I know a lot of you have been asking about fluoroscopy Imaging and ways to figure out where the barium is sitting so here's just a quick review on the fluoroscopy Physicians and imaging that you might see I'm going to start this off with the body habitus info because I think body habits is really important with stomach position gallbladder position and colon position so reviewing your body habitus is important because you know should know how the body habits is affecting where the anatomy lies their Hypersonic patient is your big patient they have a very large belly belly pushes everything up high and out to the sides or high in transverse so you'll notice that the gallbladder is pushed way up high and off to the side the duodenal bulb is also very high it's at the level of t11 T12 the large intestine is also pushed up the transverse colon is way up here so if you're looking at anatomy-wise your Hypersonic patient everything is going to be pushed up and away your aesthetic patient is your average patient and they're more midline and middle of the row so their gallbladder is at t12l1 the duodenal bulb is around L1 L2 and then the large intestine you can see how different the flexures look and the left flexor is almost always higher than the right in this type of anatomy and then the aesthetic and hypocenic are a lot of times combined this is your more slender patient they have a longer torso they also have a stomach which is shaped in a j-shaped stomach the gallbladder is really low and close to midline so it's really down and in so the gallbladder is at l3l4 just above the iliac crest the original ball was at l3l4 also and the large intestine is very low in the abdomen as well what if it's just a picture of the stomach itself so knowing these body habitats can help you figure out where the anatomy is lying if you look at this first one the stomach it looks sideways right it's lying transverse the duodenal bulb is way up here in the t11 T12 range this one is a little bit lower down in an L2 you can see the shape of a j the j-shaped stomach and the L3 L4 location so this is your Hypersonic patient your massive patient which everything got pushed up and out the stomach is your more average and then your hypo or asthenic is this long and down and in so those are helpful for your upper GI Imaging as well so you know your upper GI is focused on the stomach and the fundus itself is really the indicator of the patient position or what's in the fundus I think is more helpful but understanding how the fundus is positioned to the rest of the anatomy is important so the fundus sits posteriorly to the body so the funnest is kicked back where the body is forward so if your patient is laying supine the fundus will be closer to the spine than the body and when we're talking about barium and air that's helpful your common positions would be either supine or Pro there are two oblique options Rao which is your anterior oblique and is a 40 to 70 degree a week or the lpo and it's 30 to 60. the larger the patient the larger the degree of oblique and then there's a right lateral as well when we're talking about supine or AP stomach positioning some of the indicators that you can look for are what has air what has barium and how does the spine look so I call this ABS um I don't have them but we're going to use those the spine when it has finest processes coming straight down the middle is going to be either supine or brown so I know this patient is either supine or prone position because the spine is a true APU then I'm gonna evaluate what if my fundus has barium or if my furnace has air and I know barium is a solid liquid it's heavy right anything heavy or fluid is going to float to the lowest point so when your patient is supine that fundus is sitting back farther towards the spine the body is raised up it's going to collect the air when you're supine barium flows into the fundus because it's the lowest point there Rises into the body so this is your supine when you're prone it's reverse so you flipped your patient over now the fundus is closest to the spine it's raised up air rises so air will be in the funness barium heavy liquid is going to flow into the body so this is your prone image because it has air in the thumbs when you're in an oblique we're going to use our same ABS we're going to look at spine air barium I know when I see Scotty dogs in the spine that my patient is in oblique position we're also not seeing spinous processes coming down the middle right so you know this patient has to be an oblique the same concept of how the barium sits in the fundus works for these when you are supine remember the barium set in the fundus lpo when you're prone air was in the fundus Aria so if you have an oblique spine and barium you'll be able to figure these out lateral I think the spine is the easiest way to figure this out if it looks like the lateral lumbar spine it's a lateral position so look at your vertebrae do they look lateral excellent and the focus here is the retrogastric space so the space behind the stomach easy peasy so again we're going to look at these is this REO is it lpo well I can see a little bit of the spine here I can't see all the way to the middle it's kind of cut off but I can see the elongation of the rib cage and also the connection of the ribs to the vertebrae so I know this is an oblique I have air in the fundus so I know the patient has to be in a pron oblique my only option is REO same goes for here barium in the fundus LPL prone or supine how's the spine look spinous process is coming straight down the line on both okay this patient's either supine or prone if they're supine laying back barium goes into the funness lowest point prone air rises air in the fungus so this has to be the broom and then barium swallow I only focus on one position for barium swallow I know there's more listed on the specs but really the REO is the only one I focus on bear and swallows focusing on the esophagus right so your array of drinking where the patient is taking big swallows while you're making your exposure you're gonna try and fill the esophagus with barium you're gonna put the patient in an Rao so the esophagus is going to move off the spine in between the spine and the Heart shadow if you're not rotated enough it'll look like this where the esophagus is over the spine it's there to be kicked up a little bit farther and then the patient is just going to drink barium and keep swallowing as you make your exposure so beer and swallow Oreo is the only one that I would worry about um and then I'll be back for small bowels