Double-contrast Barium Enema Examination Research Articles

Primary colorectal lymphoma: computed tomography and double-contrast barium enema examination findings with histopathological correlation in 19 patients

Primary colorectal lymphoma (PCL) is a rare disorder, the accurate imaging diagnosis of which remains a clinical challenge. This study aimed to characterize the imaging features of PCL by double-contrast barium enema (DCBE) examination and computed tomography (CT) and correlate them with histopathological findings. DCBE (n=6) and CT (n=19) findings for 19 pathologically proven PCLs were evaluated and compared with histopathological findings in this retrospective analysis. Non-Hodgkin lymphoma was present in all patients, and the most common histological type was diffuse large B-cell lymphoma (63.2%, 12/19). The most common site was the ileocecum (84.2%, 16/19). CT revealed circumferential infiltrative lesions (68.4%, 13/19), polypoid masses (26.3%, 5/19) and ulcerative lesions (5.3%, 1/19). Most (94.7%, 18/19) lesions appeared as moderate enhancements. Fourteen (73.7%, 14/19) patients had serous membrane infiltration presenting as a poorly defined serous membrane and focal opacities in the pericolonic fat. Regional lymph node involvement was observed in twelve (63.2%, 12/19) patients who presented with aggregated nodules or masses. Frequent findings of the DCBE exam included a filling defect and niche with slight mucosal destruction, mild luminal narrowing and preserved peristalsis. The imaging appearance reflected the gross pathological findings well, although the preoperative diagnostic accuracy was low. The imaging features of PCL have a relatively characteristic appearance but are still, at times, hardly differentiated from carcinoma. Familiarity with the radiological features of PCL on DCBE and CT can help ensure a correct diagnosis.

Comparison of 64-Detector CT Colonography and Conventional Colonoscopy in the Detection of Colorectal Lesions.

Background:Colon cancer is a leading cause of morbidity and mortality in developed countries. The early detection of colorectal cancer using screening programs is important for managing early-stage colorectal cancers and polyps. Modalities that allow examination of the entire colon are conventional colonoscopy, double contrast barium enema examination and multi-detector computed tomography (MDCT) colonography.Objectives:To compare CT colonography and conventional colonoscopy results and to evaluate the accuracy of CT colonography for detecting colorectal lesions.Patients and Methods:In a prospective study performed at Gastroenterology and Radiology Departments of Medical Faculty of Eskisehir Osmangazi University, CT colonography and colonoscopy results of 31 patients with family history of colorectal carcinoma, personal or family history of colorectal polyps, lower gastrointestinal tract bleeding, change in bowel habits, iron deficiency anemia and abdominal pain were compared. Regardless of the size, CT colonography and conventional colonoscopy findings for all the lesions were cross - tabulated and the sensitivity, specificity, and positive and negative predictive values were calculated. To assess the agreement between CT colonography and conventional colonoscopy examinations, the Kappa coefficient of agreementt was used. Statistical analysis was performed by SPSS ver 15.0.Results:Regardless of the size, MDCT colonography showed 83% sensitivity and 95% specificity, with a positive predictive value of 95% and a negative predictive value of 83% for the detection of colorectal polyps and masses. MDCT colonography displayed 92% sensitivity and 95% specificity, with a positive predictive value of 92% and a negative predictive value of 95% for polyps ≥ 10 mm. For polyps between 6mm and 9 mm, MDCT colonography displayed 75% sensitivity and 100% specificity, with a positive predictive value of 100% and a negative predictive value of 90%. For polyps ≤ 5 mm MDCT colonography displayed 88% sensitivity and 100% specificity with a positive predictive value of 100% and a negative predictive value of 95%.Conclusions:CT colonography is a safe and minimally invasive technique, a valuable diagnostic tool for examining the entire colon and a good alternative compared to other colorectal cancer screening tests because of its high sensitivity values in colorectal lesions over 1 cm.

