Workbook Abdomen

Which positioning routine should be used for an acute abdominal series if the patient is to ill to stand?

2 Way abdomen 1) AP supine 2) Left Lat decub

True/False: The correct term for the radiographic study of the entire urinary system is the intravenous pyelogram (IVP)

False

True/False: The image receptor should be placed in portrait alignment for an abdomen study on an obese patient

False

True/False: The umbilicus ("belly button") is a reliable, alternative landmark to use for the obese patient

False

Free air or gas in the peritoneal cavity

pneumoperitoneum

Situation: A patient with a possible perforated dueodenal 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?

Two way acute abdomen series: - AP supine -Left Lateral decub

Inflammatory condition of the colon

Ulcerative Colitis

The two large muscles found in the posterior abdomen adjacent to the lumbar vertebra and usually visible on an anteroposterior (AP) radiograph are called the?

Psoas Muscle

Which endocrine glands are superomedial to each kidney?

Suprarenals (adrenal)

Which topographic landmark corresponds to the inferior margin of the abdomen and is formed by the anterior junction of the two pelvic bones?

Symphysis Pubis

To ensure that the diaphragm is included on the erect abdomen projection, the top of the image receptor should be at the approximate level of the:

2 inches above iliac crest

What is the recommended overlap when using two landscape-placed image receptors for an AP projection of a supine abdomen of an obese patient?

3 to 5 cm (1-2 inches)

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

A KUB

Which of the following technical considerations is essential when performing abdomen studies on a young pediatric patient? A) Short exposure times B) High-speed image receptor C) Reduced kV and mAs D) All of the above

A) All of the above

Situation: A patient with a history of ascites comes to the radiology department. Which of the following positions best demonstrates this condition? A) Erect AP abdomen B) Erect PA chest C) Supine KUB D) Prone KUB

A) Erect AP abdomen

Gonadal shielding should not be used during abdomen radiography if: A) It obscures essential anatomy B) The patient requests that it not be used C) The technologist does not elect to use it D) The patient is 40 years or older

A) It obscures essential anatomy

Which of the following abdominal regions contains the rectum? A) Pubic B) Inguinal C) Umbilical D) Epigastric E) Hypochondriac F) Lumbar

A) Pubic

The preferred imaging modality for examining the gallbladder quickly is: A) Ultrasound B) Nuclear Med C) Barium Enema Study D) MRI

A) Ultrasound

Bowel obstruction caused by a lack of intestinal peristalsis

Adynamic (paralytic) ileus

Abnormal accumulation of fluid in the peritoneal cavity

Ascites

Gonadal shielding for ___________ may be impossible for studies of the lower abdominopelvic region. A) Males B) Females C) Both males and females D) Small children

B) Females

Situation: 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 analog technique for a KUB on an average, healthy adult is 76 kV, 30 mAs. Should the tech change any of these exposure factors for this patient? A) No. Use standard settings B) Yes. Decrease the mAs C) Yes. Increase the mAs D) Yes. Increase the kV

B) Yes. Decrease the mAs

Which of the following exposure considerations would be most ideal for an AP abdomen of an average-sized adult using a digital radiographic system? A) 110-120 kV, grid, 40-inch SID B) 95-105 kV, grid, 40-inch SID C) 80-85 kV, grid, 40-inch SID D) 60-70 kV, grid, 40-inch SID

C) 80-85 kV, grid, 40-inch SID

With the use of iodinated contrast media, _____ is able to distinguish between a simple cyst or tumor of the liver. A) Ultrasound B) Nuclear medicine C) CT D) MRI

C) CT

Which of the following abdominal structures is not visible on a properly exposed KUB? A) Kidneys B) Margin of liver processes C) Pancreas D) Lumbar transverse process

C) Pancreas

Voluntary motion can be prevented by _______________ to the patient

Communication

Which of the following structures helps stabilize and support the small intestine? A) Omentum B) Peritoneum C) Viscera D) Mesentery

D) Mesentery

List the three parts of the small intestine:

Duodenum Jejunum Ileum

Exposure for an AP projection of the abdomen should be taken on ___ (inspiration or expiration)

Expiration

Which type of body habitus may require two landscape-aligned images to be taken if the entire abdomen is to be included?

