Radiographic Procedures · ARRT 2025
Esophagus, Stomach & Biliary on the ARRT Radiography Exam
The fundus rule for barium and air, the five upper GI projections centered at L1, 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 72 of 200 scored questions, and its questions turn on gravity, body habitus, and where the barium sits rather than on degrees of rotation alone.
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 every projection centers on the duodenal bulb at 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.
Procedure knowledge carries as many marks as positioning. 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 through a catheter, and the T-tube study performed days later in the radiology department.
What you’ll learn in this chapter
The 37 lessons in this chapter break down as follows. The full lesson content is unlocked when you start a free account.
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 the 8 terms most likely to appear on the ARRT registry from this chapter. Use them as a flashcard pre-quiz.
- Fundus
- The most superior part of the stomach, which also sits posterior. 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. All five projections center on the duodenal bulb, at L1 for an average build, 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 from the 75-question Thorax and Abdomen bank. 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 typically indicates underinspiration. Repeat with full inspiration.
B, Correct: Correct. The standard is at least 10 posterior ribs visible above the diaphragm on a properly inspired adult PA chest. Underinspiration (only 8 visible) compresses lung markings and may mimic pulmonary disease.
C, Incorrect: Counting anterior ribs is less reliable because they're more variable and angle differently. Use posterior ribs as the standard.
D, Incorrect: Costophrenic angle visibility is part of quality assessment but does not specifically indicate inspiration adequacy.
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Frequently asked questions
What does the ARRT Radiography Radiographic Procedures category 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 72 of 200 scored questions, and its questions turn on gravity, body habitus, and where the barium sits rather than on degrees of rotation alone.
How many lessons are in the Esophagus, Stomach & Biliary on the ARRT Radiography Exam chapter?
This chapter contains 37 lessons across 13 sections, plus a knowledge-check quiz at the end. The full lesson content is unlocked with a Premium subscription. The free tier includes 3 complete chapters.
Is this chapter aligned with the ARRT 2025 Content Specifications?
Yes. Every chapter on this site maps directly to the ARRT Radiography Content Specifications effective 2025. This chapter falls under the Radiographic Procedures domain of the official ARRT exam blueprint.