Pattern and distribution of colonic diverticulosis: Analysis of 2877 barium enemas in Thailand

To determine the pattern and distribution of colonic diverticulosis in Thai adults. A review of the computerized radiology database for double contrast barium enema (DCBE) in Thai adults was performed at the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Incomplete studies and DCBE examinations performed in non-Thai individuals were excluded. The pattern and distribution of colonic diverticulosis detected during DCBE studies from June 2009 to October 2011 were determined. The occurrence of solitary cecal diverticulum, rectal diverticulum and giant diverticulum were reported. Factors influencing the presence of colonic diverticulosis were evaluated. A total of 2877 suitable DCBE examinations were retrospectively reviewed. The mean age of patients was 59.8 ± 14.7 years. Of these patients, 1778 (61.8%) were female and 700 (24.3%) were asymptomatic. Colonic diverticulosis was identified in 820 patients (28.5%). Right-sided diverticulosis (641 cases; 22.3%) was more frequently reported than left-sided diverticulosis (383 cases; 13.3%). Pancolonic diverticulosis was found in 98 cases (3.4%). The occurrence of solitary cecal diverticulum, rectal diverticulum and giant diverticulum were 1.5% (42 cases), 0.4% (12 cases), and 0.03% (1 case), respectively. There was no significant difference in the overall occurrence of colonic diverticulosis between male and female patients (28.3% vs 28.6%, P = 0.85). DCBE examinations performed in patients with some gastrointestinal symptoms revealed the frequent occurrence of colonic diverticulosis compared with those performed in asymptomatic individuals (29.5% vs 25.3%, P = 0.03). Change in bowel habit was strongly associated with the presence of diverticulosis (a relative risk of 1.39; P = 0.005). The presence of diverticulosis was not correlated with age in symptomatic patients or asymptomatic individuals (P > 0.05). Colonic diverticulosis was identified in 28.5% of DCBE examinations in Thai adults. There was no association between the presence of diverticulosis and gender or age.

Colorectal Cancer Screening by Double Contrast Barium Enema in Thai People

The incidence of colorectal cancer (CRC) has been increasing in Asian countries including Thailand. Double contrast barium enema (DCBE) is one of the investigation tools used in CRC screening. This study aimed to determine the incidence of colorectal neoplasm detected at screening by DCBE in Thai people. The computerized radiology database of screening DCBE in Thai adults between June 2009 and October 2011 at the Faculty of Medicine, Siriraj Hospital, was reviewed. DCBE examination performed in a surveillance program after curative CRC resection or the removal of colorectal polyps was also considered as a screening DCBE. A total of 819 screening DCBEs performed during this 28-month period were analyzed. The mean age of patients was 59.8 ∓ 13.6 years. Of the total, 467 (57%) were male. A family history of CRC and a previous history of curative CRC resection or polyp removal were noted in 34 patients (4%) and 124 patients (15%), respectively. A total of 31 patients (3.8%; 95%CI = 2.7%-5.3%) were reported to have colorectal polyp or mass demonstrated on DCBE. Of these, follow-up endoscopy was performed in 20 cases (65%). According to pathological results, the incidence of advanced adenoma and CRC detected at screening DCBE was 0.7% (95%CI = 0.3%-1.6%; n=6) and 0.4% (95%CI = 0.1%-1.1%; n=3), respectively. The screening DCBE performed in Thai adults had a diagnostic yield of 0.7% for advanced adenoma and 0.4% for CRC.

Comparison between CT Colonography and Double-Contrast Barium Enema for Colonic Evaluation in Patients with Renal Insufficiency