Hypersthenic

Which portion of the small intestine is considered to be the longest?

Ileum

The central ray is centered to the level of the _______ for a supine AP projection of the abdomen.

Iliac Crest

Why may the PA projection of a KUB generally be less desirable than the AP projection?

Increased OID

Which topographic landmark is found at the level of L2-L3?

Inferior Costal Margin

Match the following structures to the correct location of the peritoneum: Ovaries

Infraperitoneum

Match the following structures to the correct location of the peritoneum: Testes

Infraperitoneum

Match the following structures to the correct location of the peritoneum: Liver

Intraperitoneum

Match the following structures to the correct location of the peritoneum: Spleen

Intraperitoneum

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

Left lateral decub to demonstrate air-fluid levels

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

No it is not - The CR needs to be centered to the iliac crest

Which projection of the three-way acute abdominal series best demonstrates free air under the diaphragm?

PA Chest

List the three accessory digestive organs:

Pancreas Liver Gallbladder

What is the primary cause for involuntary motion in the abdomen?

Peristalic Action of the Bowel

The double - walled membrane lining the abdominopelvic cavity is called the _____________.

Peritoneum

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

Rotation to the right

What is the best mechanism to control involuntary motion?

Shortest Exposure Time Possible

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 seconds, grid, and 40-inch SID. The tech is sure that the patient did not breathe or move during the exposure. What may have caused this bluriness? What can be done to correct the image?

The blurriness may have been caused my involuntary motion and can be corrected by increasing mA and decreasing exposure time

Why is the right kidney found in a more inferior position than the left kidney?

The liver is on the right side

Situation: A patient with a possible dynamic ileus enters the emergency room. The patient is able to stand. The physician has ordered an acute abdominal series. Which specific positioning routine shoud be used?

Three way acute: AP Supine and erect abdomen PA chest

Why should a patient be placed in the decubitus position for a min of 5 mins before exposure?

To allow intra-abdominal air to rise or abnormal fluids to accumulate

Why is it recomended to take abdominal radiographs at the end of patient expiration?

To increase room for expansion of the abdominal organs within the cavity

True/False A tall asthenic patient may require two 14x17in image receptors placed lengthwise if the entire abdomen is to be included

True

True/False: A radiolucent pad should be placed underneath geriatric patients for added comfort.

True

A twisting of a loop of bowel creating an obstruction

Volvulus

Large amount of air trapped in sigmoid colon with a tapered narrowing at the site of obstruction

Volvulus

General abdominal haziness

ascites

Deep air-filled mucosal protrusions of colon wall

ulcerative colitis

True/False: Because the liver margin is visible in the right upper quadrant of the abdomen, it is not necessary to place a right or left anatomic side marker on the cassette before exposure

False

True/False: For a KUB, it is accepted practice to indicate the side of the body during post processing after the exposure has been completed. The liver is always on the right side of the body.

False

True/False: For an adult abdomen, a collimation margin must be visible on all four sides of the radiograph

False

Identify which quadrant the organ is in: Two-thirds of jejunum

Left Upper

Rotation can be determined on a KUB radiograph by the loss of symmetric appearance of:

-Iliac Wings -Obturator Foramina -Ischial Spine -Outer rib margins

What are two causes of voluntary motion?

-patient breathing -patient movement during exposure

List the projections commonly performed for an acute abdominal series or three-way abdomen series.

1) AP Supine 2) AP erect or lat Decub 3) PA chest

__________________ is used to evaluate patients with acute appendicitis A) Ultrasound B) Nuclear Med C) CT D) MRI

A) Ultrasound

Gonadal shielding for females involves placing the top of the shield at or slightly above the level of the _______, with the bottom at the ____________.

