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- 2. The following information is only a personal suggested guideline to follow when positioning for Contrast exams. For additional information on positioning of these exams, please reference your Radiographic Positioning and Related Anatomy Textbook. 2
- 3. Esophagram Routine Views: • AP/PA • Lateral • RAO/LPO • LAO/RPO 3
- 4. AP/PA Esophagram • Body is supine or prone • Align MS to midline • Ensure no rotation • CR ┴ to IR • CP is to T5-T6(3”inferior to jugular notch) • Collimate a hand width • Instruct patient to swallow barium/expose 4
- 5. 5
- 6. Lateral Esophagram • Body is in lateral recumbent • Midcoronal plane to midline • Ensure no rotation • CR ┴ to IR • CP is to T5-T6(3”inferior to jugular notch) • Collimate a hand width • Instruct patient to swallow barium/expose 6
- 7. 7
- 8. 8
- 10. RAO/LPO Esophagus will be visualized between the thoracic spine and the heart. 10
- 11. RAO/LPO Esophagram • Body is rotated 35°-40° • CR ┴ to IR • CP is to T5-T6(3”inferior to jugular notch) • Collimate to hand width • Instruct patient to swallow barium/expose 11
- 12. 12
- 13. 13
- 14. LAO/RPO Esophagus will be visualized through the heart. 14
- 15. LAO/RPO Esophagram • Body is rotated 35°-40° • CR ┴ to IR • CP is to T5-T6(3”inferior to jugular notch) • Collimate to hand width • Instruct patient to swallow barium/expose 15
- 16. 16
- 17. 17
- 23. Upper GI Routine Views: • AP/PA • RAO • Rt Lateral • LPO 23
- 26. 26
- 27. Upper Gastrointestinal System Air = Black Barium = White 27
- 28. For all stomach images… Ask yourself: What is in the fundus? What is the spine doing? 28
- 29. AP/PA UGI • Body is recumbent • Ensure no rotation • CR ┴ to IR • CP for Sthenic is to L1* & 1” left of midline • CP for Hypersthenic is 2” above L1 & near midline • *one hand width above crest 29
- 30. AP PA What is in the fundus? What is the spine doing? Straight Barium = Air = 30
- 31. RAO UGI • Body is rotated 40°-70° • CR ┴ to IR • CP for Sthenic is to L1* - w/45°-55° Oblique • CP for Hypersthenic is 2” above L1 - w/70° Oblique • And midway between spine & upside lateral abdomen • *one hand width above crest 31
- 32. What is in the fundus? What is the spine doing? Air Obliqued 32
- 33. Lateral UGI • Body is in lateral recumbent • Midcoronal plane to midline • Ensure no rotation • CR ┴ to IR • CP for Sthenic is to L1* & 1-2” anterior to MC plane • CP for hypersthenic is 2” above L1 • * one hand width above crest 33
- 34. What is in the fundus? What is the spine doing? Air Lateral 34
- 35. LPO UGI • Body is rotated 30°-60° • CR ┴ to IR • CP for Sthenic is to L1* w/45° Oblique • CP for hypersthenic is 2” above L1 - w/60° Oblique • And midway between MS & left lateral abdomen • * one hand width above crest 35
- 36. What is in the fundus? What is the spine doing? Barium Obliqued 36
- 37. UGI Technical Error: Positioning error: Centering point is too low. Fundus and pyloric sphincter are clipped. 37
- 38. UGI Technical Error: Positioning error: Centering point is too low. Fundus is clipped. 38
- 39. UGI Technical Error: Positioning error: Centering point is too low. Fundus is clipped. And there is motion. 39
- 40. UGI Technical Error: Positioning error: Centering point is too close to the spine. Body is clipped. 40
- 41. Upper GI Pathology Hiatal Hernia PA▲ ◄AP 41
- 50. Small Bowel Follow Through (SBFT) Routine Views: • PA/AP (timed) 50
