Barium

Single and
Studies: Double Contrast
Manuel Poncian
1st year Resident
BGHMC Department of Radiology
Objectives
At the end of this presentation, we should be
able to:
1. Differentiate the types of barium studies
2. Understand the role of barium studies in modern
radiology practice
3. Identify GI abnormalities that can be demonstrated
by each study
  What is a Barium Study?
 Single-Contrast vs Double-Contrast
 Principles of Single-Contrast Study
 Principles of Double-Contrast Study

Outline  Types of Barium Study:

◦ Esophagography
◦ Upper Gastrointestinal Series
◦ Small Bowel Series
◦ Barium Enema
 Conclusion
What is a Barium Study?
Medical imaging of the gastrointestinal system
that uses Barium sulfate as the contrast agent
◦ White crystalline powder
◦ “Heavy”
◦ May be prepared thick or
thin, depending on study
What is a Barium Study?
◦ Side effects:
 Constipation
 Abdominal pain and cramping
 Nausea and vomiting
◦ Complications
 Aspiration pneumonitis  Embolism
 Anaphylaxis
 Barium peritonitis
What is a Barium Study?
◦ Advantages of water-soluble: By convention,
water-soluble
 Does not lead to severe peritonitis contrast is used
 Less obscuring when perforations
are suspected
◦ Disadvantages:
 Cost
 Lower contrast and sharpness
 Absorbed  Systemic toxicity
 Single-Contrast Double-Contrast
 One contrast: Barium  Two contrasts:
 Shows function, contour Barium and Air
abnormalities, strictures,  Enable visualization of
large defects subtle mucosal lesions
 Better for old/debilitated  Ideal for young,
patients cooperative patients

Single-Contrast vs Double-Contrast
Principles of
Single-Contrast Study
Single-Contrast Study
Diagnostic Principles
Observation Full-column
Compression
of function distention

Limited
air-
Mucosal relief
contrast
images
Single-Contrast Study
Equipment
Compression Paddle

Fluoroscopy unit
Principles of
Double-Contrast Study
Double-Contrast Study
Performance
Depends on three major principles:
Ensure optimal
interaction Mucosal Distend until the
Distention normal folds are
between barium
and mucosa
Coating just effaced

Obtain views until

Demonstrate both
each loop is
projected without Projection in profile and
en face
overlapping
Double-Contrast Study
Performance
Large ulcer crater
(arrow) not visualized
on initial radiograph
due to suboptimal
coating

Annular
carcinoma
when viewed:
en
face (left)
and
in profile
Double-Contrast Study
Interpretation
Barium pool
◦ Lesions best demonstrated by an extremely
shallow barium pool
◦ Use the
flow
technique
Double-Contrast Study
Interpretation
Dependent and Independent surfaces
◦ Independent surface
 thin coat
◦ Dependent surface
 thick coat and
 pooling on any
depression/concavity
Double-Contrast Study
Interpretation
Protrusions
Protrusion is
coated with
Independent
barium and
surface
is etched in
white

Protrusion
displaces
barium pool
and appears
Dependent as a filling
surface defect
Double-Contrast Study
Interpretation
Protrusions

“Mexican hat”
“Stalactite” Pedunculated polyp en face:
Barium droplet hangs outer ring – head of polyp
from protrusion inner ring - stalk
Double-Contrast Study
Interpretation
Depressed Lesions
Independent Sides are coated and
surface recognized as ring
shadows

Barium is trapped
and seen as focal Dependent
collections surface
Double-Contrast Study
Interpretation
Fold patterns
1. Striae
2. Web
3. Serpentine
4. Coil spring
5. Radiating folds
6. Stack of coins
7. Tethering
8. Pleating
9. Polypoid folds
Double-Contrast Study
Interpretation
Surface patterns
1. Villous pattern
2. Reticular pattern
3. Granularity
4. Nodularity
5. Shaggy
6. Cobblestoning
Double-Contrast Study
Interpretation
Contour
Abnormalities
1. Tapering
2. Linitis plastica
3. Thumbprinting
4. Sacculations
5. Spiculations
6. Angulation
Double-Contrast Study
Artifacts

A – pool obscures lesion on dependent surface

B – pool obscures lesion on independent surface
C – pool obscures lesion on overlapping bowel
Double-Contrast Study
Artifacts

Barium precipitates appear as

sharp dense collections on the Flaking of the barium simulates
mucosal surface cobblestoning in Chron’s disease
Double-Contrast Study
Artifacts

