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Contrast media is when they increase the image of human anatomical structure which is not easily visualized. Contrast media have 2 (two) group which is positive contrast media and negative contrast media. In general, positive contrast media have an increase absorption of x-ray and show up white or grey. Negative contrast media have lack of absorption and show up as dark or grey. An example of each contrast media is like positive contrast media is iodinated compound, negative contrast media is like gaseous-air or carbon dioxide.A contrast media is a matter used to increase the contrast of structure or liquid in the body. It is generally used to enhance the visibility of blood vessel and gastrointestinal tract.Few types of contrast media are in use in medical imaging and they can be classified by imaging modalities where this are used. Despite there have other type, most common contrast media agent work based on x-ray attenuation and magnetic resonance signal enhancement. Contrast media are highly density pharmacology agents used to visualized low-control tissue in the body such as vascular, kidney, gastrointestinal (GI) tract and biliary tree. The most frequently prescribed contrast media is iodine and barium. When iodinated compound fills the blood vessel or barium fills apportion of GI tract, these internal organ become visible on radiograph. Then, the examination will be easier to be done.
The most common types of contrast media is iodine and barium. They are using for increasing x-ray based imaging method. Assorted of iodinated contrast media exist, with different occurring between the osmolarity, viscosity and absolute iodine consist of different media. Non- ionic dimmers are forward for their low osmolarity and toxicity but have a corresponding higher value with their use.
Some time, contrast media is safe to use but but it also can cause administration of various contrast media. Reaction can happen from minor to severe and also in death. The cases about 0.9 per 100000 cases. The effect for increasing severe reaction include strong allergies, bronchial asthma, cardiac disease and beta- blocker use.The iodine is not the cause of allergic reaction to contrast media. This research shown that eve iodine is common is contrast media, iodine is not the cause of allergic reaction of contrast media. It is a misunderstanding about allergic to contrast media related to the seafood. The truth is, likely culprit are the inert ingredient and the patient history about allergy reaction.
The safety and effective application of contrast media must follow easy to administer, non-toxicity, a stable compound, concentrated in the required are when injected, rapidly eliminated when necessary, non-carcinogenic, of appropriate viscosity for administration, tolerated by the patient and cost effective.
Contrast media is divide into two (2) categories=
negative contrast media which are radiolucent and low atomic number
causing the part which it is placed to be more readily penetrated by x-ray that surrounding tissue, as they attenuate the x-ray beam less effectively than body tissue, they appear darker an x-ray image. Gasseous are common used to produce negative contrast media on radiographic image.
Positive contrast media, there are radiopaque and are of increase atomic number causing the part in which it is placed to be less readily penetrated by x-ray than the surrounding tissue. Barium and iodine based solution are used in medical imaging to produce positive contrast. Both positive and negative contrast media can be employed together in double contrast examination to produce a radiographic image.
Negative contrast media is air, that be introduced by the patient during an radiographic examination. Example such as inspiration during chest radiography or can also be introduced by the radiographer as part of the examination in double contrast barium enema.Then Oxygen is introduce into cavities of the body for example in the knee when performing an angiogram to demonstrate the knee joint.Carbon dioxide can be introduced to colon when performing a double contrast barium enema rather then air, as it causes less immediate abdominal pain as well as less procedural pain and discomfort.
Positive contrast mediais barium solution and the universal contrast media used for radiographic examination of the GIT. The following characteristics of Barium is high atomic number (56) producing good radiographic contrast insoluble, stable, relatively inexpensive, iodine based compound are divide into four (4) group depending their molecular structure. 4 group are ionic molecules, ionic dimers, non-ionic monomers and non-ionic dimers
Advantage of non-ionic and ionic contrast agents
Reduce the toxicity, effect are link to hypertonicity, the change to nearly isotonic has significantly decreased reaction in man, some report dramatic the side effect and uncomfortable due to decreasing in vasodilation and resultant sensation of heat and flushing.Myelography, cannot use ionic contrast media for myelography.Decrease hypersensitive reaction, 1/80000 dead probably from decrease osmolarity and decrease cardiotoxicity.
