radiological anatomy with barium meal
DESCRIPTION
Radiological anatomy with barium mealTRANSCRIPT
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RADIOLOGICAL ANATOMY WITH BARIUM MEAL
…Dr.Janani.A.V
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CONTRAST MEDIA IN GIT
Earliest contrast medium – LIPIODOL (Ethyl esters of iodized fatty acids of poppyseed oil)
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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 ?
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PHOTO ELECTRIC EFFECT
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APPLICATION …
Does not produce scatter radiation and it enhances tissue contrast
Patient receives more radiation
GOOD
BAD
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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.
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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
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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
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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
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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
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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
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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
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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.
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ADDITIVES
• SODIUM META BI SULPHATE, METHYL PARABEN – Preservatives.
• SIMETHICONE / METHYLPOLYSILOXONE –Antifoaming agents
• ERYTHROCIN – Coloring agent• SACCHARINE, FRUIT ESSENCES – Sweetening
agent
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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
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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
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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)
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ANATOMY
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DUODENUM (25cm)
5 cm
7.5 cm
10 cm 2.5 cm
LI
L2
L3
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BARIUM MEAL
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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
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IN CHILDREN…
• TO IDENTIFY A CAUSE FOR VOMITING:Gastro-oesophageal refluxPyloric obstructionMalrotation
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CONTRAINDICATIONS
SUSPECTED CASES OF GASTRO-DUODENAL PERFORATION
H/O OR SUSPICION OF ASPIRATIONLARGE BOWEL OBSTRUCTIONRECENT BIOPSY FROM GIT
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PREPARATION
NPO for atleast 6 hours before examination.Abstain from-smoking
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CONTRAST STUDY
SINGLE CONTRAST
LOW DENSITY BARIUM
SUSPENSION ( 80-100% W/V)
DOUBLE CONTRAST(BEST MUCOSAL
COATING)
HIGH DENSITY(250%W/V), LOW
VISCOSITY
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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
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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
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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
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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
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ADVANTAGE
Highly accurate detecting abnormalities following gastric surgery, bile reflex gastritis, marginal ulceration, recurrent carcinomas
DISADVANTAGE
• Misses some polyp, ulcers, erosion , superficial carcinoma
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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.
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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
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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
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SC (RAO) : Stomach and C-loop of the duodenum with duodenal bulb in profile
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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.
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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
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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.
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OBLIQUE VIEW
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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
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SUMMARY
KNOW WHY BARIUM IS USEDLOW/HIGH DENSITY BARIUMBARIUM MEASUREMENT SYSTEMS
BARIUM MEAL – INDICATIONS, CONTRA INDICATIONS, PREPARATION, AFTERCARE,FILMINGRADIOLOGICAL ANATOMY
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ATOMIC NUMBER OF BARIUM???
45
56
58
54
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WHICH OF THE FOLLOWING INTERACTION IS RQUIRED
COHERENT SCATTERING
PHOTOELECTRIC EFFECT
PAIR PRODUCTION
COMPTONS SCATTERING
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Double-contrast spot image of gastric fundus with patient in right-side-down position
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NAME THE PARTS