Compression of the stomach

by the aorta, producing a Kissing artifact at the lesser curvature
kissing artifact simulating a polypoid lesion
Types of Barium Study
Esophagogram
A. Single-Contrast
Indications
• Dysphagia
• Odynophagia
• Globus sensation
• Retrosternal discomfort
• Evaluation of masses, vascular rings/slings,
strictures, or aberrant anatomy
• Evaluation of esophageal motility
Esophagogram
A. Single-Contrast
Supplies
• 100-200 mL regular
barium (60% w/v)
• Barium cup
• Flexible large-caliber
straw
• ± 60 mL regular barium
diluted
Scout with
film: 60 mL
Not water
needed
Esophagogram
A. Single-Contrast
Procedure
Place patient upright or supine in right anterior
oblique (RAO) position
Place barium cup in the left hand, straw between
teeth
Neck is turned to the left, and head is placed flat on
a pillow
Position fluoroscope so that the apex of the left lung
appears at the top of monitor
Ask the patient to continuously drink the barium
(regular, then diluted)
Esophagogram
A. Single-Contrast
R. C.
50/F
2-week history of
odynophagia and
globus sensation
after fishbone
ingestion
Esophagogram
A. Single-Contrast
R. C.
50/F
2-week history of
odynophagia and
globus sensation
after fishbone
ingestion
Esophagogram
A. Single-Contrast
R. C.
50/F
2-week history of
odynophagia and
globus sensation
after fishbone
ingestion
• Examination of the upper gastrointestinal tract using contrast material showed a normal
esophagus and free flow of dye to the gastroesophageal junction.
• There was no ulceration noted.
• No evidence of intraluminal mass, mucosal irregularity and abnormal filling defects is
appreciated.
• There was no delay in the transit of opaque material.

IMPRESSION: 
NORMAL ESOPHAGOGRAM
 Esophagogram
• The superior Double-Contrast
B.mediastinum is widened.
• An air/fluid level is present.
B.
• The right heart E. is wavy and
border
irregular.
• Lateral film 49/M abnormal
demonstrates
opacity posteriorly.
1-yr history of
progressive
IMPRESSION: 
dysphagia
ACHALASIA

40-pack year
smoker
 Esophagogram
B. Double-Contrast
B. E.
49/M
1-yr history of
progressive
TERTIARY
SPASM dysphagia
CONTRACTIONS ACHALASIA
40-pack year
smoker
Esophagogram
B. Double-Contrast
Indications
• Early mucosal disease (erosions, polyps, tumors,
inflammation, infection)
Contraindications
• Suspected esophageal perforation
• Suspected aspiration
• Suspected tracheoesophageal fistula
• Esophageal strictures, or rings
• Evaluation of esophageal motility
Esophagogram
B. Double-Contrast
Supplies
• 100-200 mL dense barium
(200%-250% w/v)
• Barium cup
• 2 medicine cups for:
• 3/4 ampule effervescent
granules
• 10 ml water
Scout film: Not needed
Esophagogram
B. Double-Contrast
Procedure
Have the patient stand on a footboard in the LPO
position

