Problem Solving for Technical and Positioning Errors

SITUTION: A patient with a history of ascites comes to the radiology department. What position best demonstrates this condition?

Erect AP abdomen.

SITUATION: A patient with a possible perforated duodenal ulcer enters the emergency room. The ER physician is concerned about the presence of free air. The patient is in severe pain and cannot stand. What positioning routine should be used to rule out the presence of a kidney stone?

2 way acute abdominal series, AP Supine abdomen and left lateral decubitus.

SITUATION: A patient with possible dynamic ileus enters the emergency room. The patient is able to stand. The physician has ordered an acute adnominal series. What specific positioning routine should be used?

3 way. Includes the AP supine and erect abdomen, PA erect chest projections.

A KUB radiograph shows that the symphysis pubis was cut off along the bottom of the image. Is this an acceptable radiograph? If it is not, how can this problem be prevented during the repeat exposure?

A KUB must include the symphysis pubis. They should have positioned it to the center, the central ray at the iliac crest.

SITUATION: A patient in intensive care may have developed intra-abdominal bleeding. The patient is in critical condition and cannot stand to go to the radiology department. The physician has ordered a portable study of the abdomen. What specific position can be used to determine the extent of the bleeding?

A bedside portable left lateral decubitus to show any fluid levels in the abdomen.

SITUATION: A child goes to the radiology for an abdomen study. It is possible that he swallowed a coin. The ER physician believes it may be in upper GI tract. Which of the following routines would best identify the location of the coin?

KUB and lateral abdomen.

SITUATION: The ER physician suspects that a patient has a kidney stone. The patient is in severe r pain and cannot stand. What positioning routine should be used to diagnose this decision?

KUB with the correct exposure factors to visualize the possible store.

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

Patient is slightly rotated in RPO.

SITUATION: A KUB radiograph shows 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 next step the technologist should take?

Repeat the exposure without using gonadal shielding.

SITUATION: An obese patient comes for a KUB. The radiograph shows that the pubis symphysis is included in the image, but the upper abdomen, including the kidneys is cut off. What is the next step the technologist should take?

Repeat the exposure. Use two landscape image receptors to include the entire abdomen.

A radiograph of an AP projection of an average-sized adult abdomen was produced using the following exposure factors: 100 kV, 400 mA, 1/10 second, grid, and 40-inch (102-cm) SID using a film/screen (analog) imaging system. The overall density of the radiography was acceptable, but the soft tissue structures, such as the psoas muscles and kidneys, were not visible. Which adjustment to the technical considerations enhances the visibility of these structures on the repeat exposure?

The selected KV was too high. Lower is down to 70 to 80 kV.

SITUATION: large distended abdomen caused by a ileus. The physician suspects that the distention is caused by a large amount of bowel gas is trapped in the small intestine. The analog technique for a KUB on a n average, healthy adult is 76 kV, 30 mAs. Should the technologist change any of these exposure factors for this patient?

Yes. Decrease the mAs.

A radiographic image of an AP projection of the abdomen demonstrates motion. The following analog exposure factors were selected: 78 kV, 200 mA, 2/10 second, grid, and 40-inch SID. The technologist is sure that the patient did not breath or move during the exposure. What may have caused this blurriness?

blurriness from involuntary motion. The technologist should increase milliamperage and decrease exposure time.