Hysterosalpingography

 

What is Hysterosalpingography?

Hysterosalpingography, also called uterosalpingography, is an x-ray examination of a woman's uterus and fallopian tubes that uses a special form of x-ray called fluoroscopy and a contrast material.

An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.

Fluoroscopy is a special x-ray technique that makes it possible to see internal organs in motion. During a hysterosalpingogram, the uterus and fallopian tubes are filled with a water-soluble contrast material and the radiologist is able to use fluoroscopy to view and assess their anatomy and function.

 

What are some common uses of the procedure?

Hysterosalpingography is primarily used to examine women who have difficulty becoming pregnant by allowing the radiologist to evaluate the shape and structure of the uterus, the openness of the fallopian tubes, and any scarring within the uterine or peritoneal (abdominal) cavity.

The procedure can be used to investigate repeated miscarriages that result from congenital or acquired abnormalities of the uterus and to determine the presence and severity of these abnormalities, including:

Tumor masses

Adhesions

Uterine fibroids

Hysterosalpingography is also used to evaluate the openness of the fallopian tubes, and to monitor the effects of tubal surgery, including:

Blockage of the fallopian tubes due to infection or scarring

Tubal ligation

The closure of the fallopian tubes in a sterilization procedure and a sterilization reversal

The re-opening of the fallopian tubes following a sterilization or disease-related blockage

 

How should i prepare?

The hysterosalpingography procedure is best performed one week after menstruation but before ovulation to make certain that you are not pregnant during the exam.

This procedure should not be performed if you have an active inflammatory condition. You should notify your physician or technologist if you have a chronic pelvic infection or an untreated sexually transmitted disease at the time of the procedure.

On the night before the procedure, you may be asked to take a laxative or an enema to empty your bowels, so that the uterus and surrounding structures can be seen clearly.

Prior to the procedure, you may be given a mild sedative or over-the-counter medication to minimize any potential discomfort. Some physicians prescribe an antibiotic prior to and/or after the procedure.

You should inform your physician of any medications being taken and if there are any allergies, especially to iodinated contrast materials. Also inform your doctor about recent illnesses or other medical conditions.

You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, removable dental appliances, eye glasses and any metal objects or clothing that might interfere with the x-ray images.

Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby.

 

What does the equipment look like?

The equipment typically used for this examination consists of a radiographic table, one or two x-ray tubes and a television-like monitor that is located in the examining room. Fluoroscopy, which converts x-rays into video images, is used to watch and guide progress of the procedure. The video is produced by the x-ray machine and a detector that is suspended over a table on which the patient lies.

 

How does the procedure work?

X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special detector.

Fluoroscopy uses a continuous or pulsed x-ray beam to create a sequence of images that are projected onto a fluorescent screen, or television-like monitor. When used with a contrast material, which clearly defines the area being examined by making it appear dark (or by electronically reversing the image contrast to white), this special x-ray technique makes it possible for the physician to view joints or internal organs in motion. Still images or movies are also captured and stored electronically on a computer.

Until recently, x-ray images were maintained as hard film copy (much like a photographic negative). Today, most images are digital files that are stored electronically. These stored images are easily accessible and are frequently compared to current x-ray images for diagnosis and disease management.

 

How is the procedure performed?

This examination is usually done on an outpatient basis.

The procedure is like a gynecological exam. The patient is positioned on her back on the exam table, with her knees bent or her feet held up with stirrups and a speculum is inserted into the vagina. The cervix is then cleansed, and a catheter is inserted into the cervix. The speculum is removed and the patient is carefully positioned underneath the fluoroscopy camera. The contrast material then begins to fill the uterine cavity, fallopian tubes and peritoneal cavity through the catheter and fluoroscopic images are taken.

In some cases, if certain abnormalities are encountered, the patient will be asked to rest and wait up to 30 minutes so that a delayed image can be obtained. This delayed image may provide clues to a patient's condition that the original images with contrast material do not. On occasion, an x-ray will be taken the next day to ensure that there is no scarring surrounding the ovaries.

