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X-Ray

X-Rays, Barium Swallow/Enemas, Small Bowel Series & Intravenous Pyelography (IVP)

X-Rays

 

This section contains an overview of

  • General X-Rays,
  • Barium X-Rays,
  • Small Bowel Series X-Rays and

 

What are X-Rays?

The test relies on the fact that different parts of the body attenuate (stop) X-rays better than others. X-rays are ionising radiation, generated by an X-ray tube.
The rays are controlled by shielding down a narrow beam, directed towards the part of the body being examined. On the opposite side of the body, an x-ray film is positioned in the path of the x-rays, and is “exposed”.
The X-ray film is then processed and an image generated. Where the X-ray passes through the body easily, that part of the film will be black.
Where x-rays are stopped, the film will be white and various shades of grey in between

 

What are x-Rays used for?

X-ray examinations are used to look at many structures in the body. They are especially good at looking at the chest and at the limbs, but plain X-ray is a very versatile imaging method.

Barium Studies including Swallow/Meal Examinations

 

A range of Barium studies can be done at many of our branches, including swallows and meals. A barium meal, for example, is a study to examine the stomach and small intestine (or bowel). It is sometimes carried out with a barium ‘swallow’, to show the oesophagus (the tube connecting the mouth to the stomach), or with a barium ‘follow through’, to show the small intestine. Purpose being to identify blockages and explain symptoms such as persistent vomiting particularly if ‘bile-stains’ are present.

Barium (a chalky substance) is mixed with water and makes a white liquid. When this is swallowed, the oesophagus, stomach and small intestine can be seen on X-ray images or pictures and analysed by our Radiologists.

 

What is a Barium Swallow used for?

A Barium Swallow images the Oesophagus. A Barium Meal images the stomach. These tests are often performed together. You will swallow about a cup of barium liquid. A thin coating of a barium compound lines the inside of the Oesophagus and/or Stomach, and x-rays are taken. Barium appears white on the x-ray image and outlines any irregularity of the internal walls of the Oesophagus and/or Stomach.

 

How is it done?

A barium powder is mixed with water to make about 120 mls (one cup) of thick liquid which is placed in a glass. The doctor will instruct you on when to drink the barium, and how fast to drink. It can be reliably predicted that the taste of the barium will never become popular, and no-one has ever asked for take-away! But it’s not the worst taste in the world.

The doctor will watch the barium on the screen, and will take x-ray pictures. Most often, the doctor will also give you two small medicine glasses, one with a clear liquid, and one with a coloured liquid. These liquids when taken together make gas, and help to distend the stomach so that small irregularities can be better seen. You will be asked to drink these liquids one after the other.

Once the barium has been drunk, the table you have been standing against will be laid flat, with you on it. You will be asked to roll in various directions on the table, and asked to hold your breath so that x-rays may be taken.

Sometimes, especially for looking at the Stomach, the doctor may need to give you an injection of a drug called Buscopan. The problem is that everyone’s stomach is constantly moving, which makes x-raying them very difficult. Buscopan temporarily stops the stomach from moving. It can also make an eye disorder called Glaucoma worse, so tell the doctor if you have Glaucoma, and another drug may be used. The side effects of Buscopan are blurred vision and a dry mouth, both of which can last for about half an hour.

Barium Emenas

 

What is this examination used for?

A Barium Enema is used to look at the Large Bowel or Colon. A thin coating of a barium compound lines the inside of the colon, and X-rays are taken. Barium looks white on X-ray, and outlines any irregularity of the Bowel wall.

 

How is it done?

A barium powder is mixed with water to make about 600 mls of thick liquid which is stored in a clear plastic bag. The bag is connected to a tube which is smaller in cross-section than a finger.

The tip of the tube is lubricated and is inserted by the doctor into the rectum. Only 5 to 8 cms (2 to 3 inches) is inside the Rectum. Some tubes have a balloon around the tip which can be inflated and used to hold the tube inside the rectum.

The doctor then slowly lets the barium from the bag run into the Colon. Initially, there is little sensation, as the actual volume of liquid introduced is small. Gravity is used to flow the liquid around the colon, and the doctor will ask you to lie on your side, back or front to follow the natural loop of the colon.

Once the liquid is inside the Colon, the doctor will allow much of the fluid to flow back out into the bag, as the idea is to coat the lining of the bowel with barium to take the X-rays, not to fill the whole bowel with fluid.

The doctor then gently introduces air into the rectum from the bag. This is to force the walls of the colon apart so that any small irregularities of the bowel wall can be imaged by X-ray. At this stage you may feel uncomfortable for the first time, and feel you want to go to the toilet, as the natural response of the bowel when distended is to warn you that it is full and to try and contract. Don’t worry. It’s an unpleasant feeling, but should not be painful. If you experience pain at any time, tell the doctor.

