Fluoro II pathologies and image critique

crohn’s disease

chronic inflammatory disease of the intestines

appearance of crohn’s disease

inflammation and fibrosis with narrowing

• String sign, skipped pattern

• Cobblestone appearance

colonic diverticula

outpouchings, herniation of mucosa and submucosa through the muscular layers at points of weakness of the bowel wall

appearance of colonic diverticula

Round or oval outpouchings, tend to be in clusters

Abscesses

Extravasation

diverticulitis

complication of diverticulosis, inflammation of the diverticula

• typically in sigmoid region

ulcerative colitis

inflammatory bowel disease

appearance of ulcerative colitis

Earliest detection: fine granularity of the mucosa

Chronic: haustra pattern absent, tubular looking colon

colon cancer appearance

Polyps

Apple core

intussusception

Telescoping of one part of intestinal tract into another because of peristalsis which forces the proximal segment of bowel to move distally w/in the ensheathing outer portion

intussusception appearance

coiled - spring

disk herniation

protrusion of an intervertebral disk

herniated disk appearance

Requires CT, MRI, or myelography to demonstrate impression of the disk on the spinal cord or individual nerve roots

crohn’s disease

pathology?

crohn’s disease

pathology?

crohn’s disease

pathology?

diverticulosis

pathology?

ulcerative colitis

pathology?

colon cancer (apple core)

pathology?

intussusception

pathology?

PA stomach - 0 minute criteria

• Evidence of proper collimation and presence of side marker placed clear of anatomy of interest

• Entire stomach and duodenal loop

• Stomach centered at the level of the pylorus

• No rotation of the patient

• Penetration of the contrast medium

• Surrounding anatomy

• Best to see body of stomach; medial, lateral margins

good

PA stomach - 0 minute

RAO stomach critique

• Evidence of proper collimation and presence of side marker placed clear of anatomy of interest

• Entire stomach and duodenal loop

• No superimposition of the pylorus and duodenal bulb

• Duodenal bulb and loop in profile

• Stomach centered at the level of the pylorus

• Penetration of the contrast medium

• Surrounding anatomy

• Best view to see the duodenal bulb filled with barium.

RAO stomach positioning

4” above crest, Bisect spine and lateral border of elevated side, collimate 11x14

PA stomach positioning

4” above crest slightly off center to left, collimate 14 ×17

right lateral stomach critique

• Evidence of proper collimation and presence of side marker placed clear of anatomy of interest

• Entire stomach and duodenal loop

• No rotation of the patient, as shown by the vertebrae

• Stomach centered at the level of the pylorus

• Penetration of the contrast medium

• Surrounding anatomy

• Best to see the retrogastric area and loop in profile; anterior, posterior margins

right lateral stomach positioning

4” above crest, Bisect axillary line & anterior abdomen, collimate 11x14

BE scout image criteria

• All bowel pattern included

• Symphysis needs to be included

• No rotation

BE RPO critique

• Evidence of proper collimation and presence of side marker placed clear of anatomy of interest

• colon

• Left colic flexure and descending colon

• Penetration of the contrast medium

no

do you need symph on BE obliques?

left splenic flexure

what flexure is open on a BE RPO?

right side down

how do you mark a BE RPO?

BE LPO criteria

• Evidence of proper collimation and presence of side marker placed clear of anatomy of interest

• Entire colon

• Right colic flexure less superimposed or open compared with the AP projection

• Ascending colon, cecum, and sigmoid colon

• Penetration of the contrast medium

right hepatic flexure

which flexure is open on a BE LPO?

mark left side down

how do you mark a BE LPO?

BE PA criteria

• Evidence of proper collimation and presence of side marker placed clear of anatomy of interest

• Entire colon including the flexure and rectum (two image receptors may be necessary for hypersthenic patients)

• Vertebral column centered so that ascending and descending portions of the colon are included

• Penetration of the contrast medium

yes

do you need entire large intestine on a BE PA?

yes

do you need symph on a BE PA?

BE PA axial (sigmoid) criteria

• Evidence of proper collimation and presence of side marker placed clear of anatomy of interest

• Rectosigmoid area with less superimposition than in PA projection because of angulation of central ray

• Transverse colon and both flexures not always included

• Penetration of the contrast medium

BE left lateral rectum criteria

• Evidence of proper collimation and presence of side marker placed clear of anatomy of interest

• Rectosigmoid area in the center of the image

• No rotation of the patient

• Superimposed hips and femora

• Superior portion of colon not included when the rectosigmoid region is area of interest

• Penetration of the contrast medium

deflate balloon

what do you need to do before taking BE left lateral rectum image?

BE post evacuation PA criteria

• Same as PA

• Entire large intestine is included.

• Symphysis included (rectum is on image)

• No or minimal rotation (look at ribs, spine and pelvis).

POST

what annotation does your post evacuation PA image need?

Single BE images

scout

PA

LPO

RPO

PA axial sigmoid

left lateral rectum

post evac PA

double BE images

scout

PA

AP

RLD

LLD

PA axial sigmoid

cxt lateral rectum

BE RLD criteria

• Evidence of proper collimation and presence of side marker placed clear of anatomy of interest

• Area from the left colic flexure to the rectum

• No rotation of patient, as demonstrated by symmetry of the ribs and pelvis

• The air inflated portion of the colon is of primary importance and should not be over penetrated

mark up side (left)

how do you mark a BE RLD?

BE LLD criteria

• Evidence of proper collimation and presence of side marker placed clear of anatomy of interest

• Area from the left colic flexure to the rectum

• No rotation of patient, as demonstrated by symmetry of the ribs and pelvis

• The air inflated portion of the colon is of primary importance and should not be over penetrated

mark side up (right)

how do you mark a BE LLD?

AP

how does patient face for RLD?

PA

how does patient face for LLD?

yes

do you need symph for RLD and LLD?

PA

AP or PA?

AP

AP or PA?

BE AP (supine) criteria

• Evidence of proper collimation and presence of side marker placed clear of anatomy of interest

• Entire colon including the flexure and rectum (two image receptors may be necessary for hypersthenic patients)

• Vertebral column centered so that ascending and descending portions of the colon are included

• Penetration of the contrast medium

air

what is seen in the transverse colon in an AP image?

BE PA (prone) criteria

• Evidence of proper collimation and presence of side marker placed clear of anatomy of interest

• Entire colon including the flexure and rectum (two image receptors may be necessary for hypersthenic patients)

• Vertebral column centered so that ascending and descending portions of the colon are included

• Penetration of the contrast medium

barium

what is seen an a BE PA image?

BE PA axial (sigmoid) criteria

• Evidence of proper collimation and presence of side marker placed clear of anatomy of interest

• Rectosigmoid area with less superimposition than in PA projection because of angulation of central ray

• Transverse colon and both flexures not always included

• Penetration of the contrast medium

BE right lateral cxt rectum criteria

• Evidence of proper collimation and presence of side marker placed clear of anatomy of interest

• Rectosigmoid area visualized and centered

• No rotation of the patient

• Air-fluid level demonstrated

• Enema tip removed for an unobstructed image of the rectum

deflate and take out tip

what do you need to do prior to double BE right lateral cxt rectum image?