Fluoroscopy is a medical imaging technology that creates moving X-ray images on a screen. Several different types of fluoroscopy procedures are used to create images of different parts of the body, including:
- Barium enema. A barium enema is a series of X-rays of the colon (also called the large intestine) that accurately shows the anatomy of the colon. The procedure requires the use of a special fluid called contrast. In most cases, radiologists at Riley at IU Health use Cystografin (a clear contrast fluid) instead of barium (a thick, white contrast fluid). The fluid is administered through a small tube that is placed in the rectum. Barium enema is often used to find the causes of symptoms such as chronic constipation, rectal bleeding and abdominal pain.
- Upper gastrointestinal (UGI). An UGI is a series of X-rays of the upper gastrointestinal tract, which includes the esophagus, stomach and duodenum (the first few inches of the small intestine). Your child will drink barium during the procedure. The barium can be flavored with chocolate or strawberry syrup. UGIs evaluate the anatomical position of the stomach and duodenum and assess the esophagus. An UGI may be used to diagnose symptoms such as abdominal pain, nausea and vomiting.
- Small bowel follow through (SBFT). A SBFT allows your child's doctor to view areas of the small intestine that cannot be seen with an endoscopy. Your child will be asked to drink several cups of barium and then multiple X-rays will be taken to follow the barium as it passes through the small intestine. This procedure will take several hours.
- Video feeding study and oximetry swallow study. A video feeding study and an oximetry swallow study are procedures that use barium to evaluate swallowing function and show what happens inside your child's mouth and esophagus when he or she is eating or drinking. During the procedure, your child will consume different food and drink consistencies, such as thin liquid, thick liquid, pureed food and solid food, to see if any of the consistencies abnormally pass into the breathing tract (trachea) when he or she swallows.
- Voiding cystourethrogram (VCUG). A VCUG is a series of X-rays of the bladder that shows how the bladder is functioning. Contrast is used to make the bladder visible during the exam. The bladder is filled with contrast through a catheter that is inserted into the urethra (the tube where urine leaves the body). Conditions that often require a VCUG include urinary tract infections (UTIs), suspected urinary obstruction or bladder trauma.
Most fluoroscopy exams last 30 minutes.
The radiology team at Riley at IU Health performs exams with the most advanced fluoroscopy equipment available, using low-dose pulsed fluoroscopy and the As Low As Reasonably Achievable (ALARA) principle. The result is that your child remains safe while the doctor gets the clearest images possible.
What to Expect
What to Expect
The exam will take place in a private room. We encourage you to support your child by staying in the room during the exam. You can help your child remain calm by talking to him or her and holding his or her hand. The exam involves the use of radiation, so women who are pregnant or believe they are pregnant may not enter the room. In this case, we strongly encourage you to invite another trusted caregiver to support your child during the exam. Siblings and anyone under the age of 18 are also not allowed in the exam room. Two parents or caregivers are able to stay with a child during an exam.
In some cases, a certified child life specialist (CCLS) will help your child prepare for the exam and provide distraction during the exam.
Your child may eat or drink normally before and after a barium enema exam but should not have anything placed in the rectum for 24 hours before the exam (this includes thermometers, suppositories or enemas). You can expect the following during the exam:
- Your child will be asked to change into a hospital gown.
- Your child will be asked to lie on his or her side on the exam table with knees pulled up (fetal position).
- The radiologist or radiology assistant will place a small tube into the rectum using lubrication.
- The tube will be connected to a bag of contrast liquid that hangs from an intravenous (IV) pole.
- The fluid will flow by gravity into your child's colon, which will make your child feel the need to have a bowel movement. The radiologist will ask your child to “hold it” while he or she takes the X-rays.
- After the colon is completely full of contrast fluid and the X-rays have been taken, the radiologist will drain as much contrast through the tube as possible.
- The tube will be removed from your child’s rectum, allowing him or her to use the restroom. If your child is not potty-trained, you may be asked to put a diaper on him or her and wait for a bowel movement.