ObjectiveTo compare the CT colonography (CTC) and double-contrast barium enema (DCBE) for colonic evaluation in patients with renal insufficiency.Materials and MethodsTwo sequential groups of consecutive patients with renal insufficiency who had a similar risk for colorectal cancer, were examined by DCBE (n = 182; mean ± SD in age, 51 ± 6.4 years) and CTC (n = 176; 50 ± 6.7 years), respectively. CTC was performed after colon cleansing with 250-mL magnesium citrate (n = 87) or 4-L polyethylene glycol (n = 89) and fecal tagging. DCBE was performed after preparation with 250-mL magnesium citrate. Patients with colonic polyps/masses of ≥ 6 mm were subsequently recommended to undergo a colonoscopy. Diagnostic yield and positive predictive value (PPV) for colonic polyps/masses, examination quality, and examination-related serum electrolyte change were retrospectively compared between the two groups.ResultsBoth the CTC and DCBE were positive for colonic polyps/masses in 28 (16%) of 176 and 11 (6%) of 182 patients, respectively (p = 0.004). Among patients with positive findings, 17 CTC and six DCBE patients subsequently underwent a colonoscopy and yielded a PPV of 88% (15 of 17 patients) and 50% (3 of 6 patients), respectively (p = 0.089). Thirteen patients with adenomatous lesions were detected in the CTC group (adenocarcinoma [n = 1], advanced adenoma [n = 6], and non-advanced adenoma [n = 6]), as compared with two patients (each with adenocarcinoma and advanced adenoma) in the DCBE group (p = 0.003). Six (3%) of 176 CTC and 16 (9%) of 182 DCBE examinations deemed to be inadequate (p = 0.046). Electrolyte changes were similar in the two groups.ConclusionIn patients with renal insufficiency, CTC has a higher diagnostic yield and a marginally higher PPV for detecting colorectal neoplasia, despite a similar diagnostic yield for adenocarcinoma, and a lower rate of inadequate examinations as compared with DCBE.

Dose optimisation of double-contrast barium enema examinations

The purpose of the present work was to optimise the filtration and dose setting for double-contrast barium enema examinations using a Philips MultiDiagnost Eleva FD system. A phantom study was performed prior to a patient study. A CDRAD phantom was used in a study where copper and aluminium filtration, different detector doses and tube potentials were examined. The image quality was evaluated using the software CDRAD Analyser and the phantom dose was determined using the Monte Carlo-based software PCXMC. The original setting [100 % detector dose (660 nGy air kerma) and a total filtration of 3.5 mm Al, at 81 kVp] and two other settings identified by the phantom study (100 % detector dose and additional filtration of 1 mm Al and 0.2 mm Cu as well as 80 % detector dose and added filtration of 1 mm Al and 0.2 mm Cu) were included in the patient study. The patient study included 60 patients and up to 8 images from each patient. Six radiologists performed a visual grading characteristics study to evaluate the image quality. A four-step scale was used to judge the fulfillment of three image quality criteria. No overall statistical significant difference in image quality was found between the three settings (P > 0.05). The decrease in the effective dose for the settings in the patient study was 15 % when filtration was added and 34 % when both filtrations was added and detector dose was reduced. The study indicates that additional filtration of 1 mm Al and 0.2 mm Cu and a decrease in detector dose by 20 % from the original setting can be used in colon examinations with Philips MultiDiagnost Eleva FD to reduce the patient dose by 30 % without significantly affecting the image quality. For 20 exposures, this corresponds to a decrease in the effective dose from 1.6 to 1.1 mSv.

Retroperitoneal perforation of the rectum during double-contrast barium-enema examination: a life-threatening complication

Retroperitoneal perforation of the rectum during double-contrast barium-enema examination: a life-threatening complicationBackground. Rectal injuries during barium-enema are rare but life-threatening complications.Case report. We present a case of an 82-year-old man in whom extensive retroperitoneal perforation of the rectum occurred during double-contrast barium-enema examination. The patient was revealed acute abdomen, difficulty in breathing and diffuse subcutaneous crepitus at the chest and neck area. The patient underwent a surgery because signs of peritonitis developed. We performed a Hartmann's procedure. The patient died 20 hours after the surgery due to a septic shock.Conclusions. Prompt recognition and management of retroperitoneal perforation of the rectum are sine qua non in decreasing mortality.

