Gastrointestinal Imaging/Fluoroscopy Services:

• Upper GI
• Modified Barium Swallow (Cookie)
• Lower GI
• Esophageal and motility studies
• Small Bowel Examination
• Reproductive Hystersalpinogram
• Cystography
• Fistulagram
• Bariatric pre and post-surgical evaluation

Imaging of the gastrointestinal tract encompasses a wide array of testing to aid with diagnosis and treatment. Both x-ray and fluoroscopy are performed. X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. X-rays are made by using external radiation to produce images of the body, its organs, and other internal structures for diagnostic purposes. X-rays pass through body tissues onto specially-treated plates (similar to camera film) and a “negative" type picture is made.

Fluoroscopy is often used during an upper GI series. Fluoroscopy is a study of moving body structures — similar to an X-ray “movie." A continuous X-ray beam is passed through the body part being examined, and is transmitted to a TV-like monitor so that the body part and its motion can be seen in detail. In an upper GI series, fluoroscopy allows the radiologist to see the movement of the consumed contrast medium through the esophagus, stomach, and duodenum as a person drinks. In order to view the GI tract, a contrast medium such as barium or a water soluble contrast must be used.

Barium is a dry, white, chalky powder that is mixed with water to make a thick, milkshake-like drink. Barium is an X-ray absorber and appears white on X-ray film. When swallowed, a barium drink coats the inside walls of the upper GI tract organs so that the swallowing motion, inside wall lining, function, size, and shape of these organs are visible on X-ray. This process shows differences that might not be seen on standard X-rays. Barium is used only for diagnostic studies of the GI tract.

The use of barium with standard X-rays contributes to the visibility of various characteristics of the esophagus, stomach, and duodenum. Some abnormalities of the upper GI tract that may be detected with an upper GI series include tumors, ulcers, hernias, diverticula (pouches), strictures (narrowing), inflammation, anatomical variances and swallowing difficulties.

In addition to barium, the radiologist may use a gas, such as air or a carbonated substance. You may be given a powder, tablet, or carbonated beverage that produces gas when swallowed. Air or gas will appear black on X-ray film, contrasting with the barium’s white image. The use of the 2 substances, barium and ga s, is called a double contrast study. The radiologist may use the water-soluble contrast if you have a perforation (tear or hole) of the bowel or esophagus, or for other reasons determined by your doctor. The purpose of using 2 contrast substances is to achieve an enhancement of the inside wall lining of the esophagus, stomach, and duodenum. As the gas expands the organs (like blowing up a balloon), a barium coating is formed on the inner surface of the organs. This technique enhances visualization by sharpening the outline of the inner surface layer of the esophagus, stomach, and/or duodenum, and is useful in diagnosing structural and tissue abnormalities.

An upper gastrointestinal series (UGI) is a radiographic (X-ray) examination of the upper gastrointestinal (GI) tract. The esophagus, stomach, and duodenum (first part of the small intestine) are made visible on X-ray film by a liquid suspension. This liquid suspension may be barium or water-soluble contrast. If only the pharynx (back of mouth and throat) and esophagus (a hollow tube of muscle extending from below the tongue to the stomach) are examined with barium, the procedure is called a barium swallow, also known as an esophagram.

A modified barium swallow (Cookie test) is a fluoroscopic procedure designed to determine whether food or liquid may be entering the airway (trachea and bronchi), also known as aspiration. It may be performed as an independent test or together with an esophagram. The names of these two exams are similar, which sometimes causes confusion. Therefore, be sure to clarify with your physician which exam he intended to prescribe. It permits the medical team to observe the coordination of the mouth and throat, as they are actively functioning when chewing, drinking, and swallowing. This test is done in conjunction with the speech therapist, who immediately will initiate a treatment plan based on your individual need from the specific etiology determined by this test.

A barium enema is an x-ray exam of the large intestine (colon and rectum). It may also be called a lower gastrointestinal (GI) exam. The test is used to help find diseases and other problems that affect the large intestine. The colon is filled with a contrast material that contains barium so that the intestine can be seen on an X-ray. This is done by pouring the contrast material through a tube inserted into the anus. The barium blocks X-rays. This causes the barium-filled colon to show up clearly on the X-ray picture.

There are two types of barium enemas.

• In a single contrast study the colon is filled with barium. This outlines the intestine and shows large abnormalities.
• In a double-contrast or air contrast study, the colon is first filled with barium, and then the barium is drained out. This leaves only a thin layer of barium on the wall of the colon. The colon is then filled with air. This provides a detailed view of the inner surface of the colon. It makes it easier to see narrowed areas (strictures), diverticula, and swelling.

A barium enema is done to:

• Find swelling of the intestinal wall that occurs in inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease. A barium enema also may be used to keep track of the progress of these diseases.
• Find problems with the structure of the large intestine. Problems may include narrowed areas (strictures) or pockets or sacs (diverticula) in the intestinal wall.
• Check on belly symptoms such as pain, blood in stool, or altered bowel habits.
• Check on other problems such as anemia or unexplained weight loss.
  You may be embarrassed by the test. You may worry that you won't be able to hold the barium and that it will leak onto you or onto the table. The doctors who perform this procedure are used to this. They will be able to help you.

HYSTEROSALPINGOGRAM

A hysterosalpingogram (HSG) looks at the inside of the uterus and fallopian tubes and the area around them. It often is done for women who are having a hard time getting pregnant (infertile). During the test, a dye (contrast) is put through a thin tube. That tube is put through the vagina into the uterus. Because the uterus and fallopian tubes are connected, the dye will flow into the tubes. Pictures are taken using a steady beam of x-ray as the dye passes through the uterus and fallopian tubes. The pictures can show problems such as an injury or abnormal structure of the uterus or fallopian tubes. They can also show a blockage that would prevent an egg moving through a fallopian tube to the uterus. A blockage also could prevent sperm from moving into a fallopian tube and joining (fertilizing) an egg. The test also may find problems on the inside of the uterus that prevent a fertilized egg from attaching (implanting) to the uterine wall.

CYSTOGRAPHY

A cystogram looks at the urinary bladder. It is often done to evaluate bladder cancer, vesicoureteral reflux (when urine flows back into the ureters), bladder polyps, hydronephrosis and post-surgical repair. A catheter is inserted through the urethra into the bladder. Contrast is then passed through this catheter into the bladder. Once the bladder is full, imaging is done. Cystography may be combined with other exams such a voiding cysto-urethrogram, which images the bladder and urethra. This exam is used to watch how the bladder empties while you urinate (void).

ABDOMINAL FISTULAGRAM

A gastrointestinal fistula is an abnormal communication between a part of the gastrointestinal tract and the skin or other portion of the GI tract. A fistulagram is performed to demonstrate this communication. A small amount of contrast is gently injected through the small opening on your skin surface while watching via fluoroscopy. Occasionally, further evaluation with advanced imaging such as CT scan may be done immediately following.

BARIATRIC EVALUATION

Bariatric pre and post-surgical evaluation. Pre-operatively, an UGI test is done to assess anatomical variances as well as underlying GI problems such as hiatal hernia, gastroesophageal reflux and peptic ulcer disease. Often a test known as a marshmallow/ bagel GI is done to evaluate esophageal motility and determine which type of surgical intervention can be done. During this test, you will be positioned with your head tilted toward the floor, lying partially on your stomach. You will be asked to eat a piece of a marshmallow and a bagel that has been coated in barium. Fluoroscopy is done to evaluate the esophagus during “real-time.” Post-operatively, a water soluble UGI is done to evaluate for post-surgical complications and advance the diet.