Chapter 16, Abdomen
How far above the level of the iliac crest should the central ray enter the patient with a lateral projection, dorsal decubitus position?
2 inches (5 cm)
Which radiographic position of the abdomen requires that the patient be placed in the lateral recumbent position on his or her left side and that the horizontal CR be directed along the MSP. entering the anterior surface of the patient's abdomen at the level of the iliac crests? - Dorsal decubitus - Ventral decubitus - Left lateral decubitus - Right lateral decubitus
Left lateral decubitus
Pertaining to the lateral projection of the abdomen, what are the key patient/part positioning points?
Left lateral recumbent, shoulders and hips aligned and perpendicular to cart; Knees flexed for support; arms elevated out of field.
With the AP projection and left lateral decubitus position of the abdomen, what is the key patient/part positioning points?
Left lateral recumbent, shoulders and hips aligned and perpendicular to cart; knees flexed for support; arms elevated out of field; vertical grid device at height of MSP
Pertaining to a lateral projection, dorsal decubitus position of the abdomen, what are the anatomic landmarks and relation to IR?
MSP parallel to IR and MCP perpendicular
Pertaining to the lateral projection of the abdomen, what are the anatomic landmarks and relation to the IR?
MSP parallel to IR and MCP perpendicular
With the AP projection and left lateral decubitus position of the abdomen, what are the anatomic landmarks and relation to IR?
MSP perpendicular to IR and MCP parallel
With an AP projection of the abdomen, what anatomic landmarks and relation to IR.
MSP perpendicular to IR and MCP parallel to IR
What identification markers should be seen on the radiograph in the lateral recumbent position?
Markers indicating the side of the patient and which side is up
To what level of the patient should the long axis of the IR be centered for a lateral projection, dorsal decubitus position?
Midcoronal plane
For KUB's, which plane of the body should be positioned perpendicular to the image receptor (IR)? Parallel with the IR?
Midsagittal; midcoronal
With an AP projection of the abdomen, where is the CR orientation and entrance point?
Perpendicular to the MSP and level of iliac crests for supine and to include bladder on upright; to include the diaphragm on upright, CR centers MSP at level 2 inches (5 cm) above the level of the iliac crests or high enough to include the diaphragm
For the KUB, AP projection with the patient supine, which structure should be seen at the bottom of the image?
Pubic symphysis
Which side must be demonstrated on a AP abdomen with the patient positioned in a left lateral decubitus when a pneumoperitoneum is suspected? - Anterior - Posterior - Right - Left
Right
What three projections usually comprise the three-way or acute abdomen series?
Supine KUB, AP upright abdomen, and PA chest
What breathing instructions should be given to the patient for a KUB?
Suspend respiration at the end of expiration
Why is it desirable to include the diaphragm in the upright abdomen radiograph? - to demonstrate free air in the abdomen - to demonstrate fluid levels in the thorax - to demonstrate fluid levels in the abdomen - to demonstrate calculi in the gallbladder and kidneys
To demonstrate free air in the abdomen
Why is the left lateral decubitus position preferred over the right lateral decubitus position when the patient is unable to stand?
To enable rising free air to be seen through the homogeneous background density of the liver instead of becoming superimposed with air in the stomach
For the AP upright abdomen radiograph of an adult of average size, why should the centering be slightly higher than the centering level used for the supine KUB radiograph? - to include the bladder - to include the diaphragm - to visualize gallstones - to visualize kidney stones
To include the diaphragm
What purpose is served by having the patient slightly flex his or her knees with a lateral projection, dorsal decubitus position?
To relieve strain on the patient's back by reducing the lordotic curvature
True or False, the CR should be directed horizontally and perpendicular relative to the center of the film with a lateral projection, dorsal decubitus position?
True
True/False. A lateral projection of the abdomen can be performed with the patient placed in either the right lateral recumbent position or the left lateral recumbent position?