When the procedure is complete, the catheter will be removed and the patient will be allowed to sit up.

When the examination is complete, you may be asked to wait until the radiologist determines that all the necessary images have been obtained.

The hysterosalpingogram is usually completed within 30 minutes.

 

What will I experience during and after the procedure?

This exam should cause only minor discomfort.

There may be slight discomfort and cramping when the catheter is placed and the contrast material is injected, but it should not last long. There may also be slight irritation of the peritoneum, the lining of the abdominal cavity, causing generalized lower abdominal pain, but this should also be minimal and not long lasting. Most women experience vaginal spotting for a few days after the examination, which is normal.

 

Who interprets the results and how do I get them?

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you.

Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable or changed over time.

 

What are the benefits vs. risks?

Benefits
  • Hysterosalpingography is a minimally invasive procedure with rare complications.
  • Hysterosalpingography is a relatively short procedure that can provide valuable information on a variety of abnormalities that cause infertility or problems carrying a fetus to term.
  • Hysterosalpingography can occasionally open fallopian tubes that are blocked allowing the patient to become pregnant afterwards.
  • No radiation remains in a patient's body after an x-ray examination.
  • X-rays usually have no side effects in the typical diagnostic range for this exam.
Risks
  • There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
  • The effective radiation dose for this procedure varies. See the Safety page for more information about radiation dose.
  • In the event of a chronic inflammatory condition, pelvic infection or untreated sexually transmitted disease, be certain to notify the physician or technologist before the procedure to avoid worsening of infection.
  • Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety page for more information about pregnancy and x-rays.

A Word About Minimizing Radiation Exposure

Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection organizations continually review and update the technique standards used by radiology professionals.

Modern x-ray systems have very controlled x-ray beams and dose control methods to minimize stray (scatter) radiation. This ensures that those parts of a patient's body not being imaged receive minimal radiation exposure.

 

What are the limitations of Hysterosalpingography?

Hysterosalpingography only sees the inside of the uterus and fallopian tubes. Abnormalities of the ovaries, wall of the uterus, and other pelvic structures may be evaluated with MRI or ultrasound. Infertility problems may be from causes not evaluated with hysterosalpingography, including, but not limited to, low or abnormal sperm count or the inability of a fertilized egg to implant in the uterus.

Intravenous Pyelogram (IVP)

 

Intravenous pyelogram (IVP) is an x-ray exam that uses an injection of contrast material to evaluate your kidneys, ureters and bladder and help diagnose blood in the urine or pain in your side or lower back. An IVP may provide enough information to allow your doctor to treat you with medication and avoid surgery.

Inform your doctor if there’s a possibility you are pregnant and discuss any recent illnesses, medical conditions, medications you’re taking and allergies, especially to iodine-based contrast materials. Your doctor may instruct you to take a mild laxative the evening before the exam and to not eat or drink anything after midnight. Wear loose, comfortable clothing and leave jewelry at home. You may be asked to wear a gown.

 

What is an Intravenous Pyelogram (IVP)?

An intravenous pyelogram (IVP) is an x-ray examination of the kidneys, ureters and urinary bladder that uses iodinated contrast material injected into veins.

An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.

When contrast material is injected into a vein in the patient's arm, it travels through the blood stream and collects in the kidneys and urinary tract, turning these areas bright white on the x-ray images. An IVP allows the radiologist to view and assess the anatomy and function of the kidneys, ureters and the bladder.

 

What are some common uses of the procedure?

An intravenous pyelogram examination helps the radiologist assess abnormalities in the urinary system, as well as how quickly and efficiently the patient's system is able to handle fluid waste.

The exam is used to help diagnose symptoms such as blood in the urine or pain in the side or lower back.

The IVP exam can enable the radiologist to detect problems within the urinary tract resulting from:

Kidney stones

Nlarged prostate

Tumors in the kidney, ureters or urinary bladder

Scarring from urinary tract infection

Surgery on the urinary tract

Scongenital anomalies of the urinary tract

 

How should I prepare?

