Department of Radiology
School of Medicine Queen's University

On Call Emergent Pediatric Fluoroscopic Studies

Most pediatric UGI studies can be performed on a non-urgent basis. 

Emergent UGI studies are primarily related to a concern of malrotation. The staff radiologist needs to be consulted and aware of the procedure. These cases are often present within the first few weeks of life. In these cases, and with all cases where there is a concern of potential aspiration, a non/iso-osmolar contrast agent should be used as opposed to a barium preparation. 

Patients presenting acutely with a high level of suspicion for malrotation should be accompanied with, and monitored by, a pediatric nurse with a resident and/or staff present and they should have a NG tube in place. If the stomach is gas distended, despite the NG tube, then aspiration of the gas should be performed prior to contrast injection.  The patient should be placed on their right side and the iso-osmolar contrast (usually 1-2 ml) is injected via the NG tube during fluoroscopy. The duodenum should be noted in a normal posterior direction in the lateral view. When the contrast is seen entering the duodenum the patient should be turned on their back and an image of the DJ flexure obtained.

Other urgent requests, such as query foreign body, esophageal stricture, etc. need to be at the discretion of the radiology staff on call and will be dependent on the history, patient status, and whether there is the potential for an urgent change in management.