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Plain Film

Complete Abdomen
Supine

Looking for
n

n
n

Scout film for


gas pattern
Calcifications
Soft tissue
masses

Complete Abdomen
Erect

Looking for
n

Free air

Air-fluid levels

Complete Abdomen
LLD

Looking for
n

Free air

Air-fluid levels

Complete Abdomen
Erect Chest

Looking for
n
n

Free air
Pneumonia at
bases
Pleural effusions

Normal Gas Pattern


n

Stomach
n

Small Bowel
n

Always
Two or three loops of non-distended
bowel
Normal diameter = 2.5 cm

Large Bowel
n

In rectum or sigmoid almost


always

Gas in
stomach

Gas in a
few loops
of small
bowel

Gas in
rectum or
sigmoid

Normal Gas Pattern

Normal Fluid Levels

Stomach
n

Small Bowel
n

Always (except supine


film)
Two or three levels
possible

Large Bowel
n

None normally

Always
air/fluid
level in
stomach

A few
air/fluid
levels in
small
bowel

Erect Abdomen

Large vs. Small Bowel


n

Large Bowel
n
n

Peripheral
Haustral markings don't
extend from wall to wall

Small Bowel
n
n

Central
Valvulae extend across
lumen

Abnormal Gas Patterns


n

Functional Ileus
n

Localized (Sentinel
Loops)
Generalized adynamic
ileus

Mechanical
Obstruction
n

SBO

LBO

SBO

OMD

INDIKASI
Kelainan mobilitias
Kelainan mukosa (ulkus, divertikel, inflamasi)
Keganasan
Degeneratif
Kelainan kongenital
Kelainana obstruktif

KONTRA INDIKASI
Perforasi
Alergi kontras
Obstruksi total upper GI

PROSEDUR
Anamnese pasien adanya obstruksi
Puasa selama 6 jam sebelum pemeriksaan
Persiapan kontras barium , esofagus 1: 1 dan

saluran cerna yang lain 1: 3


Bila curiga perforasi atau fistel menggunakan
kontras water soluble

Kontras diminumkan mll oral ( 1; 1) , untuk

mengisi esofagus sambil dilakukan


fluoroskopi
Lalu kontras Barium sulfat (1 : 3 ) diminumkan
mll oral , namun untuk mengisi udara di
lambung, pasien menggunakan evervescent .
Posisi pasien supine

Pasien diminta untuk berputar, terlentang ,

miring , telungkup , miring kontralateral


dilakukan 2 kali. Lakukan fluoroskopi
untukmelihat kelainan.
Setelah full filling , dapat dinilai mulai gaster,
duodenum saat bulbus terbuka dan terisi pars
descendens dan ascendens duodenum

Barium Swallow, Single Contrast

Cricopharyngeu
s Muscle
At level of C5-C6,
Part of upper
esophageal
sphincter (UES)

Esophagu
s

Barium Swallow, Single Contrast


Main
Indication:
Dyshagia

Barium Swallow, Double Contrast

Double
Contrast

Identation of
A.A

Indentation of
L.main
bronchus

Single Contrast

Barium Swallow, Single Contrast

Double Contrast

L.
A
.

Heart

L.
V.

Barium Swallow, Double Contrast

Indentation of
L.main
bronchus

Double Contrast

Single Contrast

Barium Swallow, Single Contrast

Ampulla
Normal Varient

Fundus

Body

Barium Swallow, Single Contrast

Aortic
Arch

Barium Swallow, Double Contrast

Narrowing:
Could be peristalsis
So other shot is
advised

Barium Meal, Double Contrast


(Supine Position)
Supine

Position:

Note Barium
Distribution in the
Fundus due to gravity

Angular Notch
Incisura
Angularis

Antrum

Bod
y

Barium Meal + Follow-Through


(Erect Position)
DJJ:

Barium
Meal

Normal Position= Left


side

Angular Notch
Incisura Angularis

Duodenal
Cap
Pyloric
Canal
2nd Part of
Duodenum
3rd Part of
Duodenum

Ileu
m

Body
Antru
m

Jejunum:
Plica Circularis on the
outer border

Barium
Follow-Through

Barium Follow-Through to Cecum


(Erect Position)