Your doctor will give you detailed instructions on how to prepare for your IVP study.

You will likely be instructed not to eat or drink after midnight on the night before your exam. You may also be asked to take a mild laxative (in either pill or liquid form) the evening before the procedure.

You should inform your physician of any medications being taken and if there are any allergies, especially to iodinated contrast materials. Also inform your doctor about recent illnesses or other medical conditions.

You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, removable dental appliances, eye glasses and any metal objects or clothing that might interfere with the x-ray images.

Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See the Safety page for more information about pregnancy and x-rays.

 

What does the equipment look like?

The equipment typically used for this examination consists of a radiographic table, one or two x-ray tubes and a television-like monitor that is located in the examining room. Fluoroscopy, which converts x-rays into video images, is used to watch and guide progress of the procedure. The video is produced by the x-ray machine and a detector that is suspended over a table on which the patient lies.

 

How does the procedure work?

X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special detector.

In an IVP exam, an iodine-containing contrast material is injected through a vein in the arm. The contrast material then collects in the kidneys, ureters and bladder, sharply defining their appearance in bright white on the x-ray images.

X-ray images are typically stored as digital images in an electronic archive. However, if needed, a hard film copy (similar to a photograph) or a CD-ROM disk can be made. These stored images are easily accessible and may be compared to current or prior x-ray images for diagnosis and disease management.

 

How is the procedure performed?

This examination is usually done on an outpatient basis.

You will lie on the table and still x-ray images are taken. The contrast material is then injected, usually in a vein in your arm, followed by additional still images. The number of images taken depends on the reason for the examination and your anatomy.

You must hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image. The technologist will walk behind a wall or into the next room to activate the x-ray machine.

As the contrast material is processed by the kidneys, a series of images is taken to determine the actual size of the kidneys and to image the urinary tract in action as it begins to empty. The technologist may apply a compression band around the body to better visualize the urinary structures.

When the examination is complete, you may be asked to wait until the radiologist determines that all the necessary images have been obtained.

An IVP study is usually completed within an hour. However, because some kidneys function at a slower rate, the exam may last up to four hours.

 

What will I experience during and after the procedure?

The IVP is usually a relatively comfortable procedure.

You will feel a minor sting as the contrast material is injected into your arm through a small needle. Some patients experience a flush of warmth, a mild itching sensation and a metallic taste in their mouth as it begins to circulate throughout their body. These common side effects usually disappear within a minute or two and are harmless. Rarely, some patients will experience an allergic reaction. Itching that persists or is accompanied by hives, can be easily treated with medication. In very rare cases, a patient may become short of breath or experience swelling in the throat or other parts of the body. These can be indications of a more serious reaction to the contrast material that should be treated promptly. Tell the radiologist immediately if you experience these symptoms as he/she is well prepared to treat this.

During the imaging process, you may be asked to turn from side to side and to hold several different positions to enable the radiologist to capture views from several angles. Near the end of the exam, you may be asked to empty your bladder so that an additional x-ray can be taken of your urinary bladder after it empties.

The contrast material used for IVP studies will not discolor your urine or cause any discomfort when you urinate.

 

Who interprets the results and how do I get them?

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you.

Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable or changed over time.

 

What are the benefits vs. risks?

Benefits
  • Imaging of the urinary tract with IVP is a minimally invasive procedure.
  • IVP images provide valuable, detailed information to assist physicians in diagnosing and treating urinary tract conditions from kidney stones to cancer.
  • An IVP can often provide enough information about kidney stones and urinary tract obstructions to direct treatment with medication and avoid more invasive surgical procedures.
  • No radiation remains in a patient's body after an x-ray examination.
  • X-rays usually have no side effects in the typical diagnostic range for this exam.
Risks
  • There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
  • The effective radiation dose for this procedure varies. See the Safety page for more information about radiation dose.
  • Contrast materials used in IVP studies can cause adverse allergic reactions in some people, sometimes requiring medical treatment.
  • Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety page for more information about pregnancy and x-rays.

