Timed Esophagram PRINT
I. Equipment
a. Varibar Thin Liquid – follow mixing instructions on container for 40% W/V
b. Radiopaque yardstick (taped to the bucky)
c. Water
d. Barium tablet
e. 2 cups for drinking
f. 50mL syringe
g. Cell phone stopwatch
II. Personnel
a. RA should be present for the exam
• Tapes the yardstick to the upright bucky (not midline)
• Supervises exam
b. Hospital Technologist
• Prints order, reviews order with rad/RA
• Documents patient history and pregnancy status prior to exam
• Prepares the barium as described above
• Uses a syringe to measure 150mL’s of water for cup 1
• Uses a syringe to measure 150mL’s of barium for cup 2
• Has the stopwatch ready
• Takes timed radiographs
III. Procedure
a. Position the patient against the upright bucky in an LPO position
b. Adjust bucky to ensure entire esophagus will be included on the image
c. Scout image to confirm patient position (pt. must remain in this position for the entire exam)
d. Ask the patient to drink all 150mL of barium as quickly as possible (within 30-45 seconds)
e. Start stopwatch as the patient begins drinking and keep it running for 5 min
f. Timed images taken (1 min, 2 min, and 5min) if necessary
g. Patient to swallow 13mm barium tablet with 150 mL of water
h. Ask the patient to drink all 150mL of water as quickly as possible.
i. Start stopwatch as the patient begins drinking and keep it running for 5 min
j. Timed images taken (1 min, 2 min, and 5min) if necessary
IV. Post Procedure
a. Measure height of barium column on 1min, 2min and 5 minute images
b. If calibration is necessary, measure 1 cm mark on the yard stick and use (ctrl+M) to enter cm value (1)
V. Special Considerations
a. Timed images should only be taken until barium or the 13mm barium tablet have cleared from the esophagus. If the 1min image demonstrates a barium free esophagus, the two and five minute images are unnecessary
b. Esophagram or UGI exam with immediate and significant contrast stasis: Turn exam into a timed barium swallow (tape a ruler or coin to the fluoro table for measurement purposes, use number markers, and stopwatch)
c. Lock the fluoro tower in position to include the entire column of barium and keep pt. in LPO position
d. Use your best judgement re: additional swallows of barium when turning an exam into a timed study:
• If the barium column clears as you set up for the timed study, follow the normal timed barium swallow protocol
• If the achalasia is severe and the column of barium is not emptying, begin timed study immediately (have technologist start stopwatch) and capture fluoro images at 1min, 2 min, and 5 min intervals