The document provides an overview of the anatomy and radiographic examinations of the digestive system, including the esophagus, stomach, small intestine, and large intestine. It describes the layers, parts, and functions of the digestive organs, as well as clinical indications and procedures for upper GI series and barium swallow exams. The objectives are to discuss contrast media, imaging techniques, anatomy, procedures, and pathology related to evaluating the digestive system radiographically.

1. CHAPTER THREE
DIGESTIVE SYSTEM
B Nigatu
1

2.  Listen to the video
and tell what you
have observed.
2

3. 3

4. OBJECTIVES
After completing this chapter, the student will be able to:
 Discuss the use of contrast media in radiographic
examinations of the digestive system, to include preferred
type and route of administration
 Identify alternative methods for evaluating the digestive
system
 Evaluate radiographs of the digestive system in terms of
positioning, centering, image quality , radiographic anatomy
and pathology
 Define terminology associated with the digestive system, to
include anatomy, procedures and pathology
4

5. ANATOMY OF THE DIGESTIVE
SYSTEM
The digestive system is divided into:
 The alimentary canal and
 The accessory organs of digestion
5

6. Anatomy Cont---
1. The alimentary Canal: - is a long, hollow tube
measuring slightly less than 9 m long.
 It extends from the mouth to the anus,
consisting of the mouth, pharynx, esophagus,
stomach, small intestine and large intestine.
 It is open on both ends, with the inside channel
called the LUMEN
6

7. Anatomy Cont---
There are generally four layers of tissue forming
the walls of the alimentary canal namely:
 MUCOSA: is a mucous membrane forming
the first inner lining of the canal. This layer
has three functions protective, secretory and
absorptive.
 SUBMUCOSA: It is the second layer; Blood
vessels, nerves and lymph vessels supplying
the alimentary canal are located in this layer
7

8. Anatomy Cont---
 MUSCULARIS: it is the third layer. It consists
of an inner coat of circular muscle tissue and
an outer coat of longitudinal muscle tissue.
The contraction of these muscle layers occurs
in waves which pushes the content of the tract
onwards. This contraction of smooth muscle is
known as PERISTALSIS
8

9. Anatomy Cont---
SEROSA or ADVENTITIA (outer covering) it
is the fourth and most superficial layer. It is
the visceral portion of the peritoneum.
2. The accessory organs of digestion include:
the teeth, tongue, salivary glands, liver,
gallbladder and pancreas.

9

10. ESOPHAGUS
Is a hollow muscular tube that is approximately
25 cm long, beginning at the level of C6 and
terminating at about T11. Its only function is to
transport food and fluids from the pharynx to
the stomach. As it passes through the
mediastinum of the thorax, it is positioned
posterior to the trachea and heart and
anteriorly to the vertebral column
10

11. Esophagus
11

12. Esophagus Cont---
 The esophagus normally demonstrates three
indentations caused by the proximity of the
aortic arch, the left main bronchus and left
atrium
12

13. Indentations
13

14. Esophagus Cont---
 At its distal end, the esophagus veers slightly
to the left of the body’s mid line and passes
through an opening in the diaphragm at the
level of T10 called ESOPHAGEAL HIATUS.
The abdominal esophagus is less than 1-2 cm
in length, and it is referred to as the CARDIAC
ANTRUM as it is situated near the heart. The
esophagus merges with the stomach at the
gastro esophageal junction (Cardiac Orifice),
which is located approximately at the level of
T11.
14

15.  A condition in which
the upper portion of
the stomach
protrudes up
through the
esophageal hiatus is
known as a HIATAL
or
DIAPHRAGMATIC
HERNIA.
15

16. STOMACH
 The STOMACH is a J-shaped dilated portion
of the alimentary tract situated in the left upper
quadrant of the abdomen, or more specifically,
in the epigastric, umbilical, and left
hypochondriac regions.
16

17. Surface anatomy
17

18. Stomach Cont---
 When the stomach is empty, its mucosal lining
falls in to longitudinal ridges and folds called
RUGAE. (rugae = “wrinkles“).The average
stomach measures about 25 cm in length. The
volume of the stomach ranges from 50 ml
when almost empty to 1.5L when distended.
The stomach acts as a holding chamber so
that the digestion of proteins is initiated and
the food particles are mixed into CHYME
(semi fluid substance).The esophagus enters
the stomach
18

19. Stomach Cont---
 through an opening called the CARDIAC
ORIFICE; the opening is guarded by the
CARDIAL SPHINCTER.The small area
surrounding the cardiac orifice is known as the
CARDIA.
19