Rates of New or Missed Colorectal Cancer After Barium Enema and Their Risk Factors: A Population-Based Study

Double-contrast barium enema (DCBE) is widely used in clinical practice to detect colorectal cancer (CRC). Our objective was to evaluate the rate of new or missed CRC following DCBE and the associated risk factors in a population-based study. All patients (> or =20 yr old) with a new diagnosis of CRC between April 1, 1997, and March 31, 2004, in Ontario were identified. Data were extracted from the Ontario Health Insurance Program, the Canadian Institute for Health Information, the Registered Persons Database and the Ontario Cancer Registry. Patients who had a DCBE examination 36 months prior to the diagnosis of CRC were divided into two groups: detected cancers (DCBE within 6 months prior to diagnosis) and new or missed cancers (DCBE 6-36 months prior to diagnosis). Multivariate analysis was used to evaluate factors associated with new or missed CRC. We identified 13,849 patients who had a DCBE 36 months prior to the diagnosis of CRC. The overall rate of new or missed cancers following DCBE was 22.4%. Independent risk factors for new or missed cancers were older age, female sex, previous abdominal or pelvic surgery, diverticular disease, right-sided CRC, and having the DCBE in an office setting. Physicians who use DCBE to evaluate the colon must inform their patients that if a cancer is present, there is an approximately one in five chance that it will be missed. Given the recent endorsement of CT colonography by the U.S. Multi-Society Task Force on Colorectal Cancer as an option for CRC screening, it may be time to reconsider the use of DCBE to detect CRC.

Is There Still a Role for Double-Contrast Barium Enema Examination?

The role of double-contrast barium enema examination (DCBE) in screening for colorectal carcinoma has evolved considerably in recent years. This review will discuss the current indications for DCBE and contrast fluoroscopy of the colon and the anticipated future role of these studies.

An evaluation of a radiographer-led barium enema service in the diagnosis of colorectal cancer

Purpose This study was undertaken to assess the sensitivity and efficacy of a radiographer-led double contrast barium enema (DCBE) service in the diagnosis of colorectal cancer (CRC). Methods All patients on the CRC database from its inception in 1997 until the end of 2004 were cross-referenced with the radiology database. Details were recorded of any patient who had undergone a DCBE examination at any time prior to histological confirmation of colorectal cancer. All the DCBE in this review were performed and reported by radiographers as part of a protocol of double reporting with a consultant radiologist. The radiographers and radiologists reports were reviewed for each patient. Notes and X-rays were also reviewed when necessary. Reporting sensitivity was compared with the Royal College of Radiologists (RCR) barium enema examination targets for the diagnosis of colorectal carcinoma. Results 362 of the 1005 patients on the CRC database had undergone a DCBE. Combined radiographer and radiologist reporting demonstrated a diagnostic sensitivity of 98% for CRC and were cancer specific in 93% of cases. These results compared favourably with the referenced RCR sensitivity targets for colorectal cancer. Reporting discord only occurred with the terminology of reporting 13 equivocal polyps. None of these polyps were neoplastic and thus did not affect CRC sensitivity. Conclusion Radiographer reporting compares favourably with published CRC sensitivity data of more expensive techniques such as CT colonography. A protocol of radiographer/radiographer double reporting is now used at this hospital with radiological second opinion being acquired for more complex abnormal DCBE examination appearances. This service is a safe, cost-effective option that should not be overlooked with the increasing demand for CRC screening.

Colorectal Cancer: Screening Double-Contrast Barium Enema Examination in Average-Risk Adults Older Than 50 Years

