Method (cont.)

11. Turn x-ray table upright. Use Holzknecht paddle and/or compression cone on fluoroscope to obtain graded compression of duodenal bulb. Take two SCGC spots (4-on-1 format) of the bulb.
    
    
12. Then, use compression cone on fluoroscope (or Holzknecht paddle if patient is obese) and take four SCGC spots (4-on-1 film format) of:

• Gastric antrum (patient LPO)
  
  
• Gastric antrum/body (patient LPO or AP)
  
  

• Gastric body (patient AP)
  
  
• Gastric body/fundus (patient RPO)
  
  

13. Decrease kVp to 90. Turn patient into LPO position. Quickly scan the mediastinum to be sure that the esophagus is empty of barium. Turn the table into horizontal position and resume fluoro. Take two DC spots (4-on-1 film format) of duodenal bulb and two DC spots of air-filled duodenal C-loop.

14. Observe for spontaneous gastroesophageal reflux as you turn patient towards you (counter-clockwise if viewed from foot of table) into RAO position.

15. Increase kVp to 125. Have the patient drink several single swallows of dilute, non-carbonated barium through a straw. Observe esophageal motility and also look for anatomic lesions. Take one SC spot (2-on-1 format) of the barium-distended lower esophagus and gastric cardia during breath-holding and one SC spot of the same area during Valsalva maneuver to evaluate for a possible sliding hiatal hernia.

16. Have the technologist take one overhead film (14" x 17", 125 kVp) of the abdomen with patient in prone position.