Place barium cup in the left hand, head tilted back

Pour granules into back of patient’s mouth and add

water. Tell patient to swallow
Ask the patient to continuously drink the barium
with moderate rapidity
Observe for “silver-satin” appearance indicating
best possible coating
 Esophagogram
B. Double-Contrast
• Discrete ovoid mass in the mid to distal
esophagus well outlined by barium. Its
E. L.obtuse angles with
borders form slightly
the esophageal wall.
26/M
• Mucosal pattern is intact
Recurrent
IMPRESSION: 
episodes
LEIOMYOMA of
dysphagia and
regurgitation
 Esophagogram
B. Double-Contrast
• Filling defect noted in the mid esophagus
E. C.
with acute overhanging edges and
39/M
irregular margins
5-month history of
IMPRESSION: 
progressive
CONSIDER ESOPHAGEAL CARCINOMA
hoarseness of voice
and odynophagia
Alcoholic
 Esophagogram
• Smooth stricture in the mid-esophagus
• Multiple ulcerations,
Double-Contrast
• Reticular mucosal
B. appearance extending
down from the inferior aspect of the
stricture.
B. E.
• Innumerable tiny outpouchings in the
49/M
distal two thirds of the esophagus with
bridging noted between the adjacent
lesions 1-yr history of
progressive
IMPRESSION: 
dysphagia
BARRETT ESOPHAGUS
INTRAMURAL
40-pack year
PSEUDODIVERTICULOSIS
smoker
 Esophagogram
Esophageal Ulcerations/Strictures
B. Double-Contrast
“CAR RIMS”
B. E.
• Caustic
49/Mor Chron’s
• Adenocarcinoma
Reflux1-yr history of
• 
• progressive
Radiation
• Infectious/Inflammatory
dysphagia
• Metastasis
• 40-pack year
Skin (Pemphigus)
smoker
Upper Gastrointestinal Series
A. Single-Contrast
Indications
• To precede a small bowel series
• Inability to tolerate biphasic UGI series
• Assessment of gastric peristalsis or obstruction
• Suspected hiatal hernia
• Evaluation of masses, varices, strictures,
fistulas, or aberrant anatomy
• Post-pyloroplasty
Upper Gastrointestinal Series
A. Single-Contrast
Supplies
• 60 ml, then 120-180 ml of
regular barium (60% w/v)
• Barium cup
• Large-caliber flexible
straw
Preparation: ≥6h NPO
Scout film: Not needed
Upper Gastrointestinal Series
A. Single-Contrast LPO

Procedure
Place patient upright in left posterior oblique (LPO)
position

Have patient drink 60 ml regular barium

Quickly scan the esophagus up to the lower

esophageal sphincter
Image the stomach with compression while patient is
upright, at a 45˚angle, and supine
Have patient drink an additional 120-180 ml of
regular barium

Place patient in right lateral (RL) position

Image the duodenal bulb. Obtain at least four

slightly different views
Image both stomach and duodenal bulb in right
anterior oblique (RAO) position

Obtain overhead PA films (supine, prone)

RL RL
O
Upper Gastrointestinal Series
A. Single-Contrast
R. C.
48/F
Known case BRCA St.
IV
Multiple episodes of
abdominal pain and
vomiting after every
cycle of chemotherapy
 1-hr delay 3-hr delay

• Introduction of barium contrast material per orem shows opacification of the stomach.
• The stomach appears well opacified with normal rugal pattern.
• Prolonged transit of the contrast media from the stomach to the small bowels.
• Narrowing of the antropyloric region with deformed duodenal bulb.
• Persistent mucosal irregularity in the first to second portion of the duodenum consider new
growth. Only segmental visualization of the rest of the small bowels
3-hr delay with
7-hr delay
progression into the large bowels.
 
IMPRESSION: 
CONSIDER NEW GROWTH,
FIRST TO SECOND PORTION OF THE DUODENUM
Upper Gastrointestinal Series
B. Double-Contrast
Indications
• Early mucosal disease (erosions, polyps, tumors,
inflammation, infection)
Contraindications
• Suspected perforation
• Recent previous small bowel series to not fill
bowel with dense barium
Upper Gastrointestinal Series
B. Double-Contrast
Supplies
• 60 ml, then 120-180 ml of regular barium (60%
w/v)
• Barium cup
• Large-caliber flexible straw
• 100-200 mL dense barium (200%-250% w/v)
• 2 medicine cups for:
• 3/4 ampule effervescent granules
• 10 ml water
• 0.2 mg glucagon IV
Upper Gastrointestinal Series
B. Double-Contrast
Preparation: ≥6h NPO
Scout film: Not needed
Procedure
Administer 0.2 mg glucagon IV to temporarily paralyze
gut

With head up 20-30°, perform a routine single-contrast

UGIS.

In upright position, perform a double contrast

esophagogram
Decline table to horizontal, roll patient to prone
position.

Rock hips from side-to-side 8-10 times.

Place patient in LPO position. Film the antrum.

Place patient in AP position. Film the antrum and

body, taking several different views

Place patient in RL position. Film the fundus

Keep patient in RL position until duodenal bulb

fills with barium, then turn patient to left lateral
(LL) position. When gas fills bulb, take several
obliques.
Take overhead films of stomach, duodenum at at
least two loops of jejunum
 Upper Gastrointestinal Series
B. Double-Contrast
• Filling defect measuring 7 mm in
diameter is 
noted along the greater
G. P.
curvature of the stomach
37/M
• Upon evacuation of contrast,
fairly-defined smooth protrusion is seen
1-week history
intraluminally
of persistent
IMPRESSION: 
abdominal
GASTRIC POLYP pain