To retrospectively determine the diagnostic yield of double-contrast barium enema examinations performed for colorectal cancer screening of neoplasms 1 cm or larger or advanced neoplastic lesions of any size in average-risk adults older than 50 years. The Institutional Review Board at the affiliated Veterans Affairs Medical Center approved this HIPAA-compliant study protocol and did not require informed consent from patients. Computerized databases revealed 276 double-contrast barium enema examinations performed for colorectal cancer screening in average-risk adults older than 50 years. Radiographic and pathologic reports were reviewed to determine the number of patients who had polypoid lesions 1 cm or larger, polyps smaller than 1 cm, or advanced neoplastic lesions of any size. Forty-five (16.3%) of the 276 patients underwent follow-up sigmoidoscopy or colonoscopy. Medical, endoscopic, and pathologic records were reviewed and compared with radiographic findings. The results of double-contrast barium enema examination revealed 74 (26.8%) of 276 patients with 104 polypoid lesions in the colon, including 32 patients (11.6%) with 41 polypoid lesions 1 cm or larger, 15 patients (5.4%) with 19 polyps 6-9 mm, and 27 patients (9.8%) with 44 polyps 5 mm or smaller. Endoscopy was performed in 24 (75%) of 32 patients, the results of which confirmed 23 (72%) of 32 radiographically diagnosed lesions 1 cm or larger in 16 (67%) of 24 patients. In two of these individuals, the polyps were hyperplastic. The remaining 14 patients had a total of 21 neoplastic lesions 1 cm or larger, including 11 tubular adenomas, seven tubulovillous adenomas, one villous adenoma with marked dysplasia, and two cancers. The diagnostic yield of screening double-contrast barium enema examination was 5.1% (14 of 276 patients) for neoplastic lesions 1 cm or larger and 6.2% (17 of 276 patients) for advanced neoplastic lesions of any size. Double-contrast barium enema examinations performed in average-risk adults older than 50 years have a diagnostic yield of 5.1% for neoplastic lesions 1 cm or larger and 6.2% for advanced neoplastic lesions, regardless of size.

Exophytic colon cancer mimicking an ovarian tumor: the value of evaluation of the venous anatomy on MDCT

We report a case of exophytic sigmoid colon cancer mimicking an ovarian tumor. This tumor showed submucosal growth accompanied by an extracanal cystic component. It was difficult to determine whether this tumor derived from the sigmoid colon or from the ovary by double contrast barium enema and endoscopic examination. On multidetector-row CT (MDCT), it was possible to see that this mass continued not to the gonadal vein but to the inferior mesenteric vein indicating sigmoid colon origin. In determining the origin of a pelvic mass, it is useful to evaluate the relationship between the tumor and the venous anatomy.

Screening for colorectal cancer

A review of the literature regarding the screening strategies for colorectal cancer (CRC), particularly for average risk individuals, is analysed. The advantages and disadvantages or limitations of screening modalities for CRC, such as faecal occult blood testing (FOBT) with guaiac-based tests or the new faecal deoxyribonucleic acid tests, endoscopic screening by flexible sigmoidoscopy, colonoscopy, or CT-colonography and double contrast barium enema examination, are reported. The efficacy and cost of the screening tests are evaluated, and it is found that any of the suggested tests is more cost effective than other medical intervention or treatment as compared with no screening. The reported compliance to any form of screening test was 30-40%, a rate that is low enough. The experience of our surgical department of a screening programme, based on FOBT, on 4189 individuals over 50 years old, and application of colonoscopy in positive subjects, is reported.

Barium enema: use of increased copper filtration to optimize dose and image quality

The purpose of this study was to determine and validate the optimum copper filtration for adult double contrast barium enema examinations. Entrance surface dose rates to polymethyl methacrylate slabs and corresponding image intensifier input kermas, were measured for various added copper filters. Image contrast was assessed using a Leeds TO.10 test object. Copper filter thickness of 0.3 mm was chosen, as this reduced entrance surface dose rate by 56%, without substantially degrading image contrast due to kV and mA saturation. 20 sets of clinical films taken with each of 0.3 mm copper, 0.1 mm copper and no copper were reviewed following randomization, by a specialist gastrointestinal radiologist. Each set of digital spot and conventional films was allocated a score for each of three regions of the bowel, on a scale of 0-3 for perceived barium coating. The Kruskal-Wallis test showed no significant difference in perceived coating between the three groups (Digital spot: sigmoid colon p=0.207, splenic flexure p=0.103, hepatic flexure p=0.894. Screen-film: left colon p=0.803, right colon p=0.487, transverse colon p=0.905). All examinations but one were classified as diagnostic. The remaining one was classified indeterminate, due to poor distension of the colon. On adding 0.3 mm copper filtration, the mean dose-area product per examination was reduced by 57%, from 17.7 Gy cm(2) to 7.6 Gy cm(2). The estimated reduction in effective dose was 11%, from 3.0 mSv to 2.7 mSv. X-ray tube loading increased by 30%, but this caused no overheating with our local examination protocol and schedule. Additional filtration of 0.3 mm copper for adult double contrast barium enemas has now been implemented in routine clinical use at our hospital.

