A barium enema is an x-ray process that involves inducing a liquid, Barium into the colon by using a tube that is inserted through the rectum to check for abnormal functions in the large intestines. Therefore, there are some radiographic positions that patients are expected to maintain in the X-ray process when examining some parts of the large intestine. In conducting the X-ray, there should be proper collimation of the beams of light directed straight to the target affected areas to avoid damaging the delicate radiosensitive organs.
Posterior-anterior
Posterior-anterior is a technique used to describe the direction of a screened beam of X-ray through a patient from back to the front part of the organs being examined. Posterior-anterior mainly involves selecting the area affected in the colon and covering the other delicate organs to prevent damage. The position of the patient in posterior should be supine (face up) or prone (face down). During the posterior-anterior, proper directing of the beam should be done with the patient advised maintaining a posture that will ensure that there is no rotation of the body.
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Right anterior oblique
The right anterior oblique aim at examining the surrounding of the iliac crest where the entire air filled and barium filled large intestine is exposed for collimation. The position for right anterior oblique is semi-prone with the torso facing down and the face sideways. However, there is no motion, and the patient should maintain a constant rotational position of 35˚ to 45˚ along the axis of the bench. This position ensures that the spine is parallel to the edge of the radiograph.
Left posterior oblique
This position provides a gantry rotational of 300˚ on the provided bench. The patient maintains an orientation that enables the colon to remain parallel to the linac waveguide. However, the position for the left posterior should be semi-supine, with the face and torso facing sideways to create a vertical examination of the colon.
Left anterior oblique
In most cases, the examination involves issues related to food passage through the colon and the possible consideration of the problems. The patient is maintained at an angle of between 35˚ and 45˚ to the left and a supporting pillow below the head. The required height is about 2 inches centering for associating the left colic flexure, which in return cuts off the lower large bowel. The spine should be parallel to the edge of the radiograph to allow for visualizing the contrast-filled large intestine.
Lateral rectum position
The position is also known as ventral decubitus lateral and is usually used to analyze the weaknesses in the rectum. Failures such as fistula and the other malfunctions related to the uterus and bladder are also examined. The position for the lateral rectum examination is lateraling recumbent with the shoulders and hips superimposed to ensure that no rotation occurs.
Right lateral decubitus position
In examining the large intestines, both the right and left lateral decubitus are treated with double-contrast, where the X-rays from the colon and rectum are taken using two contrast forms to ease the work of identifying the affected areas. The patient maintains a lateral recumbent position where the hips and arms are superimposed to ensure that no rotation occurs. In this position, the entire colon is exposed for examination.
Left lateral decubitus position
The left lateral decubitus position is used to determine polyps, which are small clumps of cells that form on the lining of the colon. The patient maintains a lateral recumbent position lying on the left side. This position is very critical, and the patient’s arms need to be locked to prevent them from falling off.
Posterior, anterior post-evacuation
This position is applied for identifying small polyps and other minor defections in the large intestine. The patient position is usually supine or prone, and the entire large intestine is exposed to the X-ray collimation. Total evacuation of the colon should be conducted before the X-ray image is taken.
Anterior axial oblique
The anterior axial oblique examines polyps and other minor defections in the large intestines. The patient’s position is supine with the legs extended and arms crossed to the chest. However, the patient should not be rotating to ensure that the collimation is directed to the affected area.
Reference
David Craigie (1838). Elements of Anatomy, General, Special, and Comparative . A. and C. Black .
