Basic and advanced techniques for anterior wall radiography expected of specialized radiological technologists

Abstract

Anterior wall radiography is a pivotal technique in upper gastrointestinal X-ray examinations to ensure adequate visualization of the anterior wall of the stomach, and it requires advanced skills to correct the gastric shape with a compression bolster and effectively depict the target areas. In hook-shaped stomachs, the basic procedure of “raising the table → inserting the compression bolster → reverse-tilt imaging” allows relatively easy visualization of the target areas, and understanding this fundamental sequence forms the basis for more advanced techniques. Conversely, in the case of non-hook-shaped stomachs such as steer-horn and cascade types, due to strong dorsal flexion and poor caudal extension, it is necessary to raise the table to an upright position, confirm the gastric configuration under fluoroscopy, and insert a compression bolster adjusted in thickness and firmness to correct the shape before imaging. Patient posture during bolster insertion and the timing of respiration also affect visualization. Across all gastric morphologies, the common key points are “extension, correction, and flattening,” and specialized radiological technologists are required to optimize anterior wall radiography according to each patient’s body habitus and gastric morphology.