DJJ:
2nd Part of
Duodenum
3rd Part of
Duodenum

Normal Position= Left


side

Small Bowel Enema

A Modified Follow-Through which is called Small Bowel Enema note that the
bowel is more distended here
This procedure involves inserting a thin tube through the mouth, esophagus and past the stomach to inject
barium, methylcellulose and water into the small bowel. This allows for better visualization of the small bowel
than can be seen during a small bowel follow-through

Colon in loop

Fluoroscopy

Persiapan Pasien
48 jam sebelum pemeriksaan pasien makan makanan
lunak rendah serat
18 jam sebelum pemeriksaan ( jam 3 sore ) minum tablet
dulcolax
4 jam sebelum pemeriksaan ( jam 5 pagi ) pasien diberi
dulkolak kapsul per anus selanjutnya dilavement
Seterusnya puasa sampai pemeriksaan
30 menit sebelum pemeriksaan pasien diberi sulfas atrofin
0,25 1 mg / oral untuk mengurangi pembentukan lendir
15 menit sebelum pemeriksaan pasien diberi suntikan
buscopan untuk mengurangi peristaltic usus.

Persiapan Bahan
Media kontras BaSO4 = 70 80 % W/V ( Weight
/ Volume ), banyaknya sesuai panjang
pendeknya kolon kurang lebih 600 800 ml
dengan perbandingan 1: 8
Air hangat
Vaselin atau jelly

Teknik Pemasukan Media Kontras


Metode Kontras Tunggal
Pemeriksaan hanya menggunakan BaSO4
sebagai media kontras.
Kontras dimasukkan ke kolon sigmoid,
desenden, transversum, ascenden sampai
daerah seikum.
Dilakukan pemotretan full fillng
Evakuasi, dibuat foto post evakuasi

Metode Kontras Ganda


Kontras Ganda Satu Tingkat
Kolon diisi BaSO4 sebagian selanjutnya ditiupkan
udara untuk mendorong barium melapisi kolon
Selanjutnya dibuat foto full filling

Kontras Ganda Dua Tingkat


Tahap pengisian
Kolon diisi BaSO4 sampai kira 2 fleksura lienalis atau
pertengahan kolon transversum
Pasien disuruh merubah posisi agar barium masuk ke
seluruh kolon
Tahap pelapisan
Menunggu 1 2 menit supaya barium melapisi
mukosa kolon
Tahap pengosongan
Pasien disuruh BAB

Tahap pemotretan
Pemotretan dilakukan apabila yakin seluruh kolon
mengembang semua
Posisi pemotretan tergantung dari bentuk dan
kelainan serta lokasinya.
Proyeksi PA, PA oblig & lateral ( rectum )
Proyeksi AP, AP oblig ( kolon transversum termasuk
fleksura)
Proyeksi PA, PA oblig pasien berdiri ( fleksura lienalis
dan hepatica)

Radiography Of Colon
Barium Enema
Pneumo Colon

Single or double contrast


Single

demonstrates
anatomy and
tonus (contraction)
of colon, along
with most
abnormalities
Feces

Double Contrast
Double allows

visualization of
lumen along
with any
polyps or
lesions

AP Projection - Barium
Enema
Supine
MSP centered to

cassette
CR at iliac crest
Entire colon must
be included
Two cassettes are
sometimes
necessary

PA Projection - Barium
Enema
Pt. prone
MSP centered to film
CR at iliac crest
Entire colon must be

visualized
Barium should be
sufficiently
penetrated with
surrounding
structures visible

PA Axial Projection - BE
Pt. prone
MSP centered to film
CR directed 30 - 40

degrees caudal to
ASIS
Demonstrates
rectosigmoid area of
colon
Area must be
centered to film

PA Axial Projection - BE

AP Oblique Projection BE
Pt. supine
Body rotated 35 -

45 degrees
CR 1 - 2 in. lateral
to midline at iliac
crest

AP Oblique Projection BE

LPO - Right colic


flexure, ascending
and sigmoid
portions of colon
RPO - Left colic
flexure, descending
colon
Must demonstrate
entire colon
Which oblique is
this?

THANK YOU,,,