Types and Uses
I) Iodinated (intravascular) is Iodine contrast media are usually classified as ionic or non ionic. Both types are usually used in radiology, because the interactions are relatively harmless to the body and solubility. Especially, it is used to show the vessels, and the changes in the tissues of radiography and CT, but can also be used for tests of urinary tract, uterus and tubes falopio. It can cause patients to feel as if he had diabetes. It also put the metallic taste in the mouth of the patient.Modern intravenous contrast agents are typically based on iodine. This may be bound either in the organic (non-ionic) compound or an ionic compound. Ionic agents have been developed and is still widely used depending on the conditions but can cause additional complications. Agents with covalent binding of organic iodine has fewer side effects because they are not separated into molecular components. Most of the side effects are due to injection of hyperosmolar solutions.There are many different molecules. Some examples of organic iodine molecules are iohexol, iodixanol and ioversol. Iodine Contrast Media-based water-soluble and not harmful to the body. These contrast agents are sold as a solution of water that is colorless, the focus is usually expressed as mg I / ml. Modern iodinated contrast agents can be used almost anywhere in the body. The most frequently used in intrarena, except for various purposes, they can also be used intraarterially, intrathecally (as in spinal diskography) and intraabdominally - about any body cavity or potential space.
Iodine contrast agents used for Angiography, Venografi, VCUG (Voiding Cystourethrography) and HSG (Hysterosalpinogram), IVU (intravenous Urography)
II) barium (Gastro-intestinal) is Barium sulfate is used primarily in imaging the digestive system. Materials such as a water soluble white powder that is not made to a slurry with water and given directly to the gastrointestinal tract such as Barium enema and DCBE (Double Contrast Barium Enema), Barium swallow Double contrast barium meal and barium meal, Barium Follow Through and CT Pneumocolon
Barium sulfate, an insoluble white powder commonly used to increase the contrast to the GI tract. Depending on how it would be a compound that is mixed with water, thickeners, coagulating agents and flavor to contrast agents. As barium sulfate, the type of contrast agent is a mixture of opaque white. It is only used in the digestive tract.It is usually swallowed or carried as an enema. Upon inspection, he came out through a large stool.
Special Preparation and Precautions
If patient don not have any problems, they can fasting 4- 6 hours before the examination. If patient have the following problem, radiographer must know the precautions and realize additional risk. The known history of allergy such as tired, have had a reaction to the Contrast Media, have had a reaction to medication heart disease, Myeloma Multipelor myelodysplastik syndrome (diabetes critical)
If patient have any allergies or reactions in the past, asked to take medication Prednisolone 40 mg, 12 hours before and 40 mg, 2 hours before the examination.Inspection requirements should be compared with the risk.
Doctors usually recommend patient check this. If you are unsure about the risk factors, please tell the doctor about any allergies or medical conditions.
For patients with Multiple myeloma or myelodysplastik syndrome, patient need to drink enough water (to prevent dehydration conditions) even though such examination Urogram Intravenous (IVU).
Patient care during contrast media
Patient medical history should be state together with indication of the procedure, list of the medication taken by the patient, patient allergies and past surgical procedure.Patient must make a plan before started the examination. Patient family member must accompany the patient to send the patient go back home after the examination.
Pre- procedure care
The physician must check the patient medical history for make sure that the indication is suitable with the examination to be done.Patient must also bring their medication and medicine that their taking now.Documented of informed consent of examination must be prepared too.Patient past examination must be recorded too.
Cardiac monitor should be apply to the all patient especially anteriographic patient through out the procedure.All patient must have intravenous drip to easier for give the patient medicine and fluid resuscitation.
After the examination, nurse or doctor must observe the patient vital sign and the puncture site.The puncture site must be checked for bleeding at patient.The physician must know how to answer the question related to the patient problem and about 24 hours procedure too.
The difficulty or complications that may arise
Despite the above explanations on this matter, the possibility of a simple reaction to the strong reaction is very low. The doctor had to take into account the risk ratio than when they propose some kind of inspection to you.Contrast media are other medicines that you know. Contrast Media is the latest to be safe. Like all medications (including drugs that often take the Panadol / Paracetamol), Contrast Media also has the potential undesirable reactions. It is classified as low, moderate and severe. Through a non-ionic contrast media, the possibility of reactions occur is very low or less. Most of the reactions were weak, temporary and require no treatment, and occurred in the first 20 minutes after injection.
