Radiographic Positioning for Barium Enema

Presented byAries Paul Zeta, RRT

Property of Davao Doctors College

10 – Miller’s Routine Sequence of Radiographs

1)AP – to include flexures2)Left lateral rectum3)AP – 15 – 25 degs. Cephalic(CR)

to include rectum.4)15 – 25 degs.RPO – to include

Left colic5)Right lateral – to include rectum

Cont…

6) Prone PA – to include flexures7) Prone PA with 15 – 25 degs caudal angulation

(Angle Prone)– to include rectum.8) 15 – 25 degs LPO- to include the right colic

flexure.9) Supine – AP tightly collimated ileocecal region

proj. taken in 2 – 3 degs obliquity.10)Using horizontal central ray, upright proj. of

both flexures and lateral rectum.

Modification of Positions for Barium Enema

Usually used in the hospital

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.

L4

Sim’s PositionSims 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.

Left/Right position of the recto sigmoid areaFilm: 10x12cm lengthwise

• True lateral position of the Recto sigmoid

• CR should be 5-7cm above the level of the pubic symphysis in the midaxillary plane

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 symphysis

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 L4

AP Double ContrastFilm: 14x17cm lengthwise

• Patient lies in a supine position MSP is in line with the 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

L4

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 crest

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 at the level of the L4 or at the level of the iliac crest

Right Lateral DecubitusFilm: 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 crest

Left Lateral DecubitusFilm: 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 at the level of the L4 or at the level of the iliac crest

Ventral DecubitusFilm: 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 plane

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 30-400 caudad at approximate level of the anterior superior iliac spines.

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 evacuation

After carePatient is advised to drink plenty of water, or laxative is taken

to remove excess barium sulfate.

Acknowledgement

• Radiographic positioning demonstrated by Davao Doctors College Interns