLPOLYSILOXONE –Antifoaming agents

• ERYTHROCIN – Coloring agent• SACCHARINE, FRUIT ESSENCES – Sweetening

agent

COMPLICATIONS

PERFORATION – Into the peritoneal cavity / mediastinum.

ASPIRATION – Into bronchial tree.INTRAVASATION – embolism.BARIUM INSPISSATION – Colonic obstruction

to form hard stones.Very rarely – Barium encephalopathy

OTHER CONTRAST MEDIA

WATER SOLUBLE CONTRAST AGENTS: ( IOHEXOL/ GASTROGRAFFIN)

20ml of contrast + 20 ml of normal saline + 2 drops of sorbitol

INDICATIONS:SUSPECTED PERFORATION / FISTULAH/O RECENT BIOPSYSUSPECTED LOWER INTESTINAL OBSTRUCTIONCORROSIVE POISONINGIMMEDIATE POST OPERATIVE STATUS

OTHER CONTRAST AGENTS

ORAL COCKTAIL: Barium sulphate + Magnesium sulphate + LOCM (Absorb water into bowel and dissolve barium –

moves very fast in GIT)AIR/C02: Double contrast studiesWATER: To diagnose lipomatosis of colon (Appears more lucent compared to the water column)

ANATOMY

DUODENUM (25cm)

5 cm

7.5 cm

10 cm 2.5 cm

LI

L2

L3

BARIUM MEAL

INDICATIONS Malignancies of gastro esophageal junction, stomach, duodenum Upper abdominal mass Motility disorders Gastric or duodenal obstruction Systemic diseases like Tb (Affecting upper GIT) GIT hemorrhage

SYMPTOMS WHICH PROMPTS BARIUM MEAL STUDY:Epigastric pain suggestive of peptic ulceration/ Anorexia / Weight loss / Vomiting / Anemia / Heart burn / Dyspepsia

IN CHILDREN…

• TO IDENTIFY A CAUSE FOR VOMITING:Gastro-oesophageal refluxPyloric obstructionMalrotation

CONTRAINDICATIONS

SUSPECTED CASES OF GASTRO-DUODENAL PERFORATION

H/O OR SUSPICION OF ASPIRATIONLARGE BOWEL OBSTRUCTIONRECENT BIOPSY FROM GIT

PREPARATION

NPO for atleast 6 hours before examination.Abstain from-smoking

CONTRAST STUDY

SINGLE CONTRAST

LOW DENSITY BARIUM

SUSPENSION ( 80-100% W/V)

DOUBLE CONTRAST(BEST MUCOSAL

COATING)

HIGH DENSITY(250%W/V), LOW

VISCOSITY

STANDARD VIEWSSINGLE CONTRAST DOUBLE CONTRAST

FUNDUS SUPINE ERECT WITH 2 VIEWS 90* TO EACH OTHER OR PRONE

RIGHT SIDE DOWNBODY ERECT or PRONE SUPINE WITH 60* HEAD

END ELEVATION

ANTRUM AND PYLORUS PRONE RIGHT SIDE DOWN SUPINE RIGHT SIDE UP

D1 AND C Loop OF DUODENUM

PRONE RIGHT SIDE DOWN SUPINE RIGHT SIDE UP

D4 OF DUODENUM SUPINE PRONE RIGHT SIDE DOWN

SINGLE CONTRAST EXAMINATION

• LOW DENSITY BARIUM = 80-100%W/V• MUCOSAL RELIEF RADIOGRAPH: 60-90 ml. SUPINE AND PRONE FILMS. GASTRIC FOLD PATTERNS.

• SINGLE CONTRAST : 100 to 250 ml Prone , RAO, LPO, R LATERAL Wall rigidity, contour abnormalities – Lesions/Filling defects

ADVANTAGE

Optimal for patients who are immobile

Filling defects due to large masses in pyloric and duodenal region are more easily identifiable

DISADVANTAGE

Lack of sensitivity in detecting small erosion, linear ulcer, superficial gastric carcinoma

DOUBLE CONTRAST STUDY

100 to 150 ml of high density barium (250% w/v)300 to 500 ml of effervescent Hypotonic agent Buscopan(hyoscine butyl

bromide,20 mg i.v) or 0.1-0.2 mg i.v glucagon is injected intravenously -relax stomach and suspend peristalsis.