A Word About Minimizing Radiation Exposure

Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection organizations continually review and update the technique standards used by radiology professionals.

Modern x-ray systems have very controlled x-ray beams and dose control methods to minimize stray (scatter) radiation. This ensures that those parts of a patient's body not being imaged receive minimal radiation exposure.

 

What are the limitations of IVP exams?

An IVP shows details of the inside of the urinary tract including the kidneys, ureters and bladder. Computed tomography (CT) or magnetic resonance imaging (MRI) may add valuable information about the functioning tissue of the kidneys and surrounding structures nearby the kidneys, ureters and bladder. Small urinary tract tumors and stones are more easily identified on these examinations.

IVP exams are not usually indicated for pregnant women.

The uses for IVP in infants and children are limited. Other tests, including ultrasound, can be used in most cases to evaluate the kidneys and bladder. In general, IVPs are rarely done in pediatric patients.

Voiding Cystourethrogram

 

A children’s (pediatric) voiding cystourethrogram uses fluoroscopy – a form of real-time x-ray – to examine a child’s bladder and lower urinary tract. Exam results allow your physician to determine whether your child’s condition requires no therapy, medication, or surgery.

Tell your doctor about your child’s recent illnesses, medical conditions, medications and allergies, especially to contrast material. Your child should wear loose, comfortable clothing and may be asked to wear a gown. Little to no special preparation is required for this procedure and sedation is rarely needed. However, it’s best to explain to your child what will happen during the exam so there will be no confusion about what is expected.

 

What is a Voiding Cystourethrogram?

A children's (pediatric) voiding cystourethrogram (VCUG) is an x-ray examination of a child's bladder and lower urinary tract that uses a special form of x-ray called fluoroscopy and a contrast material.

An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.

Fluoroscopy makes it possible to see internal organs in motion. When the bladder is filled with and then emptied of a water-soluble contrast material, the radiologist is able to view and assess the anatomy and function of the bladder and lower urinary tract.

 

What are some common uses of the procedure?

A voiding cystourethrogram enables a radiologist, a physician specifically trained to supervise and interpret radiology examinations, to detect abnormalities in the flow of urine through the lower urinary tract. This examination is often recommended after a urinary tract infection to check for a condition known as vesicoureteral (VU) reflux.

About VU Reflux

Urine is produced in the kidney and flows through the ureter, the tube that carries urine from each kidney to the bladder. A valve mechanism prevents urine from backing up into the kidneys as the bladder gets full. Urine leaves the bladder through the urethra and is eliminated from the body during urination.

In some children, an abnormality in the valve or the ureters allows urine to flow backwards, a condition called VU reflux. In mild cases urine backs up into the lower ureter. In severe cases it can back up into the kidney. Usually, children with this condition are born with it. Other causes include:

Bladder obstruction

Abnormal urination with very high pressure within the bladder

Incomplete emptying of the bladder

Urinary tract infection.

Urinary tract infection may be the only symptom of the problem.

 

How should we prepare?

You should inform your physician of any medications your child is taking and if he or she has any allergies, especially to contrast materials. Also inform your doctor about recent illnesses or other medical conditions.

Your child does not need to fast or wear special clothing. Explain to your child what will happen during the examination so that there will be no confusion about what is expected. Your child will have to remove all clothing and wear a gown.

Sedation is rarely needed.

 

What does the equipment look like?

The equipment typically used for this examination consists of a radiographic table, one or two x-ray tubes and a television-like monitor that is located in the examining room. Fluoroscopy, which converts x-rays into video images, is used to watch and guide progress of the procedure. The video is produced by the x-ray machine and a detector that is suspended over a table on which the patient lies.

A catheter, a flexible, hollow plastic tube, will be used to fill the bladder with a water-soluble contrast material. The catheter has a diameter smaller than the urethra.

 

How does the procedure work?