True
An acute abdominal series may be ordered for all of the following reasons, except to: - Check for a pneumoperitoneum - Evaluate the presence of free fluid in the abdominopelvic cavity - Use as a preliminary examination before contrast administration - Rule out bowel obstruction and/or infection
Use as a preliminary examination before contrast administration
For the lateral projection with the patient placed in the dorsal decubitus position, which procedure should be performed to ensure that the entire abdomen is included on the radiograph? - Use support cushions to elevate the patient - Center the IR to the level of the xiphoid process - Center the IR to the anterior surface of the abdomen - Direct the CR to a point 2 in below the iliac crests
Use support cushions to elevate the patient
Pertaining to the lateral projection of the abdomen, where is the CR orientation and entrance point?
Vertical and perpendicular to MSP at level of iliac crests or 2 inches (5 cm) above to include diaphragm.
With an AP projection of the abdomen,what is the essential projection ?
AP
What is the major advantage of the PA projection of the abdomen over the AP projection of the abdomen? - The PA projection reduces the exposure dose to the gonads. - The PA projection magnifies gallstones for better visualization - The PA projection demonstrates the pubic rami below the urinary bladder - The PA projection reduces the object-to-image-receptor distance of the kidneys.
The PA projection reduces the exposure does to the gonads.
The lateral projection with the patient placed in the dorsal decubitus position, the left lateral projection, and the left lateral position of the abdomen all require which of the following? - the CR should enter the left side of the patient - the patient should suspend respiration after expiration - the patient should suspend respiration after inspiration - the CR should enter the anterior side of the abdomen
The patient should suspend respiration after expiration
Why is a chest radiograph included as part of the acute abdomen series?
To demonstrate abdominal free air that may accumulate under the diaphragm
What is the advantage of exposing abdominal radiographs at the suspension of the recommended phase of respiration as compared with the other respiration phase?
so that abdominal organs are not compressed
Pertaining to a lateral projection, dorsal decubitus position of the abdomen, what are the key patient/part positioning points?
supine, shoulders and hips aligned; knees flexed for support; arms elevated out of field; vertical grid device at height of MCP
Pertaining to the lateral projection of the abdomen, what is the size of the collimated field?
14x17 inches (35x43 cm): or for smaller patients, to 1 inch (2.5 cm) beyond anterior/posterior skin shadows.
Pertaining to a lateral projection, dorsal decubitus position of the abdomen, what is the size of the collimated field?
14x17 inches (35x43 cm); or for smaller patients, to 1 inch (2.5 cm) beyond lateral skin shadows
With an AP projection of the abdomen, what size of collimated field is used?
14x17 inches (35x45cm) or for smaller patients, to 1 inch (2.5 cm) beyond lateral skin shadows
With the AP projection and left lateral decubitus position of the abdomen, what is the size of the collimated field?
14x17 inches; or for smaller patients, to 1 inch beyond lateral skin shadows.
For the lateral projection with the patient placed in the dorsal decubitus position, where should the central ray enter the patient? - 2 in anterior to the MCP at the level of the iliac crests -2 in anterior to the MCP and 2 in above the level of the iliac crests - 2 in posterior to the MCP @ the level & 2 in above the level of the iliac crest. - 2 in posterior to the MCP and 2 in above the level of the iliac crests
2 in anterior to the MCP & 2 in above the level of the iliac crests
With reference to radiation protection, what is the advantage of the PA projection of a KUB over the AP projection?
A reduction in the radiation exposure to the gonads.
Which projection does not demonstrate free air levels within the abdomen? - AP projection with the patient supine - AP projection with the patient upright - Lateral projection, dorsal decubitus position - AP projection, left lateral decubitus position
AP projection with the patient supine
Which projection should be used to demonstrate free air within the abdominal cavity when the patient is unable to stand for an upright abdomen radiograph? - AP projection with the patient supine - Lateral projection, dorsal decubitus position - AP projection, left lateral decubitus position - AP projection, right lateral decubitus position
AP projection, left lateral decubitus position
With the AP projection and left lateral decubitus position of the abdomen, what is the essential projection and position?