Supine, RAO, LPO, R Lateral, ERECT

ADVANTAGE

Highly accurate detecting abnormalities following gastric surgery, bile reflex gastritis, marginal ulceration, recurrent carcinomas

DISADVANTAGE

• Misses some polyp, ulcers, erosion , superficial carcinoma

BIPHASIC STUDY

To have both mucosal delineation in double contrast phase and full column distension in single contrast phase.

CONTRAST MEDIUM: 60 -100 % low viscosity , 200 – 250 ml of barium is given orally with gas forming powder in the last few mouthfuls.

FILMINGPRONE OBLIQUE, RT SIDE DOWN DUODENAL CAP, C-Loop

SUPINE WITH RIGHT SIDE UP OBLIQUE

DUODENUM

ERECT GASTRC FUNDUS

SUPINE WITH 60* HEAD UP UPPER BODY OF STOMACH

SUPINE LOWER BODY OF STOMACH, PYLORIC ANTRUM

SUPINE WITH RT SIDE UP OBLIQUE PYLORIC ANTRUM & CANAL

HAS TO BE PERFORMED QUICKLY , WITHOUT WASTING TIME

AFTERCARE

The patient should be warned that his bowel motions will be white for a few days after the examination.

The patient should be advised to eat and drink normally to avoid barium impaction.

The patient must not leave the department until any blurring of vision produced by the Buscopan has resolved

SC (RAO) : Stomach and C-loop of the duodenum with duodenal bulb in profile

Normal stomach. Double-contrast spot image of stomach with patient supine shows distal gastric body (B) and antrum (A). Greater curvature (white arrows) and lesser curvature (black arrows) are coated by barium. Rugal fold on posterior wall of gastric body is depicted as tubular, slightly undulating, radiolucent filling defect (black arrowheads) in shallow barium pool. Dense barium pool outlines contour (white arrowheads) of gastric fundus (F). Mucosal surface and folds in fundus are obscured by barium pool, and antrum is devoid of rugal folds.

Double-contrast spot image of gastric fundus with patient in right-side-down position shows normal gastric cardia with smooth folds radiating to central point (white arrow) at closed gastroesophageal junction, also known as cardiac rosette. Long, straight fold (arrowheads) extends inferiorly from cardia along lesser curvature. Black arrows denote normal extrinsic impression by adjacent spleen

Double-contrast spot image of stomach with patient in left posterior oblique position shows normal areae gastricae pattern in antrum as 2–3-mm polygonally shaped radiolucent tufts of mucosa outlined by barium in grooves. Areae gastricae are slightly larger in distal gastric body than in antrum.

OBLIQUE VIEW

COMPARISON OF BARIUM WITH ENDOSCOPY

ENDOSCOPY BARIUM MEAL

PROCEDURE OF CHOICE – DIAGNOSTIC ACCURACY IS VERY HIGH (100%)

LOW DIAGNOSTIC ACCURACY (83%) – DONE WHEN ENDOSCOPY IS CONTRAINDICATED

IDEAL FOR EROSIVE ULCERS AND EARLY DETECTION OF TUMOR AND BIOPSY CAN BE TAKEN FROM THE LESION

IDEAL WHEN ENDOSCOPY IS CONTRAINDICATED.IT IS THE MODALITY TO STUDY THE PHYSIOLOGY (i.e) peristalsis and gastric emptying

SUMMARY

KNOW WHY BARIUM IS USEDLOW/HIGH DENSITY BARIUMBARIUM MEASUREMENT SYSTEMS

BARIUM MEAL – INDICATIONS, CONTRA INDICATIONS, PREPARATION, AFTERCARE,FILMINGRADIOLOGICAL ANATOMY

ATOMIC NUMBER OF BARIUM???

45

56

58

54

WHICH OF THE FOLLOWING INTERACTION IS RQUIRED

COHERENT SCATTERING

PHOTOELECTRIC EFFECT

PAIR PRODUCTION

COMPTONS SCATTERING

Double-contrast spot image of gastric fundus with patient in right-side-down position

NAME THE PARTS