Why should a high density barium product be used as the contrast medium for double-contrast studies

Upgrade to remove ads

Inhaltsverzeichnis Show

Why barium is used as contrast media?
What is the difference between single and double contrast barium enemas?
Why is it called double contrast barium enema?
What are the two types of contrast media used in double contrast procedures?

Only ₩37,125/year

Science
Medicine
Radiology

Flashcards
Learn
Test
Match

Flashcards
Learn
Test
Match

Terms in this set (134)

Large intestine:

What are the two basic methods of performing BE?

Single-contrast and double contrast

Large intestine:

What is the most common type of contrast medium used for a BE?

Commercially prepared barium sulfate

Large intestine:

Why should a high density barium product be used as the contrast medium for double-contrast studies?

To coat the lumen better

Large intestine:

What two radiolucent contrast media can be used during the double-contrast study?

Air and carbon dioxide

Large intestine:

When might an orally administered, water soluble, iodinated contrast medium be used in place of a barium sulfate mixture?

When colon perforation or leak is suspected

Large intestine:

What should be included in the instructions generally given to a patient in preparation for a BE?

Restrictive diet, laxatives, and a cleansing enema

Large intestine:

What is considered the most important aspect of patient preparation for the BE?

Large intestine must be completely emptied

Large intestine:

What should the temperature of the barium be when the administration of a warm solution is desirable?

about 85 to 90-degrees Fahrenheit

Large intestine:

How could the patient be affected if the barium is too warm?

can injure the intestinal tissues irritation would occur to the point that the patient couldn't retain the enema long enough to permit a satisfactory examination

Large intestine:

List three instructions that can be given to the patient to help the patient retain the barium during the examination.

*keep sphincter contracted
*Relax the abdominal muscles
*concentrate on deep oral breathing

Large intestine:

What is the maximum height above the level of the anus that a BE bag may be placed on an IV stand?

24"

Large intestine:

Approximately how far into the rectum should an enema tip be inserted?

3 1/2 to 4"

Large intestine:

What wording refers to the last image usually performed as part of a BE examination?

Post-evacuation image

Large intestine:

How should the patient be placed for the PA projection?

Prone

Large intestine:

To which level of the patient should the IR be centered?

Iliac crests

Large intestine:

How should the central ray be directed for the PA projection?

Perpendicularly

Large intestine:

What are the structures of the large intestine?

Left colic (or splenic) flexure, Right colic ( or hepatic) flexure, transverse colon, ascending colon, descending colon,vermiform appendix, cecum, sigmoid colon, rectum, and anus

Large intestine:

For the PA axial projection, which plane of the body should be centered to the midline of the table?

Midsagittal

Large intestine:

To which level of the patient should the central ray be directed for the PA axial projection?

Anterior superior iliac spines (ASIS)

Large intestine:

How should the central ray be directed for the PA axial projection?

caudally

Large intestine:

Which area of the large intestine is best demonstrated with the PA axial projection?

Rectosigmoid area

Large intestine:

TRUE OR FALSE

Both colic flexures should be seen with the PA axial projection.

FALSE
The flexures don't need to be seen. The rectosigmoid is being looked at with this projection

Large intestine:

TRUE OR FALSE

For the PA oblique projection, RAO position, the patient should be rotated 35 to 45-degrees from the prone position.

TRUE

Large intestine:

TRUE OR FALSE

For the PA oblique projection, RAO position, the central ray should be directed 35 to 45-degrees caudally.

FALSE
The CR is perpendicular to the IR.

Large intestine:

TRUE OR FALSE

The PA oblique projection, RAO position, is performed primarily to demonstrate the right colic flexure.

TRUE

Large intestine:

To which level of the patient should the IR be centered for the PA oblique projection, LAO position?

Iliac crests

Large intestine:

Which two structures of the large intestine are demonstrated primarily with the PA oblique projection, LAO position?

Left colic flexure and descending colon

Large intestine:

For the lateral projection, to what level of the patient should an IR that is 10X12" be centered?

ASIS

Large intestine:

In the image of the left lateral projection, how is it determined that the patient was not rotated?

