Positioning 2: Ch. 16 WB & Review Questions

Repeat the exposure without using the gonadal shielding, using a 10 x 12 IR centered 2 inches above the pubic symphysis.

A KUB radiograph reveals that the gonadal shielding is superior to the upper margin of the symphysis pubis. The female patient has a history of kidney stones. What is the best next step the technologist should take?

Use a preliminary examination before contrast agent administration

An acute abdominal series may be ordered fir all of the following reasons except to:

Repeat the exposure using a 14 x 17 IR placed crosswise, centered over the upper abdomen.

A hypersthenic patient comes to the radiology department for a KUB. The radiograph reveals that the symphysis pubis is included on the image, but the upper abdomen, including the kidneys is cut off. What is the best next step the technologist should take?

Yes, decrease mAs

A patient comes from the ER with a large distended abdomen caused by an ileus. The physician suspects that the distention is caused by a large amount of bowel gas that is trapped in the small intestine. The standard technique for a KUB on an adult is 76 kVp at 30 mAs. Should the technologist change any of these exposure factors for this patient? (AEC is not being used).

Left lateral decubitus abdomen

A patient in intensive care may have developed intraabdominal bleeding. The patient is in critical condition and cannnot go to the radiology department. The physician has ordered a portable study of the abdomen. Which specific position or projection can be used to best determine the extent of the bleeding?

Upright AP abdomen

A patient with a history of ascites comes to the radiology department. Which one of the following positions best demonstrates this condition?

Two-way abdomen (AP supine and Left lateral decubitus).

A patient with a possible perforated duodenal ulcer enters the emergency room. The ER physician is concerned about the presence of free air in the abdomen. The patient is in severe pain and cannot stand. What positioning routine should be used to diagnose this condition?

1.) psoas muscles 2.) lower border of the liver & 3.) transverse processes of the lumbar vertebrae

A properly exposed abdominal radiograph will exhibit the: 1.) psoas muscles 2.) lower border of the liver 3.) transverse processes of the lumbar vertebrae

Involuntary motion.

A radiograph image of an AP projection of the abdomen demonstrates motion. The following exposure factors were selected: 78 kVp, 200 mA, 2/10 second, grid, and 40 inch SID. The technologist is sure that the patient didn't breathe or move during the exposure. What may have caused this blurriness?

The patient was rotated into a slight RPO position.

A radiograph of an AP abdomen reveals that the left iliac wing is more narrowed than the right. What specific positioning error caused this?

80 kVp, 400 mA, 1/10 second, grid, 40" SID

A radiograph of an AP projection of an average-size adult abdomen was produced using the following exposure factors: 90 kVp, 400 mA, 1/10 second, grid, and 40 inch SID. The overall density of the radiograph was acceptable, but the soft tissue structures, such as the psoas muscles and kidneys, were not visible. Which adjustment to the technical factors will enhance the visibility of these structures on the repeat exposures?

to include the diaphragm

For the AP upright abdomen image of an adult of average size, why should centering be slightly higher than the centering level used for the supine KUB image?

On full expiration; elevate the diaphragm

For the KUB image, when should respiration be suspended, and what effect will that have on the patient?

Use support cushions to elevate the patient

For the lateral projection with patient placed in the dorsal decubitus position, which procedure should be performed to ensure that the entire abdomen is included on the image?

2 inches anterior to the midcoronal plane and 2 inches above the iliac crest

For the lateral projection with the patient placed in the dorsal decubitus position, where should the central ray enter the patient?

The vertebral column is centered in the collimated field

How is proper patient alignment evaluated on the AP projection, supine position (KUB) image of the abdomen?

10 to 20 minutes

How long should a patient remain in the left lateral decubitus position to demonstrate a small amount of intraperitoneal gas (free air)?

True

Hypersthenic patients may require two cross-wise radiographs to visualize the entire abdominal cavity.

False

It is not necessary to visulaize the pubic symphysis on an AP supine abdomen radiograph.

True

Respiration for abdominal radiographs is suspended at the end of expiration so that the abdominal organs are not compressed.

KUB

The ER physician suspects a patient has a kidney stone. The patient is sent to radiology to confirm the diagnosis. What specific positioning routine would be used to rule out the presence of a kidney stone?

Pelvic

The abdomen is divided into two cavities. The inferior cavity is the:

all of the above.

The contrast of an AP projection image of the abdomen must be sufficient to demonstrate the soft tissues of the: 1. lower border of the liver 2.kidneys 3. psoas muscles

The patient should suspend respiration after expiration

The lateral projection with the patient placed in the dorsal decubitus position, the left lateral projection, and the left lateral decubitus position of the abdomen all require?

Abdominal cavity

The liver, stomach and pancreas are located in the:

Mesentery and omenta folds

The portions of the peritoneum that function to support the viscera of the abdomen in position are the:

Iliac crest

To which level of the patient should the central ray be centered for the KUB?

the PA projection reduces the exposure dose to the gonads.

What is the major advantage of the PA projection of the abdomen over the AP projection of the abdomen?

iliac crest

Where is the CR directed for an AP abdominal radiograph done in the supine position?

2 inches above the iliac crests

Where is the center of the IR positioned for an AP abdominal radiograph done in the upright position?

2.) hepatic artery & 3.) portal vein

Which of the following convey(s) blood to the liver? 1.) hepatic veins 2.) hepatic artery 3.) portal vein

The ala of the ili are symmetric

Which of the following is elevated to check for rotation on the AP projection, supine position image of the abdomen?

AP projection with the patient supine

Which projection should be used to demonstrate free air levels within the abdomen?

AP projection, left lateral decubitus position

Which projection should be used to demonstrate free air within the abdominal cavity when the patient is unable to stand for an upright abdomen?

Left lateral

Which radiographic position of the abdomen requires that the patient be placed in the 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 midcoronal plane?

Dorsal decubitus

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 midcoronal plan?

Left lateral decubitus

Which radiographic projection of the abdomen requires that the patient be places in the lateral recumbent position on his or her left side and that the horizontal central ray be directed along the midsagittal plane, entering the anterior surface of the patient's abdomen at the level of the iliac crest?

Right

Which side must be demonstrated on an AP abdomen with the patient positioned left lateral decubitus when a pneumoperitoneum is suspected?

Left

Which side must be demonstrated on an AP abdomen with the patient positioned left lateral decubitus when the fluid accumulation is being evaluated?

Peritoneum

Which structure forms the mesentery and omenta folds?

Pelvis and lumbar vertebrae

Which structures should be examined to see whether the patient was rotated for a lateral projection pf the abdomen?

Supine KUB, AP upright abdomen, and PA chest

Which three projections usually comprise the acute abdomen series for ambulatory patients?

to demonstrate free air in the abdomen

Why is it desirable to include the diaphragm in the upright abdomen image?