Radiographic Procedures · ARRT 2025
GI and Hepatobiliary Procedures
Upper GI series, barium enema, IVU, contrast choices (positive, negative, water-soluble), and patient prep for the ARRT Radiography Boards.
Overview
GI and Hepatobiliary Procedures covers the contrast-enhanced studies of the digestive tract and urinary system. Although CT and MRI have replaced many of these exams in modern practice, the ARRT continues to test them in detail. The chapter is built around three skills: choosing the correct contrast, executing the patient prep, and recognizing the projections that demonstrate each anatomic question.
Contrast media split into two families. Positive contrast (high atomic number) absorbs x-rays and appears white on the radiograph: barium sulfate (the GI workhorse) and water-soluble iodinated agents (Gastrografin, Omnipaque, used when perforation is suspected because barium is fatal in the peritoneum). Negative contrast (low atomic number) appears dark: air, CO2, oxygen. Double-contrast studies use both, barium coats the mucosa, air or CO2 distends the lumen, and the combination produces the most diagnostic mucosal images.
Upper GI series: NPO 8 hours, demonstrates the esophagus, stomach, and duodenum. RAO 40–70° demonstrates the duodenal bulb in profile. Barium swallow targets the esophagus alone, RAO at 35–40° throws the esophagus off the spine. Barium enema: bowel prep (cleansing) is essential, single-contrast for general lumen, double-contrast for mucosal detail, projections include AP, RAO, LAO, lateral rectum, and post-evacuation. IVU (intravenous urography): scout film first, then injection of iodinated contrast, then sequential films at 1, 5, 10, 15, and 20 minutes plus post-void. Patient prep: NPO and laxative the night before. Cholangiography (T-tube or operative) demonstrates the biliary tree post-cholecystectomy.
What you’ll learn in this chapter
The 11 lessons in this chapter break down as follows. The full lesson content is unlocked when you start a free account.
Hepatobiliary
- Imaging Jaundice & RUQ Pain
- ERCP — The Targeted Investigation
Upper GI & Esophagus
- Heartburn, Hernia & the Esophagus
- Single vs Double Contrast
Colon
- Positioning the Colon: Unfurling Anatomy
Urinary & IVU
- Intravenous Urogram (IVU)
- First Principles of Contrast Imaging
Knowledge Check
- Question 1 of 4 Quiz
- Question 2 of 4 Quiz
- Question 3 of 4 Quiz
- Question 4 of 4 Quiz
Key terms in this chapter
These are the 7 terms most likely to appear on the ARRT registry from this chapter. Use them as a flashcard pre-quiz.
- Barium Sulfate
- Positive contrast used in GI imaging. Coats mucosa, distends lumen. Contraindicated when perforation is suspected.
- Gastrografin (Water-Soluble Iodinated Contrast)
- Substitute for barium when GI perforation is suspected. Safer because it is absorbable from the peritoneum.
- Double-Contrast Study
- Combination of barium + air/CO2. Barium coats the mucosa, gas distends the lumen for maximum mucosal detail.
- RAO 40–70° UGI
- Right anterior oblique 40–70° rotation during an upper GI series. Demonstrates the duodenal bulb in profile.
- IVU (Intravenous Urography)
- Contrast study of the urinary tract. Sequential films at 1, 5, 10, 15, 20 minutes plus post-void.
- Pyelography
- Imaging of the renal collecting system. Retrograde (catheter) or antegrade (percutaneous) approaches available.
- Hepatobiliary Imaging
- Imaging of the liver, gallbladder, and biliary tree. Includes T-tube cholangiography and operative cholangiography.
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.
Hands-on
Practice the positioning
Open the Positioning Lab to drill body position, central ray, anatomy, and common errors for each projection in this chapter.
Read the full chapter, free.
The free tier unlocks one complete chapter (11 lessons), 50 practice questions, and 1 sample timed exam. No credit card required.
Frequently asked questions
What does the ARRT Radiography Radiographic Procedures category cover?
GI and Hepatobiliary Procedures covers the contrast-enhanced studies of the digestive tract and urinary system. Although CT and MRI have replaced many of these exams in modern practice, the ARRT continues to test them in detail. The chapter is built around three skills: choosing the correct contrast, executing the patient prep, and recognizing the projections that demonstrate each anatomic question.
How many lessons are in the GI and Hepatobiliary Procedures chapter?
This chapter contains 11 lessons across 5 sections, plus a knowledge-check quiz at the end. The full lesson content is unlocked with a Premium subscription. The free tier includes the first chapter complete.
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.