RADIOGRAPHIC PROCEDURES FUTURE RRT REVIEWERS 2019

MEYNARD Y. CASTRO, RRT

FACULTY - UNIVERSITY OF MAKATI
RADIOGRAPHIC PROCEDURES QUESTION AND ANSWER
“Don’t let your pain stop you to pursue your dreams. Let the pain inspires you to keep going”
QUESTION ANSWER
Normally, the first part of the barium swallow usually reaches the
2-3 hours
ileocecal valve within how many hours?
A water-soluble iodinated contrast media normally reaches and
4 hours
outlines the colons within how many hours?
The highest degree of motor activity is normally found in what Stomach
parts of the GI tract? Proximal part of the small intestine
This is a type of barium preparations that contains gum or other Suspended or flocculation-resistant
suspending or dispersing agents preparations
What portion of the small intestine has the greatest peristaltic
Upper part of the canal
action?
Easily removed by aspiration and no ill
What is the main advantage of water soluble contrast media? effects result when escapes into the
peritoneum
The most commonly used film widths in fluoroscopic spot-image
100 and 105 mm widths
cameras
What type of contrast media is used to permit rapid survey of the Orally administered iodinated medium or
entire small intestine? water-soluble iodinated contrast media
This is a term applied to the contraction waves by which the
Peristalsis
digestive tube propels its contents toward the rectum
The lowest degree of motor activity is normally found in what
Distal part of the large intestine
parts of the GI tract?
Body habitus
Pathologic changes
What are the factors that affect peristaltic speed?
Body position
Respiration
Localized contractions occur in what parts of the small intestine? Duodenum and jejunum
What are the reasons why water-soluble contrast media cannot Dilution of the contrast medium
provide a clear anatomical detail of the alimentary canal? Decrease in opacification
Type of contrast media
What are the four factors that affect the passage of barium mixture Temperature of contrast media
through the alimentary canal? Consistency of contrast media
Motile function of the alimentary canal
Strongly bitter taste
Does not adhere to the mucosa
What are the disadvantages of water soluble contrast media? Failure to provide clear anatomic detail of
the small intestine
(dilution of the contrast media)
This route of administration allows a reasonably rapid
investigation of large intestine when a patient cannot cooperate for Oral route
a satisfactory enema study

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RADIOGRAPHIC PROCEDURES FUTURE RRT REVIEWERS 2019

What is the best method to demonstrate the entire large intestine Retrograde filling of barium sulfate
with the use of contrast media? (barium enema)
ESOPHAGOGRAPHY
It is the radiographic examination of the pharynx and esophagus Esophagogram
This condition is known as the peptic ulcer of the esophagus Barrett's esophagus
Upright
During esophageal examination, the exposure time is shorter (0.1
(Because the barium descends slowly in
s or less) in what position?
recumbent position)
Soft tissue neck or
What examination is performed to demonstrate the opaque foreign Lateral projection of the retrosternal area
bodies lodge in the pharynx or in the upper part of the esophagus? (It can be demonstrated even without
contrast media)
What position is utilized in esophagography to demonstrate a RAO 35-40o
wider space for an unobstructed image of the esophagus? (best position for esophagography)
What is the best position to obtain more complete filling of the Recumbent
proximal part of the esophagus? (barium flow against gravity)
Recumbent
What is the best position to demonstrate variceal distentions of the
(varices are best filled by having the
esophageal varices?
blood flow against gravity)
What is the alternative position when the patient cannot be placed
LPO 35-40o
in RAO position for oblique projection of the esophagus?
In AP/PA projection, the esophagus is superimposed to what
Thoracic vertebrae
structure?
The passage of barium through the esophagus is fairly slow if it is
Full inspiration
swallowed at the end of
Obstructions
These conditions are demonstrated with the use of tufts or pledgets
Nonopaque foreign bodies in the pharynx
of cotton saturated with a thin barium suspension
and upper esophagus
What methods are used to increase venous pressure and make the Full expiration
variceal filling more complete? Valsalva maneuver
The passage of barium through the esophagus is increased if it is
Moderate inspiration
swallowed at the end of
During esophageal examination, the respiration is inhibited for
Deglutition
several seconds after beginning of
What is the concentration of barium sulfate mixture needed for the
30-50% weight/volume suspension
full-column single contrast study of the esophagus?
What is the reference point in lateral projection of the esophagus? T5-T6
What is the reference point in AP/PA oblique projection of the
2 in. (5 cm) lateral to MSP
esophagus?
What is the reference point in AP/PA projection of the esophagus? T5-T6
After swallowing the barium, the patient does not have to hold
his/her breath because respiration is inhibited by how many 2 seconds
seconds?
For demonstration of the entire esophagus, the exposure is taken
Straw in rapid and continuous swallows
while the patient is drinking the barium suspension through a