X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special detector.

Fluoroscopy uses a continuous or pulsed x-ray beam to create a sequence of images that are projected onto a fluorescent screen, or television-like monitor. When used with a contrast material, which clearly defines the area being examined by making it appear dark (or by electronically reversing the image contrast to white), this special x-ray technique makes it possible for the physician to view joints or internal organs in motion. Still images or movies are also captured and stored electronically on a computer.

Until recently, x-ray images were maintained as hard film copy (much like a photographic negative). Today, most images are digital files that are stored electronically. These stored images are easily accessible and are frequently compared to current x-ray images for diagnosis and disease management.

 

How is the procedure performed?

This examination is usually done on an outpatient basis.

The technologist begins by positioning the child on the table. Infants and young children may be wrapped tightly in a blanket or other restraint to help them lie still during the imaging.

An x-ray of the abdomen may be performed before the urinary bladder is catheterized. The bladder catheterization is performed by a specially trained professional, a nurse, doctor or technologist. After cleaning the genital area, a catheter is inserted through the urethra, the tube that carries urine from the bladder out of the body. The catheter may be taped to the skin so that it will not be dislodged during the procedure. Then, the bladder is filled with a liquid contrast material. When the bladder is full, the child will urinate on the x-ray table. A urinal, bed pan or absorbent pad may be used to catch the liquid contrast material. The radiologist or technologist will use fluoroscopy to monitor the filling of the bladder and urination. X-ray images will be obtained during the monitoring. After the x-ray images are checked to make sure the exam is complete, the catheter is removed.

The radiologist will check to see if any of the liquid contrast material goes backward into one or both ureters and kidneys and whether the shape and contour of the bladder and urethra are normal.

You must hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image. The technologist will walk behind a wall or into the next room to activate the x-ray machine.

When the examination is complete, you may be asked to wait until the radiologist determines that all the necessary images have been obtained.

A voiding cystourethrogram is usually completed within 30 minutes.

 

What will my child experience during and after the procedure?

A voiding cystourethrogram may frighten some children. The antiseptic used to clean and prepare for the insertion of the catheter may feel cold. Some children may experience discomfort when the catheter is inserted and the bladder is filled with the liquid contrast material. Most children accept the procedure after an explanation of all of its parts.

A parent may be allowed to stay in the fluoroscopy room to comfort the child. Everyone, except the patient, wears a lead apron in the fluoroscopy room to protect from radiation exposure. A parent who wishes to remain in the fluoroscopy room will be required to wear a lead apron.

 

Who interprets the results and how do we get them?

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you.

Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable or changed over time.

 

What are the benefits vs. risks?

Benefits
  • Voiding cystourethrograms provide valuable, detailed information to assist physicians in diagnosing and treating urinary tract conditions to prevent kidney damage.
  • The examination results allow physicians to determine whether therapy is necessary. Some conditions require no therapy, while others may require medications. Some may even need surgery.
  • No radiation remains in a patient's body after an x-ray examination.
  • X-rays usually have no side effects in the typical diagnostic range for this exam.
Risks
  • There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
  • The effective radiation dose for this procedure varies. See the Safety page for more information about radiation dose.
  • Some children experience discomfort during urination immediately after the procedure. This discomfort usually resolves in less than 12 hours.

A Word About Minimizing Radiation Exposure

Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection organizations continually review and update the technique standards used by radiology professionals.

Modern x-ray systems have very controlled x-ray beams and dose control methods to minimize stray (scatter) radiation. This ensures that those parts of a patient's body not being imaged receive minimal radiation exposure.

 

What are the limitations of a Voiding Cystourethrogram?

A voiding cystourethrogram cannot evaluate obstruction of flow of urine from the kidneys. Additional examinations are needed if obstruction is suspected.

A voiding cystourethrogram should not be performed while an active, untreated urinary tract infection is present.