Several X-rays are then taken. Again the doctor will ask you to roll around on the X-ray table to view all the twists and turns of the bowel. The X-rays are then processed and checked by the doctor, who may need to take some more.

After the test, much of the gas and liquid is allowed to flow back into the bag. The tube is then removed, and you can go to the toilet, which is close to the X-ray room.

Small Bowel Series

 

What is this examination used for?

A small bowel series is used to examine the small bowel; the part of the digestive tract between the stomach and the colon. A barium compound diluted with water fills the inside of the small bowel, and x-rays are taken. Barium looks white on x-ray, and outlines the bowel wall.

How is it done?

A thin barium liquid is swallowed, and passes from the stomach into the small bowel. The object of the test is to fill the length of the small bowel with barium. This means that several hundred mls of liquid may have to be swallowed. Don’t worry – we want you to swallow as much as possible, but we won’t force you to drink it so fast that you feel sick. After the liquid is drunk, you will be asked to lie on your right side, so the liquid leaves the stomach and passes into the small bowel.

The normal “transit time” through the small bowel is very variable, and may be between 45 minutes and several hours depending on how fast The Barium travels through the small bowel. If you experience pain at any time, tell the doctor or radiographer. The pain may help to localise areas of disease, so don’t hesitate in telling.

Several x-rays will be taken. The doctor may ask you to roll around on the x-ray table to view all the loops of the bowel. The x-rays are then processed and checked by the doctor, who may need to take some more.

Once the barium is through the small bowel and the pictures are taken, you will be allowed to go to the (nearby) toilet, as the liquid has reached the large bowel. Usually the capacity of the large bowel, and the ability of the large bowel to absorb water mean that diarrhoea is uncommon.

General X-Rays do not have any specific restrictions if referred by a GP or Specialist.

 

Allied Health practitioners such as Physiotherapists, Osteopaths, Chiropractors, Podiatrists have specific restrictions around examinations they can request which are medicare eligible see HERE

Often Allied Health practitioners  request other examinations which we can accept for example MRI’s. Patients need to be aware that such examinations are unlikely to qualify for a medicare rebate.

General X-Ray Examinations

There is no specific preparation for general X-Ray examinations.

Depending on what body region is being examined, may be asked to remove most of your clothes, but may keep on your underpants, Buttons, clips etc on clothes show up too well on x-ray and can be confusing to report or may hide abnormalities. You may be asked to change into a cotton gown which opens at the back.

 

Barium Studies

Barium Swallow

You are required to fast for 6 hours prior to this examination. The examination takes about 30 minutes. After the test, you can eat again. Remember to drink plenty of clear fluids over the next day.

Barium Enema

The colon has to be as clean as possible before the test. If there is a lot of faeces in the bowel, the barium won’t be able to flow to the end of the large bowel. Small pieces of faeces left inside the bowel may look like abnormalities.

There is a 3 day preparation with the examination being on the 4th day. You are required to purchase a Moviprep from a Chemist which will cost approximately $25-$30. A preparation sheet will be given to you by our staff and is available from the downloads section of this page.

There is specific diet preparation required for this examination. When your appointment is booked your specific preparation will be explained to you. However you might find it useful to also download the diet requirements from HERE or via the downloads tab on this page.

Small Bowel Series

The small bowel has to be as clean as possible before the test. If there is a lot of food product in the intestine, the barium won’t be able to flow freely, and small pieces of food product left inside the bowel may look like abnormalities.

In order to do this, you will need to fast for 6hrs prior to your appointment and follow a low residue diet for 2 days prior to your appointment.

The examination takes about 20 mins.  You will be asked to remove most of your upper clothes, but may keep wearing your underpants. Buttons, clips etc on clothes show up too well on x-ray and can be confusing to interpret or hide abnormalities. You will be asked to change into a gown.

You will be asked to drink a thin barium liquid. The object of the test is to fill the length of the small bowel with barium. This means that several hundred mls of liquid may have to be swallowed. Don’t worry – we want you to swallow as much as possible, but we won’t force you to drink it so fast that you feel sick. After the liquid is drunk, you will be asked to lie on your right side, so the liquid leaves the stomach and passes into the small bowel.

The normal “transit time” through the small bowel is very variable, and may be between 45 minutes and several hours depending on how fast the Barium travels through the small bowel. If you experience pain at any time, tell the doctor or radiographer. The pain may help to localise areas of disease, so don’t hesitate in telling.

  1. Patient Information Barium Enema (Link to come)
  2. Patient Information Preparation for Barium Enema-Low Residue Diet
  3. Patient Information Barium Meal (Link to come)
  4. Patient Information X-Ray (Link to come)

X-Ray images are often the most recognisable of Radiology examination images done and can be a key starting point before undertaking more specialist diagnostic imaging as they show up bone structures so well.

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