This is the standard barium enema technique where the radiologist performs the study – filling and distension phase – followed by taking limited views of certain areas of the colon. The radiographic technologist then takes overhead views of the colon.

The limited spot views taken b the radiologist should include the following:

1. Lateral upright rectum (balloon deflated)
2. RPO Upright Splenic flexure
3. LPO Upright Hepatic flexure
4. Supine sigmoid views (angled)
5. Cecum

 

Overhead Films:
Supine Antero-Posterior Projection (AP): The central ray is perpendicular and directed to the patient’s midline at the level of the right iliac crest. This should include the entire colon including the flexures and rectum. AP to include rectum (14 x 17-inch, or 36 x 40-cm IR).
Left Posterior Oblique View (LPO): Patient obliqued 30º with the left side lowermost. The central ray is angled 35º cephalad and directed over the raised side at the level of the left anterior superior iliac spine. The 35º angulation unfolds the sigmoid colon.
Prone Postero-Anterior Projection: The central ray is perpendicular and directed to the patient’s midline at the level of the left iliac crest. This view should include the entire colon including the flexures and rectum.
Right Anterior Oblique Views: Patient obliqued 30º with the right side lowermost. The central ray is angled 35º caudal and directed over the raised side at the level of the left iliac crest. The 35º angulation (cephalad) unfolds the sigmoid colon (14 x 17-inch, or 36 x 40-cm IR); .
Right Lateral Decubitus View: Patient lying true lateral on the right side and elevated on a suitable radiolucent support. With the cassette behind the patient, the horizontal central ray is directed to the patient’s midline at the level of the left iliac crest. This view is best for the left colon.
Left Lateral Decubitus View: Patient lying true lateral on the left side and elevated o a suitable radiolucent support. The cassette on patient’s anterior body surface. The horizontal central ray is directed to the patient’s midline at the level of the right iliac crest. This view is best for the right colon.  (14 x 17-inch, or 36 x 40-cm IR).

ALL the films must be evaluated by a radiologist before the patient leaves the department in case additional radiographs are needed to evaluate suspicious areas. If a lesion is suspected in the distal rectum, removal of the enema tip and additional radiographs will be necessary.

Pearls:

• Drain barium with the patient prone and the rectal tube open to bag (have the patient bear down, done after barium in the transverse colon).
   
• Double contrast cecum can be obtained by the patient placed Trendelenberg, in the left lateral decubitus position.