Presented by Aries Paul Zeta RRT Property of Davao Doctors College 10 Millers Routine Sequence of Radiographs AP to include flexures Left lateral rectum AP 15 25 degs ID: 685177
Download Presentation The PPT/PDF document "Radiographic Positioning for Barium Enem..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Radiographic Positioning for Barium Enema
Presented by
Aries Paul Zeta, RRT
Property of Davao Doctors CollegeSlide2
10
–
Miller’s Routine Sequence of Radiographs
AP
– to include flexures
Left
lateral rectum
AP
– 15 – 25 degs.
Cephalic(CR)
to include rectum.
15
– 25 degs.RPO – to include
Left
colic
Right
lateral – to include rectumSlide3
Cont…
Prone PA – to include flexures
Prone PA with 15 – 25 degs caudal angulation (Angle Prone)– to include rectum.
15 – 25 degs LPO- to include the right colic flexure.
Supine – AP tightly collimated ileocecal region
proj
. taken in 2 – 3 degs obliquity.
Using horizontal central ray, upright
proj
. of both flexures and lateral rectum.Slide4
Modification of Positions for Barium
E
nemaUsually used in the hospitalSlide5
Scout Film
First exposure of the procedure should be a plain radiograph of the abdomen area.
Advice the patient to lie down on the radiographic table, the MSP of the patient should be inline with the MSP of the Table.
Center the CR at the level of the L4 or the level of the iliac crest.
Respiration is suspended during expiration.
L4Slide6
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 IV pole/enema bag is no more than 24 inches (60cm) above the table. Ensure tubing stopcock is in the closed position and no barium flows into the pt.Slide7
Left/Right 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
planeSlide8
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
symphysisSlide9
AP (Single Contrast)
Film: 14x17cm
An Entire colon filled
with contrast media
should be demonstrated including the splenic flexure
and the rectum.
CR is at the level of the L4
or at the level of the iliac crest
L4Slide10
AP Double Contrast
Film: 14x17cm lengthwise
Patient lies in a supine position MSP is in line with th
e MSP of the table
An Entire colon filled
with positive and negative contrast media
should be demonstrated including the splenic flexure
and the rectum.
CR is at the level of the L4
or at the level of the iliac crest
L4Slide11
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 crestSlide12
LAO Position (optional)
Film: 14x17cm lengthwise
It is taken primarily to demonstrate the right colic (hepatic) flexure and sigmoid portion of the colon
CR is a
t the level of the L4
or at the level of the iliac crestSlide13
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 crestSlide14
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 a
t the level of the L4
or at the level of the iliac crestSlide15
Ventral Decubitus
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
planeSlide16
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 30-40
0
caudad
at approximate level of the anterior superior iliac spines.Slide17
Supine position
Film: 14x17cm lengthwise
A
postevacuation
radiograph view of the colon is taken after the procedure is done
If inadequate satisfactory delineation of the mucus the patient may be given hot beverage (tea/coffee) to stimulate evacuationSlide18
After care
Patient is advised to drink plenty of water, or laxative is taken to remove excess barium sulfate.Slide19
Acknowledgement
Radiographic positioning demonstrated by Davao Doctors College Interns