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•Approximately 20 cm in length
•Starts at the cricoid cartilage and extends to
the stomach
•Esophagus is composed of different types of
muscles
•Proximal third contains striated muscle
•Distal third contains smooth muscle
•Middle section is composed of both striated
and smooth muscle

INDECATIONS:
 Evaluation of dysphagis
 achalasia- sphincter not relaxing
 strictures obstructions
 scleroderma
 diffuse esophageal spasms

Contraindications & pt preparation
 none
 Fasting a minimum of 4 hour
 IDpt , check order, verify order, pt hx & explain
procedure
Scheduling:
Allow one hour for the test; 15 min for acquisition, the
remainder for readying and processing.

Radiopharmaceutical
 Prepare 2 to 3 syringes with 15 mL water or juice boluses
in each
(to form a radioactive liquid bolus)
 Each bolus should contain 300 μCi of Tc99mSulfur Colloid
The camera acquires in 128 x 128 dynamic mode with 1-second frames for 2
minutes, then 15second frames for 10 minutes (for a total of 160 frames).
Imaging Device: Gamma camera with LEHR collimator.

Imaging Procedure
 The patient lies supine with head turned to one
side, with the FOV extending from nose to
stomach.
 A straw is used to sip the tube contents, and the
patient is instructed to swallow after the
acquisition has started.

 Practice swallows without radioactivity are recommended
to improve the procedure result.
 The patient then swallows the contents of the test tube
using a single swallow.
 The patient then "dry swallows" once, every 15 seconds
for the duration of the test (~ 10 minutes, a total of 60
swallows).

The above image identifies the first set of images collected
at 0.1 seconds per frame. Note the lack of activity seen in
these images.

 Note that the images above indicate three ROIs –
mouth, cricoid cartilage, and the entire esophagus
 This data represents the initial images that were
collected above.
 Time activity curves are then generated.
 According to the data above the bolus of activity
arrives at the stomach within a second (normal)
and no reflux or delayed transit is noted.

(Patient instruction(is very important)
 The following procedure should be practiced first with the
patient taking a sip of regular water.
 The patient will be given a syringe full of radiowater that
will be placed in the patient’s mouth
 The patient will be asked to keep the radiowater in his/her
oral cavity (don’t swallow until I tell you)

 When acquisition is started, the patient will be asked to
swallow the bolus and then continue to dry swallow for an
additional 10 minutes
 After the study is complete, have the patient drink a 12-oz
glass of water to wash any residual activity out of the
esophagus.

INDICATIONS
 1-Detection and quantitation of gastro-esophageal reflux
 2-Suspected aspiration pneumonia.
 3-This scan is done for children mainly with indications of
Vomiting, gastroparesis, esophageal reflux, failure to
thrive, and poor feeding.
 4-give an idea of how well stomach contents are being
emptied.

Patient Identification:
 Patient identification is an important step to ensure your
patient always receives the right care. You will be asked to
state your patient’s name and date of birth several times
during the Nuclear Medicine study.
PATIENT PREPARATION:
 NPO past midnight or at least 4 hours prior to study.
 Nasogastric tube for pediatric patients.
 No anti reflux medication for 24 hours prior to study

RADIOPHARMACEUTICAL:
 1 mCi Tc-99m albumin or sulfur colloid in acidified orange
juice (in adults 150 mL of orange juice plus 150 mL 0.1 N
hydrochloric acid)or in milk is given orally.
 In children the radiopharmaceutical dose is reduced and
given with formula via NG tube.
 the amount of formula given may be based upon the
patients age: less than 3 months- 90cc; 3 to 6 months-
120cc; or over 6 months- 150cc.

Imaging Procedure
 Before the examination begins we tell patient There are no
side effects with the tracer and the patient will not be able
to taste it.
 A parent may stay in the room for the imaging.
 An abdominal binder or valsalva maneuver (only in adults)
is used to increase intra-abdominal pressure.
 The patient will be lying flat on the scan table.

SCANNING TIME:
 Once the patient drinks the mixture they will be imaged for
1 hour continuously
 supine images of the stomach and esophagus are
acquired. This imaging requires 40-60 minutes to
complete.
 For evaluation of possible aspiration: Delayed views
are performed at 4 and possible 24 hours. These images
take 20-30 minutes to acquir
 This extra image would take place 2hrs from the original
time the formula or milk was given and would only take 60
seconds to complete

OTHER CONSIDERATIONS:
 The acid, abdominal binder, and supine positioning are
used to promote reflux. Sensitivity with this method is in
excess of 90%. Computer analysis quantitates the total
percent of reflux and the number of times reflux
occurred during the hour after the administration of the
radiopharmaceutical

Refrences
http://www.people.vcu.edu/~mhcrosthwait/clrs317web/Esophageal%20Transit.htm
http://jnm.snmjournals.org/cgi/content-nw/full/45/6/1004#SEC4
https://www.studyblue.com/#flashcard/view/10498169
https://www.bing.com/search?q=full+15cc+IN+MUTH&qs=n&form=QBRE&sp=-
1&pq=full+15cc&sc=0-9&sk=&cvid=08653CE445A3435683389776C10D7724
https://www.radiology.wisc.edu/fileShelf/sections/nucmed/protocols/files/1_protocol
s_by_system/GI_hepatic/Esophageal_Transit.pdf
http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=54757
https://my.clevelandclinic.org/ccf/media/files/Radiology/CCF_NuclearMedicine_GE
R.pdf
https://radiology.uic.edu/nuclearmedicine/gastro.php

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Esophageal transit imaging

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