Barium x-rays are usually performed in a physician’s office, hospital or outpatient clinic. A mild sedative may be given. Barium is chalky but has flavoring added and does not taste bad to most people. Depending on the test, it can be in the form of a thin liquid, thick liquid, paste or solid. The type of test determines the exact nature of the procedure. Details that apply to specific tests include:

• Barium swallow: Typically, the patient will be instructed not to eat or drink after midnight the day before the test. The patient may be instructed to consume baking soda along with the liquid barium because the resulting gas improves the appearance of the barium on x-rays. Tests may be done with the patient standing or lying on a tilt table or both. When standing behind a fluoroscope patients may be asked to change positions and hold their breath while x-rays are taken. Patients may be strapped to a table that is tilted to allow pictures from various angles. The abdomen may be compressed by a belt or the examiner’s lead-gloved hand during testing. The test can take one to two hours to complete.
  
  
• Modified barium swallow (MBS). This test also may be called a videofluoroscopic swallow study (VFSS). The patient sits in a special chair during the exam, which uses fluoroscopy with or without cineradiography (video images). The patient ingests small amounts of thin or thickened liquid barium. The patient may drink a small amount of barium or eat a soft substance (e.g., pudding, applesauce) mixed with barium. Depending on the condition, the patient also may ingest a cookie or cracker coated with barium.
  
  This test is used when dysphagia (difficulty swallowing) or aspiration (food or liquids entering into the airway)  is suspected. Fasting is not required. A speech-language pathologist and radiologist conduct this test jointly to diagnose swallowing problems and evidence of aspiration. An MBS can help determine the most appropriate diet for a patient and suggest techniques to reduce the risk of choking and aspiration. The test, usually performed in a hospital, can take up to an hour to complete.
  
  
• Barium meal. Typically, the patient will be instructed not to eat or drink after midnight the day before the test. The patient digests a meal containing barium. The radiologist uses fluoroscopy to watch how long the stomach takes to digest the meal. If the barium meal is performed within a few days of a barium enema, a cleansing enema and laxative may be required first to clear all barium from the intestines. The procedure can take anywhere from 20 minutes to several hours, depending on the number and nature of x-rays required.
  
  
• Small-bowel series. A small-bowel series is typically done in conjunction with a barium swallow. The patient will drink additional barium and more x-rays will be taken every half hour until the barium reaches the large intestine. The barium swallow and small-bowel series can take up to six hours to complete because of waiting time between the tests.
  
  
• Barium enemas. The patient lies down sideways, and a lubricated enema tube is inserted into the rectum. The barium contrast agent is slowly administered through the tube into the colon.  The entire procedure takes from 20 to 45 minutes and may cause discomfort or minor cramping. To allow different views of the lower GI tract during x-rays, the table can be tilted and the patient instructed to change position. After filming, the tube is removed and the patient uses a bedpan or toilet to begin expelling the barium. Following expulsion of the barium, more x-rays are taken. When a double-contrast barium enema is used, the entire process is repeated. In the second procedure, air is supplied through the enema tube. The air helps outline the colon better for better viewing by the physician.