Radiographic Technique &

Procedure Urinary System

Procedure
Indication

Barium Enema
Complication

A.T. Ruaa Emad

CM
s

ruaa.hussen@epu.edu.iq

Radiology department
4th semester
2nd stage
 Barium Enema Procedure
Barium Enema
Procedure
Indication

CM

Content
Contrast Media Indication

Complications
 Learning outcome

Outcome
At the end of this lecture the student able to know
the radiographical procedure of Barium Enema
 Barium Enema
Barium Enema

It is radiographic study of large bowel by administration of barium

through rectum, Alternative names include BE (BaE ) and lower GI
series.
 Barium Enema
Purpose
The purpose of the barium enema is to demonstrate radiographically
the form and function of the large intestine to detect any abnormal
conditions. Both the single-contrast and the double-contrast barium
enema involve study of the entire large intestine.
Indications

1 2 3 4 5 6
Colon Inflammator Diverticular Patency
abdominal Failure
cancer y bowel
mass
disease
colonoscopy of distal
disease.
loop
Contraindications

1- Toxic megacolon: occurs when swelling and

inflammation spread into the deeper layers of the
colon.
2- Recent biopsy
3- Peritonitis: is a redness and swelling
(inflammation) of the lining of your belly or
abdomen
 Complications
1. Abstraction
2. Perforation
These patients should not be given barium
as a contrast medium. Although not as
radiopaque as barium sulfate, water-soluble
contrast media can be used for these
conditions.
- Anatomy of Urinary System

consists of:
1- two kidneys
2- two ureters
3- one urinary bladder
4-and one urethra
• he two kidneys and the ureters are organs that lie in the
retroperitoneal space. These two bean-shaped organs lie on either
side of the vertebral column in the most posterior part of the
abdominal cavity. The right kidney is generally slightly lower or more
inferior than the left because of the presence of the liver. Superior
and medial to each kidney is a su rarenal (adrenal) gland. These
important glands of the endocrine system are located in the fatty
capsule that surrounds each kidney.
• he two kidneys and the ureters are organs that lie in the
retroperitoneal space. These two bean-shaped organs lie on either
side of the vertebral column in the most posterior part of the
abdominal cavity. The right kidney is generally slightly lower or more
inferior than the left because of the presence of the liver. Superior
and medial to each kidney is a su rarenal (adrenal) gland. These
important glands of the endocrine system are located in the fatty
capsule that surrounds each kidney.
Urinary System
Urinary System
 Ureters

The ureters transport urine from the kidneys to

the urinary bladder. This is a radiographic image
taken 10 minutes after injection of contrast
medium into the bloodstream. It was performed
as part of an IV urography procedure. The ureters
vary in length from 28 to 34 cm, with the right
one being slightly shorter than the left.
- Ureters Size and Points of
Constriction

The ureters vary in diameter from

1 mm to almost 1 cm.
- Ureters Size and Points of Constriction

Normally, If a kidney stone attempts to pass from

kidney to bladder, it may have trouble passing
through these three regions

• The first point is the ureteropelvic (Up)

junction, at which the renal pelvis funnels down
into the small ureter.

• The second is near the brim of the pelvis, where

the iliac blood vessels cross over the ureters.

• The third is the ureterovesical junction, or UV

junction where the ureter joins the bladder.
 - Rectum and Anal Canal
The rectum extends from the sigmoid colon to the anus
CM
 - Radiograph
The radiograph demonstrates the
four parts of the colon
ascending, transverse,
descending, and sigmoid
CM

The two flexures

the right colic (hepatic) flexure and
the left colic (splenic) flexure.
Three parts of the large intestine
cecum, rectum, and anal canal
https://youtu.be/AwGt8TKOrnI?si=es8zqD8l7I2269O0
 Equipment and supplies

• A closed-system enema container is used

to administer barium sulfate or an air and
barium sulfate combination during the barium
enema.
 Equipment and supplies
• This system,, includes: 1-the disposable enema
3
bag with a premeasured amount of barium
1
sulfate.
4
• Once mixed, the suspension travels down its
own 2-connective tubing.

• Flow is controlled by a3- plastic stopcock.

• 4-An enema tip is placed on the end of the

2
tubing and is inserted into the patient’s rectum.
 Equipment and supplies
Enema tips: various types and sizes of enema

tips are available, all are considered single-use,

disposable enema tips.

• The three most common enema tips are

(A) plastic disposable

(B) rectal retention (retention catheters)

(C) air-contrast retention enema tips (retention

catheters).
 Equipment and supplies

• A special type of rectal tip (C) is needed to

inject air through a separate tube into the
colon.

