Background and Objective:

Additional radiography imaging in gastric cancer screening using X-ray can be broadly classified into two categories: imaging performed when the gastric mucosal region cannot be adequately visualized within the prescribed imaging positions and number of images, and imaging performed to improve the reproducibility of abnormal findings. The purpose of such imaging is to achieve both accurate lesion depiction and comprehensive evaluation. However, the specific techniques and imaging methods depend largely on the experience and knowledge of the operator, and variability in technical skill remains a recognized issue. In this article, we aimed to clarify the techniques and necessity of additional radiography imaging according to gastric morphology and examination conditions, as well as the criteria for determining when additional radiography imaging is required.

Subjects and Methods:

The subjects included cases requiring additional radiography imaging due to gastric morphological conditions such as cascade stomach, steer-horn stomach, and flexion of the posterior wall of the antrum, as well as cases with abnormal fold formation in the greater curvature and difficulty in imaging the anterior wall. Furthermore, the usefulness of additional radiography imaging for qualitative diagnosis in cases with abnormal findings was described through case studies.

Results and Conclusion:

In cases requiring additional radiography imaging, imaging techniques combining positional changes, appropriate selection of imaging positions, compression methods, respiratory control, and adjustment of barium volume were essential. In addition, case-by-case management of barium outflow, insufficient or excessive air volume, and blind areas was required. Appropriate implementation of these techniques led to improved diagnostic accuracy.

In recent years, amid a growing shortage of physicians responsible for interpreting gastric X-ray examinations, the roles of imaging technologists in identifying abnormal findings and certified interpretation support technologists in appropriately presenting category classifications have become increasingly important. In this article, the process of detecting abnormal findings is organized into four steps: pre-examination preparation, background mucosal assessment, detection of subtle abnormalities, and classification of Category 5. Through concrete examples of category classification, the practical significance of this approach is demonstrated. In background mucosal assessment, evaluating not only the presence or absence of Helicobacter pylori infection but also the degree of mucosal atrophy, intestinal metaplasia, hypertrophic gastritis, and nodular gastritis allows for a more detailed assessment of gastric cancer risk. Particularly in individuals at high risk for gastric cancer, optimization of fluoroscopic observation and imaging techniques can increase sensitivity to subtle abnormal findings, leading to improved accuracy of category classification. Furthermore, certified radiologic technologists for reading assistance play an important bridging role by appropriately identifying candidates for further examination and guiding them toward detailed diagnostic evaluation based on category classification, thereby contributing to improved screening accuracy. These efforts are directly linked to the early detection of gastric cancer and highlight that the technical skills of radiologic technologists have a decisive impact on the quality of gastric cancer screening.

In gastric barium examinations, lesions may remain unrecognized even when the entire stomach is successfully imaged. The primary reason is insufficient contrast enhancement, a situation frequently encountered in mass screening settings. Nevertheless, it remains the examiner’s responsibility to detect potentially curable gastric cancers under such suboptimal conditions. Enhancing realtime observational skills during fluoroscopy is therefore essential. Improved observation enables the detection of subtle abnormalities that may appear even when contrast is inadequate, prompting appropriate additional imaging. This report presents specific subtle findings that should be recognized during screening, along with cases in which such findings led to the detection of gastric cancer through additional imaging. It also emphasizes that overlooking these early signs and failing to perform supplemental views may result in cancers not being visualized on routine images, underscoring the importance of continuous efforts to strengthen observational capability.

Objectives: This review evaluates the effectiveness of integrating dynamic compression maneuvers into standard protocols for upper gastrointestinal (UGI) screening and setting conditions suitable for compression maneuvers.

Methods: We compared the characteristics of look-up tables (LUT10 for double-contrast, LUT1 for compression). Dynamic compression maneuvers were assessed for diagnostic performance.

Results: Dedicated compression LUTs (LUT1) effectively prevented image saturation, maintaining high visibility of mucosal patterns. Compression maneuvers improved visibility in approximately 70.6% of cases with overlapping structures.

Conclusions: Integrating engineering optimization and dynamic compression into standard protocols enhances diagnostic accuracy while ensuring patient safety through dose reduction.

In upper gastrointestinal X-ray examinations, adequate visualization of the anterior gastric wall is often difficult to achieve during anterior wall imaging in patients with a horizontally oriented stomach. Since April 2022, our institution has implemented a technique combining two compression cushions of different shapes. Compared with the previous year, this approach improved the extent of visualization in double-contrast imaging of horizontally oriented stomachs. The combined use of compression cushions allowed sufficient thickness to correct gastric morphology while enabling anterior wall imaging without causing additional discomfort to patients. In addition, as one of the auxiliary techniques for double-contrast studies, we describe prone compression imaging using compression cushions, based on representative cases in which this method was effective for lesion visualization.

