Positioning of Large Intestine (RADS 320)

Single Contrast Method for examing the large intestine:

barium sulfate only (or water soluble)

Double Contrast Method for examining large intestine:

the radiologist induces air in the rectum with the barium

-barium is administerd then the enema tube is clamped and the radiologist with introduce air

Air contrast is most useful in detection of...

poly poid tumors (polyps)

Cathartic

a laxative that should not be used when gross bleeding, severe diarrhea, obstructions, and inflammatory lesions are known

Preperation of Intestinal Tract for Barium Enema

large bowel must be completely empty - usually done with the use of cathartics

-will also have dietary restrictions, laxatives, and cleansing enemas

Enema Tip

a plastic, or rectal retention, or air contrast retension tips

Platic Tips are used on...

single contrast BE's or pediatric patients

Rectal Retention and air contrast retention tips are used for...

patients who may not be able to hold to

The rectal retention and air contrast retention tips will have...

a balloon on the end of the tip which should not be inflated until the radiologist walks into the room, because it can cause intestinal rupture

Cuffulator

tool used to blow up the balloon of the rectal rentention and air contrast retention tips, that squeezes 90-100 cc's of air in 1 squeeze

The IV pole bag is no higher than...

24 in above the level of the anus

The thbe for the BE is inserted how many inches?

3 1/2 - 4 inches

Tannic Acid

may be added to barium sulfate to produce a more complete evacuation of the colon and also provide better mucosal coating

-should not be used in cases of suspected colitis, may cause GI hemorrhage

Room Temperature water mixed with barium sulfate provides...

maximum comfort to the patient as hot water may scald the colon which would injure tissue and cause irritation

Cold Barium enemas

reccomended because they are less irritating and will have a mild anasthetic effect and relaxes the colon

Glucagon

drug used to control spasms of the colon (relaxes large intestine)

Insertion of Enema Tip: Pt. Position

Sims Position

Why is the patient placed in the SIms position for insertion of enema tip?

it relaxes abdominal muscles and decreases intra-abdominal pressure on the rectum and helps relax the anal sphincter

Routine for SIngle Contrast Study

AP, AP Axial, L or R Lateral, Post Evac (PA)

SIngle Contrast Study kVp

110-120 (BaSO4), 70-80 (Gastrografin)

Double Contrast Study kVp

90-100 because air in intestine

Routine for Double Contrast Study

AP, AP Axial, AP Obl. (RPO & LPO), L Lateral, Both Decubs, Post Evac (PA)

AP or PA projection of Large Intestine: CR

Perpendicular entering MSP at iliac crest

For projections of Large Intestine: Breathing Instructions

Suspend Respiration

AP or PA projection of Large Intestine: SS/ EC

the entire colon with pt supine

-including the splenic flecure and the rectum (two images may be neccesary)

AP Axial - Butterfly Pos. (Tilt) of Large Intestine: CR

Angled 30-40 degrees (35) cephalic entering 2" (5cm) distal to ASIS

What is the purpose of the AP Axial - Butterfly Pos. of Large Intestine

it straightnens out the rectosigmoid segments

AP Axial - Butterfly Pos. (Tilt) of Large Intestine: SS/EC

the rectosigmoid area of the colon

-will have less superimposition than in the AP & transverse colon and flecures not included

AP Oblique (LPO or RPO) of Large Intestine: CR

perpendicular to level of crest; 1-2" lateral to the MSP toward the side up

Degree of obliquity for AP Oblique (LPO or RPO) for rectosigmoid area

30 degrees and center to level of ASIS and 1" to elevated side

Degree of obliquity for AP Oblique (LPO or RPO) for flexures

35-45 degrees, center to level of iliac crest and 1-2" to the elevated side

AP Oblique (LPO) of Large Intestine: SS/EC

right colic flexure (hepatic flexure); ascending and sigmoid portions of the colon

-right colic flexure less superimposed or open compared with the AP

LPO and RPO positions of the Large Intestine demonstrates...

the flexure farthest from the IR

AP Oblique (RPO) of Large Intestine: SS/EC

left colic flexure (splenic flexure); descending colon

-entire colon

PA Axial - Butterfly Pos. (Tilt) of Large Intestine: CR

30-40 degrees caudad enters at MSP at the level of ASIS

Lateral Projection (R or L) of Large Intestine: Pt. Position

patient lies on left side (or right), midcoranal plane centered to midline of table, flex patients hips and knees. no rotation

Lateral Projection (R or L) of Large Intestine: CR

perpendicular enters ASIS and midcoronal plane

Lateral Projection (R or L) of Large Intestine: SS/EC

the rectum and the distal sigmoid portion of the colon

-rectosigmoid area in the center of the image, superimposed hips and femora

For decubs call it by side _______, mark the side ______

down; up

AP Projection (Right & Left Lateral Decub): CR

horizontal and perpendicular; enters MSP and iliac crest

AP Projection (Right Lateral Decub): SS

demonstrates the medial side of the ascending colon and demonstates the lateral side of descending colon

For Right and Left Lateral Decubs of the Large, what is of primary importance when looking at the image?

the air-inflated portion of the colon and should not over penetrated

AP Projection (Left Lateral Decub): SS

demonstates the medial side of the descending colon and demonstates the lateral side of the ascending colon

Evacuation

discharge from the bowels

PA Projection Post Evac: SS/EC

Residual contrast in the colon

-want to see entire colon including the flexures and the rectum (two images may be necessary for hypersthenic patients)

Ulcerative colitis

ulcerations on mucosa, gives a lead pipe appearance on image due to loss haustra