Exam 4

• Soft tissues are more difficult to demonstrate than bony structures
• Sequencing orders for diagnostic studies


  • All radiographic examinations not requiring contrast media and any laboratory studies for iodine uptake
  • Radiographic examinations of the urinary tract
  • Radiographic examinations of the biliary system
  • Lower gastrointestinal series (barium enema)
  • Upper gastrointestinal series
• CT studies requiring IV contrast may be done any time after blood has been drawn for iodine uptake studies
• Inpatients


  Compliance ensured by nursing staff
• Diet


  The patient's diet may be restricted to clear liquids 24 hours before exam, NPO order 8 to 12 hours before the procedure
• Cathartic


  A laxative preparation often prescribed to aid in cleansing the bowel

  
• Suppository


  A semisolid nugget of medication that is inserted into the rectum to stimulate peristaltic action in the colon and promote evacuation of the distal portion of the lower bowel
• Cleansing enemas


  Another method of bowel cleansing that is sometimes prescribed in preparation for radiographic examination, although they are not used as frequently today as in the past
• Barium sulfate


  Used exclusively for the GI tract, Administered orally or rectally, Powder form is mixed with water to form a suspension, Liquid form—concentrate or ready-to-use, Paste form used for swallow studies, Barium-enema bags—disposable kits with tubing, plastic bag with graduated markings, and rectal catheter

  
• Iodinated media


  Water-soluble iodinated solutions, Used when barium is contraindicated, Risks of use: Severe dehydration, Aspiration causes complications, Contraindicated for use on esophageal study when fistula is suspected, Can be absorbed into the bloodstream from within the peritoneal cavity, More expensive and generally produce less radiographic contrast

  
• Air contrast


  Negative agent that increases visibility of structures by increasing image density, Double-contrast studies: Combined with positive agents, iodinated or barium
• Glucagon


  Drug that relaxes GI tract, slows peristalsis, and reduces cramps, Administration of 2 mg (2 units) produces a higher incidence of nausea and vomiting than does lower doses
• Routine upper gastrointestinal series


  Provide instructions and take history, Obtain scout radiograph, Hand the patient the barium cup, Receive the cup when the patient is finished with it, Assist the patient into needed positions as directed by the radiologist during fluoroscopy, Obtain radiographs as directed by radiologist
• Double-contrast upper GI study


  Provides better visualization of the mucosal lining, Patient is given gas-producing substance before drinking barium, Patient is instructed to resist urge to belch so gas is retained in the stomach
• Oral method for small-bowel studies


  Patient drinks barium, A series of timed radiographs is obtained, First radiograph at 15 min after ingestion, Subsequent images obtained at 15–30-min intervals, Exam is complete when barium reaches ileocecal valve
• Enteroclysis


  The injection of nutrient or medicinal liquid into the small bowel, A tube is passed through the mouth or nose into the duodenum, Barium is administered via a syringe attached to the tube, Rate—100 mL/min, Fluoroscopy is used to observe barium, Exam complete when barium reaches cecum
• Routine barium enema


  Scout is obtained before contrast administration, Barium is instilled under fluoroscopy, Radiographs of the contrast-filled colon are obtained, The patient evacuates the barium, Postevacuation radiograph is obtained
• Enema insertion


  Radiographer is usually responsible for insertion of the enema tip, Place patient in Sims position, Wear gloves, Lubricate tip, Spread buttocks with your fingers, Gently push the lubricated tip through the anus, Direct tip toward the umbilicus and insert into the rectum 2–4 inches, In a female patient, take care to ensure that the catheter enters the anus and not the vagina, If any resistance is felt, do not exert more force
• Barium enema considerations and precautions


  Special care and consideration must be given to patients with: Enlarged colon (megacolon), Potential for perforation of the colon, An ostomy
• Double-contrast barium enema


  Air and barium are instilled into the colon, Barium is thicker than that used for single-contrast exam, Air instilled slowly to avoid cramping, Provides better visualization of the mucosal lining
• Defecography


  A procedure for the evaluation of patients with defecational dysfunction, Also known as: Evacuation proctography, Dynamic rectal examination, High-density barium paste is instilled, Video is used to record defecation
• Instruct patient to increase fluid intake and high-bulk foods after the exam, Cathartic may be administered after exam
• Soft tissues are more difficult to demonstrate than bony structures
• Guide to sequencing orders for diagnostic studies


  • All radiographic examinations not requiring contrast media and any laboratory studies for iodine uptake
  • Radiographic examinations of the urinary tract
  • Radiographic examinations of the biliary system
  • Lower gastrointestinal series (barium enema)
  • Upper gastrointestinal series
• CT studies requiring IV contrast may be done any time after blood has been drawn for iodine uptake studies
• Inpatients


  Compliance ensured by nursing staff
• Diet


  The patient's diet may be restricted to clear liquids 24 hours before exam, NPO order 8 to 12 hours before the procedure
• Cathartic


  A laxative preparation often prescribed to aid in cleansing the bowel
• Suppository


  A semisolid nugget of medication that is inserted into the rectum to stimulate peristaltic action in the colon and promote evacuation of the distal portion of the lower bowel
• Cleansing enemas


  Another method of bowel cleansing that is sometimes prescribed in preparation for radiographic examination, although they are not used as frequently today as in the past
• Barium sulfate is used exclusively for the GI tract, administered orally or rectally

  
• Iodinated media


  Water-soluble iodinated solutions like Gastrografin and Oral Hypaque, used when barium is contraindicated

  
• Air contrast


  Negative agent that increases visibility of structures by increasing image density, used in double-contrast studies
• Glucagon


  Drug that relaxes GI tract, slows peristalsis, and reduces cramps
• Routine upper gastrointestinal series


  Radiographer provides instructions and takes history, obtains scout radiograph, hands patient barium cup, receives cup when patient is finished, assists patient into needed positions as directed by radiologist during fluoroscopy, obtains radiographs as directed by radiologist
• Double-contrast upper GI study


  Provides better visualization of the mucosal lining, patient is given gas-producing substance before drinking barium and instructed to resist urge to belch so gas is retained in the stomach
• Oral method for small-bowel studies


  Patient drinks barium, a series of timed radiographs is obtained starting at 15 min after ingestion and then at 15-30 min intervals until barium reaches ileocecal valve
• Enteroclysis


  Injection of nutrient or medicinal liquid into the small bowel, a tube is passed through the mouth or nose into the duodenum and barium is administered via a syringe attached to the tube, fluoroscopy is used to observe barium until it reaches the cecum
• Routine barium enema


  Scout is obtained before contrast administration, barium is instilled under fluoroscopy, radiographs of the contrast-filled colon are obtained, the patient evacuates the barium, and a postevacuation radiograph is obtained
• Enema insertion


  Radiographer is usually responsible for insertion of the enema tip, place patient in Sims position, wear gloves, lubricate tip, gently push the lubricated tip through the anus directing it toward the umbilicus and insert into the rectum 2-4 inches, take care in female patients to ensure the catheter enters the anus and not the vagina