Examples of patient reaction to contrast media:
I) weak reaction such as Nausea or vomiting,Heat throughout the body (as if after exercise),Itching on the body (temporary or last for a few days, given the antihistamine drug),Flu
II) reaction medium like Trouble breathing (like asthma),Hypotension (bloodpressure dropped suddenly)
III) Severe Reactions like Anaphylactic rare but can happen and not expected
Intravenous urography is a radiological apply to viewing the unusual structure of urinary system (from kidney to urinary bladder).This examination will inserted a injection.Then x-ray will be taken at accurately timing to take a image when a contrast go follow through the urinary system. IVU is done because to detect the stone at urinary system that influence the urinary system.Intravenous urografi frequently called IVU or IVP. This research will be proposed to patients with problems related to the urinary system (bladder). It also is one of many tests x-rays to assist in producing an anatomic structure and processes that occur in the human excretory system. These tests show the kidney, uterus and bladder. IVU is the appropriate test for the investigation of blood in the urine (hematuria), pain in the genital and kidney stones. Inventories are required depending on the situation. If testing is required as soon as possible, supply is not needed. However, if it is in accordance with the time prescribed by doctors, patients are required to fast overnight / day and aims to empty the bowel. An agent (drug) to empty the bowel will be performed at the time of appointment. If the patient has a history of asthma, allergic to iodine or a history of reactions to contrast media beriodin, medicine or other allergies, or interpreter radiologist x-ray should be notified. During the test, patients lie on the x-ray table. An x-ray will be taken before the contrast medium injected into the patient's blood nerve. The radiologist will place a small needle on the arm or hand vein for the injection. When the contrast medium injected into the vein, the patient may feel hot. These feelings will soon disappear after the injection. X-rays are taken and subsequently, a pressure ring will be placed on the abdomen to show clearly the renal system and better. This will cause discomfort but will not affect the patient's breathing. Radiographs (x-ray) will be taken. When the band released emphasized, patients need to empty the bladder and one more x-rays are taken. Not all patients need a ring to the abdominal pressure. It depends on the picture obtained for the patient's urinary system. After this test, the patient can return to daily activities and no food taboos. It is also not available to test long-term effects of this IVU.
INTRAVENOUS UROGRAPHY (IVU)
Indication for IVU is suspected urinary tract pathology, Repeat infection, Hematuria, Trauma, Chronic pyelonepritis, Kidney stone, Renal carcinoma, Transitional cell carcinoma, Polycystic kidney, Anatomical variation and Obstruction
Before patient go to the examination, patient must make a preparation as advise by the doctor
Before examination start, patient can take a small quantity of breakfast, and also can take small amount of water 4 hour before examination.For patient who have diabetic, myeloma, renal failure water is recommended or allowed to them because to give the patient energy before examination.After examination, patient can eat and drink as normal.
The radiographer should ask if the patient have allergic or disease such as asthma or known allergies.
Patient before examination can take low-residue vegetable and water before starting fasting. 2 days before examination, patient must avoid eating green vegetables, so patient is recommended to eat meat, potatoes and cereals. Patient also must take 2 tablets of laxative such as dulcolax to cleansing the bowel a day before examination. Administered IVU must prior to Infants, The elderly, Those with cardiac or renal impairment, Diabetic,Patient with history of asthma or severe allergy and Patient with a history of previous reaction to contrast media
If the patient is female, ask about her 28 days rule. If she feels that she might be pregnant, let the patient do the pregnancy test first. If she is confirmed to be pregnant make another appointment for her.
Preparation before IVU examination.
Ask the patient to change to hospital gown and urinate for empty the bladder.Keep the patient valuable things to radiographer of keep it to safe placeThen, ask the patient lying on the x-ray table and do the x-ray abdomen. Contrast media will be given after preliminary radiograph through vein on the forearm.At the early stages, some compression may only be applied to the lower abdomen by means of pads and belt or may only a head down tilt of the table.The procedure of urine flow from kidney to bladder will take only at least 30 minutes to complete.Then, the final stages is when post- micture between the last film is taken. But it depends on image delayed as well.
Precaution taken before the administration of contrast media.
Radiographer or radiologist should know about the patient and their medical history. The low- osmolarity contrast media also should be using to the patient that have high risk.Then, radiographer or radiologist must consider the high risk factor which are related to the administer of IVU contrast medium such as Previous adverse reaction to contrast media,Severe renal, Asthma, Hypertension to iodine, Epilepsy, Hyperthyrolism, Severe respiratory disease and Diabetic
The expired date of contrast media should be checked. The. temperature of contrast media also must at same to body temperature. If not, radiographer must put the contrast media into a boiled water. The radiographer and radiologist must alert about the effect, reaction, indication and the procedure of the examination. must also always check the emergency trolley and be used to it.
