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