PA SMALL BOWEL SERIES

Tuesday, March 11, 2014

POSTEROANTERIOR (PA) PROJECTION SMALL BOWEL SERIES

Pathology Demonstrated
  • In PA Small Bowel Series Pathology demonstrates are Inflammatory processes, neosplasm, and obstructions of the small intestine are shown.
  • Upper GI small bowel combinations are commonly done by additional barium is ingested after completion of the upper Gastrointestinal (GI)
Procedure Summary for Upper GI Small Bowel Combination:
Basic Procedure:
  • Routine Upper Gastrointestinal (GI) first
  • Notation of time patient ingested first cup 8oz of barium
  • Ingestion of second cup of barium.
  • 30 minutes PA radiograph (Centering high for proximal Small Bowel (SB)
  • Half hour interval radiographs, centered to iliac crest, until barium reaches large bowel usually 2hrs.
  • 1 hour interval radiographs, if more time is needed after 2 hrs.
Optional Preparation for Upper GI small bowel:
  • Fluoroscopy and spot imaging if ileocecal valve and terminal ileum and compression cone may be used.
  • Small Bowel only Series: Includes scout abdomen radiograph followed by ingestion of barium mixture and timed interval radiograph see Procedure Summary below
Procedure Summary of Small Bowel only Series
These are the Basics:
  • Plain abdomen radiograph also known as Scout film.
    2 cups (16 oz) of barium ingested (noting time)
    15 to 30 minute radiograph ( centered high for proximal Small Bowel)
  • Half hour interval radiograph (centered to crest) until barium reaches large intestine or large bowel it is usually takes 2hrs.
  • 1 hour interval radiographs, if more time is needed, because some routines including continuous half hour intervals.
Optional Preparation for Small Bowel Series:
  • The use of fluoroscopy with compression sometimes required
  • Enteroclysis and Intubation Procedures
  • A third method of small bowel study is the enteroclysis procedure, which is a double contrast method that is used to evaluate the small bowel
  • Procedure Summary for Enteroclysis (Double Contrast Small Bowel Series)
Procedure:
  • Special Catheter advanced to duodenojejunal junction.
  • Thin mixture of barium sulfate instilled.
  • Air and methylcellulose instilled.
  • Fluoroscopic spot images and conventional radiographs taken.
Optional:
  • Patient must be taken to Computed Tomography for scan of GI tract.
  • On successful completion of exam, intubation tube removed.
  • Technical Factors in PA Small Bowel Series:
  • Image Receptor size 35 x 43 cm or 14 x 17 inches, lengthwise
  • Moving or stationary grid
  • 100 to 125 kV range
  • Time markers to be used
Technique and Dose:
  • mAs 4
  • PA: 30 minutes SB
small bowel series
PA 30 minutes - centered approximately 2 inches above iliac crest
Shielding of the Patient:
  • Shield gonads only if such shielding does not cover pertinent anatomy.
Patient Position:
  • Patient is in prone or supine if patient cannot lie in prone position, with a pillow for the head.
Part Position:
  • Align Mid Sagital Plane (MSP) to midline of table/grid and or CR.
  • Place arms up beside head with legs extended and support provided under the ankles.
  • Ensure that no rotation occurs.
Central Ray
  • CR is perpendicular to IR.
  • 15 to 30 min: Center to about 2 inches or 5 cm above the iliac crest (see note).
  • Hourly: Center CR and midpoint of IR to iliac crest.
  • Center the Image Receptor to Central Ray
  • Minimu Source to Image Distance (SID) is 40 inches or 100 cm
Collimation:
  • Collimate on four sides to outer margins of Image Receptor.
Respiration During Exposure:
  • Suspend respiraton and EXPOSE on EXPIRATION.
Note:
  • Timing begins with ingestion of barium. Timed intervals of radiograph depends on transit time of the specific barium preparation used and on departmental protocol.
  • For First 30 minute radiograph, center high to include the entire stomach.
  • Subsequent 30 minute interval radiographs are taken until barium reaches into the large bowel usually 2hrs.
  • The study generally is completed once the contrast media reaches the cecum and / or the ascending colon.
  • Fluoroscopy and spot imaging of the ileocecal valve and terminal ileum after barium reaches this area are commonly included in the small bowel series routine.
  • This procedure, however is determined by the radiologist's preference and by department routines.
Radiographic Criteria for Small Bowel Series:
small bowel series
AP 30 minutes showing stomach and small intestine

Structure Shown for Small Bowel Series:
  • Entire small intestine is demonstrated on each radiograph, with the stomach included on the 15 - and or 30 minutes radiograph.
Position:
  • No rotation is present. The ala of the ilium and the lumbar vertebrae are symmetric.
Collimation and CR when performing Small Intestine Series:
  • Only minimal collimation margins are seen on all four sides for adults.
  • CR is centered approximately 2 inches (5cm) above the iliac crest for the the initial radiographs.
  • CR is centered at iliac crest for the remaining radiographs.
Exposure Criteria and Markers for Small Bowel Series or Small intestine X-ray:
  • Appropriate technique is employed to visualize the contrast filled small intestine without overexposing those parts that are filled only partially with barium.
  • Sharp structural margins indicate no motion.
  • Patient ID information, time interval markers, and right and left marker are visible without superimposition of essential anatomy.

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