RAD Registry Prep logo

Fluoro & OR Guide

Small bowel follow-through

The small bowel series (small bowel follow-through, SBFT) follows barium from the stomach through the jejunum and ileum to the large bowel. It's often added to the end of an upper GI. Most of it is timed overhead images that you take; the radiologist adds fluoro spots of the terminal ileum at the end.

What the ARRT tests

  • Prep: NPO about 8 hours; often combined with a UGI.
  • Images are timed from when the patient starts drinking: usually at 15–30 minute intervals until the barium reaches the cecum. The exam often takes about 1–2 hours.
  • PA prone is preferred: the abdominal compression separates the loops of bowel.
  • Centering: the first images about 2 inches (5 cm) above the iliac crest (to include the stomach); later images at the iliac crest as the barium moves into the lower abdomen.
  • The exam is done when barium reaches the cecum; the radiologist takes compression spots of the terminal ileum and ileocecal valve.
  • Barium is contraindicated if a perforation or a large-bowel obstruction is suspected; water-soluble contrast is used instead.
  • Enteroclysis is a related exam: contrast is injected through a tube placed into the duodenum or jejunum for a more detailed look.

Why it's done

  • Suspected Crohn's disease (often in the terminal ileum), small bowel narrowing, or partial obstruction.
  • Abdominal pain, diarrhea, weight loss or malabsorption without another explanation.
  • Much of this work has moved to CT or MR enterography, but the SBFT is still done and still tested.

Who's in the room

Radiographer (you)
Gives the barium, times and takes the overhead images, checks each image with the radiologist.
Radiologist
Reviews the films, decides when the barium has reached the colon, and takes fluoro spots of the terminal ileum.

Step by step

  1. Before. Confirm the order, NPO status, allergies and pregnancy status. Take a scout if your protocol asks for one.
  2. Drink. Patient drinks the thin barium (often two cups). Note the time; all images are timed from this point.
  3. Timed overheads. PA prone images at the protocol times, for example 15, 30, 60 minutes, then every 30 minutes. Label each image with the time.
  4. Terminal ileum. When barium reaches the cecum, the radiologist takes compression spots of the terminal ileum and ileocecal valve under fluoro.
  5. After. Fluids to flush the barium; stool will be white for a day or two.

Your job

  • Keep track of time; a missed time point leaves a gap in the exam.
  • Raise the centering as needed: stomach in the first images, lower abdomen later.
  • Show each image to the radiologist; they decide when to stop.

Watch out for

  • Long waits: diabetic patients who are NPO may get low blood sugar.
  • If the patient vomits or has severe pain, stop and tell the radiologist.

Tips from the room

  • Have the patient lie on the right side between images: it helps the stomach empty into the duodenum.

Quick check

1. Which feature identifies the dilated loops on this abdominal radiograph as large bowel rather than small bowel?

Image: James Heilman, MD. CC BY-SA 3.0.

2. During a small bowel follow-through, the terminal ileum shows a pattern of crisscrossing ulcers with raised islands of swollen mucosa between them, giving a 'cobblestone' appearance. Which condition is MOST likely?

3. During a routine small bowel follow-through, when are overhead images typically taken?

4. In a double-contrast enteroclysis, what is infused after the barium to distend the small bowel?

5. During ileocecal spot imaging in a small bowel follow-through, why does the radiologist apply a compression paddle over the right lower quadrant?

Practice it in 3D

Fluoro Room

A 3D fluoro suite: turn the patient, tilt the table and time the contrast while the radiologist calls the spots.

More in the guide

C-arm basics

The parts, the movements, the dose modes, and where to stand.

Sterile basics

What's sterile, what you can touch, and how to move around the field.

Esophagram and upper GI series

Barium swallow and UGI: why they're ordered, the positions, and your role.

Modified barium swallow (swallow study)

Video swallow study with speech therapy: bolus types, the field of view, and your role.

Barium enema

Single- and double-contrast BE: prep, tip insertion, positions, and overheads.

Cystogram and VCUG

Bladder filled through a catheter: leak checks, reflux, and voiding images.

Hysterosalpingogram (HSG)

Uterus and fallopian tubes for infertility: timing, setup, and dose.

Arthrogram

Joint injection under fluoro, usually before MRI or CT.

Myelogram

Contrast in the spinal canal: needle site, table tilt, and keeping contrast out of the head.

Lumbar puncture (fluoro-guided)

Spinal tap under fluoro when bedside attempts fail.

ERCP and cholangiograms

Bile ducts through a scope, in surgery, or through a T-tube.

Hip pinning (hip fracture fixation)

The most common C-arm case: the fracture table, the two views, and your role.

Ankle and wrist ORIF

Open reduction and internal fixation of the ankle or wrist: the views, the mini C-arm, and hands in the beam.