Make sure the contrast volume, dose and strength or procedure be undertaken. If the patient have history with contrast media t the past, the patient probably will having a fatal reaction if the examination is done. So the great are must be under view to avoid the bad probabilities.
Preparation of injection site
Washing hand correctly and drying it. Then, clean the area of the skin to be injected with isopropyl alcohol or 1% Iodine. Use alcohol swabs and once the area become swabs, it should not been touch again.
During examination / injection
Radiographer should know where doctors can be reach in case of emergency. Always evaluate the patient ital sign and watch carefully the patient respiration, pulse, blood pressure ,patient colour and level of consciousness.
Leave the patient for 15 minute and record all information and it's administration.
If the patient is fine, the patient can travel home. But if not, patient have to wait until feel better.
Procedure of IVU
Make sure that all the devices needed are already and available for injection procedure. Conform patient medical history and check the allergies. Comfort the patient and explain the procedure, also gain consent. Select a vein using the criteria already discussed. Place the sterile cotton wool ball over the site. Remove the needle and give pressure to the site until the bleeding stopped. Ensure the patient no allergies to the plaster.
Essential criteria for the ideal intravenous contrast agent is Water soluble, Heat, Non-antigenic, Available at the right viscosity and density,Low-viscosity ~making them easy to administer, Persistent enough in the area of interest to allow its visualization, Lower or the same osmolarity compared to plasma , Non-toxicity, both locally and systemically and Low cost
Routine IVU procedure
Film size (35 x 42 cm)
Patients are in a position to lie on the boundary of the AP abdomen to include the symphysis pubis and the diaphragm. To inspect, inventory abdomen and values for any exposure and calcifications of the renal tract
Additional films to determine the position of any opacities
35 degrees posterior to the renal area
Function to see the inventory in the patient's bowel, Identify the patient's renal status, Determining the appropriate amount of exposure factors and Seeing patients and identify any pathology
Film size (24 x 30cm)
AP based on the patient's renal area to see nefrogram
5 minute film
Film size (24 x 30cm)
AP based on the patient's renal area to determine whether the waste products properly or not if you take a less healthy diet and the dose of contrast required
Compression can be used in some centers at this time to tighten pelvicalyceal systems to demonstrate any defects core and a film taken at 10 minutes in the renal area
Compression should not be used in cases such as renal colic, or renal injury after abdomen surgery
Compression is released to demonstrate the system and ureter pelvicalyceal
25 minute film (release)
Film size (24 x 30cm) 15 ° caudal angulation centered 5 cm above the upper boundary of symphysis pubis to demonstrate bladder distention
Post micture film
15 ° caudal angulation centered 5 cm above the border of symphysis pubis to show the bladder successfully, and returns once the lower end of the ureter to normal distention
The examination will take about 1 hour, but if delayed film or have problem, it could reach until 2 hour or more.
Disadvantage of IVU, Require kidney function,Insensitive in small masses, Cant distinguish cyst from solid tumors and Only indirect visualize process area kidney and urinary tract
Advantage of IVU is ,Relatively inexpensive, Good view of the urinary tract, Standardize and easily available, Most detail visualization of pelvicalyceal system, Easy and rewarding to communication.
The only difficulty arises from the contrast media. These difficulties are minor, such as itching, tired of difficulty breathing, blood pressure falls (usually temporarily) and rare patients with life-threatening (anaphylaxis).Rarely pain and discomfort occurs when the abdominal compression done, but the compression is usually stopped when you told the interpreter that operates x-ray of your examination.