X-ray (Radiography) - Lower GI Tract(BariumEnema)


Lower gastrointestinal tract radiography or lower GI uses a form of real-time x-ray called fluoroscopy and a barium-based contrast material to help detect disease and abnormalities and diagnose symptoms such as pain, constipation or blood in the stool. It can often provide enough information to avoid more invasive procedures such as colonoscopy. Tell your doctor if there’s a possibility you are pregnant and discuss any recent illnesses, medical conditions, medications you’re taking and allergies, especially to contrast materials. You doctor will instruct you on how to cleanse your bowel, restrict you to clear liquids on the day before your procedure, and not allow you to eat or drink anything after midnight. Take your regular medication with sips of water. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown.

What is Lower GI Tract X-ray Radiography (Barium Enema)?

Lower gastrointestinal (GI) tract radiography, also called a lower GI or barium enema, is an x-ray examination of the large intestine, also known as the colon. This examination evaluates the right or ascending colon, the transverse colon, the left or descending colon, the sigmoid colon and the rectum. The appendix and a portion of the distal small intestine may also be included.

An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.

The lower GI uses a special form of x-ray called fluoroscopy and a contrast material called barium or a water soluble iodinated contrast.

Fluoroscopy makes it possible to see internal organs in motion. When the lower gastrointestinal tract is filled with barium, the radiologist is able to view and assess the anatomy and function of the rectum, colon and sometimes part of the lower small intestine.

 

What are some common uses of the procedure?

A physician may order a lower GI examination to detect:

Benign tumors (such as polyps).

Cancer.

Ulcerative colitis (inflammatory bowel disease).

Hirschsprung disease in children (a blockage of the large intestine).

The procedure is frequently performed to help diagnose symptoms such as:

Chronic diarrhea.

Blood in stools.

Constipation.

Irritable bowel syndrome.

Unexplained weight loss. 

A change in bowel habits.

Suspected blood loss.

Abdominal pain.

Images of the small bowel and colon are also used to diagnose inflammatory bowel disease, a group of disorders that includes Crohn's disease and ulcerative colitis.

 

What does the x-ray equipment look like?

The equipment typically used for this examination consists of a radiographic table, one or two x-ray tubes and a television-like monitor that is located in the examining room. Fluoroscopy, which converts x-rays into video images, is used to watch and guide progress of the procedure. The video is produced by the x-ray machine and a detector that is suspended over a table on which the patient lies.

 

How should I prepare for the procedure?

Your physician will give you detailed instructions on how to prepare for your lower GI imaging.

You should inform your physician of any medications being taken and if there are any allergies, especially to iodinated contrast materials. Also inform your doctor about recent illnesses or other medical conditions.

On the day before the procedure you will likely be asked not to eat, and to drink only clear liquids like juice, tea, black coffee, cola or broth, and to avoid dairy products. After midnight, you should not eat or drink anything. For adults (but not usually in children), it is important that your colon be completely empty for the procedure. You may also be instructed to take a laxative (in either pill or liquid form) and to use an over-the-counter enema preparation the night before the examination and possibly a few hours before the procedure. Just follow your doctor's instructions. You can take your usual prescribed oral medications with limited amounts of water.

You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, removable dental appliances, eye glasses and any metal objects or clothing that might interfere with the x-ray images.

Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See the Safety page for more information about pregnancy and x-rays.

Infants and children may undergo lower GI radiography. Usually, there is no special preparation, but your doctor will give you detailed instructions to prepare your child for the examination. The use of barium and the taking of x-ray images is similar to that described for adults.

 

How does the procedure work?

X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special detector.

Fluoroscopy uses a continuous or pulsed x-ray beam to create a sequence of images that are projected onto a fluorescent screen, or television-like monitor. When used with a contrast material, which clearly defines the area being examined by making it appear dark (or by electronically reversing the image contrast to white), this special x-ray technique makes it possible for the physician to view joints or internal organs in motion. Still images or movies are also captured and stored electronically on a computer.