Objective (Background):

In recent years, the proportion of elderly participants in population-based gastric cancer screening with barium X-ray examination has increased, placing them at higher risk of adverse events due to delayed barium excretion. Promoting smooth elimination of barium is therefore of critical importance. Many previous studies have demonstrated that resistant maltodextrin is effective for improving constipation and difficulty in defecation. This study evaluated the effect of a resistant maltodextrin-containing beverage, Project F 500 mL (dextrin water), which the Miyagi Cancer Association began distributing throughout Miyagi Prefecture in 2023.

Subjects and Methods:

A total of 751,579 examinees who underwent population-based gastric cancer screening with barium X-ray between 2019 and 2024 were included. Post-examination telephone consultations were categorized and analyzed. Consultation rates before distribution (2019–2022) and after distribution (2023–2024) were compared. Multivariable logistic regression models, including interaction terms, were applied to adjust for age, sex, screening year, and potential confounders.

Results:

Before distribution, there were 20 consultations per 10,000 examinees, whereas after distribution the number decreased to nine (odds ratio 0.44, 95% confidence interval [CI]: 0.38–0.51). Logistic regression analysis demonstrated that distribution of dextrin water was independently associated with a significant reduction in consultations (odds ratio 0.42, 95% CI: 0.33–0.54), with no significant interaction by age or sex. The reduction was largely attributable to fewer consultations regarding constipation or difficulty in defecation. Importantly, there were no reports regarding deleterious effects associated with ingestion of dextrin water.

Conclusions:

Distribution of dextrin water significantly reduced post-examination telephone consultations, particularly those related to constipation, among participants in population-based gastric cancer screening with barium X-ray. This simple intervention was effective across all age groups and appears to be particularly valuable in elderly populations, who are at increased risk of defecation-related complications. These findings highlight the potential of dextrin water as a safe, effective, and scalable public health intervention to facilitate barium elimination and improve safety in population-based gastric cancer screening programs.

Purpose: The purpose of this study was to evaluate the impact of antispasmodic administration on bowel distension during CT colonography (CTC).

Method: A total of 774 patients who underwent CTC at our facility between 1 April 2021 and 31 March 2024 for follow-up of positive fecal occult blood tests were included. The subjects were classified into two groups: an antispasmodic group (n = 590) and a non-antispasmodic group (n = 184). Virtual barium enema images obtained from supine CT scans were divided by anatomical segments. The degree of bowel distension was scored and compared between the two groups.

Results: While the scores for the cecum were comparable between the two groups, the antispasmodic group showed significantly better bowel distension in all other segments compared to the non-antispasmodic group.

Conclusion: The administration of antispasmodics was considered a significant factor influencing bowel distension in CTC.

Background: Esophageal cancer screening is conducted as a routine part of population-based gastric cancer screening in Japan. As a screening method, in addition to conventional fluoroscopy, endoscopy has recently been introduced into population-based screening programs, and an increase in esophageal cancer detection is expected. Importantly, double-checking of endoscopic images is required to ensure quality control of endoscopic screening. The purpose of this study was to determine whether the esophageal cancer detection rate has increased with endoscopic screening and double-checking. In addition, examination time of screening endoscopy and endoscopists’ evaluation of the recently available endoscopic AI were also investigated. Subjects and Methods (Study 1): The esophageal cancer detection rate was investigated in 48,719 persons who underwent gastric cancer screening in Wakayama City between 2011 and 2022. Results: The esophageal cancer detection rate of endoscopic screening was significantly higher than that of fluoroscopy screening performed during the same period (0.07% vs 0.02%, p<0.01). The esophageal cancer detection rate of endoscopic screening with a double-check was significantly higher than that without a double-check (0.09% vs 0.01%, p<0.01). Subjects and Methods (Study 2): Examination time for 20 cases in which endoscopic AI was used during screening upper gastrointestinal endoscopy and the time for 20 cases in which endoscopic AI was not used were compared, and 10 endoscopists were asked to complete a questionnaire about endoscopic AI. Results: No significant difference in examination time was found between the two groups. Endoscopic AI was generally evaluated favorably. Conclusion: Endoscopic screening and double-checking may contribute to an increased esophageal cancer detection rate.