- 51. (SBFT) Small Bowel Follow Through • The prone position allows abdominal compression to separate the various loops of bowel, creating a higher degree of visibility. However follow departmental protocols 51
- 52. (SBFT) Small Bowel Follow Through • Depending on departmental protocol, the Immediate, 15 & 30 min. images are generally centered at least 2” above crest. Additional timed images thereafter are centered at the crest to include pubic bone. 52
- 53. (SBFT) Small Bowel Follow Through • SBFT is complete when the barium enters through the ileocecal valve into the cecum. 53
- 54. What quadrant(s) is the: 1. Duodenum located? Length? 2. Jejunum location? Length? 3. Ileum location? Length? 4. Ileocecal Valve location? 1. RUQ & LUQ – 10” 2. LUQ & LLQ – 2/5 3. RUQ, RLQ & LLQ – 3/5 4. RLQ 54
- 55. 55
- 56. Proximal Stomach & Duodenum Anatomy 56
- 57. 57
- 58. Terminal Ileum & Proximal Colon Anatomy A B C D E 58
- 59. 59
- 60. SBFT Technical Error: Transverse lock of CR tube is not on center to the table bucky. 60
- 61. SBFT Technical Error: Wrong centering. Anatomy is clipped for the appropriately timed image. Wrong 45 min 61
- 63. SBFT 15 minute Image Centered higher to include the stomach and proximal small bowel. Good 63
- 64. SBFT 30 minute Image Centered higher to include the stomach and proximal small bowel. Good 30 min 64
- 65. 45 min SBFT 45 minute Image Centered at the crest to include distal small bowel. Good 65
- 66. SBFT 4 hour Image Centered at the crest or slightly below to include distal small bowel/pubic bone. Good 66
- 68. SBFT Pathology – Crohn’s 68
- 71. Lower GI (BE) Routine Views: • AP/PA • LPO/RAO • RPO/LAO • Lateral • AP/PA Axial • AP/PA Axial Oblique • Rt & Lt Decubitus 71
- 72. Lower Gastrointestinal System • Barium Enema - Single Contrast • Barium Enema - Iodinated, Water-soluble Contrast • Barium Enema - Double Contrast • Defecogram – Barium mixed with potato starch 72
- 73. Lower GI (Colon) Exams • Single Contrast - 100-125kV • Iodinated Contrast - 80-90kV • Double Contrast - 90-100kV • Barium/potato starch - 100-125kV 73
- 74. ◄ Single contrast Double contrast ► Barium/Potato Starch contrast ► 74
- 75. Lower GI in relation to the peritoneal cavity: 1. Jejunum? 2. Ascending & descending? 3. Ileum? 4. Duodenum? 5. Sigmoid? 6. Transverse? 7. Rectum? 1. Intraperitoneal 2. Retroperitoneal 3. Intraperitoneal 4. Retroperitoneal 5. Intraperitoneal 6. Intraperitoneal 7. Retroperitoneal & Infraperitoneal 75
- 76. What quadrant(s) is the: 1. Hepatic flexure? 2. Transverse colon? 3. Splenic flexure? 4. Sigmoid colon? 5. Cecum? 1. RUQ 2. RUQ & LUQ 3. LUQ 4. LLQ 5. RLQ 76
- 78. Barium vs Air in Large Intestine 78
- 79. PA BE • Body is prone • Align MSP to Midline • Ensure no rotation • CR ┴ to IR • CP to iliac crest 79
- 80. 80
- 81. RAO/LPO BE • Body is rotated 35°-45° • CR ┴ to IR • CP at the iliac crest & 1” to the left of MSP • Right colic/hepatic flexure 81
- 82. 82
- 83. LAO/RPO BE • Body is rotated 35°-45° • CR ┴ to IR • CP 1-2” ABOVE iliac crest & 1” to the upside of MSP • Left colic/splenic flexure 83
- 84. Great positioning… However: On this view the most important anatomy is clipped! 84
- 85. Lateral Rectum BE • Body is in lateral recumbent • Midcoronal plane to midline • Ensure no rotation • CR ┴ to IR • CP at level of ASIS & Midcoronal Plane 85
- 86. 86
