Answer to Question #3608 Submitted to "Ask the Experts"

My daughter's doctor recommended an upper GI test (esophagus, stomach, and small intestine) for her. After researching the specific problems he suspects, and the various tests, I think the more appropriate test is actually the barium swallow (pharynx and esophagus only). Is there a difference in the amount of radiation the child is exposed to in both procedures? I am assuming the barium swallow would expose the child to less radiation than the upper GI. Is this correct? Also, I know the figures vary depending on how the test is performed and how many x-ray films are taken, but can you please provide me with an estimated amount of radiation received for both procedures?

First, I would say that this is a difficult question to respond to. We try to avoid making judgements about the appropriateness of medical exams or procedures. This is an issue that should remain between the patient and physician. In all situations, the risk of the procedure, for example, radiation and pain to the patient, should be weighed against the benefits that could be derived, for example, diagnosis and follow-up treatment.

I will try to give you some information on the difference between the two procedures. As you say, the exposure results will depend on the complexity of the case and the number of x-ray films taken. It will also depend on the x-ray units used and the skill of the radiologist. "Ask the Experts" Q708 states that the effective dose for various x-ray and nuclear medicine exams are listed. The dose to an adult patient from a typical barium swallow would be approximately 150 mrem. From a barium meal, which corresponds to the upper GI series you describe, the adult patient dose would be approximately 300 mrem. No information on doses is given for children, but I would estimate the doses to be approximately ½ those for an adult, that is, 75 mrem for the barium swallow and 150 for the barium meal. A more exact measure would require radiation output and fluoroscopic time measurements of the x-ray unit used. In any case, these doses are well below those that result in demonstrated effects¹.

John Jacobus, MS
Certified Health Physicist

¹Health Physics Society, Radiation Risk in Perspective; March 2001.