Defecography 

Preparation
• Light dinner the night before the exam, NPO (solid food) for 8 hours prior to exam, lots of clear liquids the day of the exam
• Take fleets enema 2 hours prior to exam and bring second enema in case necessary at the time of exam
• Arrive 1 hour prior to study
• During this hour patient should drink 8-16 oz of water MD discussion in waiting room
• Scheduling will call reading room when patient arrives
• MD will review EPIC chart to know if pt has urine incontinence, fecal incontinence, constipation, etc.
• MD will discuss procedure and counseling of patient about procedure, including squeeze (kegel), strain (valsalva) and evacuation maneuvers On MR table
• Full urinary bladder
• Have patient insert approximately 40cc of gel in vagina
• MR tech to insert two 60 cc syringes of warmed ultrasound gel

1) SCOUT
2) SAGITTAL T2 TSE
3) AXIAL T2 TSE
4) CORONAL T2 TSE
5) SAGITTAL HASTE – relax
6) SAGITTAL TRUEFISP CINE – squeeze
    a. Start cine with pt in relax position
    b. After 3-5 seconds, squeeze and hold for approximately 10 sec
    c. Relax and end cine

7) SAGITTAL HASTE SQUEEZE (KEGEL) – single shot
8) SAGITTAL TRUEFISP CINE STRAIN (VALSALVA)
     a. Start cine with pt in relax position
     b. After 3-5 seconds, strain and hold for approximately 10 sec
     c. Relax and end cine
     d. Repeat PRN

9) SAGITTAL HASTE STRAIN
     a. If patient did not evacuate during strain then get these SS images
10) SAGITTAL TRUEFISP CINE EVACUATE
     a. Start cine with pt in relax position
     b. After 3-5 seconds, begin evacuation
     c. Relax and end cine
     d. Repeat PRN

OPTIONAL
AXIAL TRUEFISP CINE STRAIN/EVACUATE
      a. To look for sigmoidodocele, enterocele, peritoneocele
      b. Will have to be at scanner to choose level – approx. acetabular roof
      c. After 3-5 seconds, begin strain
      d. Relax and end cine
      e. Repeat PRN – may change levels