for radiology

1. Barium Enema
By Virendra K Maurya

2. It is the radiographic study of the large bowel
by administration of the contrast medium
through the rectum.

3.  Barium sulphate
 Particle size varies from 0.6-1.4 microns (fine
and uniform) to 4-50 microns (large crystal in
more heterogeneous form).
 Nature :-
 rapid flow, good mucosal adhesion, adequate
radiographic density, an even coating

4.  Carboxy Methyl Cellulose
 Simethicone, Gum acaeeae, Pectin
 Dimethyl Polysilicone (anti foaming agent)

5.  Diet- A low residue (low fibre) diet for 2 days
prior to the examination.
 Laxatives- (removal of most solid material)
 Castor Oil (30 ml)
 Bisacodyl (15-20 mg) (Dulcolax.)
 Magnesium Citrate (5-10 mg)- Picolax (one
sachet contains 10 mg of sodium
picosulphate, 3.5 g of magnesium oxide and
12 g of citric acid).

6.  Bowel Wash:-
 Left lateral position-receiving first 500 ml.
 Prone position-receiving second 500 ml.
 Right lateral position-receiving third 500 ml.

9.  by Fischer in 1923 and later popularized by
Welin in 1960s.

10.  Plain radiograph of the abdomen is essential
and helps in assessing any abnormalities of
gas filled bowel loops.

12.  Barium suspension : High density (slower
flowing, better coating) 75% to 95% w/v.
 The patient is in prone position with left side
down oblique and high density low viscosity
barium suspension is allowed to flow upto
splenic flexure.

13.  Air should push the barium column and
never pass beyond the column. The role of IV
muscle relaxant before or after the double
contrast barium study had found to have no
effect on the mucosa! coating. Frontal view
of rectum is taken in prone position and then
the patient is turned left lateral to take the
lateral view. Then oblique right side down
view for recto sigmoid junction is taken. The
patient is taken back in prone position with
right side dependent and air is pumped into

14.  left sided colon. Once barium comes into
transverse colon turm the patient left side
up - barium enters right sided colon and
reaches the ileocaecal junction. Now with
the right side up, more air is pumped till air
outlines the ileocaecal junction. Take spot
films for flexures and ileocaecal junction.
Now proceed with full films in supine, both
decubitus and erect as required.

16.  Buscopan 1ml i.v
 Use Foley's catheter with big balloons.

17.  Indications
 1.Uncooperative, very debilitated or
immobile patient.
 2. Evaluation of acute obstruction or
volvulus
 3. Reduction of intussusception.
 4. Show configuration of colon.
 5.Where only gross pathology is to be
excluded.

18.  Contraindications
 1. Allergy to barium suspension.
 2. Risk of perforation.
 3. Peritonitis.
 4. Suspicion of acute/fulminating ulcerative
colitis.
 5. Following a recent deep biopsy

19.  Barium suspension : Low density (to promote
see through effect with a high kV or
compression) 15% to 20% w /v.

20.  Pelvic outlet view for rectum : Give 30°
cranial angulation to the tube with the
patient supine so that pubic symphysis and
sacral promontory overlap.
 Pelvic inlet view for sigmoid : Should be
taken before the transverse colon is filled
with barium. 30° caudal tilt is given to the X-
ray tube with patient supine.

21.  SPECIAL BARIUM ENEMA STUDIES
 Sigmoid Flush
 500-700 ml of dilute barium suspension is run in at
the end of standard DCBE and spot radiographs are
taken of the filled sigmoid and descending colon.
 Colostomy Enema
 A non-wash out bowel preparation is strongly advised
in patients with a colostomy. Standard barium
suspension may be used.
 Instant Barium Enema
colitis- No bowel preparation is required as residue
does not accumulate in a segment of active colitis.
 Water-Soluble Contrast Enema (*Gastrografffin )

22.  Patient evacuates after SCBE.
 Adequacy of evacuation is checked. If the
evacuation is near total, about 300-400 ml of
barium is again filled.
 Now air is pumped in from the rectum under
fluoroscopy and double contrast filming is
done.
 If there is a large amount of residual
barium, then supine, right and left
decubitus, frontal films, and if required,
erect films should be taken.

23.  Colonoscopy • This exam involves placing a
flexible endoscope into the colon.
 VIRTUAL COLONOSCOPY Virtual colonoscopy,
also known as CT colonography, refers to
using spiral CT scanning or multidetector CT
and computers to simulate colonoscopy by
generating high-resolution multidimensional
views of the colon.
 CT COLONOSCOPY In this procedure entire
colon is visualized by C.T. examination with 3
D reconstruction.

24.  MR COLONOGRAPHY Currently three different
liquid enema techniques are used for MR
colonography
 1 Bright lumen. Water gadolinium enema is
used.
 2. Black lumen. Water enema for luminal
distension and intravenous infusion of
gadolinium for enhancement of the colonic
wall.
 3. Fecal tagging. Based on die that contains
barium to give stools the same signal
intensity as water on T1Wt GRE image.

25.  Radiological Procedures {A Guideline)
Dr Bhushan N. Lakhkar
Professor and Head Department of
Radiodiagnosis & Imaging
Shri B M Patil Medical College, BLDE University,
Bijapur, Kamataka