- 87. Lateral Decubitus BE • Body is in lateral recumbent • Ensure no rotation with IR • CR is horizontal to IR • CP at iliac crest* • *possibly center higher for when Left colis/splenic flexure is up. 87
- 88. 88
- 89. AP Axial BE • Body is supine • Align MSP to Midline • Ensure no rotation • CR 30°-40° cephalad to IR • CP 2” inferior to ASIS 89
- 90. 90
- 91. AP Axial Oblique LPO (Butterfly) BE • Body is rotated 30°-40° LPO • CR 30°-40° cephalad to IR • CP 2” inferior and 2” medial to right ASIS • Elongates sigmoid colon 91
- 92. 92
- 93. 93
- 94. PA Axial Oblique RAO (Butterfly) BE • Body is rotated 35°-45° LPO • CR 30°-40° caudad to IR • CP at the level of the ASIS and 2” to the left of the lumbar spinous processes • Elongates sigmoid colon 94
- 95. AP Post Evac BE • Body is supine • Align MSP to Midline • Ensure no rotation • CR ┴ to IR • CP to iliac crest 95
- 96. 96
- 97. BE Technical Error: Rectal sigmoid decompressed. Give more air and repeat image. 97
- 98. Lower GI Pathology: Ulcerative Colitis Normal Hustra 98
- 101. Lower GI Pathology Colon Herniated into the chest 101
- 104. Urinary System IVU Routine Views: • AP & Tomo Scout • Nephrotomogram • Both Obliques • Uprt (opt) • PostvoidCystogram Routine Views: • AP • Both Obliques • Postvoid/voiding 104
- 105. Urinary organs in relation to the peritoneal cavity: 1. Kidneys? 2. Ureters? 3. Adrenal glands? 4. Bladder? 5. Reproductive organs? 1. Retroperitoneal 2. Retroperitoneal 3. Retroperitoneal 4. Infraperitoneal 5. Infraperitoneal 105
- 106. 106
- 107. AP Intravenous Urography • Body is supine • MS to midline • Ensure no rotation • CR ┴ to IR • CP to level of iliac crest • At timed intervals 107
- 108. 108
- 109. AP Nephrogram Urography • Body is supine • MS to midline • Ensure no rotation • 10°-20° angle tomogram • CR ┴ to IR • CP midway between xiphoid & iliac crest 109
- 110. Understanding Kidney positioning for Tomography slices Scout: Measure thickness of patient including pad. Divide by 2, then subtract 2. 110
- 112. LPO/RPO Intravenous Urography • Body is rotated 30° • CR ┴ to IR • CP at the iliac crest • LPO = Right kidney in profile, proximal left ureter & distal right ureter. • RPO = Left kidney in profile; proximal right ureter & distal left ureter. 112
- 113. LPO RPO 113
- 114. Oblique IVU Kidney - UP Proximal Ureter - DOWN Distal Ureter - UP 114
- 115. AP Uprt/PA Post Void Intravenous Urography • Body is AP Uprt or prone • Align MSP to Midline • Ensure no rotation • CR ┴ to IR • CP to iliac crest *MUST include bladder 115
- 116. 116
- 122. Intravenous Urography Procedure Surgical Retrograde 122
- 123. AP Cystography • Body is supine • MS to midline • CR 10°-15° caudad to IR • CP 2” superior to pubic symphysis 123
- 124. LPO & RPO Cystography • Body is rotated 45°-60° • CR 10°-15° caudad to IR • CP 2” superior to pubic symphysis & 2” medial to upside ASIS 124
- 125. Lateral Cystography • Body is lateral recumbent • Midcoronal is ┴ to IR • CR ┴ to IR • CP 2” superior to and posterior to pubic symphysis 125
- 126. ◄LPO RPO► ◄ Lateral Cystography Name the view: AP/Voiding► 126
- 129. Biliary Tract System Exams: • Oral Chole • Surg Chole • Surg T-tube • ERCP 129
- 131. 131
- 133. Biliary Tract Procedure Surgical Cholangiogram w/C-Arm133
- 134. Biliary Tract Procedure Surgical Postoperative T-tube Cholangiogram 134
- 135. Biliary Tract Procedure Endoscopic Retrograde Cholangiopancreatography (ERCP) 135
- 136. ~ The End ~ 136