Fluoro Part 2- Positioning notes

FL small bowel series routine

1. scout (AP)

2. PA stomach

3. RAO stomach

4. right lateral stomach

5. PA abdomen small bowel

small bowel/ BE scout AP technique

85 kVp, 10 mAs, all cells

Small bowel scout AP overview

1. 14×17 LW

2. center slightly above crest

3. suspended expiration

4. symph NOT REQUIRED

small bowel PA stomach technique

120 kVp, 5 mAs, center cell

small bowel PA stomach overview

• 1st image taken after barium ingestion

• 14×17 LW

• center 4” above crest, just slightly left

• suspended expiration

• annotate 0 minute

PA stomach small bowel main purpose

barium filled stomach and duodenal bulb

evaluation criteria small bowel PA stomach

1. entire stomach & c loop

2. stomach centered at level of pylorus

3. best to see body of stomach (medial/lateral margins)

4. mark time=0 minutes!!

if barium filled small intestine is cut off on PA stomach…

additional image is needed, do bowel follow thru

• need small intestines/small bowel (clipping stomach is okay)

small bowel RAO stomach technique

120 kVp, 7.5 mAs, center cell

small bowel RAO stomach overview

• 11×14 LW

• 40-70 degree oblique

• center 4” above crest- bisect spine & lateral border- light should just be skimming elevated side

• R marker POSTEIORLY

• suspended expiration

merrills centering for small bowel PA & RAO stomach

1-2” above L1-L2

main purpose of RAO small bowel stomach

obliqued stomach and entire duodenal loop

evaluation criteria for small bowel RAO stomach

1. entire stomach & loop

2. no superimposition of pylorus and bulb

3. duodenal bulb and loop in profile

4. stomach centered at level of pylorus

if pt cannot do an RAO small bowel stomach, do a

LPO

if bowel is cut off do small bowel follow thru only on what image?

PA stomach

you do NOT need to annotate times for which views?

• RAO stomach

• right lateral stomach

right lateral stomach small bowel technique

120 kVp, 15 mAs, center cell

right lateral stomach small bowel overview

• 11×14 LW

• patient lays like an L spine

• center 4” above crest (bisect axillary line & anterior abdomen)

• R marker on POSTERIOR

• suspended expiration

main purpose of small bowel right lateral stomach

c loop

evaluation criteria for small bowel right lateral stomach

1. entire stomach & duodenal loop

2. stomach centered at the level of pylorus

3. best to see the retrogastric area & loop in profile; anterior, posterior margins

merrills centering for small bowel R lateral stomach

level of L1-L2

if no rotation is present on small bowel R lateral stomach, but can not see the c loop…

it is okay (patient anatomy at that point)

if there is bad rotation on the RAO, but you are able to see the bulb/loop…

the image is sufficient

PA/AP abdomen small bowel technique

90-120 kVp, 8 mAs, all cells

PA/AP abdomen small bowel overview

• 14×17 LW

• center at level of crest (L4/L5)- around small of back & down MSP

• minute annotation

• suspended expiration

main purpose of PA/AP abdomen small bowel

small intestine progressively filling until barium reaches ileoceccal valve

PA/AP abdomen small bowel evaluation criteria

1. entire small intestine on each image

2. stomach on initial image (0 minute PA stomach)

3. time marker

4. complete exam when barium reaches cecum

small bowel special view- AP ileocecal spot

• 9×9

• center over RLQ

• suspended respiration

• barium filled ileum and passage of barium through the ileocecal valve into the large intestine

BE single contrast protocol

1. Scout

2. RPO

3. LPO

4. PA

5. PA axial

6. Left lateral rectum

7. post evac

BE double contrast protocol

1. Scout

2. right lateral decubitus

3. left lateral decubitus

4. AP

5. PA

6. PA axial

7. x-table lateral rectum

notes for BE

• scout image needs SYMPH

• take first image, if flexures are not on, then take second image using 17×14 w/ overlap from first image (can collimate down if able to)

RH single contrast tip & balloon note

remain inserted & inflated until left lateral rectum image, then prior to exposure, deflate the balloon and leave tip inserted. take exposure & drain the barium from the patient

RH double contrast tip & balloon note

remain inserted & inflated until x-table lateral image, then prior to exposure, deflate the balloon and remove the tip. take exposure

BE scout image requirement

all bowel pattern & symph

BE RPO/ LPO & L/R lateral decub technique

120 kVp @12.5 mAs, all cells

BE RPO/ LPO overview

• 14×17 LW

• 45 degree rotation

• center 1” above crest & 2” towards ELEVATED side

• suspended respiration

merrills obliquity & centering recommendation for BE RPO/LPO

35-45 degrees

1-2” lateral to elevated side at level of crest

BE RPO evaluation criteria

1. entire colon

2. left colic flexure open & descending colon

BE RPO vs LPO

RPO

• right pelvic wing is flattened

• left splenic flexure is OPEN

LPO

• left pelvis wing is flattened

• right hepatic flexure is OPEN

BE LPO evaluation criteria

1. entire colon

2. right colic flexure is open

3. ascending colon, cecum, & sigmoid colon

BE right lateral decub overview

• need to measure with calipers!!

• 17×14 (if pt is hypersthenic, do 2 14×17’s)

• IR is placed BEHIND pt

• RH- drop IR slightly below pt (this will place the spine in center of the IR)

• center IR so symph is at bottom of image

• place left marker on top portion of light field

• suspended respiration

BE right lateral decub (AP) best shows

“UP”/medial side of ascending colon & the lateral side of the descending colon when the colon is inflated w/ air

BE right/ left lateral decub (AP) evaluation criteria

1. area from left colic flexure to rectum is seen

2. air inflated portion of the colon is of primary importance

merrills recommendations for pt position and IR position for BE lateral decub (Left & right)

• place radiolucent sponge under patient

• center IR at level of crest (rather than symph)

BE left lateral decub best visualizes

“UP” lateral side of the ascending colon & the medial side of the descending colon when the colon is inflated with air

AP supine BE technique

90 kVp @10 mAs, all cells

BE AP supine centering & breathing

• center at crest (L4/L5) & ensure symph is at bottom of image

• suspended respiration

BE AP supine purpose

shows entire colon/ AIR FILLED TRANSVERSE COLON

BE ap supine evaluation criteria

1. entire colon including flexure & rectum (2 images may be needed for hypersthenic patients)

2. vertebral column centered so that ascending & descending portions of the colon are included

BE PA single contrast technique vs double contrast technique

single- 120 kVp @10 mAs, all cells

double- 90 kVp @10 mAs, all cells (due to air)

BE PA prone overview

• center at level of crest (around small of back)

• make sure symph is at bottom of image (2” below asis)

• suspended RESPIRATION

evaluation criteria BE PA prone

1. entire colon including the flexure & rectum (2 images may be needed for hypersthenic patients)

2. vertebral column centered so that ascending & descending portions of the colon are included

merrills special note for BE PA prone

fluoro table be in slight Trendelenburg position (helps separate redundant & overlapping loops of bowel by “spilling” them out of the pelvis)