AP, Left Lateral Decubitus
The liver, stomach, and pancreas are located in the: Abdominal cavity, Pelvic cavity, Digestive cavity, or Retroperitoneal
Abdominal cavity
If a compression band is needed to immobilize the patient, where should it be placed with a lateral projection of the abdomen?
Across the pelvis
What three evaluation criteria that indicate the patient was properly positioned without rotation for a KUB radiograph? (a) intervertebral foramina should be open. (b) Alae or wings of the ilia should be symmetric (c) Lumbar vertebrae pedicles should be superimposed. (d) If seen, ischial spines of the pelvis should be symmetric. (e) Spinous processes should be in the center of the lumbar vertebrae.
Alae or wings of the ilia should be symmetric, If seen, ischial spines of the pelvis should be symmetric, and spinous processes should be in the center of the lumbar vertebrae.
What is the advantage of the left lateral decubitus position compared with the supine positions AP abdomen?
Demonstration of air-fluid levels
What structure of the upper abdomen should be seen on the abdomen radiograph when the patient is upright? Explain why,
Diaphragm; to demonstrate any free air within the abdominal cavity that may rise and become trapped under the diaphragm
Which radiographic position of the abdomen requires that the patient be supine and that the central ray be directed to a lateral side of the patient, entering slightly anterior to the MCP? - Dorsal decubitus - Ventral decubitus - Left lateral decubitus - Right lateral decubitus
Dorsal decubitus
True or False, the exposure should be made after the patient has suspended respiration after full inspiration.
False (make the exposure after the patient suspends respiration after expiration.)
True or False, The exposure should be made after the patient has suspended respiration at the end of inspiration for a lateral projection, dorsal decubitus position?
False (make the exposure after the suspension of expiration)
True or False, the midsagittal plane should be perpendicular and centered to the IR?
False (the midcoronal plane should be perpendicular and centered to the IR)
With the AP projection and left lateral decubitus position of the abdomen, where is the CR orientation and entrance point?
Horizontal and perpendicular to MSP at level of iliac crests or 2 inches above to include the diaphragm
To which level of the patient should the central ray be centered for the KUB? - T10 vertebral body - L3 vertebral body - 2 inches (5cm) above the iliac crests - Iliac crests
Iliac crests
What is the commonly used acronym that refers to the AP projection of the abdomen with the patient supine?
KUB
What is the meaning of KUB acronym?
Kidneys, ureters, and bladder
Pertaining to the lateral projection of the abdomen, what is the essential projection?
Lateral
Pertaining to a lateral projection, dorsal decubitus position of the abdomen, what is the essential projection and position?
Lateral, dorsal decubitus
Which side must be demonstrated on an AP abdomen with the patient positioned in a left lateral decubitus when fluid accumulation is being evaluated? - Anterior -Posterior - Right - Left
Left
In the acute abdomen series, what radiograph should be substituted for the upright abdomen radiograph when the patient is unable to stand?
Left Lateral Decubitus
Which radiographic position of the abdomen requires that the patient be placed in the lateral recumbent position on his or her left side, that the IR be placed under the patient and centered to the abdomen at the level of the iliac crests, and that the central ray be directed to enter the right side of the patient slightly anterior to the MCP? - Left lateral - Right lateral - Left lateral decubitus - Right lateral decubitus
Left lateral
For the KUB radiograph, when should respiration be suspended, and what effect will that have on the patient? - On full expiration; elevate the diaphragm - On full expiration, depress the diaphragm - On full inspiration, elevate the diaphragm - On full inspiration, depress the diaphragm
On full expiration, elevate the diaphragm
The abdomen is divided into two cavities. The inferior cavity is the: Abdominal, Pelvic, Gonadal, or Retroperitoneal
Pelvic
What two areas of the image can be closely examined to determine if the patient was rotated for a lateral abdomen?