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RADIOGRAPHIC PROCEDURES FUTURE RRT REVIEWERS 2019

Normally, the last part of the barium swallow usually reaches the
4-5 hours
ileocecal valve within how many hours?
It is a gas producing substance that is used in double contrast
Carbon dioxide crystals
examination of the esophagus
Esophagram, Barium Swallow or Barium
Esophagogram is also known as
Meal
This is used to increase both intrathoracic and intraabdominal
Breathing exercises
pressures
In compression technique, the patient is placed in what position? Prone
Esophagus is delineated between hilar region of lungs & thoracic
LAO position
spine in what position?
What is the best position to demonstrate the upper esophagus
Swimmer's lateral position
without superimposition of arms and shoulders?
Breathing exercises
These techniques are used to demonstrate esophageal reflux Water test
disease Compression paddle technique
Toe-touch maneuver
UPPER GI SERIES
What is the average emptying time of the normal stomach? 2-3 hours
A device that is placed under the duodenal bulb to place pressure Pneumatic paddle
on the abdomen (Compression device)
What type of barium is developed for double contrast gastric
Low-viscosity, high density barium
examination?
Exposures during examination of the stomach and small intestine
Expiration
are made at the end of
A water-soluble iodinated contrast media normally clears the
1-2 hours
stomach within how many hours?
What is the most important consideration in GI radiography? Elimination of motion
This examination is used to evaluate the distal esophagus, stomach
Upper GI examination/series (UGIS)
and some or all of the small intestine
This is used to delineate the liver spleen, kidneys, psoas muscles
Preliminary radiograph
and bony structures
This is used to detect any abdominal or pelvic calcifications and Preliminary radiograph
tumor masses (requires cleansing of the intestinal tract)
What is the best position for examination of ambulatory
Supine (Dorsal Recumbent)
outpatients or acutely ill patients?
A non-gas forming laxative is usually administered 1 day prior to
Constipation
the examination to patient with
What is the purpose of instructing the patient to have a soft, low To prevent gas formation from excessive
residue diet for 2 days? fermentation of the intestinal contents
This is given to ensure a properly prepared colon Cleansing enema
To ensure empty stomach, the food and water are usually withheld
8-9 hours before the examination
by how many hours?
These should be restricted to prevent stimulation of gastric
secretion and salivation causing excessive fluid from Smoking and chewing a gum
accumulating in the stomach and diluting the contrast media