Hips and femurs are superimposed

Large intestine:

Which portions of the large intestine are of prime interest with the lateral projection?

Sigmoid and rectum

Large intestine:

For the lateral projection, which plane of the body should be centered to the midline of the table?

Midcoronal

Large intestine:

Which plane of the body should be centered to the grid for the AP projection?

Midsagittal plane

Large intestine:

To what level of the patient should the IR be centered for an AP projection?

Iliac crests

Large intestine:

TRUE OR FALSE

The patient should suspend respiration for an AP projection.

TRUE

Large intestine:

TRUE OR FALSE

The entire colon should be demonstrated for the AP projection.

TRUE

Large intestine:

Which projection produces an image similar to the AP axial projection?

PA axial

Large intestine:

In which direction and how many degrees should the central ray be directed for an AP Axial?

Cephalically 30 to 40-degrees

Large intestine:

For the AP axial projection, where on the patients anterior surface should the central ray enter when a 14X17" IR is used?

2" below the ASIS

Large intestine:

To produce a coned down image of the AP axial projection on an IR that is 10X12", where on a patient should the central ray enter?

Inferior margin of the symphysis pubis

Large intestine:

The AP oblique projection, LPO position, produces an image similar to the ____________ projection
(____________ position).

PA oblique projection
RAO position

Large intestine:

For the PA oblique projection, LPO position, the patient should be rotated ____________ to
____________ degrees.

35 to 45

Large intestine:
For the AP oblique projection, LPO position, which side of the patient (right or left) should be elevated away from the x-ray table?

Right

Large intestine:

Which flexure (right colic or left colic) should be well demonstrated with the AP oblique projection, LPO position?

Right colic flexure

Large intestine:

What other oblique projection produces an image similar to the AP Oblique projection, RPO position?

PA oblique projection, LAO position

Large intestine:

Which flexure (right colic or left colic) should be well demonstrated with the AP oblique projection, RPO position?

Left colic flexure

Large intestine:

How many degrees should the patient be rotated from the supine position for the AP oblique projection, RPO position?

35 to 45

Large intestine:

Which BE projection requires that the patient be placed in the right lateral recumbent position and that a horizontal central ray be directed to the mid-line of the patient at the level of the iliac crests?

right lateral decubitus position

Large intestine:

For lateral decubitus positions, what should be accomplished to ensure that the dependent side of the patient is demonstrated?

To ensure that the side on which the patient is lying is shown, elevate the patient on a radiolucent support

Large intestine:

How much of the colon should be demonstrated in the image of a lateral decubitus position?

from the left colic flexure to the rectum

Large intestine:

For upright frontal, oblique, and lateral projections, how is the centering of the IR adjusted from that used for the recumbent positions? Why is this compensation necessary?

IR is placed at a lower level to compensate for the drop of the bowel caused by the effect of gravity.

Small intestine:

List three methods by which a barium sulfate mixture can be administered for a small bowel series.

* by mouth
* by enema
* by direct injection into the bowel through an intestinal tube

Small intestine:

Which small bowel series method is most commonly used?

Oral

Small intestine:

What are the four instructions given to patients preparing for the oral method of performing small bowel series?

* Have cleansing enema
* Do not eat breakfast on morning of examination
*Consume nothing by mouth after the evening meal the night before the examination
*Eat a restricted diet (soft, low residual foods) for two days before the examination

Small intestine:

Why is a time marker displayed on each image made during the oral method small bowel series?

To indicate the interval between the exposure of the image and the ingestion of the barium

Small intestine:

How should the patient be placed for timed images when compression of the abdominal contents is desired?

Prone

Small intestine:

Approximately how long after the patient swallows the barium sulfate mixture should the first image be made?

15 minutes

Small intestine:

Approximately how long after the exposure of the first image should subsequent images be exposed?

15 to 30 minutes

Small intestine:

How might the oral method of small bowel examination be affected by giving the patient a cup of cold water after the administration of the contrast medium?

Peristalsis is accelerated

Small intestine:

Which small bowel series method often requires the administration of glucagon or diazepam (Valium) to relax the intestine and reduce patient discomfort during the initial filling of the small intestine?