Pelvis and lumbar vertebrae
Which structures should be examined to see whether the patient was rotated for a lateral projection of the abdomen? - Pelvis and lumbar vertebrae - Pelvis and thoracic vertebrae - Diaphragm and lumbar vertebrae - Diaphragm and thoracic vertebrae
Pelvis and lumbar vertebrae
Which three projections usually comprise the acute abdomen series for ambulatory patients? - supine KUB, AP upright abdomen, and PA chest - supine KUB, right lateral decubitus abdomen, and PA chest - Left lateral decubitus abdomen, dorsal decubitus abdomen, and PA chest - Right lateral decubitus abdomen, left lateral decubitus abdomen, and dorsal decubitus abdomen
Supine KUB, AP upright abdomen, and PA chest
With an AP projection of the abdomen, what are the key patient/part positioning points?
Supine or upright, shoulders and hips aligned; knees may be flexed when supine for comfort
Which side of the abdomen (the "up" side or the "down" side) should be demonstrated if only one side can be imaged and the patient may have free air in the abdomen in the lateral recumbent position?
The "up" side
How is proper patient alignment evaluated on an AP projection, supine position (KUB) image of the abdomen? - The spinous processes are seen in the midline of the lumbar vertebrae - The transverse processes of the lumbar vertebrae are visible - The vertebral column is centered in the collimated field - the psoas muscles are clearly demonstrated on each side of the lumbar spine..
The vertebral column is centered in the collimated field
Why is it advisable to let the patient remain in the lateral recumbent position for several minutes before making the exposure?
To allow any air to rise to its highest level within the abdomen
What two identification markers should be seen on the radiograph of a KUB when the patient is upright?
a right or left marker and an appropriate marker indicating the patient is upright
What structure of the upper abdomen should be demonstrated on the radiograph in the lateral recumbent position?
diaphragm
What is the name of the radiographic position that produces a lateral image of the abdomen with the patient in the supine position?
dorsal decubitus
Pertaining to a lateral projection, dorsal decubitus position of the abdomen, where is the CR orientation and entrance point?
horizontal and perpendicular to MCP at a level 2 inches (5cm) above the iliac crests to include the diaphragm
The contrast of an AP projection image of the abdominal must be sufficient to demonstrate the soft tissues of the: 1. lower border of the liver 2. kidneys 3. psoas muscles 1 and 2 only; 2 and 3 only; 1 and 3 only; 1, 2, and 3
lower bower of the liver, kidneys, psoas muscles
The portions of the peritoneum that function to support the viscera of the abdomen in position are the: retroperitoneal viscera and omentery, diaphragm and visceral folds, abdominal aorta and diaphragm, or mesentery and omenta folds.
mesentery and omenta folds
What breathing instructions should be given to the patient with a lateral recumbent position?
suspend respiration after expiration
Which of the following is evaluated to check for rotation on an AP projection, supine position image of the abdomen? - The vertebral column is centered in the collimated field - the ala of the ilia are symmetric - The transverse processes of the lumbar vertebrae are visible - Ribs, pelvis, and hips are equidistant to the edge of the radiograph on both sides.
the ala of the ilia are symmetric
Which side of the abdomen (the "up" side or the "down" side) should be demonstrated if only one side can be imaged and the patient is suspected of having fluid levels within the abdominal cavity in the lateral recumbent position?
the dependent "down" side
From the following list, which three evaluation criteria that indicate the patient was correctly positioned for a lateral projection while placed in the dorsal decubitus position? (a) the wings of the ilia should be symmetric, (b) the entire abdomen should be demonstrated, (c) the diaphragm would be included without motion, (d) the abdominal contents should be seen with soft tissue gray tones, (e) the spinous processes should be seen in the center of the lumbar vertebrae, (f) the ribs and pelvis should be equidistant to the edge of the IR on both sides.
the entire abdomen should be demonstrated, the diaphragm should be included without motion, the abdominal contents should be seen with soft tissue gray tones.