Signs of patients who need to undergo IVU is ,Trauma, Heamaturia, Renal colic, pathologist who was found in urinary tract (bladder), Infection of the bladder, Infections of the kidney and cancer (tumor)
Equipment isX-ray power generator is simple, 40-60 kW,The basic tools tomography, Abdominal Compression Tools, Film combined in different sizes
pad. Intravenous instrument is 50ml syringes, needles, sticky tape, Options needles, straight / butterfly size 16, 19, 21, 23 and measuring blood pressure
Contrast agent like examples of typical 70 kg adult with normal blood urea values (2.5 - 7.5mmol / L), Contrast media should be warmed to body temperature before injection,Main Product, iodine constituent mg / ml Dose Route, opamidol 300 300 Niopam 50ml I.V,Omnipaque, 350 350 50ml Iohexhol I.V, Urograffin
370 370 50ml Diatrozates I.V
The typical exposure is STAIN kV mAs F.F.D Grid Focus Film / Screen
AP Abdomen 100cm 60-75 50-70 Broad yes Regular,Tomogram 20
@ 9cm 60-75 70-120 Broad yes Regular 100cm
A barium swallow is a medical imaging procedure used to make examination to the upper GI (gastrointestinal) tract, which includes the esophagus and, to a lesser extent, and the stomach.The contrast media that visible to x- ray is barium sulfate. As the patient swallows the barium, it cover the esophagus with a thin layer of the barium. This allow the hollow structure to be imaged., they will appear as black spot, as opposed to the white produced by relatively-dense barium. As such, it is useful in produce a contrast to the barium, to produce a double contrast image, to provide better visual of the contrasting features within the muscolar layer of the esophagus. In cases where a leak is suspected or desired to be demonstrated, contrast imaging involving the use of water soluble contrast media containing iodine is used.As with all X-rays, the barium swallow technique produce radiation, and may irradiate the patient unnecessarily. The barium swallow should be used only if required, and, although it cannot be replaced by endoscopy as for the barium enema, it should be avoided as for children and pregnant women.
Barium is a strong contrast that give high quality on the image. Barium swallow is related to barium meal. The indication for contrast swallow is dysphagia, anaemia, pain, assesment of trachea- osophagus fisture and assesment of the site of the perforation. If no contraindication, contrast media is E-Z HD 250ml, gastrografin, LOCM. Gastrografinshould not be used for the investigation of trachea- osophageal fistula or when aspirationis possibility and barium should not be used for perforation is suspected. The equipment ofbarium swallow is rapid serial radiography (2 frames per second), or videofor recording may be need for assessment of the laryngopharynx and upper osophagus deglution. Complication of barium swallow is leakage of barium from an unsuspected obstruction and aspiration. Barium swallow is oftenly for upper GI tract. The upper GI tract consist of oropharynx, hypopharynx, oesophagus, stomach and first part of the duodenum. The aim of a contrast examination is to make outline sharp image of the structure. The most contrast media been using is barium sulphate suspension, even though ionic and non- ionic contrast agent can be used. The barium swallow and meal can therefore reasonably be split into a number of sub examination when the clinical picture has a define direction.
Preliminary film is required for a water- soluble study if have obstruction. The technique is patient need to be in erect RAO position to make the oesophagus out from spine. Barium is swallowed and take film of the upper and lower oesophagus and it rapid serial radiography is needed, it will perform in right lateral, RAO and PA position. To show the tracheo- oesophageal fistula in infants, a nasogatric is use to the level of mid- oesophagus, and the contrast is inserted to the distend of the oesophagus. This will make the contrast media through a small fistula. This is important to make to take image of x-ray in lateral projection during injection of contrast media. Some study says that infant should be examine in the prone position while lying on the vertical tilting table, the best result are possible when children lying on the side of horizontal table. When the examination is done to the children by giving barium using bottle is important that it be performed first, before they aspiration into the airway from overspill. Overspill may cause the incorrect diagnosis of the tracheo- oesophageal fistula. If it not possible to know wheter contrast media in the bronchi is due to a small fistula, which is hard to see, or due to aspiration.
Patient preparation is patient should fasting at least 6 hours before the examination but 5 hour if consider adequate by some. It is advise that this should be the case even if the only barium swallow is indicated, in case view of the gaster are found to be required, this avoid the patient having the repeat examination. Patient jewellery ar any artifact should be remove and patient gown must be worn. Patient must be informed about the procedure, so they can give their consent. Make sure the patient follow the instruction and fasting period. The examination is used to patient that have high dsyphagia or definite oesophageal symptom, always have normal OGD, but are still symptomatic, quiet often motility disorder may the reason. The contraindication when aspiration during ingestion. Contrast agent is barium sulfate suspension or water soluble contrast medium. The additional equipment of this examination is disposable cup and tissue.
The technique, if there any doubt that the patient may aspire, the initial swallow is best out using a water- soluble contrast media, even aspiration of barium has been by some to be relatively damages. Aspiration may not be suspected but unsuspected 'silent aspiration' may be appear unless using the technique.
