Barium Follow Through and Barium Enema PDF

BARIUM FOLLOW THROUGH AND BARIUM ENEMA BY DR. ROAA MOHAMED ATEF SHEHATA LECTURER OF DIAGNOSTIC RADIOLOGY ENTEROCYLSIS Barium Enema A barium enema is an X-ray exam that can detect changes or abnormalities in the large intestine (c...

BARIUM FOLLOW THROUGH AND BARIUM ENEMA BY DR. ROAA MOHAMED ATEF SHEHATA LECTURER OF DIAGNOSTIC RADIOLOGY ENTEROCYLSIS Barium Enema A barium enema is an X-ray exam that can detect changes or abnormalities in the large intestine (colon). An enema is the injection of a liquid into the rectum through a small tube. In this case, the liquid contains a metallic substance (barium) that coats the lining of the colon. During a barium enema exam, air may be pumped into the colon. The air expands the colon and improves the quality of images. This is called an air-contrast (double-contrast) barium enema. Before a barium enema the patient is instructed to completely empty the colon. The doctor may recommend a barium enema to determine the cause of signs and symptoms, such as the following: Abdominal pain Rectal bleeding Changes in bowel habits Unexplained weight loss Chronic diarrhea Persistent constipation A barium enema X-ray may enable the doctor to detect such conditions as: Abnormal growths (polyps) Inflammatory bowel disease Before a barium enema exam, you'll be instructed to empty the colon…………? Why. Any residue in the colon may obscure the X-ray images or be mistaken for an abnormality. To empty your colon, you may be asked to: Follow a special diet the day before the exam. The patient may be asked not to eat and to drink only clear liquids — such as water, tea or coffee without milk or cream. Fast after midnight. Usually, the patient will be asked not to drink or eat anything after midnight before the exam. Take a laxative the night before the exam. A laxative, in a pill or liquid form, will help empty your colon (castor oil……60ml). Use an enema kit (enemax). In some cases, the patient may need to use an over-the- counter enema kit — either the night before the exam or a few hours before the exam — that provides a cleansing solution to remove any residue in the colon. Ask your doctor about your medications. At least a week before your exam, talk with your doctor about the medications you normally take. He or she may ask you to stop taking them days or hours before the exam. RADIOGRAPHIC POSITIONING FOR BARIUM ENEMA  10 – MILLER’S ROUTINE SEQUENCE OF RADIOGRAPHS 1) AP – to include flexures 2) Left lateral rectum 3) AP with 15 – 25 degs. Cephalic(cr) to include rectum. 4) RPO with 15 – 25 degs.– to include left colic 5) Right lateral – to include rectum  CONT… 6) Prone PA – to include flexures 7) Prone PA with 15 – 25 degs caudal angulation (angle prone)– to include rectum. 8) LPO with 15 – 25 degs - to include the right colic flexure. 9) Supine – AP tightly collimated ileocecal region proj. Taken in 2 – 3 degs obliquity. MODIFICATION OF POSITIONS FOR BARIUM ENEMA  SCOUT FILM First exposure of the procedure should be a plain radiograph of the abdomen area. L4 Advice the patient to lie down on the radiographic table. Center the CR at the level of the L4 or the level of the iliac crest. Respiration is suspended during expiration.  SIM’S POSITION -Sims position – relaxes the abdominal muscles and decreases pressure within the abdomen. -Instruct the patient to lie on their side away from the tech. Let the lower arm of the patient to be put at the back of his body. The up side knee should be flex for support and lower side extremity should not be flex or bent. -Wearing gloves, coat enema tip with water-soluble lubricant.(KY jelly or any sterile lubricant). On expiration, direct enema tip toward the umbilicus proximally 1 to 1.5 inches. After initial insertion, advance up superiorly and slightly anteriorly. Do not force enema tip. -Tape tubing in place to prevent slippage. Do not inflate unless directed by radiologist. Ensure enema bag is no more than 24 inches (60cm) above the table AP (recto sigmoid area) film: 10x12cm crosswise AP view of the rectum & sigmoid should be included CR 5-7 cm above the level of the pubic symphysis 5-7cm above pubic symphysis Left/right lateral position of the recto sigmoid area film: 10x12cm lengthwise True lateral position of the recto sigmoid CR should be 5-7cm above the level of the pubic symphysis in the midaxillary plane AP (single contrast) film: 14x17cm An entire colon filled with contrast media should be demonstrated including the splenic flexure and the rectum. In double contrast study : an entire colon filled with positive and negative contrast media should be demonstrated including the splenic L4 flexure and the rectum. CR is at the level of the L4 or at the level of the iliac crest RPO position(optional) film: 14x17cm lengthwise Instruct the patient to lie on his right side making an angulation of 35-45deg It is taken primarily to demonstrate the left colic (splenic) flexure and ascending colon should be visualized. CR is at the level of the L4 or at the level of the iliac crest LAO position (optional) film: 14x17cm lengthwise It is taken primarily to demonstrate the left colic (splenic) flexure and sigmoid portion of the colon CR is at the level of the L4 or at the level of the iliac crest Right lateral decubitus film: 14x17cm lengthwise Best demonstrate the “up” medial side of the ascending colon and the lateral side of the descending colon, when the colon is inflated with air due to gravity. CR at the level of the L4 or at the level of the iliac crest Left lateral decubitus film: 14x17cm lengthwise Best demonstrate the “up”, medial side of the descending colon and the lateral side of the ascending colon, when the colon is inflated with air. CR is at the level of the L4 or at the level of the iliac crest Prone PA VIEW Film: 10x12cm lengthwise A cross table view of the recto sigmoid area Demonstrate the air-fluid level of the recto sigmoid area CR is at 5-7 cm above the level of the pubic symphysis in the midaxillary plane Prone PA axial position (angle prone) film: 10x12cm or 11x14cm crosswise Rectosigmoid area must be less superimposition than in the PA projection because of the angulation of the CR Center it the midline of the body with an angulation of 30-400 caudad at approximate level of the anterior superior iliac spines. Supine AP position Film: 14x17cm lengthwise A post-evacuation radiograph view of the colon is taken after the procedure is done