Rad Tech Abdomen
Which of the portions of the urinary system would normally be visible on a preliminary intravenous urogram image? 1.Lower poles of the kidneys2. Ureters3. Urinary bladder A. 1 only B. 1 and 2 C. 1 and 3 D. 2 and 3 E. 1, 2, and 3
A. 1 only Without contrast enhancement, the ureters and the urinary bladder are not normally seen on an AP abdomen radiograph. The kidneys are surrounded by a layer of fat, called the perirenal fat which results in a significant difference in x-ray absorption. Because of this difference in tissue contrast, a faint shadow of the kidneys is commonly visible on abdomen images.
At what vertebral level is the anterior superior iliac spine (ASIS)? A. 2nd sacral segment B. L5 C. Junction of sacrum and coccyx D. Sacral promontory
A. 2nd sacral segment The ASIS is a prominent projection of bone on the anterior surface of the pelvis that corresponds to the 2nd vertebral segment of the sacrum. It can easily be found by palpating the iliac crest and following the curve of this landmark anteriorly until a prominent bony "bump" is felt.
Which of the following structures is commonly NOT seen on acorrectly centered AP abdominal r[c]adiograph of a hyposthenicpatient? A. Diaphragm B. Femoral head C. Ischial spines D. Transverse processes of L5
A. Diaphragm A correctly positioned and centered AP abdomen radiograph should normally include the kidney shadows, psoas muscles, and pelvic structures including the femoral heads and the symphysis pubis. On a hyposthenic (tall and thin) patient the image receptor may not be large enough in many cases to also include the diaphragm.
The appropriate SID for a routine AP abdomen image is: A. 30 inches B. 40 inches C. 60 inches D. 72 inches
B. 40 inches Routine AP abdomen images are generally performed with the patient supine on the radiographic table. 40 inches is the recommended SID for this type of positioning. Upright abdomen images may sometimes be performed using a 60 inch SID when certain focused grids are used.
Which of the following structures would most commonly be found in the right lower quadrant of the abdomen? A. Right kidney B. Cecum C. Tail of pancreas D. Descending colon
B. Cecum The right lower quadrant (RLQ) of the abdomen includes structures inferior to a plane through the iliac crests and to the right of the midsagittal plane. Structures located in the RLQ include: the cecum, appendix, terminal portion of the ileum, ileocecal valve, and the origin of the ascending colon.
Which of the following abdominal organs is classified as retroperitoneal? A. Stomach B. Bladder C. Right kidney D. Transverse colon
C. Right kidney The peritoneum is a double-walled membrane in the abdomen that surrounds and protects many of the abdominal organs. The urinary bladder and reproductive organs lie inferior to the peritoneum and are considered infraperitoneal. Organs such as the kidneys, ureters, pancreas, and adrenal glands develop posterior to the peritoneum and are classified as retroperitoneal.
A patient with cholelithiasis is suffering from: A. Gastritis B. Portal hypertension C. Stones in the gallbladder D. Fatty liver
C. Stones in the gallbladder Chole- is a medical term meaning bile; lithiasis is the medical term for the formation of stones. Cholelithiasis is the formation of stones in the gallbladder.
For an AP abdomen image the central ray should enter at what level for a sthenic patient? A. Anterior superior iliac spine (ASIS) B. Iliac crest C. Symphysis pubis D. Lower costal margin
B. Iliac crest For a survey abdomen x-ray examination (commonly referred to as a[b] KUB) the central ray should enter the midsagittal plane at the level of the iliac crest to ensure that both kidneys and the bladder are included on the image. A hypersthenic patient might require more than one exposure to include all of the abdominal anatomy.
What anatomic landmark lies at the level of the interspace between L2 and L3? A. Xiphoid process B. Inferior margin of the ribs C. Umbilicus D. 7th costal cartilage
B. Inferior margin of the ribs The inferior costal (rib) margin lies at the L2/L3 interspace on the average patient. This positioning landmark is useful when centering for radiographs of the gallbladder, pyloric region of the stomach, or splenic flexure of the large intestine.
Which statement regarding the pancreas is true? A. The head of the pancreas lies in the left upper quadrant B. The tail of the pancreas lies near the hilum of the spleen C. Secretions of the pancreas empty into the jejunum D. The body of the pancreas lies anterior to the body of the stomach
B. The tail of the pancreas lies near the hilum of the spleen The pancreas is an organ involved in both digestion and insulin regulation. It lies posterior to the stomach; the head is encircled by the c-shaped loop of the duodenum and the tail lies near the hilum of the spleen. Secretions from the pancreas pass through the hepatopancreatic ampulla to empty into the 2nd (descending) portion of the duodenum.
Which of the following landmarks could be considered a reliable indicator of the hypersthenic or obese patient's midsagittal plane (MSP) when performing abdomen images? 1. Xiphoid process2. Umbilicus3. Spinous process of L5 A. 1 only B. 1 and 2 C. 1 and 3 D. 2 and 3 E. 1, 2, and 3
C. 1 and 3 The xiphoid process and the spinous processes of the lumbar spine are both midline structures and generally do not deviate laterally, so can be used as indicators for the MSP in AP or PA abdomen imaging. In large or obese patients the abdomen may shift laterally when the patient is supine, so the umbilicus is not always an accurate indicator for the MSP.
Ideally, how long should a patient be in position for a lateraldecubitus abdomen prior to exposing the image? A. The image can be exposed immediately B. 2 minutes C. 5 minutes D. 12 minutes
C. 5 minutes Ideally, the patient should be in the lateral position for at least 5 minutes prior to exposure to allow air to rise to the highest level in the abdomen. This can be accomplished by placing the patient in the lateral position as soon as they are brought into the examination room.