Ask the patient to stand erect in the AP position on the fluoroscopy table and hold cup of barium in their left hand, as when the machine turning the patient, is usually on the left. The arm must be in the trunk without patient disturb it movement around the intensifying screen carriage. Then, the patient is turn to lateral position as for the assessment of possible aspiration. Then, ask patient to take the liquid and hold in their mouth until has ask by the radiologist to swallow it. This is to give the radiographer a chance to centre on the area of interest and optimize the collimation. The patient then swallow the barium and exposure is irradiate. Then the patient is turn into the lateral position and same procedure when barium in mouth and when it swallow capture it. Patient of barium swallow always present with clinical symptom of GOR. Patient always have feeling of retrosternal discomfort and have no other symptom. The barium study can be useful as an increase the other test, GOR patient have small hiatus hernia that can not see on endoscopy. Patient preparation and contraindication are as the for the upper swallow. The additional equipment is disposable cup, small cup for effervescent agent, tissue and a straw may be required for ingestion of the barium when the table is horizontal. Technique apply is Anterior posterior (AP) and lateral projection can be taken of the oesophagus as previous describe for the barium swallow. A more useful view of distal third of oesophagus is using by the erect left posterior oblique taken when patient is ask to swallow. Then, the patient is ask to take the effervescent granules followed by the citric acid. It is important to impress patient that this will produce gas in the stomach and will and will give them feeling to belch. Then, the patient is ask to swallow another barium while in the LPO position and image can be capture of the lower oesophagus. The patient will rotate 360 degree ask by radiologist at own pace, this will ensure the coating of all aspect of the gastric mucosa ready for assessment of the stomach. To show the reflux actually occur, patient can lying head downward, but it may limited the bearing on the accuracy estimation of true extent of reflux. The barium can detect the problems of narrowing of the oesophagus, hiatal hernia, abnormal enlarge vein of the oesophagus that can cause bleeding, ulcers, tumors and polyps. There have some complication when patient taking the barium such as allergic reaction for patient that allergic to barium sulfate, constipation and barium may present in trachea. After patient get home, tell the patient that his stool will in light color because of the barium for 1-3 days, patient also have to eat vegetables and drink lot of plenty water to lightness of the constipation. Patient must quickly call the doctor if having vomiting, bleeding, pain or trouble in breathing. If patient have no past motion during 2-3 days, must call the doctor also.
Barium enema is a type of contrast media used for examine the colon using x-ray. Colon is situated between small intestine and rectum. Barium enema of the small intestine is created to show the small intestine from duodenum portion until to the ileo ceacal. By passing to the stomach contrast media is directly to the duodenum, a better flow of the contrast media can be achieved and decrease the probabilities risk of the stomach lining. It use x-ray examination to produce the image of large intestine. It have 2 different type of contrast media which is different technique contrast media, barium sulfate will be injected through rectum to see the clearer view of large intestine image. But for double contrast agent, air will be injected to rectum. Barium enema or double contrast media is a examination using a white liquid called barium that will be inserted by the rectal tube insert into rectum until it full the large intestine. Then, the x-ray will be taken. This examination is done to identify the abnormalities of intestine including diverticulosis, diverticulitis, polyps, colonic abcesess, abnormal colon movement, dilation of the colon and Hirschsrungs disease in infants. Disease that can be found in the colon is appendicitis, celiac spure, colonic polyps, crohn disease, diarrhea, lower gastrointestinal bleeding and ulcerative colitis.
