1. 1
Imaging of Gastrointestinal System
義大醫院 影像醫學科
李浩銘醫師

2. Plain Photo
EUS
Fluoros copy
Nuclear Medicine
Ultrasound CT Scan MRI

3. Digestive system:
Digestive tracts:
- Oral cavity
- Pharynx
- Esophagus
- Stomach
- Small bowel
- Large bowel (Colon)
- Rectum
Accessories organs:
- Parotids
- Liver
- Billiary
- Pancreas

4. •
•
•
•
Plain abdominal x-ray
Technique :
AP – Supine
AP – Erect
•
•
LLD
Semi recumbent
CXR
Indication :
Acute abdomen

5. What to Examine ??
- Air (bowel gas)
- Bone density
- Calcification
(stone / foreign body)
- Soft tissue mass

6. Air
Sub diaphragm free air
Bowel perforation

7. Bowel obstruction
AP-semi
recumbent 
LLD, horizontal
AP-supine
-dilated bowel loops
-thickening of bowel wall
-multiple air-fluid levels

8. Ileo-cecal valve
incompetent
small and large
bowel distention
Bowel obstruction

9. Mechanical large bowel
obstruction
Colon dilatation
obstruction.
Barium enema

10. volvulus of sigmoid colon

11. Bone density
- Osteoporosis
- Compression fracture

12. Calcifications, stones Soft tissue mass

14. Barium Enema (BE)
Plastic irigator :
1. enema tip
2. enema tube
3. enema reservoir bag
4. balloon with it inflator.
1
4
4
2
1
3
4
4
2

15. Colon Radiology Anatomy

16. Technique & positioning
A.
Left lateral position :
contrast filling rectum
and rectosigmoid
B.
Left posterior oblique:
contrast filling sigmoid

17. C.
Left lateral with 15o
Trendelenberg position :
contrast flow to descendent
colon and splenic flexure
D.
Clockwise to prone position:
contrast filling transversal
colon

18. E.
Clockwise to right lateral
with 15o Trendelenberg
position : contrast filling the
hepatic flexure
F.
From E, turn left to supine
position : contrast filling
hepatic flexure and
ascendant colon

19. Contrast
Single Double
Barium Barium + air

20. Contrast
Single Double
Motility study Mucosa study
Simple & relative safe More difficult

21. Indication
Double contrast BE
Melena / bloody stool
Cancer
Suspected colonic polyp
Family hx of colon ca / polyp
Chronic diarrhea / bowel habit change
IBD (inflamatory bowel disease)
Pain & abdominal discomfort
Diverticulosis

22. Intussusceptions
Hirschprungs disease
Fatique / very old patient /
serious illness
Suspected pelvic
metastasis
Indication
Single contrast BE

23. Contraindicati
on
Suspect bowel perforation
Toxic megacolon
After colonic biopsy
Pregnant Patient

24. Complicati
on
Gas pain
Colonic perforation/rupture
Intramural barium
Stool impaction
Bacterial contamination
Allergy / hypersensitivity

25. Patient
preparation
Low residue diet
Increased fluid intake
Rectal or oral laxative
Antispasmodic agent (if needed)
1. Glucagon: iv 0.5 – 1 mg
2. Buscopan: iv or im 1 amp (20 mg/mL)

26. Record / filming
Plain abdominal photo
Spot photo
Overhead whole abdomen
Plain abdominal photo

29. Barium
Enema
Single
Contrast

30. Spot film : Single contrast
Rectum (left lateral)
Hepatic flexure
Sigmoid Splenic flexure
Cecum

31. Whole abdomen : single contrast
Whole colon :
overhead film

32. Barium
Enema
Double
Contrast

33. Spot film : double contrast
Rectum & sigmoid :
Lateral position Supine position Prone position

34. Spot film : double contrast
Sigmoid :
posterior oblique
Distal descendant colon Proximal
descendant colon

35. Spot film : double contrast
Splenic flexure
(RPO)
Transverse colon
Erect position

36. Spot film : double contrast
Ascendant colon
Hepatic flexure
Erect position Erect position, LPO

37. Spot film : double contrast
Cecum & appendix Cecum & terminal ileum

38. Overhead film :
whole colon

40. Hirschsprung disease
Dilatation of proximal bowel with caliber change at rectum
Transitional zone

41. Intussusception
Doughnut Sign

42. Polyp
Bubble 
Filling defect

43. Pedunculated Polyp
Sessile Polyp
Mexican hat sign

44. Malignant polyp : villous type

45. Apple core sign
Colon cancer : annular type

46. Colonic diverticulitis
Colonic diverticulosis

47. Ulcerative colitis
Continuous lesion, lead pipe sign
Segmental colitis Pancolitis

48. Crohn’s disease
Discontinuous skip lesion
Fistula formation

49. Colitis TB
Rectal carcinoma
Overhanging edges / shouldering
Annular constriction
Irregularity border

50. Colonic polyp
Filling defect on single contrast Soft tissue mass on double
contrast

51. Extraluminal tumor
ileocecal intussusceptions
(Coiled spring appearance)

52. Digestive system:
Digestive tracts:
- Oral cavity
- Pharynx
- Esophagus
- Stomach
- Small bowel
- Large bowel (Colon)
- Rectum
Accessories organs:
- Parotids
- Liver
- Billiary
- Pancreas

53. Diffuse esophageal spasm:
corkscrew esophagus
15

54. Foreign body
Mimicking tumor
Intraluminal filling defect
16

55. 17
Gastric wall filling defect
Gastric carcinoma

56. Linitis plastica
18

57. 19
Additional shadow
Duodenum diverticulosis

58. 3. Small Intestines
Barium follow through (Single Contrast)
Enteroclysis (Double Contrast)
20

59. Barium Follow Through
• Patient fasting
• Single contrast : 200 – 500 cc of barium
suspension is given to drink
• Followed by fluoroscopic or conventional x- ray.
• Taken serial photo : 5‘ , 10’, 20’ etc.
• Examination must be stop when barium filling
the cecum.
21

60. Enteroclysis = small bowel enema
• Inserted the NG Tube (12F 135 cm long)
• Maneuver catheter tip to the antrum 
passing pylorus placed and fixation
catheter tip in duodenal 3rd parts.
• Contrast irrigation (+ methylcellulose) or
air insufflating
• Filming
22

61. Normal follow through
Enteroclysis - normal small
bowel mucosa
23

62. ascariasis in small intestine
24

63. Take home
message
• ABCS in KUB
• Single v.s
Double contrast
• Indication /
Contraindication /
Complication of
barium enema

64. Learn to
be better !