BE = Barium Enemas Lower Gastrointestinal SeriesSlide 2Slide 3Slide 4PREP FOR EXAMSlide 6SCOUT 14 X 17Slide 8Slide 9Get suppliesMaking the BE bagSlide 12Slide 13Slide 14Slide 15Slide 16Slide 17Slide 18Slide 19‘tipping”What position ?Slide 22Slide 23Slide 24Slide 25Start filling in Prone position or on LT sideSlide 27Slide 28“SPOT FILMS” BESingle contrast Double ContrastSlide 31Gastro enema ‘ “limited study”“OVERHEADS” POST FLUORO FILMINGSlide 34Slide 35Slide 36Slide 37Slide 38Slide 39PA double contrast“sigmoid”Slide 42LPO – AXAIL “BUTTERFLY”Slide 44Slide 45Slide 46Slide 47Slide 48Slide 49Slide 50LAO RAOSlide 52Slide 53Slide 54Projection?Slide 56Slide 57Slide 58Using a compensating filterSlide 60Slide 61Slide 62PRE OR POST EVACSlide 64POST EVACMore images positioning reviewSlide 67Slide 68Slide 69Slide 70Single/Double contrast BENot preppedINGESTED ORALLYSlide 74Appedicolith r/o appenditis BE / CT / US ?COMMON PATHOLOGIESSlide 77Slide 78CancerSlide 80Slide 81PolypSlide 83Slide 84Slide 85Volvulus – scout shows? Contrast used?Slide 87Colitis “stove pipe” Chron’s Disease / Laxative UseUlcerative Colitis or Chron’s dxCOLOSTOMYNot well preppedSlide 92Slide 93Ulcerative colitisSame pt 5 yr earlierSlide 96Radiation enteritisSlide 98Slide 99Intussuception VolvulusChron’s DiseaseSlide 102Slide 103Slide 104Slide 105Slide 106Slide 107Slide 108Slide 109Slide 110Slide 111CHRONSCHRONIC POLYPSCANCER STAGINGPERFORATED RECTUMSlide 116Slide 117Slide 118Slide 119Slide 120ILEOSTOMYSlide 122Slide 123Slide 124Slide 125Slide 126Slide 127Colostomy bagRESECTIONSlide 130Slide 131Slide 132Slide 133Slide 134Slide 135Filling defectSlide 137Slide 138Scrotal herniaThe end - almost1BE = Barium EnemasLower Gastrointestinal SeriesContributions by: Ballinger, Bontrager, Lampignano & McQuinlin Copyright Mosby 2001 REV Sp 2010RT - 1242ANATOMY REVIEW3PATHOLOGY REVIEW4Virtual ColonoscopyMAY REPLACE BE?5PREP FOR EXAMGETTING READY67SCOUT 14 X 17The importance of a scout film:•checks for prior contrast•pathology present•technique correct•abnormal position of organs89What do you seeWhat type of contrastShould be used for this patient? Why?10Get supplies•Extra towels•Tape •Extra Clamps•Donut•Gel - lubricant11Making the BE bag•ALWAYS CHECK•CLAMP IS CLOSED•(DOUBLE CLAMP)•FOLD TUBE•CAP IS ON TIGHT!•BLEED THE TUBE1213BE Contrast:Barium - Single and Double Contrast& Gastrographin/Powdered Hypaque (Iodine)1415BEAC - BE AIR CONTRASTTHICK BARIUM & AIR16BE SINGLE CONTRAST“THIN” BARIUMPOWDER MIXES WITH 2000 CC WATER17181920‘tipping”SIMS POSITIONPOINT THE TIP TOWARDS THE NAVELEX OF COLONOSCOPY21What position ?SIMS POSITION222324 CAPTURING THE BARIUM DURING OR AFTER THE PROCEDURE25The technologist role:Assist the Patient & PhysicianControl the flow of contrast26Start filling in Prone positionor on LT sideBeginning the Procedure- After Scout Film – Fluoro begins27Exam begins with fluoro – filling the colon with Barium – then air28Remote control –Or in the roomPatient & Tech exposure rate?29“SPOT FILMS” BERadiologist will take several images during fluoroscopy - size of image is limited to the FOV of II30Single contrast Double ContrastLook at AIR/BA to the position…….3132Gastro enema ‘ “limited study”Notice the difference in density of contrastWhy?What kvp ranges are needed?33“OVERHEADS”POST FLUORO FILMINGBegin Series Notes3435NOTE Reflux into the small bowel36PA37AP383940PA double contrast41“sigmoid”◄NOTE C/R DIRECTION42“sigmoid”43LPO – AXAIL “BUTTERFLY”30 /3044“sigmoid”Best seen45ObliquesLPO/RAO464748ObliquesRPO/LAO495051LAO RAO525354LATERAL RECTUMRECUMBANT VSX-TABLE LAT55Projection?56RLD57LLD58DECUBS CAN BE PA OR APPOSITION OF TUBE/CASSETTE PT STABILITY59Using a compensating filter60616263PRE OR POST EVAC6465POST EVACMay have to send patient back to the bathroom and do a second post66More imagespositioning review6768697071Single/Double contrast BE72Not prepped73INGESTED ORALLY74CECUM FILLED? – “AIR BLOCK”75Appedicolithr/o appenditis BE / CT / US ?76COMMON PATHOLOGIES777879Cancer808182Polyp83848586Volvulus – scout shows?Contrast used?87INTUSSUSCEPTIONTELESCOPING OF BOWELCAUSES???88Colitis “stove pipe”Chron’s Disease / Laxative Use89Ulcerative Colitis or Chron’s dx90COLOSTOMY91Not well prepped929394Ulcerative colitis95Same pt 5 yr earlier9697Radiation enteritis9899100Intussuception Volvulus101Chron’s Disease102103104105106107108109110111112CHRONS113CHRONIC POLYPS114CANCER STAGING115PERFORATED RECTUM116117118119120121ILEOSTOMY122123124125126127128Colostomy bag129RESECTION130131•Conditions treated with colostomy•Colostomies are most often performed in patients who have colorectal cancer or other cancers of the abdomen or pelvis.132•Inflammatory bowel disease. This includes Crohn's disease, which causes chronic inflammation and ulceration within the digestive tract, and ulcerative colitis, which is marked by chronic inflammation of the colon that creates ulcers in the colon’s lining.133134135136Filling defect137138139Scrotal hernia140The end -