The Upright Phase

1. Patient stands on foot rest of upright x-ray table. (If patient is incapable of standing, elevate head of table as much as is safely possible.) 
   
   
2. Rotate patient into left posterior oblique (LPO) position. Place 1/2 cup of "bubbly barium" in patient's left hand and ask him to drink it rapidly. 
   
   
3. Fluoroscopically scan esophagus while patient swallows. Obtain two double-contrast (DC) spot images to include esophagus from clavicles to gastric cardia during maximal distention. Wait until bubbles disappear before taking each image. Do not have patient stop breathing while making exposures. 
   
   
4. Rotate patient into the right posterior oblique (RPO) position. Place 1/2 cup of "bubbly barium" in his right hand. While the patient drinks, obtain two DC images of the same region as in #3 (above).