RAD 111 Chapter 3 Lesson 2
False
For an adult abdomen, a collimation margin must be visible on all four sides of the radiograph.
ASIS, Symphysis Pubis
Gonadal shielding for females involves placing the top of the shield at or slightly above the level of the _____________, with the bottom at the ______________ ____________.
LUQ
Left Colic Flexure
LLQ
Descending Colon Sigmoid Colon 2/3 of Jejunum
Abdominal Regions
1. Right Hypochondriac 2. Epigastric 3. Left Hypochondriac 4. Right Lateral (Lumbar) 5. Umbilical 6. Left Lateral (Lumbar) 7. Right Inguinal (Iliac) 8. Pubic (Hypogastric) 9. Left Inguinal (Iliac) Right Lateral Plane Left Lateral Plane Transpyloric Plane Transtubercular Plane
Abdominal Quadrants
1. Right Upper Quadrant (RUQ) 2. Left Upper Quadrant (LUQ) 3. Right Lower Quadrant (RLQ) 4. Left Lower Quadrant (LLQ) used most frequently for organ location most accurate on a sthenic (average) patient
7 Abdominal Landmarks
1. Xiphoid Process 2. Inferior Costal Margin 3. Iliac Crest 4. Anterior Superior Iliac Spine 5. Greater Trochanter 6. Symphysis Pubis 7. Ischial Tuberosity
LLQ
2/3 of Jejunum
Repeat Exposures
ALARA Do it right the first time Careful positioning and technical factors Clear Breathing Instructions *Take those couple of seconds to make sure everything is right*
ASIS
Anterior and Inferior to the Iliac Crest Prominent bump on the anterior portion of pelvis More prominent on females Secondary Landmark
RLQ
Appendix
RLQ
Ascending Colon Appendix Cecum 2/3 of Ileum Ileocecal Valve
Voluntary Movement
Body Movement and Breathing Movements
Clinical Indications
Bowel Obstructions or Perforations Acute Abdominal Series is used Looking for air-fluid levels. Erect or decubitus positions
Obese Patient
Challenge with Palpation Can use xiphoid process and lower rib margin Very critical to image the entire abdomen (large intestine can extend skin margin to skin margin) "belly button is not a reliable landmark) Sometimes two exposures (overlap, landscape)
Digital Considerations
Collimate to area being imaged (don't cut off marker) Body Part is centered Exposure Index or S-value
Greater Trochanter
Easily palpated on sthenic-hyposthenic patients Not an acceptable positioning landmark but is a secondary landmark to locate symphysis pubis
Geriatrics
Extra Care and Patience More Padding Support -Kyphosis will require "building up feet and legs" Decrease in exposure due to lack of density to bones
Inferior Costal Margin
Level L2-L3 used to locate upper abdominal organs such as gallbladder and stomach
Iliac Crest
Level L4-L5 upper most portion of the pelvis more difficult on Hypersthenic patients typically corresponds with umbilicus
Xiphoid Process
Level of T9-T10 -top of diaphragm NOT used as a primary landmark for positioning
RUQ
Liver
RUQ
Liver Gallbladder Right Colic Flexure "C" Loop of Duodenum Head of Pancreas Right Kidney Right Suprarenal Gland
Positioning Considerations
Make patients as comfortable as possible. Expose on expiration Anatomical Markers (on the image receptor when on table/ on bucky with wall stand) Side to side collimation
Lead Shielding
Males will be easier than females because of lower reproductive organs Make Sure that Lead Shields will not obscure anatomy Males: upper edge placed as pubic symphysis Females: slightly above ASIS and lower half at the symphysis pubis
Pediatrics
Motion is a big factor Reduction in technical factors due to smaller body habitus
Involuntary Movement
Peristalsis- contraction and relaxation of intestinal muscles to cause a wavelike motion to propell food/liquid through bowel
Image Markers
Placed before exposure Correct Side Marked Correct position markers "Right Red"
LLQ
Sigmoid Colon
LUQ
Spleen
LUQ
Stomach
LUQ
Stomach Spleen Left Colic Flexure Left Kidney Left Suprarenal Gland Tail of Pancreas
1 1/2 (1-4 cm), distal
The lower margins of the ischial tuberosities are about ________________ inches ______________ to the symphysis pubis.
Ultrasound
The preferred imaging modality for examining the gallbladder quickly is _______________.
Superior Border
The prominence of then greater trochanter is about the same level as the _________________ ______________ of symphysis pubis.
Shortest Exposure Time
What is the best mechanism to control involuntary motion?
Umbilical
What is the correct name for the abdominal region found directly in the middle of the abdomen?
Pubic
Which of the abdominal regions contains the rectum?
CT
With the use of iodinated contrast media, _________ is able to distinguish between a simple cyst and a tumor of the liver.
Ultrasound
________________ is used to evaluate patients with acute appendicitis.
Ascites
abnormal accumulation of fluid in the peritoneal cavity caused by chronic conditions such as cirrhosis of the liver overall haziness to the radiograph increase technical factors due to density
Crohn Disease
aka regional interitis chronic inflammation of intestinal wall results in bowel obstruction in at least 50% of patients most common in young adults loops of bowel being joined together by fistulas or openings Common sites: terminal ileum and proximal colon decrease technical factors
Symphysis Pubis
anterior junction of the two pelvic bones corresponds to the inferior margin of the abdomen
CT and MRI
both are useful in the evaluation of neoplasms in abdomen use of IV contrast, CT can discriminate between a simple cyst or solid neoplasm. visualizes soft tissue better
Ulcerative Colitis
chronic disease, inflammation of the colon young adults rectosigmoid colon is common site can cause a megacolon (extreme dilation of segment of colon) decrease technical factors
Pneumoperitoneum
free air or gas in the peritoneal cavity caused by either perforation to bowel, ruptured GI ulcer or trauma decrease technical factors
Sonography
method of choice for gallbladder useful for abscesses, cysts, or tumors involving the KUBs
Fibrous Adhesions
most common mechanical obstruction fibrous band of tissue interrelates with the intestine causing a blockage shows up as distended loops of air-filled small intestine decrease technical factors
Ileus
nonmechanical obstruction without power or force caused by peritonitis (peristalsis stopped) occurs frequently after surgery to the bowel (24-72 hrs.) rarely leads to perforations large amounts of air and fluid with air-fluid levels present no distinct point of obstruction decrease technical factors
Nuclear Medicine
radionuclides liver, gallbladder, bile ducts, and kidneys are visualized better by absorbing the radionuclides and filtering them out of the body.
Intussusception
telescoping of a section of bowel into another loop causing an obstruction most common site: distal small intestine requires surgery within 48 hrs. to prevent necrosis air-filled coiled spring appearance decrease technical factors
Volvulus
the twisting of a loop of intestine causing an obstruction sometimes requires surgery to correct sigmoid colon most common large amount of air with tapered narrowing at site (beak sign) decrease technical factors
Ischial Tuberosity
used to determine the lowest margin of the pelvis on a PA Abdomen Only used in a prone position 1 1/2 inches below symphysis bears our weight when we are seated
Dynamic Obstruction
with power or force mechanical- not spontaneous