Background and Objectives: The ileocecal valve is a common pitfall in computed tomography (CT) colonography interpretation, resulting in false-negative and false-positive findings. Notably, studies on the features of the ileocecal valve using CT colonography are lacking. This study examined the characteristics of normal ileocecal valves on CT colonography and analyzed educational cases to assist clinicians with accurate interpretation.

Methods: Among participants who underwent CT colonography screening, we analyzed the characteristics of 188 normal ileocecal valves in the two-position images of 94 participants. A normal ileocecal valve was defined as a case in which a colonoscopy was performed within 18 months after CT colonography and no tumor or polyp was identified in the ileocecal valve. In addition, two educational cases were presented. The first was a false-positive case. The second case was a cancer case from a different cohort that was not a normal case.

Results: The morphology of the normal ileocecal valve was the papillary type in 53%. The mean size of the papillary type of ileocecal valve was 20.7 mm, with a maximum size of 33.0 mm. Eighteen percent of normal ileocecal valves exhibited irregularities or asymmetries such as unnaturally raised areas. In multiplanar reconstruction images, 88%, 7%, and 2% of the normal ileocecal valves exhibited a mix of low- and high-density areas to various degrees, nearly uniform low attenuation, and nearly uniform high density, respectively. Notably, a few cases showed nearly uniform high density in the supine position, and not in the second position. The first case presented was a false positive due to an enlarged ileocecal valve. This case was found to be lipomatosis as a normal variant of the ileocecal valve and was a mixture of low- and high-density areas. The second case presentation was a cancer case. In this case, the ileocecal valve was replaced by cancer, showing an irregular shape and uniform high density.

Conclusion: The presence of low-density areas in normal ileocecal valves aids in distinguishing them from lesions; however, the degree of low-density areas varies widely. Although the ileocecal valve exhibits morphological variation, the presence of uniform high-density areas is suggestive of a lesion. Knowledge of the characteristics of the normal ileocecal valve on CT colonography facilitates accurate interpretation.

Purpose

The Japanese Society for Gastrointestinal Cancer Screening (formerly the Japanese Society for Gastrointestinal Mass Screening) established its Certified Gastric Cancer Screening Radiotechnologists program in 2001. The higher-level Certified Reading Assistants of Radiotechnologists program was established in 2019. The purpose of these programs is to improve the accuracy of gastric cancer X-ray screening. This study examined the current status of Certified Gastric Cancer Screening Radiotechnologists and Certified Reading Assistants of Radiotechnologists, and also investigated the attendance status for the 10^th Certified Gastric Cancer Screening Radiotechnologists Training Seminar.

Subjects

The subjects included members of the Japan Society of Gastrointestinal Cancer Screening who were registered Radiotechnologists as of October 1, 2025, certified Gastric Cancer Screening Radiotechnologists, Certified Reading Assistants of Radiotechnologists, and participants in the 10^th Certified Gastric Cancer Screening Radiotechnologists Training Seminar.

Results

The number of radiological technologist members in the Japanese Society for Gastroenterological Cancer Screening was 5,850. The number of Certified Gastric Cancer Screening Radiotechnologists was 3,533 (acquisition rate: 60.4%), with no significant regional variation in acquisition rates among branches. The number of Certified Reading Assistants of Radiotechnologists was 832 (acquisition rate: 23.5%), with disparities observed between branches. The number of participants in the 10^th Gastric Cancer Screening Specialist Radiotechnologists Training Course was 1,142 (participation rate: 32.3%), with disparities observed between branches.

Conclusion

Although the certification system was established to improve the accuracy of gastric cancer X-ray screening, it is estimated that the current manpower of certified individuals is insufficient. It is hoped that disparities among branches will be eliminated and that the number of members in this society will increase.

A 64-year-old male patient underwent gastric X-ray screening, which revealed an elevated 12-mm-diameter lesion that was not morphologically altered by compression in the duodenal bulb and therefore required a detailed examination. Upper gastrointestinal endoscopy revealed an elevated smooth-surfaced lesion, with the same color as the surrounding area, in the anterior wall of the duodenal bulb. A biopsy of the lesion resulted in its diagnosis as a neuroendocrine tumor (NET). Distal gastrectomy led to the final diagnosis of NET-G1, Ki-67 index 2%, SM, v0, ly0, pT2pN0cM0 pStage II. We report this case as an extremely rare duodenal NET, detected at gastric X-ray screening.