20. Main portions of the stomach
 fundus,
 body, and
 pyloric antrum.
20

21. Portion Cont---
 The FUNDUS is the rounded, upper portion of
the stomach located laterally to the cardiac
orifice. It is the most posterior portion of the
stomach
 The BODY is the large, central area of the
stomach. It is the most anterior portion of the
stomach.
21

22.  The PYLORIC ANTRUM (Pyloric portion or
Pylorus) is the funnel shaped area located
inferiorly to the body and in the curve of the
stomach. The pyloric antrum narrows into the
pyloric canal as it joins the duodenum of the
small intestine at the pyloric orifice. The pyloric
sphincter acts as a valve at the orifice to adjust
the flow of chime into the duodenum
22

23. Curved margins:
 The Greater curvature:- It is the lateral
margin on the left side of the stomach and is
long and convex border. It is approximately 40
cm long.
 The lesser curvature: It is the medial margin
on the stomach’s right side. It is shorter and
concave border. It is about 10 cm long.
23

24. notches
 The ANGULAR NOTCH (Incisura angularis) is
located on the lesser curvature where the
stomach curves to the right side of the
abdomen. It marks the transition between the
body of the stomach and the pyloric antrum.
24

25.  The CARDIAC NOTCH (Incisura Cardiaca):-
is located on the superior aspect of the
stomach between the cardiac antrum of the
esophagus and the greater curvature
25

26. Stomach
26

27. SMALL INTESTINE
 The small intestine is continuous with the
stomach at the pyloric sphincter and leads into
large intestine at the ileocecal valve. It is the
longest portion of the alimentary canal with an
average length of 6 m.
27

28. segments of small intestinem
 The DUODENUM: is the first and the shortest
segment measuring approximately 25 cm in
length; it is usually C-shaped with the head of
the pancreas lying in the C-loop.
 It is divided into four parts: the duodenal bulb
or Cap, descending duodenum, the horizontal
duodenum and the ascending duodenum
 The junction between the duodenum and
jejunum is a rather sharp bend called the
duodenojejunal flexure or angle of Treitz.
28

29. 29

30.  The JEJUNUM: It is the second segment of
the small intestine; it measures approximately
2.5 m.
 The ILEUM: is the last segment and measures
in as the longest segment at approximately 3.3
m
30

31.  The last portion or terminal ileum connects to the
large intestine at the ILEOCECAL VALVE located
in the right lower quadrant of the abdomen.
 Chyme moves through the small intestine in a
spiral fashion because of small circular folds in
the mucous membrane called PLICAE
CIRCULARIS.
31

32.  After the administration of positive contrast
medium, the jejunum normally resembles sponge
painting, appearing rather light and feathery ( due
to the presence of too many plicae circularis)
Because the plicae circularies are not as
predominant in the ileum, this part of the small
intestine appears much smoother
32

33. • Another characteristic of the small intestine is the
presence of tiny villi. These fingerlike protrusions of
the mucosal membrane range from 0.5-1mm &
serve to increase absorption.
33

34. 34

35. LARGE INTESTINE
 The large intestine functions to manufacture
particular vitamins; to absorb water, which
allows feces to form and compact; and to
expel the feces from the body. The average
length of the large intestine is 1.5 m.
35

36. Parts
 Cecum,
 Colon, and
 rectum
36

37. Parts Cont---
The Cecum is a rounded sac measuring 5-8 cm
and located inferiorly to the ileocecal valve in the
right iliac region or right lower quadrant of the
abdomen.
The appendix or vermiform process is a
narrow pocket hanging from the posteromedial
surface of the cecum. It measures from 5-15
cm in length: its wall contains lymphatic tissue.
37

38. • The second segment of the large intestine called
the colon is a long tube that continues from the
cecum to the rectum. It is subdivided into four
parts:-
 The ascending colon is directed superiorly
from the cecum to the right upper guardant,
where it bends medially and anteriorly at the
right colic flexure or hepatic flexure.
38

39.  The transverse colon is the longest part of the
colon. It crosses the upper anterior abdomen
from the right to left sides, where it bends
inferiorly & posteriorly under the spleen to form
the left colic or splenic flexure.
39

40.  The descending colon is located on the left
side of the abdomen and extends inferiorly
from the splenic flexure into the pelvis, where it
becomes the sigmoid colon
 The sigmoid colon or pelvic colon (because of
its location) is an S-shaped loop of the colon
extending from the iliac crest of pelvic brim
inferiorly to the third segment of the sacrum
where it connects the rectum.
40