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RADIOGRAPHIC PROCEDURES FUTURE RRT REVIEWERS 2019

It is a combination of the single-contrast and double contrast

Biphasic examination
methods
In UGIS, what pathology is demonstrated when the patient is
Hiatal hernia
placed in trendelenburg 25-30 degrees?
In UGIS, what pathologies are demonstrated when the patient is
Hiatal hernia
placed in trendelenburg 10-15 degrees and is rotated slightly
Esophageal regurgitation
toward the right side?
This technique best demonstrates small lesions and mucosal lining
Double contrast technique
of the stomach
What is the patient preparation if the patient is scheduled early in NPO from midnight until the time of the
the morning? examination
What is the patient preparation if small intestine study is to be
NPO after evening meal
included after stomach study?
This medication is given to the patient during GI studies to relax
Glucagon or anticholinergic medications
the GI tract
This examination is used for evaluation of postbulbar duodenal
Hypotonic duodenography
lesions and for detection of pancreatic disease
What is the patient preparation for child older than 1 y.o.? NPO 6 hrs
What is the reference point for stomach studies when the patient 1-2 inches superior to lower rib margin
is prone? (L1-L2 level)
What examinations should be performed if pancreatic disease is CT scan
suspected? Needle biopsy
The greatest visceral movement between prone and upright occurs
Asthenic
in what type of patient?
The patient that is at high risk of dehydration during GI studies Geriatric patient
In asthenic patient, this adjustment keeps the stomach and
duodenum from pressing against the vertebrae with resultant Pillows under the thorax and pelvis
pressure filling defects
This should not be applied for standard radiographic projections
of the stomach and intestine because it interferes with empting and Immobilization band
filling of the duodenal bulb
What is the reference point for stomach studies when the patient 3-6 inches inferior to lower rib margin
is upright? (L1-L2 level)
What is the method for the roentgen demonstration of minimal Wolf Method
hiatal herniation? (PAO Projection)
What is the patient preparation to prevent the fluid from
accumulating the stomach and prevent diluting the barium Avoid smoking or chewing a gum
suspension?
What projection will best demonstrate pyloric canal and duodenal PA Projection
bulb of asthenic and hyposthenic patients? (prone position)
What modality will best demonstrate Barrett’s esophagus? Nuclear medicine
In sthenic patient, the duodenal bulb is located at what level? L2
In asthenic patients, the fundus usually fills in what position? Prone Position
What is the patient preparation for infant younger than 1 y.o.? NPO 4 hrs
What projection will best demonstrate pyloric canal and duodenal
PA Axial Projection
bulb of sthenic and hypersthenic patients?

MEYNARD Y. CASTRO, RRT

RADIOGRAPHIC PROCEDURES FUTURE RRT REVIEWERS 2019

This position is used to demonstrate the size, shape and relative

Upright
position of the stomach
What modality will best demonstrate hemochromatosis or iron
Magnetic Resonance Imaging
overload?
What method will best demonstrate the greater and lesser Gordon Method
curvature, the antral portion of the stomach, the pyloric canal and (PA Axial Projection)
duodenal bulb of hypersthenic type? (Angled PA Projection)
What position is used for serial studies of the pyloric canal and the
RAO position
duodenal bulb?
What is the patient preparation to free the stomach of gas and fecal
NPO 8-9 hours prior to examination
material?
What body rotation is required to give the best image of the 40-70o RAO
pyloric canal and duodenal bulb in sthenic patient? (PAO Projection)
What examination should be performed if the suspected lesions
Double contrast examination
are beyond the duodenum?
What is the central ray for Gordon Method? 35-45o cephalad
The gastric peristalsis is more active in what position? RAO position
What part of the stomach is located between the xiphoid process
Body of the stomach
and the lower margin of the ribs?
LPO 45o
What position will demonstrate the fundic portion of the stomach LPO 30-60o
in asthenic patient? (APO Projection)
Trendelenburg position
Gugliantini Method
What method will best demonstrate the stomach in infants? (PA Axial Projection)
(Angled PA Projection)
LPO 45o
The pyloric canal and duodenal bulb are not filled with barium in
LPO 30-60o
this oblique position
(APO Projection)
In sthenic patient, the stomach moves superiorly and to the left in
Supine position
what position?
In wolf method, the patient is placed in what oblique position? RAO 40-45o
In asthenic patient, the stomach moves superiorly and to the left
Supine position
in what position?
Wolf and Guglielmo
(1)
Provide trendelenburg angulation of the
What are the purposes of compression device in Wolf method?
patient's trunk
(2)
Increases intraabdominal pressure
AP projection
What projection will best demonstrate the retrogastric portion of
(Because of elevation and superior
the duodenum and jejunum?
displacement of the stomach)
What method is used to demonstrate the relationship of the
Wolf method
stomach to the diaphragm?

