Digestive system imaging 2 class
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This document discusses radiographic techniques for examining the small intestine, including oral, complete reflux, and enteroclysis methods. The oral method involves administering barium sulfate by mouth and taking x-rays at timed intervals. For complete reflux, the colon and small intestine are filled with barium enema. Enteroclysis involves inserting a tube into the duodenum and injecting contrast medium under fluoroscopy. Preparation and procedures for each technique are described.
Digestive system imaging 2 class
- 1. Radiographic Technique 3 May, 2014 Prepared by: Behzad Ommani Bachelor of Radiology Master of Medical Engineering
- 2. Radiologic examinations of the small intestine are performed by administering a barium sulfate preparation: 1. By Mouth 2. By complete refluxfilling with a large volume Barium Enema 3. By Direct Injection into the bowel through an intestinal tube, a technique that is called Entroclysis, or small intestine enema. The latter two methods are usually used only when the oral method fails to provide conclusive infomation.' Small Bowel
- 3. PREPARATION FOR EXAMINATION • Preliminary preparation of he patient is necessary. 6 or 8 hours NPO. • Food and fluid are usually withheld after the evening meal of the day before the examination, and breakfast is withheld on the day of the study. • The patient's Bladder should be empty before and during the procedure to avoid displacing or compressing the ileum. Small Bowel
- 4. Indication : • Crohn disease • Neoplastic disease • Meckel s diverticule Contraindication : • Bowel Perforation • Colon Obstruction Small Bowel
- 5. ORAL METHOD OF EXAMINATION The radiographic examination of the small intestine is usually termed a small bowel series since several identical radiographs are done at timed intervals. The supine position is used (1) to take advantage of the superior and lateral shift of the barium-filled stomach for visualization of the retrogastric portions of the duodenum and jejunum and (2) to prevent possible compression overlapping of loops of the intestine. Small Bowel
- 6. • The prone position is used to compress the abdominal contents, which increases radiographic quality. Film Times : • The first small intestine radiograph is usually taken 15 minutes after the patient drinks the barium. Prefer RAO toward Supine or prone. • The interval to the next exposure varies from 15 to 30 minutes depending on the average transit time of the barium sulfate preparation used. Small Bowel
- 7. AP PROJECTION Image receptor: 35 x 43 cm lengthwise. Position of patient : Place the patient in the prone or supine position. Position of part : Similar KUB. Central ray : Perpendicular to the midpoint of the IR (L2) for early radiographs or at the level of the iliac crests for delayed sequence exposures. Small Bowel
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- 11. COMPLETE REFLUX EXAMINATION • For a complete reflux examination of the small intestine,the patient's colon and small intestine are filled by administering a barium enema to demonstrate the colon and small bowel. • Before the examination, glucagon may be administered to relax the intestine. • Diazepam (Valium) may also be given to diminish patient discomfort during the initial filling of the bowel. • A 15% +_ 5% weight/volume barium suspension is often used, and a large amount of the suspension (about 4500 ml) is required to fill the colon and small intestine. Small Bowel
- 12. • A retention enema tip is used, and the patient is placed in the supine position for the examination. The barium suspension is allowed to flow until it is observed in the duodenal bulb. • The enema bag is then lowered to the floor to drain the colon before radiographs of the small intestine are obtained Small Bowel
- 13. ENTEROCLYSIS PROCEDURE • Enteroclysis (the injection of nutrient or medicinal liquid into the bowel) is a radiographic procedure in which contrast medium is injected into the duodenum under fluoroscopic control for examination of the small intestine. • The contrast medium is injected through a Bilbao or Sellink tube. • Before the procedure is begun, the patient's colon must be thoroughly cleansed. • Enemas are not recommended as preparation for enteroclysis because some enema fluid may be retained in the small intestine. Small Bowel
- 14. • Under fluoroscopic control, a Bilbao or Sellink tube with a stiff guide wire is advanced to the end of the duodenum at the duodenojejunal flexure, near the ligament of Treitz. • Barium is then instilled through the tube at a rate of approximately 100 ml/minute . • Spot radiographs, with and without compression, are taken as required. In some patients, air or methylcellulose is injected into the small intestine after the contrast fluid has reached the cecum. Small Bowel
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