Until recently, x-ray images were maintained as hard film copy (much like a photographic negative). Today, most images are digital files that are stored electronically. These stored images are easily accessible and are frequently compared to current x-ray images for diagnosis and disease management.

 

How is the procedure performed?

The lower GI examination is usually done on an outpatient basis and is often scheduled in the morning to reduce the patient's fasting time.

A radiology technologist and a radiologist, a physician specifically trained to supervise and interpret radiology examinations, guide the patient through the barium enema.

The patient is positioned on the examination table and an x-ray film is taken to ensure the bowel is clean. After performing a rectal examination, the radiologist or technologist will then insert a small tube into the rectum and begin to instill, using gravity, a mixture of barium and water into the colon. Air may also be injected through the tube to help the barium thoroughly coat the lining of the colon. In some circumstances, the radiologist or referring physician may prefer a water and iodine solution rather than barium. Next, a series of x-ray images is taken.

You must hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image. The technologist will walk behind a wall or into the next room to activate the x-ray machine.

The patient may be repositioned frequently in order to image the colon from several angles. Some x-ray equipment will allow patients to remain in the same position throughout the examination.

When the examination is complete, you may be asked to wait until the radiologist determines that all the necessary images have been obtained.

Once the x-ray images are completed, most of the barium will be emptied through the tube. The patient will then expel the remaining barium and air in the restroom. In some cases, additional x-ray images will be taken.

A barium enema is usually completed within 30 to 60 minutes.

 

What will I experience during and after the procedure?

As the barium fills your colon, you will feel the need to move your bowel. You may feel abdominal pressure or even minor cramping. Most people tolerate the mild discomfort easily. The tip of the enema tube is specially designed to help you hold in the barium. If you are having trouble, let the technologist or radiologist know.

During the imaging process, you will be asked to turn from side to side and to hold several different positions. At times, pressure may be applied to your abdomen. With air contrast studies of the bowel (air contrast barium enema), the table may be moved to an upright position.

After the examination, you may be given a laxative or enema to wash the barium out of your system. You can resume a regular diet and take orally administered medications unless told otherwise by your doctor. You may be able to return to a normal diet and activities immediately after the examination. You will be encouraged to drink additional water for 24 hours after the examination.

Your stools may appear white for a day or so as your body clears the barium liquid from your system. Some people experience constipation after a barium enema. If you do not have a bowel movement for more than two days after your exam or are unable to pass gas rectally, call your physician promptly. You may need an enema or laxative to assist in eliminating the barium.

 

Who interprets the results and how do I get them?

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you.

Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable or changed over time.

 

What are the benefits vs. risks?

Benefits

X-ray imaging of the lower GI tract is a minimally invasive procedure with rare complications.

Radiology examinations such as the lower GI can often provide enough information to avoid more invasive procedures such as colonoscopy.

Because barium is not absorbed into the blood, allergic reactions are extremely rare.

No radiation remains in a patient's body after an x-ray examination.

X-rays usually have no side effects in the typical diagnostic range for this exam.

Risks

There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.

The effective radiation dose for this procedure varies. See the Safety page for more information about radiation dose.

In rare cases, the barium could leak through an undetected hole in the lower GI tract producing inflammation in surrounding tissues.

Even more rarely, the barium can cause an obstruction in the gastrointestinal tract, called barium impaction.

Iodinated contrast administered rectally may cause allergic reactions, but this is very rare.

Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety page for more information about pregnancy and x-rays.

A Word About Minimizing Radiation Exposure

Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection organizations continually review and update the technique standards used by radiology professionals.

Modern x-ray systems have very controlled x-ray beams and dose control methods to minimize stray (scatter) radiation. This ensures that those parts of a patient's body not being imaged receive minimal radiation exposure.

 

What are the limitations of Lower GI Tract Radiography?

A barium enema is usually not appropriate for someone who is in extreme abdominal pain or who has had a recent colonic biopsy. If perforation of the colon is suspected, the enema should be performed with a water-soluble contrast solution.

X-ray imaging is not usually indicated for pregnant women.

 

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