and episodes of
vomiting
 Upper Gastrointestinal Series
B. Double-Contrast
T. L.
• Small barium collection within an ulcer
50/Fof the stomach
cavity in thebody
Known case of
IMPRESSION: 
metastatic melanoma
ULCERATED GASTRIC NODULE
Sudden onset of
epigastric pain
Unwilling to
undergo endoscopy
 Upper Gastrointestinal Series
Target Lesions in the Stomach
B. Double-Contrast
“MEin BLACK”
T. L.
50/F
• Melanoma
• Known case of
Eosinophilic
Granuloma/ Ectopic
metastatic melanoma
Pancreas
Sudden onset of
• Breast mets
• epigastric pain
Leiomyoma/Lymphoma
• Unwilling to
Adenocarcinoma
• Carcinoid
undergo endoscopy
• Kaposi
 Upper Gastrointestinal Series
B. Double-Contrast
 E. G.
• Multiple punctate ulcers with surrounding
edema seenin 40/M
the body of the stomach
 Recurrent epigastric
IMPRESSION: 
EROSIVE pain with 1 episode of
GASTRITIS
hematemesis
 Known case of gouty
arthritis, managed with
Naproxen
 Upper Gastrointestinal Series
Double-Contrast
B. elevated lesions
• Numerous slightly
measuring a few millimeters clustered in
a small
 E.segment
G. of the duodenal
bulb
 40/M
IMPRESSION: 
 Recurrent epigastric
NODULAR DUODENAL MUCOSA.
pain CORRELATION
SUGGEST TISSUE with 1 episode of
hematemesis
BIOPSY:
Known case of gouty
HETEROTOPIC GASTRIC MUCOSA
arthritis, managed with
Naproxen
 Upper Gastrointestinal Series
Double-Contrast
B. projecting from the lesser
• Convex opacity
curvature, probably an intraluminal ulcer
 G.filling
• Irregular nodular C. defect is noted
surrounding the ulcer described which
85/M
may represent a mass
 1-year
• Thickened gastric folds history of
crampy abdominal
IMPRESSION: 
ULCERATEDpain and gradual
GASTRIC MASS,
weight
PROBABLY loss
MALIGNANT
 On PE, patient was
cachectic
 Upper Gastrointestinal Series
Recall: Double-Contrast
B. Fold patterns
 G. C.
 85/M
 1-year history of
crampy abdominal
pain and gradual
weight loss
 On PE, patient was
cachectic
 Upper Gastrointestinal Series
B. Double-Contrast
Thickened Gastric Folds
“LAMAZE” classes
 G.
 85/M
C.

•  1-year history of
Lymphoma
• crampy abdominal
Adenocarcinoma
• Menetriers
pain and gradual
• Zollinger Ellison
•
weight loss
Eosiniophillic gastritis
 On PE, patient was
cachectic
Small Bowel Series
Indications
• Evaluation of small bowel obstruction
• Malabsorption, diarrhea
• Systemic diseases (scleroderma, celiac disease)
• Gastrointestinal bleeding, anemia of unknown
origin
Small Bowel Series
Supplies
• 400-500 ml of regular barium (60% w/v)
• Barium cup
• Large-caliber flexible straw
Preparation: ≥6h NPO
Scout film: AP abdomen
Small Bowel Series
Procedure
Have the patient drink 300 ml of regular barium.

Place patient in supine.

Obtain PA films at 20-minute intervals until barium

reaches cecum. Additional barium may be given.

When ileum is well visualized, film jejunum, and

ileum in AP with compression.
When cecum is visualized, film ileocecal valve and
terminal ileum with compression.
Small Bowel
Series
D. A.
60/M
Known case of Gastric
Cancer s/p Exlap, Total
Radical Gastrectomy,
Feeding Jejunostomy
Abdominal pain on 7th
post op day
Small Bowel
Series
D. A.
60/M
Known case of Gastric
Cancer s/p Exlap, Total
Radical Gastrectomy,
Feeding Jejunostomy
Abdominal pain on 7th
post op day
 • Introduction of water soluble contrast material per orem shows opacification of
esophagus and free flow of dye from the cervical esophagus to the esophagojejunal
anastomosis and into the small intestine.
• The rest of the small intestines demonstrate a smooth feathery pattern with no filling defects
appreciated.
• No areas of narrowing, mucosal irregularities, or leakage of contrast material were noted.
 
