Procedures · ARRT Radiography
Esophagus, Stomach & Biliary on the ARRT Radiography Exam
The fundus rule for barium and air, the five upper GI projections, centered by body habitus (L1 for sthenic), RAO stomach rotation of 40 to 70 degrees, NPO for 8 hours, and ERCP through the mouth.
Overview
This chapter follows contrast from the mouth to the duodenum and through the biliary ducts: the esophagram, the upper GI series, ERCP, and the operative and T-tube cholangiograms. On the ARRT Radiography exam it sits inside Procedures, the largest domain at 66 of 200 scored questions to 28 February 2027, 72 from 1 March 2027, and the ARRT content specifications list body habitus as a procedure adaptation: here the build moves the stomach itself, and gravity decides where the barium and the air sit.
One rule organizes most of it: the fundus of the stomach is superior and posterior. Lie the patient supine and barium fills the fundus. Turn them prone and gas fills it instead. Apply that to the five upper GI projections (RAO, PA, right lateral, LPO, and AP) and the barium-or-air questions answer themselves. The numbers that repeat: the RAO stomach rotates 40 to 70 degrees from prone, the LPO 30 to 60, and the projections center at about L1 for a sthenic build, moving 2 inches (5 cm) up for hypersthenic patients and down for hyposthenic ones. The esophagram RAO runs 35 to 40 degrees, centered at T6.
Positioning is only part of it: the ARRT content specifications also list contrast media and their suitability for the patient under Patient Care. NPO for at least 8 hours with no smoking or gum, thin barium for the tract and thick for the esophagus, single contrast at 110 to 125 kV, and the perforation rule: any chance of barium escaping into the peritoneal cavity means a water-soluble iodinated agent instead.
The biliary section traces bile from liver to duodenum and separates ERCP, where a duodenoscope enters through the mouth and contrast runs retrograde up the ducts, from the operative cholangiogram done during surgery, and the T-tube study performed after the operation in the radiology department.
What you’ll learn in this chapter
The 23 study slides and 14 quiz questions in this chapter break down as follows. 3 chapters are free in full with a free account. The others come with a paid plan, and paid plans open soon.
Esophagus, Stomach & Biliary
- Esophagus, Stomach and Biliary
Anatomy
- Mouth and Pharynx
- Swallowing and Aspiration
- The Esophagus
- The Stomach
- Duodenum and Digestion
- Quiz
Biliary anatomy
- Liver, Gallbladder and Ducts
- Quiz
Body habitus
- Body Habitus and Where the Stomach Sits
Contrast media
- Barium, Thin and Thick
Preparation
- Patient Preparation and NPO
Fluoroscopy
- The Room and the Order of Events
Esophagram
- The Esophagram
- Quiz
- The Swallowing Dysfunction Study
- Quiz
- Esophagram Projections
- Demonstrating Reflux
- Quiz
Upper GI
- Where to Center an Upper GI
- Barium, Air and the Fundus
- Quiz
- The Five Upper GI Projections
Biliary procedures
- ERCP
- Quiz
- Operative and T-Tube Cholangiography
- Quiz
Image critique
- Critiquing an Upper GI Film
- Quiz
Clinical indications
- What You Are Looking For
Recap
- What to Carry Out of This Chapter
- Quiz
- Quiz
- Quiz
- Quiz
- Quiz
Key terms in this chapter
These are 8 key terms from this chapter. Use them as a flashcard pre-quiz.
- Fundus
- The upper part of the stomach, superior to the cardiac orifice, and posterior when supine. It fills with barium when the patient is supine and with gas when prone, the rule behind every barium-or-air question.
- Esophagram
- The barium swallow, demonstrating the form and function of the pharynx and esophagus. The RAO at 35 to 40 degrees is the workhorse, showing the esophagus between the vertebral column and the heart.
- Upper GI Series
- Contrast study of the distal esophagus, stomach, and duodenum. The projections center at about L1 for an average build, and all five are exposed on expiration.
- Body Habitus
- The build that moves the stomach. Hypersthenic stomachs sit high and transverse, hyposthenic and asthenic stomachs low and vertical, shifting the centering 2 inches (5 cm) above or below L1.
- NPO
- Nil per os, nothing by mouth. At least 8 hours before an upper GI, with no smoking or gum, because both increase gastric secretions that keep barium from coating the mucosa.
- Barium Sulfate
- An insoluble, chemically inert colloidal suspension used through most of the GI tract. Contraindicated whenever it might escape into the peritoneal cavity; a water-soluble iodinated agent substitutes.
- ERCP
- Endoscopic retrograde cholangiopancreatography. A duodenoscope passes through the mouth, esophagus, stomach, and duodenum, and iodinated contrast runs backward up the biliary and pancreatic ducts.
- T-Tube Cholangiogram
- A delayed duct study performed in the radiology department after a cholecystectomy, through a T-shaped catheter the surgeon left in the common bile duct.
Sample practice question: Thorax and Abdomen
One free sample question from the Thorax and Abdomen subcategory, like those in its 285-question bank. Several chapters share each sample, so it may not match this chapter's topic. See the format, the rationale style, and the difficulty before you sign up.
On a properly positioned and exposed PA chest radiograph in an adult, how many posterior ribs should be visible above the diaphragm to indicate adequate inspiration?
Show answer and rationale
A, Incorrect: 8 posterior ribs falls short of the count.
B, Correct: Correct. At least 10 posterior ribs above the diaphragm indicates adequate inspiration. Bontrager also notes that patients with pulmonary disease or trauma may be unable to reach 10.
C, Incorrect: Bontrager's count uses posterior ribs, not anterior ribs.
D, Incorrect: Costophrenic angle visibility is part of quality assessment but does not specifically indicate inspiration adequacy.
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The free tier unlocks 3 complete chapters, 50 practice questions, and 1 sample timed exam. No credit card required.
Frequently asked questions
What does the Esophagus, Stomach & Biliary on the ARRT Radiography Exam chapter cover?
This chapter follows contrast from the mouth to the duodenum and through the biliary ducts: the esophagram, the upper GI series, ERCP, and the operative and T-tube cholangiograms. On the ARRT Radiography exam it sits inside Procedures, the largest domain at 66 of 200 scored questions to 28 February 2027, 72 from 1 March 2027, and the ARRT content specifications list body habitus as a procedure adaptation: here the build moves the stomach itself, and gravity decides where the barium and the air sit.
How many study slides are in the Esophagus, Stomach & Biliary on the ARRT Radiography Exam chapter?
This chapter has 23 study slides and 14 quiz questions across 13 sections. The full chapter comes with a paid plan, and paid plans open soon. The free tier includes 3 complete chapters.
Is this chapter aligned with the current ARRT Content Specifications?
Every chapter on this site is mapped to the ARRT Radiography Content Specifications, but our line-by-line check against ARRT's outline isn't finished, so keep ARRT's outline beside it. Nothing here follows your exam date, so check which version applies to you. This chapter falls under the Procedures domain of the official ARRT exam blueprint.