MEYNARD Y. CASTRO, RRT

RADIOGRAPHIC PROCEDURES FUTURE RRT REVIEWERS 2019

In diaphragmatic herniation, the organs involved usually

Esophageal hiatus
protrude most commonly through what part of the GI tract?
What position is used to demonstrate the left retrogastric space? Upright left lateral position
What position is used to demonstrate the right retrogastric space,
Recumbent right lateral position
duodenal loop and duodenojejunal junction?
What projection will best demonstrate the pyloric canal and
Right lateral projection
duodenal bulb in patients with a hypersthenic habitus?
AP projection
Double contrast visualization of the gastric body, pylorus and
(Gas bubble is displaced into the pyloric
duodenal bulb during single contrast examination of the stomach
end of the stomach which allows double
is demonstrated in what projection?
contrast visualization)
What method is useful in diagnosing a hiatal hernia? Wolf method
What is the central for Gugliantini method? 20-25o cephalad
In wolf method, the patient is placed in what position during
Modified knee-chest position
placement of the compression device?
(1)
Permit adequate contrast filling and
maximum distention of the entire
What are the advantages of compression device in Wolf method?
esophagus
(2)
Does not require angulation of the table
What is the central ray angulation in Wolf method without a
CR 10-20o caudad
compression device?
Pneumatic paddle
What device is used in serial and mucosal studies of the stomach?
(provides pressure)
What projection will best demonstrate gross hernia protrusion AP Projection with partial and full
through the diaphragm or diaphragmatic herniations? trendelenburg
These studies are used to demonstrate a compression and a
noncompression study of the pyloric end of the stomach and the Serial and mucosal studies
duodenal bulb at different stages of filling and emptying
Gordon Method
What method will best demonstrate the high transverse stomach? (PA Axial Projection)
(Angled PA Projection)
In Wolf method, the compression device is placed in what part of Inferior the abdomen
the patient? Inferior the costal margin
The compression paddle is placed under what parts of the Pyloric sphincter
stomach? Duodenal bulb

MEYNARD Y. CASTRO, RRT

FACULTY – UNIVERSITY OF MAKATI
MAY 11, 2019

MEYNARD Y. CASTRO, RRT

RADIOGRAPHIC PROCEDURES FUTURE RRT REVIEWERS 2018
F U T U R E R R T 2 0 1 9
MEYNARD Y. CASTRO, RRT
UNIVERSITY OF MAKATI – FACULTY
RADIOGRAPHIC PROCEDURES QUESTION AND ANSWER
"DO YOU BEST AND GOD WILL DO THE REST"
QUESTION ANSWER
Dont let pain stop you to pursue your dreams. Let the pain motivates you to keep going
SMALL BOWEL SERIES
What position is used to demonstrate retrogastric portion of the
Supine position
duodenum and jejunum?
What position is used to prevent possible compression overlapping
Supine position
loops of intestine?
What position is used to compress abdominal contents, which
Prone position
increases radiographic quality?
A technique performed by administration of contrast media by Enteroclysis
direct injection into the bowel through an intenstinal tube (Small intestinal enema)
Peristaltic Stimulants
Glass of ice water
These should be given to the patient with hypomotility 3-4 hours
Tea
after administration of contrast media to accelerate peristalsis
Coffee
Water-soluble contrast media
(1)
Soft or low residue diet for 2 days
(2)
NPO after evening meal the day prior the
examination
(3)
What are the preparations of the patient prior to the small Breakfast is withheld on the day of the
intenstinal study? study
(4)
Cleansing enemas
(5)
Bladder should be empty
(to avoid displacing or compressing the
ileum)
Enteroclysis
Cleansing enemas are not always recommended for what
(because enema fluid may be retained in
examination of the small intestine?
the small intenstine)
During small intestinal study, the examination is usually when the
Cecum
barium is visualized in what region of the GI tract?
During small intestinal study, fluoroscopy is performed and
compression radiographs are obtained when the barium has Ileocecal region
reached what part of the GI tract?
In delayed radiographs, the IR should be centered in what part of
Iliac crest
the body?
What are the two method performed when oral method fails to (1)
provide conclusive information? Complete reflux filling with large volume