IMPRESSION:
UNREMARKABLE SMALL BOWEL STUDY
 Small Bowel
Series
C. T.in the jejunum with
defect
• Round filling
adjacent bowel narrowing
50/M
IMPRESSION: 
1 year history of
JEJUNAL NEW GROWTH.
gradual
SUGGEST CROSS weight loss,
SECTIONAL
IMAGING FOR FURTHER EVALUATION
fatigue, chronic
diarrhea, and
flushing episodes
 Small Bowel
Series
C. T.
50/M
1 year history of
Coarsely calcified and spiculated mass in the
gradual weight loss,
mesentery adjacent to a thickened segment of small
bowel. Spoke-wheel arrangement of local mesenteric
fatigue, chronic
vessels are also noticed.
There are some nodular formations that projects into
diarrhea, and
lumen of the proximal thickened intestinal segment.

flushing episodes
IMPRESSION: 
CARCINOID TUMOR, JEJUNUM
 Small Bowel
• Series
A diverticular outpouching measuring
approximately 2 cm is seen at the terminal
ileum M. D.
• Other small bowel findings were
18/F
unremarkable

Two episodes of
IMPRESSION: 
ABOVE FINDINGS ARE CONSISTENT
WITH hematochezia
MECKEL
1 day prior to
DIVERTICULUM

consult
Barium Enema
A. Single-Contrast
Indications
• Suspected obstruction
• Suspected fistulization
• Evaluation of distal colon after colostomy
• Indicated for Double-Contrast Barium Enema
but unable to stand on their own or turn 360º
while lying down
Barium Enema
A. Single-Contrast
Contraindications
• Generalized peritonitis
• Gas in bowel wall
• Toxic megacolon
• Biopsy of colon after rigid sigmoidoscopy
• Recent polypectomy by colonoscopy
• Acute diverticulitis
• Acute inflammatory bowel disease
Barium Enema
A. Single-Contrast
Preparation
A B
• Day before examination: • Light dinner
1. 24-hour clear liquid diet • Bisacodyl 10 mg
2. One glass of water hourly (2x 5mg tablets)
3. Magnesium citrate at 4:00 PM after dinner
4. 60 ml Castor oil at 8:00 PM • Bisacodyl suppository at
• Optional 1500 ml bowel enema in 3 AM in the morning
the morning before examination before examination

* Presence of stool limits detection of lesions and is the most

common cause of error
Barium Enema
A. Single-Contrast
Supplies
• 500-600 mL barium (85-100% w/v)
• Barium enema bag with wide tubing
• Enema tip
• Lubricating jelly
• Gloves
• Tape
Scout film: AP abdomen
Barium Enema Sim
s
A. Single-Contrast
Procedure
Place patient in Sims position

Mix barium solution. Allow barium to flow

through tubing to remove air then close.
Wear gloves, lubricate tip, and gently insert tube to
anal orifice, directed anteriorly.

Insert 3-4 cm of tube tip, then tape in place.

Ensure that enema bag is no more than 60 cm above

the table.
Tilt table to -20º then allow enema to flow. Film
rectum when distended in AP and LL.
Film sigmoid when distended in LPO and RPO
view.
Film splenic flexure in RPO and hepatic flexure in
LPO
Film cecum when distended in AP with and without
compression.
Palpate colon for masses and obtain spot films if
needed.

Obtain the following overhead films:

PA (include rectosigmoid area), LAO, RAO

Obtain post-evacuation films

Barium Enema
A. Single-Contrast
J. A.
1mo/M
Noted decrease in BM
from 3x a day to 1x a
day
Clinical Impression: t/c
Hirschsprung disease
Barium Enema
A. Single-Contrast
J. A.
1mo/M
Noted decrease in BM
from 3x a day to 1x a
day
Clinical Impression: t/c
Hirschsprung disease
 • On passive retrograde administration of contrast, there is opacification of the rectum to the
cecum without obstruction to the flow of contrast.
• No definite mucosal irregularities or abnormal filling defects noted.
• The rectosigmoid index is normal without evidence of a transition zone.
• The sigmoid is redundant.
• 24-hour delayed image shows evacuation of the contrast material with residua along the
descending colon and rectum.
 
