Radiographer Performed Barium Swallow

Barium Swallow

• ·      Examination of the pharynx, oesophagus, stomach and duodenum
• ·      Used to disclose abnormalities that may be either structural or functional or both
• ·      Often used in conjunction with endoscopy when there is a suspected structural abnormality of the oesophagus as endoscopy can not assess functional abnormalities

Relevant Anatomy

Indications

• ·      Heartburn
• ·      Dysphagia (difficulty swallowing)
• ·      Odynophagia (painful swallowing)
• ·      Globus (feeling of something stuck in throat)
• ·      Hiatus hernia
• ·      Reflux
• ·      Unexplained vomiting
• ·      Assess gastric band position/tightness (limited study)

Patient Preparation

·      NBM from midnight of the night before examination

Imaging

·      Examinations on otherwise healthy patients can frequently be performed by the radiographer, with a supervising radiologist available to check the images – this will vary between practices however

·      If performing the study without direct radiologist supervision, the following projections provide a well rounded examination

Lateral and AP Upper Oesophagus

• ·      To show swallowing mechanism
• ·      May be rapid acquisition (2/3fps), fluoroscopy capture or single shot however need to demonstrate entire oesophagus filled with contrast
• ·      Stop examination if aspiration occurs

Lateral and AP Distal Oesophagus

• ·      Ensure overlap occurs with upper oesophagus images (arch of aorta as landmark)
• ·      Show entire oesophagus filled with contrast including gastroesophageal junction
• ·      May be rapid acquisition (1/2fps), fluoroscopy capture or single shot
• ·      Ensure oesophagus is shown to have emptied before performing supine images

Gas (Part 1, Part 2 solution) is administered to the patient before lying them down to distend stomach and oesophagus

Supine

• Centred to include only the distal oesophagus which should be empty

Left Lateral

• ·      Roll patient onto left side before RPO to move the barium to encourage reflux

RPO

• ·      If contrast is seen in the gastroesophageal junction or distal oesophagus then reflux has been demonstrated provided that it is proven that the barium has in fact emptied completely into the stomach initially
• ·      To demonstrate reflux it may be necessary to roll the patient slightly onto the left (to deposit gastric barium into the fundus) then slowly back into RPO position
• ·      Patient can also drink a small amount of water or dry swallow to help induce reflux

Prone

• ·      On full inspiration can better demonstrate a hernia and Schatzki’s ring

RAO

• ·      Have patient swallow barium continuously through a straw and image as it fills the cardioesophageal junction and passing into the fundus
• ·      Can also demonstrate a hiatus hernia

L-R Upper: R Lateral Erect, AP Erect Upper and Lower

L-R Lower: AP Erect Lower,

 R Lateral Erect Lower, RPO Supine demonstrating reflux

Variations

Modified Barium Swallow

• ·      Performed with presence of speech pathologist
• ·      Usually performed with patient erect with primarily oesophagus pictures (limited interest in stomach pictures other than to demonstrate hiatus hernia)
• ·      Patient swallows liquids of varying thickness and textures mixed with barium – prepared by speech pathologist
• ·      Checking swallowing mechanism, aspiration, reflux, hiatus hernia
• ·      Fluoroscopy store generally preferred with runs saved to video/DVD

Possible Pathology Demonstrated

• Hiatus Hernia
• Reflux
• Oesophageal Cancer
• Diverticulum
• Aspiration