41. The transverse colon & sigmoid colon are
intraperitoneal structures, but the ascending &
descending colon are retroperitoneal.
The rectum is the last segment of the large intestine,
measuring approximately 15 cm in length. It is a
retroperitoneal structure. The last 2-3 cm of the
rectum is a more constricted area called the anal
canal.
41

42.  The external opening of the rectum is the anus
which is guarded by the internal & external
anal sphincters. The internal sphincter is
involuntary where as the external one is
voluntary.
42

43.  The longitudinal muscle in the large intestine
consists of three bands called TENIAE COLI
situated round the colon. As these bands of
muscle tissue are slightly shorter than the total
length of the colon they produce a puckering
effect and form HAUSTRA (sacs or pouches).
43

44. Large Intestine
44

45. Rad. Exam of Upper GI
Barium Swallow
Barium swallow is the common radiographic
procedure which includes the examination of
the pharynx and esophagus utilizing
radiopaque CM (mostly barium sulfate).
45

46. Clinical Indication
DYSPHAGIA: is difficulty in swallowing.
The cause may be:
 due to congenital or acquired condition,
 paralysis of the pharyngeal or esophageal
muscle,
or inflammation. Narrowing or an enlarged,
flaccid appearance of the esophagus is seen.
46

47. Indication Cont---
ACHALASIA : failure of the esophagogastric
sphincter to relax with swallowing, due to
degeneration of ganglion cells in the wall of
the organ.
47

48. Indication Cont---
DIVERTICULA/ZENKER’S DIVERTICULUM
(pharyngeal pouch): is characterized by a
large out pouching of the esophagus just
above the upper esophageal sphincter. It is
cause by weakening of the muscle wall.
48

49. Zenker’s diverticulum
49

50. Indication Cont---
 ESOPHAGEAL VARICES: Are characterized
by dilation of the veins in the distal esophagus.
It occurs as a consequence of portal
hypertension in cirrhosis of the liver. It has a
“Worm like” appearance on esophagram.
50

51. Esophageal varices
51

52. Indication Cont---
 CARCINOMA OF THE ESOPHAGUS: It is the
most common tumor of the esophagus. On
barium swallow a carcinoma produces an
irregular intraluminal mass, or deformity with
loss of normal distensibility and narrowing, or
a small plaque, nodule, polyp or ulcer.
52

53. Esophageal carcinoma
53

54. Indication Cont---
 BENIGN ESOPHAGEAL TUMORS: Barium
swallow examination demonstrates a filling
defect bulging into the esophageal lumen.
54

55. Esophageal Tumor
55

56. Radiological Procedure
Esophagus
PREPARATION OF THE PATIENT
 Inform the patient about the procedure
 Prepare a thick paste of barium
56

57. Projection
Two possible ways of doing:
 Fluoroscopy guided & Table Top
PA CXR may be requested as a scout film.
Fluoroscopic examination
With the patient in the upright position, the
study begins with a preliminary fluoroscopic
examination of the esophagus prior to
administration of CM.
57

58. Projection Cont----
 using fluoroscopy the esophagus is assessed
as the patient swallows a barium paste.
 Spot films of the areas of interest are obtained
at this time.
 Film size- 24x30 cm film is loaded length wise
in the cassette changer.
58

59. Projection Cont---
Over table, Table Top
AP
Prier to the exam, a thick paste of barium Sulphate is
prepared with a cup.
Patient should be undressed above the waist.
Position the patient in lying or erect or supine position.
CP. Mid point of the cassette 7.5cm inferior to sternan
notch.
Technical factors
 Film size: 30x40 cm lengthwise
 Use high KV technique
 Use gonad shield
59

60. AP Supine
60

61. Projection Cont---
RAO
Patient position
 Rotate the patient 350- 400 from supine position to
RAO position
 Place right arm down & left arm flexed at elbow.
 Rise the patient’s head up.
 provide the patient with the cup of barium
 Flex left knee for support (recumbent)
Central ray
 7.5 cm inferior to jugular notch (T5-T6)
61

62. RAO
62

63. Lateral
Patient position
 Position patient recumbent or erect
 Adjust the patient to a true right or left lateral
position ; arms should be placed over the
head, with the elbows flexed and
superimposed
 Align the mid coronal plane to midline of the
table. CP 7.5cm below sternal notch
63