Complete reflux

Small intestine:

How should the patient be positioned when the small intestine is to be filled by the complete reflux method?

Supine

Small intestine:

Which small bowel series injects contrast medium through an intestinal tube?

enteroclysis

Small intestine:
Where in the small intestine should the tube be inserted for the enteroclysis method of performing a small bowel series?

Duodenum

Small intestine:

Which method of performing a small bowel series does not use a cleansing enema as a part of patient preparation?

Enteroclysis

Small intestine:

For the AP projection demonstrating the small intestine, which plane of the body should be centered to the grid?

Midsagittal

Small intestine:

For the AP projection demonstrating the small intestine of a sthenic patient within thirty minutes after the administration of contrast medium, to which level of the patient should the IR be centered?

Small intestine:

For delayed AP projections demonstrating the small intestine of a sthenic patient, to which level of the patient should the IR be centered?

Iliac crests

Small intestine:

For the AP projection, when should the exposure be made?

At the end of expiration

Small intestine:

For the AP projection, how should the central ray be directed?

Perpendicularly

Small intestine:

When examining images of a small bowel series, which structure usually indicates adequate demonstration of the entire small intestine?

Cecum

Small intestine:

What are the evaluation criteria for AP projection of small intestine

*Patient should not be rotated/A time marker should be included/The exposure factors should demonstrate the anatomy/The stomach should be included on the initial image/The vertebral column should be in the middle of the image/The entire small intestine should be included in each image/The examination is usually completed when the barium is visualized in the cecum

Large intestine:

PA Projection

IR: 14X17 LW

CR: perp to IR enters the midline of body at iliac crests

STRUCTURES SHOWN: Entire colon

Eval criteria: Entire colon including the flexures and rectum

Large intestine:

PA Axial Projection

IMAGE RECEPTOR: 14X17, 14X14, or 10X12 LW/CENTRAL RAY: 30 to 40-degrees caudal to enter midline of body at level of ASIS/STRUCTURES SHOWN: rectosigmoid area of colon/EVAL CRITERIA: rectosigmoid area with less superimposition than in PA projection because of angulation of central ray

Large intestine:

PA Oblique projection (RAO)

IR: 14X17 LW/ CR: perp to the IR and entering 1 to 2" lateral to the midline of the body on elevated side at level of iliac crests/ STRUCTURES SHOWN: RAO best shows right colic flexure, the ascending colon, and sigmoid colon/
Eval criteria:Right colic flexure less superimposed than in PA; Ascending colon, cecum, and sigmoid colon

Large intestine:
PA Oblique projection (LAO)

IR: 14X17 LW/ CR: perp to the IR and entering 1 to 2" lateral to the midline of the body on elevated side at level of iliac crests/ STRUCTURES SHOWN: LAO best shows the left colic flexure and the descending colon/ Eval criteria:Left colic flexure less superimposed than in PA; Descending colon

Large intestine:

Lateral Projection

IR: 10X12 or 14X14 LW/ CR: perp to IR to enter midcoronal plane at level of ASIS/ STRUCTURES SHOWN: rectum and distal sigmoid/
Eval criteria:rectosigmoid area in center of image; Superimposed hips and femora

Large intestine:

AP Projection

IR: 14X17 LW

CR: perp to IR to enter midline of body at level of iliac crests

STRUCTURES SHOWN: entire colon

Eval criteria:
entire colon including the splenic flexure and rectum

Large intestine:

AP Axial

IR: 14X14, 14X17, or 10X12 LW

CR: 30 to 40-degrees cephalic to enter midline of body 2" below ASIS

STRUCTURES SHOWN: rectosigmoid area

Eval criteria:
rectosigmoid area with less superimposition than in AP because of angulation

Large intestine:
AP Oblique (LPO)

IR: 14X17 LW/ CR: perp to IR to enter 1 to 2" lateral to the midline of the elevated side at the level of the iliac crests/ STRUCTURES SHOWN:LPO best shows right colic flexure, ascending, and sigmoid colon/ Eval criteria:
Right colic flexure less superimposed than in AP; Ascending colon, cecum, and sigmoid

