Radiographic Positioning for
Barium Enema
Presented by
Aries Paul Zeta, RRT
Property of Davao Doctors College
10 – Miller’s Routine Sequence of
Radiographs
1)AP – to include flexures
2)Left lateral rectum
3)AP – 15 – 25 degs. Cephalic(CR)
to include rectum.
4)15 – 25 degs.RPO – to include
Left colic
5)Right lateral – to include rectum
Cont…
6) Prone PA – to include flexures
7) Prone PA with 15 – 25 degs caudal angulation
(Angle Prone)– to include rectum.
8) 15 – 25 degs LPO- to include the right colic
flexure.
9) Supine – AP tightly collimated ileocecal region
proj. taken in 2 – 3 degs obliquity.
10)Using horizontal central ray, upright proj. of
both flexures and lateral rectum.
Usually used in the hospital
Modification of Positions for
Barium Enema
Scout Film
• First exposure of the
procedure should be a
plain radiograph of the
abdomen area.
• Advice the patient to lie
down on the radiographic
table, the MSP of the
patient should be inline
with the MSP of the Table.
• Center the CR at the level
of the L4 or the level of
the iliac crest.
• Respiration is suspended
during expiration.
L4
Sim’s Position
Sims position – relaxes the abdominal
muscles and decreases pressure within
the abdomen.
Instruct the patient to lie on their side
away from the tech. let the lower arm of
the patient to be put at the back of his
body. The up side knee should be flex
for support and lower side extremity
should not be flex or bent.
Wearing gloves, coat enema tip with
water-soluble lubricant.(KY jelly or any
sterile lubricant). On expiration, direct
enema tip toward the umbilicus
proximally 1 to 1.5 inches. After initial
insertion, advance up superiorly and
slightly anteriorly. Do not force enema
tip.
Tape tubing in place to prevent
slippage. Do not inflate unless directed
by radiologist. Ensure IV pole/enema
bag is no more than 24 inches (60cm)
above the table. Ensure tubing stopcock
is in the closed position and no barium
flows into the pt.
Left/Right position of the
recto sigmoid area
Film: 10x12cm lengthwise
• True lateral position of
the Recto sigmoid
• CR should be 5-7cm
above the level of the
pubic symphysis in
the midaxillary plane
AP (recto sigmoid
area)
Film: 10x12cm
crosswise
• AP view of the Rectum
&Sigmoid should be
included
• CR 5-7 cm above
the level of the
pubic symphysis
5-7cm above pubic symphysis
AP (Single Contrast)
Film: 14x17cm
• An Entire colon filled
with contrast media
should be
demonstrated
including the splenic
flexure and the
rectum.
• CR is at the level of the
L4or at the level of
the iliac crest
L4
AP Double Contrast
Film: 14x17cm
lengthwise
• Patient lies in a supine
position MSP is in line
with the MSP of the
table
• An Entire colon filled
with
positive
and
negative
contrast
media
should
be
demonstrated
including the splenic
flexure and the rectum.
• CR is at the level of the
L4 or at the level of the
iliac crest
L4
RPO Position(optional)
Film: 14x17cm
lengthwise
• Instruct the patient to lie
on his right side making
an angulation of 3545deg
• It is taken primarily to
demonstrate the Left
Colic(splenic) flexure and
ascending colon should
be visualized.
• CR is at the level of the L4
or at the level of the iliac
crest
LAO Position (optional)
Film: 14x17cm
lengthwise
• It is taken
primarily to
demonstrate the
right colic
(hepatic) flexure
and sigmoid
portion of the
colon
• CR is at the level of
the L4 or at the
level of the iliac
crest
Right Lateral Decubitus
Film: 14x17cm
lengthwise
• Best demonstrate the
“up” medial side of the
ascending colon and
the lateral side of the
descending colon,
when the colon is
inflated with air due to
gravity.
• CR at the level of the L4
or at the level of the
iliac crest
Left Lateral Decubitus
Film: 14x17cm
lengthwise
• Best demonstrate
the “up”, medial
side of the
descending colon
and the lateral side
of the ascending
colon, when the
colon is inflated
with air.
• CR is at the level of
the L4 or at the
level of the iliac
crest
Ventral Decubitus
Film: 10x12cm
lengthwise
• A cross table view
of the recto
sigmoid area
• Demonstrate the
air-fluid level of
the recto sigmoid
area
• CR is at 5-7 cm
above the level of
the pubic
symphysis in the
midaxillary plane
PA Axial position (Angle
Prone)
Film: 10x12cm or
11x14cm crosswise
• Rectosigmoid area
must be less
superimposition than
in the PA projection
because of the
angulation of the CR
• Center it the midline of
the body with an
angulation of 30-400
caudad at approximate
level of the anterior
superior iliac spines.
Supine position
Film: 14x17cm
lengthwise
• A
postevacuation
radiograph view of
the colon is taken
after the procedure
is done
• If
inadequate
satisfactory
delineation of the
mucus the patient
may be given hot
beverage
(tea/coffee)
to
stimulate evacuation
After care
Patient is advised to drink plenty
of water, or laxative is taken to
remove excess barium sulfate.
Acknowledgement
• Radiographic positioning demonstrated by
Davao Doctors College Interns