d. Radiographic Examination.
(1) Radiographs are made as requested by the radiologist or according to
clinical routine. An RAO (right anterior oblique) is almost always included. Other
radiographs may consist of AP (anterior-posterior) and lateral projections. The
radiographs may be made with the patient in either the erect or recumbent position.
See figure 2-1. In addition, the table may be tilted in the modified Trendelenburg
position. In the case of large, heavy patients, the use of grid techniques should be
(2) As soon as the patient is positioned, he is given a spoonful of the paste
(contrast medium) and told to retain it in his mouth. Here, a definite sequence of steps
(a) The patient is instructed to swallow the contrast medium at a given
signal and suspend respiration.
(b) Respiration is suspended for about 3 seconds to allow the contrast
medium to distribute through the esophagus (this time interval will vary with clinical
The exposure is taken.
(3) The following information applies to an RAO of the esophagus. See
figures 2-2 and 2-3.
Film. 14 x 17-inch, lengthwise.
(c) Position. Patient upright or recumbent, rotated 40, right-hand palm
out on hip, left hand resting on film support. Coronal plane through acromial processes
4 inches below upper edge of film holder (plane is taken with arms down).
CR (central ray). Directed to the center of the film.
(e) Precautions. Respiration suspended in forced inspiration.
Exposure is made during ingestion of contrast medium.
(f) Variations. For study of mucosal pattern of lower esophagus, use
modified Trendelenburg position (head lowered-feet elevated). This is used in many
clinics with the PA and lateral projections for the basic study of the esophagus.
(4) See figures 2-4 A, B, C and 2-5 A, B, C. These will provide examples of
the AP and lateral esophagus.