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21-10-2008 1Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

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21-10-2008 2

Barium MealBarium Meal

byby

Dr Khursheed H. AwanDr Khursheed H. AwanRadiology Dept, HMC PeshawarRadiology Dept, HMC Peshawar

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21-10-2008 3Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

Presentation OutlinePresentation Outline

(Part 1)(Part 1)

Introduction

Radiologic Anatomy

Technique

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21-10-2008 4

I

ntroductionI

ntroduction

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21-10-2008 5Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

IntroductionIntroduction

Barium examination remains the basic techniqueBarium examination remains the basic techniquefor radiological investigation of the stomachfor radiological investigation of the stomachalthough, in many parts of the world, endoscopyalthough, in many parts of the world, endoscopy

has reduced the need for this examination.has reduced the need for this examination.

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21-10-2008 6Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

our basic techniquesFour basic techniques

There areThere are four basic techniquesfour basic techniques to theto theperformance of this examinationperformance of this examination

(A)(A) DistensionDistension

(B)(B) CompressionCompression(C)(C) Mucosal reliefMucosal relief

(D)(D) Full column / barium fillingFull column / barium filling

(A)(A) Each has specific advantages as well asEach has specific advantages as well aslimitations in evaluating the stomach.limitations in evaluating the stomach.

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21-10-2008 7Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

Four basic techniquesFour basic techniques

(A)(A) TheThe singlesingle--contrast upper gastrointestinalcontrast upper gastrointestinalexaminationexamination emphasizes compression, bariumemphasizes compression, bariumfilling and mucosal relief, whereas the doublefilling and mucosal relief, whereas the double--

contrast examination utilizes these techniquescontrast examination utilizes these techniquesto a limited degree.to a limited degree.

(B)(B) DoubleDouble--contrast techniquecontrast technique combines thecombines the

principles of distension, mucosal coating andprinciples of distension, mucosal coating andproper projection.proper projection.

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21-10-2008 8Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

Why Double Contrast ?Why Double Contrast ?

SingleSingle--contrast studies have a number ofcontrast studies have a number oflimitations that may affect diagnostic accuracy.limitations that may affect diagnostic accuracy. Distention :Distention : increased barium => increased opacity.increased barium => increased opacity.

En En--face lesions lesions obscured by bariumface lesions lesions obscured by barium

column; lesion in profile well visualizedcolumn; lesion in profile well visualized Palpation and compression :Palpation and compression : Unfortunately, manyUnfortunately, many

parts of the GI tract such as the gastric fundus andparts of the GI tract such as the gastric fundus andcardia, colonic flexures, and rectosigmoid are notcardia, colonic flexures, and rectosigmoid are not

easily accessible to palpation. In addition, in obeseeasily accessible to palpation. In addition, in obesepatients / those with recent surgery effectivepatients / those with recent surgery effectivecompression can not be achieved.compression can not be achieved.

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21-10-2008 9Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

Why Double Contrast ?Why Double Contrast ?

IncreasingIncreasingdistentiondistention is achieved by gas ratheris achieved by gas ratherthan barium. Thus, the contour of the bowel canthan barium. Thus, the contour of the bowel canbe seen without losing thebe seen without losing the en faceen facemucosalmucosal

surface detail.surface detail.AlthoughAlthough compressioncompression is still useful with doubleis still useful with double

contrast, it is certainly not as critical for thecontrast, it is certainly not as critical for the

demonstration of lesionsdemonstration of lesions en face.en face.

Furthermore, regions of the GI tract that areFurthermore, regions of the GI tract that areinaccessible to palpationinaccessible to palpation can be easily examined.can be easily examined.

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21-10-2008 10Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

Barium examination of StomachBarium examination of Stomach

Single contrast examinationSingle contrast examination

Double contrast examinationDouble contrast examination Biphasic examinationBiphasic examination

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21-10-2008 11

R

adiologic AnatomyR

adiologic Anatomy

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21-10-2008 12Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

Stomach : AnatomyStomach : Anatomy

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21-10-2008 13Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

Stomach : AnatomyStomach : Anatomy

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21-10-2008 14Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

Stomach : AnatomyStomach : Anatomy

Tracing of double contrast barium meal x-ray

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21-10-2008 15Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

CT of normal stomach distended with positive contrast and air.

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21-10-2008 16Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

CT of normal stomach distended with positive contrast and air.

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21-10-2008 17Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

CT of normal stomach distended with positive contrast and air.

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21-10-2008 18Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

CT of normal stomach distended with positive contrast and air.

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21-10-2008 19Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

CT of normal stomach distended with positive contrast and air.

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21-10-2008 20Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

CT of normal stomach distended with positive contrast and air.

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21-10-2008 21Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

CT of normal stomach distended with positive contrast and air.

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21-10-2008 22Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

CT of normal stomach distended with positive contrast and air.

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21-10-2008 23Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

CT of normal stomach distended with positive contrast and air.

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21-10-2008 24Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

CT of normal stomach distended with positive contrast and air.

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21-10-2008 25Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

CT of normal stomach distended with positive contrast and air.

Turn image so thatpatient left side is toyour left , as if looking

at your own CT fromabove)

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21-10-2008 26Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

CT of normal stomach distended with positive contrast and air.

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21-10-2008 27Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

CT of normal stomach distended with positive contrast and air.

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21-10-2008 29Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

4.1Air rises up

B

a settlesdown

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21-10-2008 30Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

Gastric Antrum

Left posterior oblique

4.1

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21-10-2008 31Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

Gastric Antrum

Left posterior oblique (LPO)

4.1

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21-10-2008 32Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

4.2

yGastric body, inferior portion

yPatient Supine (AP)

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21-10-2008 35Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

4.3

yFundus

yRight Lateral (RL)

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21-10-2008 36Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

4.3

yFundus

yRight Lateral (RL)

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21-10-2008 37Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

4.3

yFundus

yRight Lateral (RL)

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21-10-2008 38Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

4.3

yFundus

yRight Lateral (RL)

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21-10-2008 39Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

4.4

Gastric body, superior portion

yRight Posterior Oblique (RPO)

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21-10-2008 40Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

4.4

yGastric body, superior portion

yRight Posterior Oblique (RPO)

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21-10-2008 41Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

4.4

yGastric body, superior portion

yRight Posterior Oblique (RPO)

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21-10-2008 42

TechniqueTechnique

Double Contrast examinationDouble Contrast examination

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21-10-2008 43Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

Take four DC spots (4Take four DC spots (4--onon--1 film format) in the1 film format) in the

following sequence from the distal to thefollowing sequence from the distal to theproximal end of the stomach (90 kVp)proximal end of the stomach (90 kVp)

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21-10-2008 44Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

1

2

3

4

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21-10-2008 45Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

Body &Antrum

Left posterior oblique (LPO)

4.1

Duodenal bulb also seenwith double contrast.

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21-10-2008 46Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

Gastric body and antrum

Supine (AP)

4.2

In this case there is

early filling of theduodenum.

Note: Fine transverse

antral folds

4 3

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21-10-2008 47Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

Fundus, cardia.

Right Lateral (RL)

4.3

In this patient smooth,

broad-based extrinsicimpression from the

spleen is present.

4 4

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21-10-2008 48Presented by Dr Khurshid H. Awan, Radiology Dept., HMC Peshawar

Gastric body, Superior portion

Right Posterior Oblique (RPO)

4.4

Note:- Areae gastricae

demarcated by barium-filledgrooves which are normal

mucosal features, are depicted inthis image.

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21 10 2008 P t d b D Kh hid H A R di l D t HMC P h

End ofPart 1End ofPart 1

Thank you