MEYNARD Y. CASTRO, RRT

RADIOGRAPHIC PROCEDURES FUTURE RRT REVIEWERS 2018

barium enema
(2)
Enteroclysis
In early radiographs, the IR should be centered in what part of the
L2
body?
What preparation should be instructed to the patient to prevent or
Bladder should be empty
avoid displacing or compressing the ileum?
How many mL of contrast media is required to fill the colon and
4500 mL
small intestine?
What examination is performed for localizing small bowel
Complete reflux small bowel examination
hemorrhage?
What material is used to introduce contrast media during
Bilbao or Sellink tube
enteroclysis procedure?
What medication is given to relax the GI tract prior the complete
Glucagon
reflux examination of the small intestine?
What medication is given to diminish the patient discomfort
Diazepam (Valium)
during the initial filling of the bowel?
A radiographic examination that involves the injection of nutrient
Enteroclysis
or medicinal liquid into the bowel
Duodenum
The Bilbao or Sellink tube is advanced to what part of the GI
(at the duodenojejunal flexure)
tract?
(near ligament of Treitz)
What is the rate of contrast administration during enteroclysis? 100 mL/minute
What material is injected into the small intestine after contrast Air or methylcellulose
medium has reached the cecum? (air-contrast enteroclysis)
A procedure in which the tube is connected to a suction system
Therapeutic GI intubation
for continuous siphoning of gas and fluid contents of the GI tract
This is a double-lumen, single balloon tube that is used to intubate
Miller-Abbott (M-A)
the small intestine
A position in which gastric peristalsis is more active RAO position
The procedure in which a long, specifically designed tube is
Gastrointestinal intubation
inserted through the nose and passed into the stomach
What part of the M-A tube communicates with the balloon only? Small balloon lumen
What part of the M-A tube communicates with GI tract through
Large aspiration lumen
perforations near and at distal end of the tube?
After the placement of the M-A tube, the tip is situated in what
Pyloric sphincter
part of the GI tract?
What are the methods to relieve symptoms of intestinal
Suction and surgical intervention
obstruction?
After the placement of the M-A tube, the patient is placed in what
RAO position
position?
What are the purposes of GI intubation? Therapeutic and diagnostic
What are the purposes of securing the M-A tube with an adhesive To prevent regurgitation
strip beside the nostril? To prevent advancement of the tube
What procedure is performed to prevent or relieve postoperative
Therapeutic GI intubation
distention or to deflate or decompress an obstructed small intestine