64. Lateral
Technical factors
 Film size :30x40 cm lengthwise
 Use high KV technique
 Use gonad shield
64

65. Lateral
65

66. Upper GI series
Barium Meal
Barium meal is the radiographic examination of
the Distal Esophagus, Stomach and
duodenum.
66

67. Clinical Indication
• GASTRIC CARCINOMAS: comprise 70% of all
stomach neoplasms.
Radiographic signs include a large irregular filling
defect with in the stomach, marked or nodular
edges of the stomach lining, rigidity of the stomach,
and associated ulceration of the mucosa.
• GOO
• Gastric ulcer
• Duodenal ulcer
67

68. Clinical Indication---
• DIVERTICULA: are weakening and blind
outpouchings of a portion of the mucosal wall.
They can best be demonstrated with lateral
projection.
• HEMATEMESIS ( the vomiting of blood): which
may indicate other forms of pathologic processes
in the stomach
68

69. B meal Cont----
Patient preparation
 NPO after mid nighit or 8 hrs before the exam
 The patient should not :
 chew gum & smoke.
69

70. BM Cont---
Technique
Double contrast technique is used to
demonstrate gastric mucosal surface; and it
also allow the demonstration of very small
abnormalities . Eg early gastric carcinoma
70

71. BM Cont---
 Approximately 0.1mg of glucagon is injected
intravenously inorder to relax the stomach and
suspend peristalsis
 The patient is then instructed to ingest gas-
producing substance (Ca or Mg citrate, sodium
bicarbonate) prior to ingestion of CM. This
releases CO2 with in the stomach and
achieves gastric distention (200-300 ml of gas
is sufficient)
 The patient then rapidly drinks about 200ml
barium sulfate suspension
71

72. B meal Cont----
 In order to coat the mucosal surface properly
with barium, the patient must be rolled in a
complete circle.
The examination usually begins with the
patient holding a cup of barium in the left hand
and standing behind a fluoroscopic tower. After
the path of the initial swallow of barium is
assessed, the table is lowered to the
horizontal position.
72

73. Cont-----
 Then the films will be taken in different
projections by the aid of fluoroscopy.
 All areas of interest will be imaged
 Spot films of duodenal cup in deferent position
will be taken by dividing the film into four parts.
AP, AO, PO and PA.
73

74. PA radiograph on the tab top
(BM)
Structure and pathology demonstrated:
body and pylorus seen barium filled
74

75. AP Radiograph (BM)
Structure and Pathology Demonstrated:
- Entire stomach & duodenum are visible,
- Fundus is filled with barium;
75

76. RAO Radiograph (BM)
Entire stomach:
Duodenal bulb and C-loop is in profile.
Demonstrate pathologies of the pylorus, duodenal bulb
and C-loop
76

77. RL Radiograph ( BM)
Structure & Pathology Demonstrated:
Pathologies of the retrogastric space are seen
77

78. Gastric ca
Ulcers
Ga polyps Extrinsic
masses
78

79. SMALL BOWEL EXAMINATION
 Examination of small bowel Includes:
 from the duodeno-jejunal flexure to the ileo-
cecal valve
 Small Bowel Follow Through (SBFT): upper
GI and small bowel series
79

80. INDICATIONS
 Enteritis
 Regional enteritis (crohn’s disease)
 Ilieus
 Diverticullum
 Neoplasm
 Malabsorption syndroms
80

81.  CONTRAINDICATIONS
 complete obstruction
 CONTRAST MEDIA
 Adult: 500-600ml of thin suspension of
barium sulfate
 Perforation: water soluble, iodinated CM
(Gastrographin)
81

82. Preparation
 Low-residue diet 1-2 days before the
examination
 Laxative is taken the night before the
examination
 NPO after evening meal
 Before the procedure the patient should void
82

83. SMALL BOWEL
PROCEDURES
 There are three types of small bowel
serieses:-
1. UGI-Small bowel combination (SBFT)
2. Small bowel only series
3. Small bowel enema (Enteroclysis).
 Method 1 and 2 are the commonest
 Method 3 is special type, it is performed
when method 1and 2 are unsatisfactory
or contraindicated
83

84. Procedure
 Routine upper GI series is done first, (200-
300ml) of CM
 The time the patient ingested the barium
should be noted
 Patient is given 1 additional cup of barium
 30 minutes after the initial ingestion, a PA
radiograph R adiographs are obtained at
specific intervals until barium passes
through ileocecal valve
 For the first 2 hours, radiographs are
usually obtained at 15-30 min intervals;
84