IMPRESSION:
NO RADIOGRAPHIC EVIDENCE OF HIRSCHPRUNG DISEASE NOTED
AT THE TIME OF EXAMINATION. HOWEVER, A RECTAL BIOPSY IS
SUGGESTIVE FOR DEFINITIVE DIAGNOSIS IF CLINICALLY WARRANTED
REDUNDANT SIGMOID COLON
Barium Enema
B. Double-Contrast
Indications
• Family or personal history of colon neoplasia
• Inflammatory bowel disease
• Anemia
• Weight loss
• Hematochezia
Contraindications
• Similar to Single-Contrast Barium Enema
Barium Enema
B. Double-Contrast
Supplies
• 500-600 mL barium (105% w/v)
• Barium enema bag with wide tubing
• Double contrast enema tip with retention
cuff
• Lubricating jelly Preparation: similar to
• Gloves
Single-Contrast
• Tape
Scout film: AP abdomen
• Pneumatic bulb
Barium Enema Sim
s
B. Double-Contrast
Procedure
Proceed with enema similar to Single-Contrast
procedure.

Tilt table -30º and allow colon to fill with barium.

Clamp tubing and elevate table to horizontal

position.
Place patient in LPO and begin inflating colon with
air using pneumatic bulb
Change positions to LL, LAO, prone RAO, and RL
while applying 4-5 puffs per position
When barium is well in the right colon, stop
inflating and place patient in prone.

Drain excess barium.

Inflate colon with more air and film rectum in PA LLD

and LL when distended.

Film sigmoid in LPO and RL.

Place patient upright and film splenic flexure in

RPO and hepatic flexure in LPO

Obtain the following overhead films:

1. PA (include rectosigmoid area),
2. Left lateral decubitus (LLD)
3. Right lateral decubitus, (RLD)
RLD
4. Crosstable lateral with patient prone and tip removed
5. Upright abdomen
 Barium Enema
• There is severe stricturing of the
ascending colon
B. Double-Contrast
• Multiple outpouchings are noted in the
transverse colon
• Several large C.
 D.
discrete ulcers on
backgroundof21/M
normal mucosa in the
proximal descending
3-month colon
history of recurrent
• Sigmoid and distal descending colon
abdominal pain, diarrhea
appear normal
and blood-tinged stool
PE revealed multiple oral
IMPRESSION: 
aphthous
ABOVE FINDINGS AREulcers
IN KEEPING
WITH KNOWN CASE OF
Clinically diagnosed with
CHRON’S DISEASE
Chron’s disease
 Barium Enema
• Irregular mucosa with granular
appearance B. Double-Contrast
is seen involving the entire
colon with loss of normal haustral
markings U.C.

40/M
IMPRESSION: 
ABOVE FINDINGS ARE
Chronic
SUGGESTIVE OF diarrhea
with COLITIS
ULCERATIVE unrecalled
onset
 Ulcerative Colitis Chron’s Disease
 No skip lesions  Skip lesions
 Shallow ulcers  Deep ulcers
 Findings:  Findings:
◦ Lead-pipe colon ◦ Apthous ulcers
◦ Collar button ulcers ◦ Pseudosacculation
◦ Backwash ileitis ◦ String sign

Inflammatory Bowel Diseases

 Ulcerative Colitis Chron’s Disease
◦ Lead-pipe ◦ Apthous ulcers
colon

◦ Collar button ulcers ◦ Pseudosacculation

◦ Backwash ileitis

◦ String sign
Do Barium Studies still have a role in modern radiology?
 Barium studies, till date, remains the safest,
fastest, and cheapest diagnostic investigation to
evaluate vague abdominal symptoms.
In conclusion, our goal is not to “save” barium studies simply to keep
this technology alive, per se, but rather to preserve barium radiology
for the quality of patient care. 
Conclusion
 Barium studies can be classified as Single-Contrast
and Double-Contrast
 Having proper supplies, careful patient positioning,
and choosing the correct views are essential in
obtaining optimal images
 These studies remain valuable as the safest, fastest,
and cheapest diagnostic investigation to evaluate
vague abdominal symptoms.
 References
 Gore R, Levine M. Textbook of Gastrointestinal Radiology, 4th Edition. USA:
Elsevier Saunders. pp. 23-55.
 Barium Swallow. Retrieved August 8, 2021 from
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swallow
 Ahmad N. Patient positioning techniques for a quality esophagogram,
premium UGI series, and lower gastrointestinal series. Retrieved August 13,
2021 from www.auntminnies.com
 Ballinger P, Frank E. Merrill’s Atlas of Radiographic Positions and Radiologic
Procedures, 9th Edition. USA: Elsevier Science.
 Matherne T. GI OBR 2004 [PPT Presentation]. University of South Alabama