- After your child has a bowel movement, one final X-ray of your child’s abdomen will be taken.
- Your child may need to use the restroom frequently for a couple hours after the exam. You may want to bring extra undergarments and clothing.
Upper Gastrointestinal (UGI)
An UGI exam requires you to follow specific food and drink instructions based on your child's age:
- Newborn to 4 weeks old. Your child cannot eat or drink anything for two hours before the exam.
- 1 month to 12 months old. Your child cannot eat or drink anything for three hours before the exam.
- 1 year old and up. Your child cannot eat or drink anything for four hours before the exam.
You can expect the following during an UGI:
- Your child may be asked to change into a hospital gown.
- Your child will be asked to lie down on his or her back on the exam table. A radiologist, radiology assistant or advanced fluoroscopy technologist will move the X-ray machine over your child.
- Your child will then be asked to lie in various positions while he or she drinks the barium. The barium will allow the upper gastrointestinal (GI) tract to be seen on the X-ray. A technologist will help your child move on the table during the exam.
- X-rays will be taken until the content in the stomach begins to empty into the first portion of the small intestine.
- After the exam is complete, you should encourage your child to drink plenty of fluids to help push the barium through his or her GI tract. Fluids are especially important if your child has chronic constipation. You should expect your child to have white or lightly colored bowel movements for a day or two after the exam.
Small Bowel Follow Through (SBFT)
A SBFT is usually performed after an UGI. You can expect the following:
- Once the UGI has been performed, your child will be asked to drink two more cups of flavored barium over several minutes.
- An image of the abdomen will be obtained.
- After the first image is obtained, a series of images will be taken—usually at 45-minute intervals—as the contrast passes through the small bowel.
- When an image shows that contrast has passed into the large bowel (colon), the radiologist may choose to take several images with your child in different positions while lightly pressing on his or her abdomen.
- Encourage your child to drink plenty of fluids after the exam is complete.
Video Feeding Study & Oximetry Swallow Study
Video feeding studies and oximetry swallow studies are commonly called "feeding studies." During a feeding study, the radiologist will take X-ray images of your child's head and neck area while he or she swallows multiple consistencies of liquids using a variety of nipples or straws and cups. The liquids are mixed with barium. Your child should drink plenty of fluids to help move the barium through his or her GI tract once the exam is complete.
Voiding Cystourethrogram (VCUG)
If your child has had a recent UTI and is taking antibiotics, the antibiotics have to run through a course of seven days to avoid the risk of further infection by the exam. If you suspect your child has a UTI before the exam, please contact his or her doctor.
You can expect the following during a VCUG:
- If your child is a boy, he will be asked to lie down on the exam table with his legs relaxed out in front of him. If your child is a girl, she will be asked to lie down on the exam table with her legs placed in the "frog position" (feet together, knees bent outward). The technologist will then use Betadine (liquid soap) and a cotton swab to clean the area where the catheter will be inserted. This may feel cold and wet.
- The technologist will then insert a catheter (small, flexible tube) into the urethra (the tube where urine leaves the body). This can be uncomfortable, so your child may need support and comfort. He or she can reduce the discomfort by taking slow, deep breaths and remaining still. In many cases for boys, numbing gel can be administered into the penis to prevent discomfort during the catheter placement.
- The catheter is then connected to a bag of liquid. The liquid is called contrast. It flows through the tube into your child's bladder, making the bladder visible on the X-ray.
- The X-ray machine will move over your child to take pictures. The machine will not touch him or her.
- During the exam, the bladder needs to be filled as full as possible. Your child will be asked to hold his or her urine as long as possible.
- When your child can no longer wait to urinate, the technologist will remove the small piece of tape used to hold the catheter in place during the exam. This allows the catheter to simply fall out while your child urinates. Your child will then urinate while images are being taken.
- The technologist will encourage your child to push out all of the contrast while they continue taking X-ray pictures. This might sound uncomfortable or embarrassing, but it is a very important part of the exam.