Large intestine:

AP Oblique (RPO)

IR: 14X17 LW/ CR: perp to IR to enter 1 to 2" lateral to the midline of the elevated side at the level of the iliac crests/ STRUCTURES SHOWN:RPO best shows left colic flexure and descending colon/ Eval criteria: -left colic flexure and descending colon - entire colon

Large intestine:

PA or AP: Left lateral decubitus

IR: 14X17 LW/ CR: horizontal and perp to IR to enter midline of body at level of iliac crests/ STRUCTURES SHOWN: best shows "UP" lateral side of ascending colon and medial side of descending colon when inflated with air/ Evaluation criteria:-Area from left colic flexure to rectum -No rotation of patient. demonstrated by symmetry of ribs and pelvis

Large intestine:

Lateral: R or L Ventral Decubitus

IR: 14X17 LW/ CR: horizontal and perp to IR to enter midcoronal plane of body at level of iliac crests/ STRUCTURES SHOWN: best shows "UP" posterior portions of colon/ Evaluation criteria: -Area from flexures to rectum- No rotation -Enema tip removed for unobstructed image of rectum

Large intestine:

Which oblique will produce the same image as a PA Oblique RAO?

AP Oblique LPO

Large intestine:

Which oblique will produce the same image as a PA Oblique LAO?

AP Oblique RPO

Large intestine:

LAO and RAO Obliques demonstrate which side?

The side down

Large intestine:

LPO and RPO Obliques demonstrate which side?

The side up

Large intestine:

What is included in a series of the large intestine?

AP, RPO, LPO, AP axial, and lateral rectum
or
PA, RAO, LAO, PA axial, and lateral rectum

(If it's an air contrast add left and right decubitus)

Large intestine:

What projection produces the same image as an AP?

Large intestine:

What projection produces the same image as an AP Axial?

PA Axial

Gastrointestinal:

What acronym refers to the upper gastrointestinal series?

UGI

Gastrointestinal:

As part of patient preparation; why should the patient maintain a soft, low-residue diet for two days?

reduces production of gas and feces

Gastrointestinal:

How can the UGI study be affected if the patient smokes cigarettes shortly before the examination?

It can increase saliva production which leads to excessive fluids in the stomach

Gastrointestinal:

What type of radiopaque contrast medium usually is used in routine UGI studies?

barium sulfate 30 to 50 % weight per volume

Gastrointestinal:

List the two general GI studies routinely used to examine the stomach.

Single contrast
Double contrast

Gastrointestinal:

What is the range of weight per volume concentration for barium sulfate suspension usually used for single contrast examinations?

30 to 50%

Gastrointestinal:

List two advantages to performing the double contrast examination.

*Small lesions are less easily obscured
*Mucosal lining can be more clearly visualized

Gastrointestinal:

What are the two types of contrast media used in double-contrast procedures?

*gas
*barium

Gastrointestinal:

TRUE OR FALSE

The barium sulfate suspension used for double-contrast examinations should have a higher weight per volume ratio than the barium sulfate suspension used for single-contrast examinations.

TRUE

Gastrointestinal:

Why should patients undergoing double-contrast examinations turn from side to side or roll over a few times during the procedure?

To coat the mucosal lining

Gastrointestinal:

During double-contrast examinations, what instructions should be given to the patient after the patient swallows the carbon dioxide crystals or tablets to ensure a double-contrast effect?

Not to belch

Gastrointestinal:

What is the purpose of using the glucagon during the double-contrast examination?

To relax the gastrointestinal tract

Gastrointestinal:

What is a biphasic GI examination?

Incorporates the advantages of single-contrast and a double-contrast exams by including both exams in the same procedure.

Gastrointestinal:

Which method of examination is performed first as part of a biphasic examination?

Double-contrast

Gastrointestinal:

What are the two methods of performing hypotonic duodenography?

-Double contrast gastrointestinal exam
-(CT) or needle biopsy

Gastrointestinal:

TRUE OR FALSE

Other imaging modalities such sonography and computed tomography have largely replaced hypotonic duodenography.

TRUE