CT and MR colonography: scanning techniques, postprocessing, and emphasis on polyp detection.

In the last decade, computed tomographic (CT) and magnetic resonance (MR) colonography, two new cross-sectional techniques for imaging of the colon, emerged. Both techniques show promising initial results in the detection of polyps equal to or greater than 1 cm in diameter in symptomatic patients. Imaging protocols are still mostly under development and prone to change. Both CT and MR colonography generate a large number of source images, which have to be read carefully for filling defects and, if intravenous contrast material is used, enhancing lesions. An important postprocessing technique is multiplanar reformatting, which allows the viewer to see potential lesions in an orientation other than that of the source images. Virtual endoscopy, a volume rendering technique that generates images from within the colon lumen, is used for problem solving. CT and MR colonography have potential advantages over colonoscopy and double-contrast barium enema examination: multiplanar capabilities, detection of enhancing lesions that make the distinction between fecal residue and true lesion possible, and ante- and retrograde virtual colonoscopy. Currently, a number of studies suggest that patients have a preference for CT colonography over colonoscopy. Patients consider bowel cleansing the most uncomfortable part of any colon examination; hence, from the acceptance point of view, fecal tagging techniques are promising. Before CT and MR colonography can be implemented in daily practice, they must show approximately the same accuracy as colonoscopy for polyp detection in both symptomatic and screening patients.

Early invasive colorectal carcinomas with submucosal invasion: radiographic characteristics with barium double contrast images.

We assessed the radiographic characteristics of early colorectal carcinomas with submucosal invasion (CCSI) with the use of double-contrast images. From 1989 to 1997, 193 patients with 196 CCSI lesions underwent double-contrast barium enema examinations. Three gastrointestinal radiologists retrospectively reviewed the radiographic characteristics of the lesions and classified them as protruding and depressed types by consensus. Further, subclassifying the protruding into lobular and smooth types was accomplished on the basis of surface structure. Each type was compared with pathologic findings of resected specimens. The incidence of the protruding type was 98.0%, and that of the depressed type was only 2.0%. The proportion of smooth lesions was 49.0% for the protruding type; these had a mean diameter of 17.9 mm, which was significantly smaller than the 23.1 mm mean observed for lobular lesions (p < 0.01). Of the smooth lesions, 44.7% demonstrated massive invasion, whereas 91.8% of lobular lesions exhibited only slight or moderate invasion into the submucosa (p < 0.01). The extent of invasion of the smooth lesions was greater than that for their lobular counterparts in terms of venous and lymph node involvement. Almost all CCSIs could be identified radiologically as protruding lesions; these had a smooth rather than a lobulated surface and demonstrated greater malignancy, despite the smaller size. It is clinically important to discriminate these from other polypoid lesions in establishing patient treatment. Double-contrast imaging is useful for evaluation of the surface characteristics of CCSIs in barium enema studies.

Ileocecal valve: spectrum of normal findings at double-contrast barium enema examination.