85. Proc Cont---
 If continuing, radiographs are obtained
every hour until barium passes the
ileocecal valve
 The region of the terminal ileum and
ileocecal valve is studied
fluoroscopically
 When compression cone is lowered
against the abdomen, it spreads out
loops of ileum to better visualize the
ileocecal valve
85

86. SMALL BOWEL ONLY SERIES
 Patient ingests 2 cups (500-600 ml) of barium
and the time is noted
 The first radiograph is taken either 15 or 30
minutes after ingestion
 Then, half hour radiographs are taken for 2
hours then 1-hour radiographs thereafter,
until barium reaches the cecum and/or
ascending colon.
86

87. SMALL BOWEL ENEMA
(ENTEROCLYSIS)
 patient is intubated under fluoroscopic
control with a special catheter up to
duodenojejunal junction
 First, barium is injected
 Fluoroscopic and conventional
radiographs are taken
 Then, either air of methylcellulose is
injected
87

88. 88

89. Advantage of ENTEROCLYSIS
over follow through:
 It bypasses the transit delaying action of the
pylorus
 Deliver contrast agent direct into the particular
section
 The chance of complete obstruction is less
 Better demonstrates stricture and dilated
bowel, ulceration and internal fistulae
89

90. POSITIONING SMALL BOWEL
PA/AP
90

91. Crohn’s disease
91

92. BARIUM ENEMA (LOWER GI
series)
 Investigation of the large intestine by
retrograde administration of CM via rectal
catheter
 Double contrast (air-contrast) method is used
92

93. INDICATIONS
 Colitis
 Diverticulum
 Neoplasm
 Intussusception
 Polyps
 Volvulus
93

94. CONTRAINDICATION
 Complete large bowel obstruction
 If a biopsy of the colon was performed (
Sigmoidoscopy, Endoscopy)
94

95. PATIENT PREPARATION
i. Low-residue diet for 2-3 days prior to
examination
ii. Increase fluid intake for 2-3 days prior to
examination
iii. Clear liquid diet 24 hours prior to
examination
iv. Laxative the afternoon before the
examination
v. Cleansing enema in the morning of the
examination
95

96. CM Preparation
Adult :
 500ml – 1000ml of thin barium suspension
 A lukewarm water at body temperature is used
2. In case of perforation iodinated CM is used
3. Air as a negative contrast agent
96

97. EQUIPMENT NEEDED
 Enema bag with barium tubing
 clamp and sterilized tip
 IV pole
 Disposable gloves
 Water- soluble lubricating jell
 Towel for wiping excess lubricant
97

98. EQUIPMENT PREPARATION
 Prepare the enema bag, clamp tubing about 6 in.
from the tip of the tubing and add enough warm
water to the barium filled bag to achieve the
desired consistency. Shake the bag to mix
thoroughly. Force the bead at the junction of the
bag and tubing in to the bag. Open the clamp and
allow the barium to fill the tubing.
 Using an IV pole, suspend the enema bag
approximately 24-30 in above the table
 Set disposable gloves and towel near the foot end
of the table
98

99. PATIENT PREPARATION
 When ready, explain the procedure to the
patient and instruct the patient to turn to the
left Sim’s position, cover the patient with a
blanket or sheet for warmth and modesty
99

100. PROCEDURE
 Wearing disposable gloves; cover the tip of the
catheter with lubricant
 Exposing only the anal area, spread the buttocks
with the fingers of your left hand
 Ask the patient to take in a breath and blow it out
slowly. During exhalation, gently push the
lubricated tip through the anus, directing it
superiorly and anteriorly in to the rectum2-4 in
initially, the tip should be pointed in the general
direction of the umbilicus. If resistance is
encountered, do NOT apply force.
100

101. Tipping
101

102. TECHNEQUE
 The barium is instilled under fluoroscopic
guidance with the patient in left sim’s position.
Then, the patient is rolled on the table to
maneuver the barium into the cecum.
102

103. Projections/ positioning for
barium enema
(PRELIMINARY, CONTRAST FILLED & POST
EVACUATION)
TECHNICAL FACTORS
 Film size : 35x35 cm
 Grid required
 Use high KV technique for single contrast and
reduce KV for double contrast
 Use gonad shield for male patients
103

104. PATIENT POSITIONING
 Patient lie prone ( if not possible, supine)
 Place arms up by the side of the head
 Align midsagital plane with the midline of the
table
104

