Medical Imaging: lnterventional Radiography (Fluoroscopy) - What To Expect

What is a water-soluble enema?

A water-soluble enema is an x-ray examination of your large bowel (colon) or a portion of the bowel when it is filled with a water-soluble x-ray contrast, which has been administered by an enema through a flexible catheter.

This test may be ordered by your doctor to rule out a bowel leak after surgery or if your bowel has become connected to another structure in your body (“fistula”).

No preparation is required for this exam.

What is an intravenous pyelogram (IVP)?

An IVP is an x-ray examination of your kidneys, ureters, and urinary bladder area after contrast dye has been injected into a vein in the arm. 

As the contrast material moves into and through the kidneys, ureters, and urinary bladder, the technologist captures a series of images that track its progress. This exam enables the radiologist to review the anatomy and function of your kidneys and urinary tract.

Why is an IVP done?

While a CT scan is the more common exam to study the urinary tract, special circumstances may cause the radiologist and urologist to request an IVP study for better follow-up of a known condition (e.g., after pyeloplasty surgery or renal cell cancer).

How do I prepare for the procedure?

Please make the following arrangements for your appointment:

1. If you are allergic to x-ray contrast dye  (contrast material that contains iodine), please call 519-646-6044 for special booking arrangements.

2. It is very important that your bowels are empty and cleansed for this exam so that your kidneys can be seen clearly.

You will need to purchase a 300 ml bottle Citro-Mag at your local pharmacy.  This medication may be chilled in the refrigerator for better taste.  Please refer to package insert for warnings and precautions for use. 

On the day before your exam:

1. Eat a normal breakfast

​​​​​2. Drink one full glass (250ml) or more of water or clear liquids every hour after breakfast until 12:00 pm. Clear liquids include apple juice, Jell-O, chicken broth, Gatorade, plain tea or coffee, popsicles, pop, ice, etc.  You may not eat any solid food or drink any milk (dairy or dairy-free) products.

3. At 12:00 pm (noon), drink the entire 300 mL container of Citro-Mag (cold).

4. From 12:00 pm until you go to bed, drink at least one glass of fluid (250 mL) every hour to prevent dehydration. Water is the best choice.

5.  You may have a liquid dinner of clear fluids such as Jell-O, chicken broth, Gatorade, plain black tea/ coffee, popsicles, pop, apple juice, ice, etc.

6.  At 12:00 am (midnight) you must stop eating and drinking until the time of your test. NOTHING TO EAT OR DRINK AFTER MIDNIGHT (until after your test is finished).

What will happen at my appointment?

An IVP examination is done on an outpatient basis. After you register at the Diagnostic Imaging Centre, you will be asked to change into a hospital gown. 

The technologist will ask you various health-related questions. Once the screening is completed, you will be positioned on the exam table and receive an injection of the contrast material, usually into a vein in your arm.  

Images are taken before and after the injection of the contrast dye.

When the contrast dye is injected, some people feel nothing while others report:

• Cool feeling leading away from the injection site
• Warm sensation travelling from the back of the throat, through the abdomen and into the groin
• Metallic taste in the mouth

In rare cases you may experience a more serious reaction to the contrast dye which would be treated promptly.

The contrast dye used for IVP studies will not discolor your urine or cause any discomfort when you urinate. If you experience such symptoms after your IVP exam, let your doctor know right away.

As the contrast material is processed by the kidneys, a series of images is captured to determine the actual size of the kidneys and to show the collecting system as it begins to empty. Kidneys don't empty at the same rate. While  , a typical IVP study usually takes about an hour, there could be a delay of three to four hours in obtaining images.

Near the end of the exam, you may be asked to empty your bladder so that an additional image can be taken of your bladder after it empties.

A radiologist will analyze the images and send a report to your physician. You will receive your IVP exam results from the doctor who ordered the test. 

What is a small bowel follow-through?