To characterize the spectrum of normal findings of the ileocecal valve at double-contrast barium enema examination to allow differentiation between a normal valve and one infiltrated by tumor. A search of radiology and endoscopy files showed 106 patients who underwent double-contrast barium enema examination and colonoscopy. The radiographic images were reviewed by two authors to determine the morphology of the ileocecal valve and to evaluate whether it appeared normal or abnormal. The radiographic data were then correlated with endoscopic and pathologic findings. The ileocecal valve was visible in 91 (86%) of 106 patients. It was round or ovoid in 71 patients (78%) and triangular in 20 (22%). In the 88 patients with a normal valve at colonoscopy, mean valve height was 1.7 cm, and mean width was 2.8 cm. The valve was smooth in 75 patients (85%) and smoothly lobulated in 13 (15%). The lips of the valve were symmetric in 77 patients (88%) and asymmetric in 11 (12%). All 87 patients with a normal valve at double-contrast barium enema examination had a normal valve at colonoscopy, whereas the two patients with a valve suspicious for tumor at barium enema examination had neoplasms (one carcinoma and one villous adenoma) at colonoscopy. The ileocecal valve may show a spectrum of normal findings at double-contrast barium enema examination and may appear as a round, ovoid, or triangular structure with a maximal height of nearly 4 cm. The valve may be large, asymmetric, or smoothly lobulated, even in the absence of tumor.

Complications of radiographer performed double contrast barium enema examinations

Aim: To determine the complication rate from radiographer performed double contrast barium enema examinations.Method: Questionnaires were sent to radiographers who had attended a barium enema training course to determine the complications encountered during a 3-year period.Results: A total of 444 questionnaires were posted and 250 (56.3%) were returned completed. These radiographers had performed approximately 134700 examinations. Fifty-four complications were reported including 20 cardiac events, 10 intraperitoneal and six extraperitoneal perforations. There were three deaths resulting in an overall mortality rate of one in 44900; two deaths were from cardiac complications and one was from bowel perforation.Conclusions: The mortality rate for radiographer performed examinations is similar to that previously reported for examinations performed by radiologists. The rate of cardiac deaths is similar but the bowel perforation rate may be higher. Training should concentrate on minimizing the risk of perforation, which can result from the generation of excessive intracolonic pressures, excessive colonic distension and the use of rectal balloon catheters.

Patient and occupational dosimetry in double contrast barium enema examinations.

A new and relatively simple method is presented to distribute total dose-area product (DAP) over a number of projections that model exposure during double contrast barium enema (DCBE) examinations. In addition, hitherto unavailable entrance and effective doses to the physician performing the DCBE examination have been determined. DAP, fluoroscopy time, number of images as well as some patient data were collected for 150 DCBE examinations. For a subset of 50 examinations, the distribution of DAP over 12 hypothetical but representative projections was estimated by measuring the entrance dose in the centre of each of these projections during the complete procedure. Effective dose to the patient was obtained using DAP to effective dose conversion coefficients calculated for each of the 12 projections. Exposure of the worker was quantified by measuring the entrance dose at the forehead, neck, arms, right hand and legs. The sex-averaged effective dose to the patient per examination was 6.4+/-2.1 mSv (mean+/-SD; n=50) and the corresponding DAP was 44+/-22 Gy cm(2). The effective dose to the worker per examination was 0.52 microGy (n=50), whereas the highest entrance dose of 30+/-25 microGy was found for the right arm. The proposed method for deriving the distribution of total DAP over a set of representative projections is much less time consuming than visual observation of patient exposure, whilst accuracy seems acceptable. Entrance and effective doses per examination for workers in DCBE examinations are very low. For a normal workload, doses remain far below the legally established dose limits.

Peripheral T-cell Lymphoma of the Colon: Double-Contrast Barium Enema Examination Findings in Six Patients

To evaluate radiologic findings of peripheral T-cell lymphoma (PTCL) of the colon at double-contrast barium enema examination. Double-contrast barium enema findings in six patients with pathologically proved PTCL of the colon were retrospectively evaluated and compared with colonoscopic and histopathologic findings. There was a diffuse involvement of almost all segments of the colon in four patients and a focal segmental involvement in two. Frequent findings at double-contrast barium enema examination included geographic ulcerations (n = 6), aphthous ulcerations (n = 4), pseudopolyps (n = 4), circumferential luminal narrowing (n = 4), and ileocecal deformity (n = 4). PTCL of the colon manifested as either a diffuse or a focal segmental lesion and showed extensive mucosal ulceration at double-contrast barium enema examination. These findings are similar to those of inflammatory bowel disease and are different from those of colorectal lymphoma with the B-cell phenotype.