If an acute abdominal series is ordered for a patient who cannotstand or sit upright, which projection should be included in place of the erect abdomen? A. Left lateral decubitus B. Right lateral decubitus C. AP supine D. Left lateral
A. Left lateral decubitus A horizontal beam is needed to demonstrate air-fluid layers and the presence of free intraabdominal air so neither an AP supine or lateral abdomen would be appropriate substitutes for an erect abdomen. A left lateral decubitus is preferred so that there is no confusion between free intraabdominal air and the air in the fundus of the stomach.
What is the appropriate term for the double-walled layer of peritoneum in which the smallbowel is enveloped? A. Mesentery B. Greater omentum C. Lesser omentum D. Mesocolon
A. Mesentery The peritoneum is a double-walled membrane found in the abdomen. Many of the abdominal organs originate and develop by growing within some of the folds of the peritoneum. The small bowel is one such organ which develops within folds of peritoneum. These folds, called the mesentery, support and protect the small bowel and its vascular supply.
The gallbladder of a sthenic patient would normally be found in which of the following quadrants? A. Right upper quadrant (RUQ) B. Left upper quadrant (LUQ) C. Right lower quadrant (RLQ) D. Left lower quadrant (LLQ)
A. Right upper quadrant (RUQ) The right upper quadrant lies superior to the level of the iliac crests and to the right of the midsagittal plane. The major portion of the liver, the gallbladder, hepatic flexure, c-loop of the duodenum, and the head of the pancreas lie within this portion of the abdomen.
Breathing instructions for a routine AP abdominal radiographshould be: A. Suspended expiration B. Suspended inspiration C. Suspended respiration; either inspiration or expiration is acceptable D. Quiet breathing
A. Suspended expiration Suspended expiration will cause the diaphragm to rise, minimizing compression of the abdominal structures.
When performing an erect AP abdomen projection, the central ray should enter the midsagittal plane: A. At the level of the iliac crests B. At the level of the ASIS C. Two inches above the iliac crest D. Two inches below the iliac crest
C. Two inches above the iliac crest Erect images of the abdomen are performed primarily to demonstrate air-fluid levels and the presence of free intra-abdominal air. In the erect position, air will rise to the highest possible point, the inferior surface of the diaphragm. Centering above the crest is critical so that the diaphragm can be included on the image.
A patient presents in the Emergency Department with a potential ileus. Which of the following projections would demonstrate the air-fluid levels associated with this pathology? 1. AP supine abdomen2. Erect AP abdomen3. Left lateral decub abdomen A. 1 only B. 1 and 2 C. 1 and 3 D. 2 and 3 E. 1, 2, and 3
D. 2 and 3 In order to accurately demonstrate the layering of air and fluid, a horizontal beam must be used. Because the beam is vertical for an AP abdomen x-ray, air-fluid levels will not be demonstrated.
A barium enema tip was incorrectly inserted, resulting in a tear of the rectum. Which of the following procedures woulddemonstrate the presence of free abdominal air that might beassociated with this occurrence? 1. AP supine abdomen2. Erect AP abdomen3. Left lateral decub abdomen A. 1 only B. 1 and 2 C. 1 and 3 D. 2 and 3 E. 1, 2, and 3 Skip
D. 2 and 3 In order to accurately demonstrate the presence of free abdominal air, a horizontal beam must be used. Because the beam is vertical for an AP abdomen x-ray, free air will not be demonstrated. E. 1, 2, and 3
A patient who has ascites is suffering from: A. Liver enlargement B. Gallstones C. Renal hyperplasia D. An accumulation of fluid in the peritoneal cavity
D. An accumulation of fluid in the peritoneal cavity Ascites is an abnormal accumulation of fluid in the peritoneal cavity. It can be caused by many pathologic processes. Two of the most common causes are cirrhosis of the liver and metastatic disease of the peritoneum.
The most superior portion of the stomach is called the: A. Antrum B. Pylorus C. Cardiac incisura D. Fundus
D. Fundus The stomach lies mainly in the left upper quadrant and from superior to inferior is comprised of the fundus, the body, and the pyloric portion or pyloric antrum.
The most distal portion of the small bowel is termed the: A. Jejunum B. Cecum C. Duodenum D. Ileum
D. Ileum The small intestine is a portion of the digestive system that occupies most of the central abdominal cavity. This tubular structure is normally around 18-22 feet in length and about 1 inch in diameter. It is divided into three sections from proximal to distal: duodenum, jejunum, and ileum.
Which of the following would most likely require an erect APabdomen radiograph to demonstrate the layering of air and fluid associated with the patient's pathology? A. Longstanding gastritis B. Acute abdominal aortic aneurysm C. Metastatic adrenal tumor D. Severe, chronic Crohn's disease
D. Severe, chronic Crohn's disease Crohn's disease is a chronic condition that most commonly affects the terminal portion of the ileum. This disease is an inflammatory condition that may also lead to ulceration of the bowel wall and formation of fistulous tracts. Inflammation and dilation of the bowel can be associated with the layering of air and fluid.
Which of the following would indicate that an erect abdomenimage is correctly positioned? A. Lower margin of the liver is symmetrical B. Kidneys are demonstrated in profile C. Psoas muscles are foreshortened D. Spinous processes of the lumbar vertebrae are centered to the vertebral bodies
D. Spinous processes of the lumbar vertebrae are centered to the vertebral bodies Correct positioning of an AP image of the abdomen (supine, erect, or decub) can be evaluated easily by examining the vertebral column. The pedicles of the lumbar spine should symmetrically superimpose the superolateral vertebral bodies and the spinous processes should be centered to the vertebral bodies. The psoas muscles should appear symmetrical but are not always visible on an abdominal image. The kidneys will lay in an oblique orientation when the patient is positioned for a frontal image of the abdomen.