Radio graphic technique 3

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

8. Small Bowel

9. Small Bowel

10. Small Bowel

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

15. Small Bowel