The air mixes with the barium to produce a

double-contrast barium enema examination.
Contrast Media
Barium sulfate is the most common type of positive-contrast medium used for the barium enema

CM 1 SINGLE CONTRAST

2 Double contrast
 Single
Contrast 1 • low density contrast media
of barium sulphate, 15% -
25% weight-to-volume (w/
v).
 Double
Contrast 2
• High density contrast media of
barium sulphate, 75% - 95% or
greater + Air.
Room of
Patients
preparation
Contrast Media Preparation

1- Shaking the enema bag before tip insertion is important for preventing
separation of barium sulfate from water.
2- Glucagon can be given intravenously, to prevent spasm.
 PATIENT
PREPARATION

1 Low fiber diet • for 2 days

Bisarcodyl tab for 2 days\

2 laxative caster oil
Bowel wash
Water cleaning enema previous
night and at morning
3 Water cleaning
•Patient preparation

1-The patient is placed in sims

position before the enema tip is
inserted.
 •Preparation for Rectal Tip Insertion
Step 1 Describe the tip insertion procedure to the patient.
Answer any questions.
Step 2 Place the patient in Sims position. The patient should lie
on the left side, with the right leg flexed at the knee and hip.
Step 3 Shake the enema bag once more to ensure proper mixing
of barium sulfate suspension. Allow barium to flow through the
tubing and from the tip to remove any air in the system.
Step 4 Wearing gloves, coat the enema tip well with water-
soluble lubricant.
 •Preparation for Rectal Tip Insertion
Step 5 On expiration, direct the enema tip toward the
umbilicus approximately 2.5 to 4 cm (1 to 1.5 inches).
Step 6 After initial insertion, advance up superiorly and
slightly anteriorly. The total insertion should not exceed 7.5 to
10 cm (3 to 4 inches). Do not force enema tip.
Step 7 Tape tubing in place to prevent slippage.
Step 8 Ensure that the intravenous pole/ enema bag is no more
than 60 cm (24 inches) above the table. Ensure that the tubing
stopcock is in the closed position, and no barium flows into the
patient.
 Procedure
7-Spot film Level 7

Level 6 6-Air pumped

5-Barium infusion
screen hepatic Level 5
flexure and stop.
Level 4 4- Buscopan IV
3-Lubricate catheter
tip , inserted Level 3
genteelly in rectum
Level 2 2-(sims position)
3cm Lie on left lateral with
1-Plain film Level 1 right leg flexed
(AP abdomen)
Technique •ROUTINE
•PA or AP

•Clinical Indications
•Obstructions, including ileus, volvulus.

• Double-contrast media barium enema

•is ideal for demonstrating diverticulosis,
polyps, and mucosal changes.
•(iodinated, water-soluble contrast media)

•Patient Position Patient is prone or supine,

with a pillow for the head
Technique •ROUTINE
•PA or AP
•RAO

•Clinical Indications
•Obstructions, including ileus, volvulus.

• Double-contrast media barium enema

•is ideal for demonstrating diverticulosis,
polyps, and mucosal changes.

Patient Position Patient is semiprone, rotated

RAO (centered high RAO (centered low into a 35° to 45°, RAO, with a pillow for the
to include R and L to include rectal head
colic flexures). ampulla).
Technique •ROUTINE
•PA or AP
•RAO

•Clinical Indications
•Obstructions, including ileus, volvulus.

• Double-contrast media barium enema

•is ideal for demonstrating diverticulosis,
polyps, and mucosal changes.
•(iodinated, water-soluble contrast media)

Patient Position Patient is semiprone, rotated

RAO include rectal into a 35° to 45°, RAO, with a pillow for the head
ampulla).
Technique •ROUTINE
•PA or AP
•RAO
•LAO

•Clinical Indications
•Obstructions, including ileus, volvulus.

• Double-contrast media barium enema

•is ideal for demonstrating diverticulosis,
polyps, and mucosal changes.

Patient Position Patient is semiprone, rotated

into a 35° to 45°, LAO, with a pillow for the head
Technique •ROUTINE
•PA or AP
•RAO
•LAO

•Clinical Indications
•Obstructions, including ileus, volvulus.

• Double-contrast media barium enema

•is ideal for demonstrating diverticulosis,
polyps, and mucosal changes.

Patient Position Patient is semiprone, rotated

LAO into a 35° to 45°, LAO, with a pillow for the head
Technique •ROUTINE
•PA or AP
•RAO
•LAO
•LPO and RPO

•Clinical Indications
•Obstructions, including ileus, volvulus.

• Double-contrast media barium enema

•is ideal for demonstrating diverticulosis,
polyps, and mucosal changes.

Patient Position Patient is semiprone, rotated into a

35° to 45°, right and left posterior obliques, with a
pillow for the head
Technique
Technique •ROUTINE
•PA or AP
•RAO
•LAO
•LPO and RPO
•Lateral rectum

•Clinical Indications
Lateral position for demonstrating polyps,
strictures, and difference between rectum and
bladder/ uterus
The ventral decubitus position is best for double-
contrast study

Patient Position Patient position is lateral

Technique
Technique •ROUTINE
•PA or AP
•RAO
•LAO
•LPO and RPO
•Lateral rectum
•R and L lateral decubitus (double-contrast
stud )

•Clinical Indications
Demonstrating polyps of the left side or air- filled portions of
the large intestine
Both right and left decubitus positions
generally are taken with the double-contrast study.

Patient Position Patient is in lateral recumbent position, with a

pillow for the head and lying on the right side on a radiolucent
pad, with a portable grid placed behind the patient’s back for
an
Technique
Aftercare

1. Bowel motion normally white for 3 days

2. Eat and drink normally to prevent barium impaction
3. The patient must not go home or drive until any blurring of vision caused by
Buscopan