MEYNARD Y. CASTRO, RRT

RADIOGRAPHIC PROCEDURES FUTURE RRT REVIEWERS 2018

What contrast media are used for studies of localized segment of

Water-soluble contrast media
small intestine when passage of intestine tube is arrested due to
Thin barium sulfate suspension
obstruction?
When the intestinal tube is introduce for the purpose of
performing a small intestinal enema, the tube is advanced into Proximal loop of the jejunum
what part of the GI tract?
What part of the M-A tube is used to withdraw gas and fluids and
Large aspiration lumen
inject the liquids?
What part of the M-A tube is used for the inflation and deflation
Small balloon lumen
of the balloon and for injection of mercury to weight the balloon?
LOWER GI SERIES
What position will help separate redundant and overlapping loops
Slight trendelenburg position
of the bowel by spilling them out of the pelvis?
What is the reference point for PA projection of the colon? Level of iliac crest
What projection will best demonstrate the rectosigmoid area of the
AP/PA Axial projection
colon?
What is the reference point for PA axial projection of the colon? Level of ASIS
LAO 35-45o
(PAO projection)
(side closest demonstrated)
What position will best demonstrate the left colic flexure and
descending colon?
RPO 35-45o
(APO projection)
(side farthest demonstrated)
A ventral or dorsal decubitus position provides what projection? Lateral projection
What central ray angulation is utilized in PA axial projection of
30-40o caudad
the colon?
What central ray angulation is utilized in AP axial projection of
30-40o cephalad
the colon?
What projection will best demonstrate the rectum and distal Lateral projection
sigmoid portion of the colon? (R or L)
What position will best demonstrate the up medial side of the
ascending colon and the lateral side of the descending colon when Right lateral decubitus
the colon is filled with air?
What is the obliquity of the body in PA oblique projection of the
35-45o
colon?
What is the reference point for AP axial projection of the colon? 2 inches below the level of the ASISs
What is the reference point for AP axial projection of the colon
when a collimated image is desired for demonstration of the Inferior margin of the pubic symphysis
rectosigmoid region?
What position is the most valuable in double contras examination Ventral decubitus position
of the colon? (Lateral Projection)
RAO 35-45o
What position will best demonstrate the right colic flexure, (PAO projection)
ascending colon and sigmoid colon? (side closest demonstrated)

MEYNARD Y. CASTRO, RRT

RADIOGRAPHIC PROCEDURES FUTURE RRT REVIEWERS 2018

LPO 35-45o
(APO projection)
(side farthest demonstrated)
What method is used to demonstrate the rectum, rectosigmoid Chassard-Lapine method
junction and sigmoid? (Axial Projection)
No preparation is necessary
No cleansing enemas
What are the patient preparations for defecography?
(because water remaining in the rectum
dilutes the contrast medium)
1-2 inches lateral to the midline of the
What is the reference point for PA oblique projection of the
body on the elevated side at the level of
colon?
the iliac crest
Lumbosacral region at the level of greater
What is the central ray used in Chassard-Lapine method?
trochanter
What position will best demonstrate the up posterior portions of Ventral decubitus position
the colon? (Lateral Projection)
The exposure required in Chassard-Lapine method is
approximately the same as that required for what projection of the Lateral projection
pelvis?
A right or left lateral decubitus position provides what projection? AP/PA projection
This method demonstrates the anterior and posterior surfaces of
Chassard-Lapine position
the lower portion of the bowel?
(1)
Irrigation of the stoma the night prior the
examination
What are the patient preparations for the patient with a colostomy?
(2)
Irrigation of the stoma on the morning of
the examination
This technique is not performed during examination because the
Sterile technique
stoma is part of the GI tract
A new radiologic procedures performed on patients with
Defecography
defecational dysfunction
What position will best demonstrate the up lateral side of the
ascending colon and the medial side of the descending colon when Left lateral decubitus
the colon is filled with air?
This method is performed to permit the coils of the sigmoid to be Chassard-Lapine position
projected free of overlapping? (Axial Projection)
Evacuation proctography
Defecography is also known as
Dynamic rectal examination
These examinations are performed to detect new or recurrent
Postoperative contrast enema studies
lesions in the patient who has had a tumor
The general term applied to the surgical procedure of forming an
artificial opening to the intestine, usually through the abdominal Enterostomy
wall for fecal passage
These examinations are performed to determine the efficacy of
Postoperative contrast enema studies
treatment in the patient with diverticulitis or ulcerative collitis

MEYNARD Y. CASTRO, RRT

RADIOGRAPHIC PROCEDURES FUTURE RRT REVIEWERS 2018

MEYNARD Y. CASTRO, RRT

UNIVERSITY OF MAKATI
FACULTY
JULY 12, 2018

MEYNARD Y. CASTRO, RRT