A small bowel follow-through/small bowel meal is an x-ray examination of the small bowel. This exam is done to find inflammation, ulcers, growths, narrowed areas or other issues in your bowel. This examination is done separately from an upper gastrointestinal exam.

An alternate exam, known as a small bowel enteroclysis, may be ordered (details below).

How do I prepare for a small bowel examination?

Please make the following arrangements for your appointment:

It is very important the bowels are cleansed for this exam by following this instruction sheet: Small Bowel Examination Preparation Instructions

This exam will require you to stay in the medical imaging area for up to 3 hours or more.

You may wish to:

• Bring a friend or family member for company
• Bring something to read
• Make appropriate parking/babysitting plans

What will happen at my appointment for a small bowel follow-through?

After you have registered in the Diagnostic Imaging Centre, you will be asked to change into a hospital gown. You will be asked to drink several glasses of barium liquid, which will show up on x-ray. Images will be taken at timed intervals to check the distance the barium has traveled. 

Once the barium has reached the area where your small bowel joins the large bowel, images are taken under fluoroscopy, which allows the imaging technologist to see the images in real time on a monitor. 

Gentle pressure will be used to maximize visualization of all parts of your small bowel.  Sometimes a tube will be put into the rectum and air will be blown in (called a pneumocolon) while more images are taken. The test may take 2-4 hours from start to finish.

What will happen at my appointment for a small bowel enteroclysis?

A small bowel enteroclysis is an examination of the small bowel where liquid barium is introduced through a tube inserted into a nostril, through the stomach and into the duodenum.  

Intermittent fluoroscopy or “live imaging” and still imaging are used to follow the barium through your system. The test takes approximately 1-2 hours.

What happens after a small bowel examination?

After the exam you will need to drink lots of fluids to clear the barium from your system.  You may go back to your normal diet unless you are told differently by your doctor.

The barium will temporarily change the colour of your stool. Drink lots of fluids until the barium passes.

How do I find out the results?

The radiologist will send a report to the doctor who sent you for the test. Your doctor will give you the results.

What is an upper gastrointestinal (upper GI) series/barium swallow?

An upper GI or barium swallow is an x-ray test done to examine your upper digestive tract, including esophagus, stomach and duodenum. These organs are not normally visible on x-rays so you will need to drink a liquid, called barium, which shows up on x-rays.

This test is useful for finding ulcers, growths, inflammation in the GI tract, problems that cause narrowing of the esophagus, and assessing some swallowing problems.

How do I prepare for an upper G.I. series/barium swallow?

Please make the following arrangements for your appointment:

• You must fast – no eating or drinking at all from midnight the night before your exam until your exam is complete.
• If you have been given an afternoon appointment, you may have a small glass of juice and a piece of toast early in the morning so that it is digested by your afternoon appointment.
• DO NOT take any medication the morning of your test. Your stomach needs to be empty. Bring your medication with you to take after the test.
• If you are diabetic, request an early morning appointment. Do not take your insulin before the exam. Bring your insulin and something to eat with you.
• Do not chew gum or smoke prior to your exam.

What will happen at my appointment?

You will be asked to put on a hospital gown and pants and stand in front of an x-ray machine that has moving parts. This machine is equipped to do fluoroscopy, which allows the imaging technologist to see images in real time on a monitor.

Before the exam, you will asked to swallow a gas-producing fizzy drink that might make you feel like burping, but try not to until the end of the test. After the fizzy drink, you will be instructed to drink the barium, a liquid that looks like a milkshake.

You will be instructed to move through different positions and to hold your breath occasionally.

The procedure takes about 20 to 30 minutes.

What happens after the upper GI series/barium swallow?

When the test is completed, you may go back to your normal diet unless you are told differently by your doctor. Drink lots of fluids for 3 days following your test as the barium can cause constipation. The barium will change the colour of your stool.

Your images will be reviewed by a radiologist and a report sent to your doctor. Your doctor will review the results with you.