Conduct of the Examination (cont.)

4. Roll the patient back into the RPO position.
   • Again, instruct the assistant to partially unclamp the tubing and allow the barium to slowly flow by gravity through the colon to the cecum while you pan back and forth with the fluoroscope between the head of the barium column and the splenic flexure region.
   • When the cecum is well filled, perform graded compression with the balloon paddle or F-Spoon to get good see-through penetration of the barium.
   • Take a spot image of the cecum in the RPO or supine position with graded compression. When possible, also include the barium filled terminal ileum. 

   

   NOTE: Complete cecal filling is confirmed by identifying at least one of three landmarks: the appendix, an appendiceal stump, or the ileocecal valve. 

   NOTE: If an "air lock" forms in the cecum and it will not fill with barium, turn the patient into a right lateral position, or even into a RAO position. This should cause the air to escape from the cecum into the left colon and be replaced by barium. After this, the compression spot images of the cecum can be obtained, as usual.