105. CENTRAL RAY
 To the level of iliac crest
RESPIRATION
 Exposure is made during suspended
expiration
105

106. STRUCTURE DEMONSTRATED
 On a double-contrast study, barium will fill the
transverse colon when the patient is prone;
and the ascending and descending colon
when the patient is supine
 Entire large intestine should be demonstrated.
106

107. 107

108. AP OBLIQUE (RPO & LPO)
TECHNICAL FACTOR
 Film size : 35x35 cm
 Use grid
 Use high KV for single & less for double
contrast
 Use gonad shield
108

109. PATIENT POSITIONING
 Patient lie supine, rotated 350-450 into Right and
Left posterior obliques
 For the RPO, position the patient so the
midsagital plane is approximately 5-8 cm left of
the midline of the table. Note: Bothe oblique will
be obtained.
 Flex elevated side elbow and place in front of
head; place opposite arm down by patient’s side.
 Partially flex elevated side knee for support
 Align midsagital plane along long axis of table.
109

110. RPO/LPO
110

111. CENTRAL RAY
 To the level of iliac crest
BREATHING
 Exposure is made during suspended expiration
STRUCTURE DEMONSTRATED
 LPO: The right colic (hepatic) flexure and ascending
and rectosigmoid portions should appear “Open”
without significant superimposition.
 RPO: The left colic (Splenic) flexure and the
descending portions should appear “open” without
significant superimposition.
 Entire large intestine should be visualized
111

112. 112

113. LATERAL RECTUM (Contrast–filled & post
evacuation)
TECHNICAL FACTOR
 Film Size: 24X30 cm lengthwise
 Grid required
 Use high KV for single & less for double
contrast method
 Use gonad shield for male patient as long as it
does not compromise the examination.
113

114. PATIENT POSITIONING
 Patient lie to the left lateral position. Note: This
projection can also be obtained using prone
(ventral) decubitus, especially when performing a
double-contrast study.
 Align midaxillary ( midcoronal ) plane to midline of
the table
 Flex and superimpose knees; place arms up in
front of head.
 Ensure no rotation exists; superimpose shoulders
and hips
114

115. 115

116. CENTRAL RAY
 To the level of ASIS
BREATHING
 Exposure is made during suspended
expiration
STRUCTURE DEMONSTRATED
 Contrast-filled rectosigmoid region is
demonstrated
116

117. 117

118. LATERAL DECUBITUS BARIUM
ENEMA
(Double-Contrast study)
TECHNICAL FACTOR
 Film size: 35x35 cm /30x40 lengthwise
 Use Grid
 Use lower KV than the single contrast method
 Use gonad shield for males if it does not
compromise the examination
118

119. PATIENT POSITIONING
 Patient lie in Right and Left lateral decubitus
position one at a time on the table or stretcher
 The patient should be on or elevated by
radiolucent support.
 Place arms up, with knees flexed and
superimposed
 Ensure no rotation exists; superimpose shoulders
& hips from above
 Align midsagital plane to the midline of the
cassette
 AP or PA projections can be performed
119

120. 120

121. CENTRAL RAY
 To the level of iliac crest and midsagital plane
RESPIRATION
 Expose on suspended expiration

121

122. STRUCTURE DEMONSTRATED
 Right lateral decubitus: air-filled left colic
(splenic) flexure and descending colon
 Left lateral decubitus: air-filled right colic
(hepatic) flexure and ascending colon, and
cecum.
 Entire large intestine should be demonstrated
122

123. 123

124. AP AXIAL or AP AXIAL OBLIQUE
(LPO)
RECTOSIGMOID REGION
TECHNICAL FACTORS
 Film size : 35x35 cm
 Use Grid
 Use high KV for barium & less for double contrast
PATIENT POSITIONING
 AP AXIAL:-Position patient supine and align
midsagital plane to midline of the table -Ensure
there is no rotation
 LPO: Rotate patient 300-400 into LPO -Raise right
arm, with left arm extended, and right knee
partially flexed
124

125. CENTRAL RAY (CR)
 AP : Direct central ray 300-400 cephalad and 5
cm inferior to the level of ASIS
 LPO: Direct CR 300-400 cephalad 5 cm inferior
and 5 cm medial to right ASIS

125

126. 126

127.  BREATHING
 Expose on suspended expiration
STRUCTURE DEMONSTRATED
 AP AXIAL: Elongated views of the
rectosigmoid segments are visible with less
overlapping of sigmoid loops than with a 900
AP projection.
 AP axial (LPO): Better demonstrate a tortuous
rectosignmoid area with less superimposition.
127

128. 128

129. THANK YOU!
129