Risk from the barium enema
large intestine will feeling uncomfortable. Pregnant woman might not be advise to taking barium enema because it will dangerous the baby and the mother. The end of the tube will be inserted to the intestine and it can cause infection. The patient preparation is patient must cleansing the bowel before the examination because to easy the examination be done and it can be done by 'cleansing enema'. Laxative must be given to clean the bowel. Patient must not eat at midnight before examination. When patient arrive to the examination, the consultant will checked if the patient follow the instruction by it last day of eating and drinking. Patient will be realize when the staff inserted the tube. Patient will feel uncomfortable. The a few x-ray will be taken. After the examination, the radiologist will evaluate the image and the patient will come back after a week to take his x-ray image. If there have some abnormalities, the doctor will discuss about the surgical or the examination next. On the day of examination, patient must drink a big glass of a plenty of water, do not eat or drink until the examination os finish, lying on the left side and enter a suppositori rectal medication and wait until 15-20 minute before going to post motion. Empty the blader before examination. For infants and children under 12 years old, there have important things which is they need to drink a plenty varies with bowel preparation. Give children a soft food such as porridge, fruit and soup. Vegetables are not allowed. Milk and fluid is acceptable. Do not give the infant laxative. By the day of the examination, no food is allowed. Liquid only give 2-3 hour before the examination. After the examination, patient can not drive home by it self. They must bring their family members or their friend. It also for patient safety and because to avoid vision problem effect by muscle relaxent. Drink a lot of water and eat vegetables to faster the post motion because to descreate the barium in the intestine and the stool will be in white colour. Before the examiantion, patient is needed to change to hospital gown and take off all the jewellery. To avoid patient bacome to strain the muscle relaxent must be injected. Patient will be lie down and blanket will be cover patient and radiologist will be inserted a tube to patient rectum. If the tube is soft, the patient will not feel pain but feeling uncomfortable. The barium and gas will be in patient intestine and patient will feeling like distended and want to past motion. The x-ray unit will be variuos angle. There are four positioning when do the barium enema examination which is prone,because patient back got tube at the rectum. Then, hampton view, the patient have to angle 45 degree caudad for show the rectum and using casette 14x14. patient right side down and lastly patient left side down. Patient have to do all four this positioning because to make the Barium flow in the intestine and the Barium must in watery. When the Barium in enter the rectum, have to stopped the Barium. Double contrast need to injected gas that will give pain to the patient. So the staff must do with softly and careful. Stopped injected air when the air is arrive to the tranverse colon because air can move by itself and only barium enema examination have double contrast. A preliminary plain abdominal film is not necessary unless severe constipation render the effectiveness of bowel preparation doubtful and toxic megacolon is suspected. The technique is the patient lies on the one site on an incontinence sheet and catheter is insert into the rectum. It will taped firmly in position. Some radiologist choose to give relaxent half way through the procedure. The infusion of the barium is started. The infusion is discharge when the barium reaches the hepatic flexure. The differential examinationof low intestinal obstruction in newborn contain five condition which comprise nearly all cause. Hirschsprung disease , functional immaturity of the colon and colonic atresia involve in the colon. Then, two involve in the distal ileum meconium ileus and ileal atresia. Infant eith low intestinal obstruction required contrast enema. Contraindication is only perforation. Patient preparation is when the baby already intravenous assess and it will be hydrated prior to the procedure. the colon will be microcolon, then the diagnosis will be meconium ileus or ileal atresia for treatment of meconium ileus, the main is to run the water. Soluble contrast medium to the small bowel to surround the meconium. If it successful, meconium should be passed in the next hour. Barium enema is used to detect colon cancer and it also used to evaluate the inflammatory of bowel disease. Barium must be in the colon to show the abnormalities of the colon and the blackness of the colon. Colonoscopy is the other way to determine the problems or the abnormalities in the colon. Barium enema is not good as colonoscopy. Colonoscopy can detect colon cancer and polyps than barium enema that sometime can not detect it. Barium also hard to detect the colitis in the outlining of the colon. They also can not remove the polyps. Patient that can not be detect using barium enema must do the colonoscopy for better view. The advantages by using this examination is can see the constriction of the bowel and also can be using for another treatment such as diverticular disease and fistula disease. The disadvantage by using barium enema is patient might to do the bowel preparation, feeling some uncomfortable, patient also need to hold the contrast and also the air, no patient will like this examination and not exactly as colonoscopy examination. Barium enema is not totally safe in uses because it can cause to complication to the patient such as severe ulcerative colitis, toxic megacolon or perforation in the colon. But the test must do in safety and careful when the patient have block intestine, ulcerative colitis or blood diarrhea. When patient do the single- contrast enema, their colon will filled with barium that differentiate the colon sign. Then, it can show the colon shape with barium. When barium leave out the intestine, the intestine will fall down. After the barium is leaving the intestine by post motion, the intestine lining will be like hairy. The double contrast barium will make the intestine widening that being cover by the barium enema lining with using air for present the clear image mucosa pattern. Patient positioning must in many ways to make the barium full the all area in the intestine. The barium enema can show the x-ray of a abnormalities in intestine to easier the doctor to make a diagnosis from a different conditions. Again, barium enema is a examination of x-ray use for diagnose the abnormalities of the large intestine. Then the x-ray image will be taken by the radiographer when the barium fill the colon by rectum. If have perforation on the intestine, the water soluble is used. It is similar to the barium enema examination but the producing of the image is not as good as barium enema.