ASIS Symphysis Pubis

What scale of contrast is recommended for visualization of the abdominal structures on an abdominal x-ray? A) Short B) Long

B) Long

Situation: 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's the next step the tech should take ? A) Accept the radiograph because the shielding did not obscure the kidneys B) Repeat the exposure without using shielding C) Repeat only if the patient complains of pain in the lower abdomen D) Repeat exposure with gonadal shielding, but position it below symphyis pubis

B) Repeat the exposure without using shielding

Which of the following organs is considered part of the lymphatic system? A) Liver B) Spleen C) Pancreas D) Gallbladder

B) Spleen

Which of the following organs is not directly associated with the digestive system? A) Gallbladder B) Spleen C) Jejunum D) Pancreas

B) Spleen

Which of the following structures is a double fold of peritoneum that connects the transverse colon to the greater curvature of the stomach? A) Mesocolon B) Lesser Omentum C) Greater Omentum D) Mesentery

C) Greater Omentum

Situation: A child goes to radiology for an abdomen study. It is possible that he swallowed a coin. The ER physician believes it may be in the upper GI tract. Which of the following routines would best identify the location of the coin? A) KUB and left lateral decub B) Acute abdominal series C) KUB and lateral abdomen D) Supine and erect KUB

C) KUB and lateral

Which of the following projections requires a kV setting of 110 to 125? A) Erect abdomen for ascites B) Supine abdomen for intra-abdominal mass C) PA, erect chest for free air under diaphragm D) Dorsal decubitus abdomen for calcified aorta

C) PA, erect chest for free air under diaphragm

What is the correct name for the abdominal region found directly in the middle of the abdomen? A) Epigastric B) Inguinal C) Umbilical D) Pubic

C) Umbilical

Chronic inflammation of the intestinal wall that may result in bowel obstruction

Chron's Disease

Distended loops of air-filled small intestine

Chron's Disease

Situation: An obese patient comes to the radiology department for a KUB. The radiograph shows that the symphsis pubis is included on the image, but the upper abdomen, including the kidneys, is cut off. What is the next step the rad tech should take? A) Accept image B) Repeat exposure but expose it during inspiration to for kidneys lower into the abdomen C) Ask the radiologist whether the upper abdomen really needs to be seen. D) Repeat exposure. Use two landscape image receptors to include entire abdomen.

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

The sigmoid colon is located between the ____________and____________of the large intestine

Descending Colon Rectum

Which decubitus position best demonstrates possible aneurysms, calcifications of the aorta, or umbilical hernias?

Dorsal Decubitus

The medical prefix for stomach is?

Gastro

Match the following structures to the correct location of the peritoneum: Urinary Bladder

Infraperitoneum

The iliac crest is at the level of the _____________ vertebra

Interspace between L4-L5

Match the following structures to the correct location of the peritoneum: Stomach

Intraperitoneum

Match the following structures to the correct location of the peritoneum: Transverse Colon

Intraperitoneum

Air-filled "coiled spring" appearance

Intussusception

Telescoping of a section of bowel into another loop of bowel

Intussusception

Which projection best demonstrates a possible aortic aneursym in the prevertebral region of the abdomen?

Lateral Position

Which decubitus position of the abdomen best demonstrates intraperitoneal air in the abdomen?

Left Lateral Decub

Identify which quadrant the organ is in: Sigmoid Colon

Left Lower

Identify which quadrant the organ is in: Left colic flexure

Left Upper

Identify which quadrant the organ is in: Spleen

Left Upper

Identify which quadrant the organ is in: Stomach

Left Upper

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 SID using a film/screen analog imaging system. 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 enhances the visibility of the structures on the repeat?

Lower the kV to 70-80

Thin crest-shaped radiolucency underneath diaphragm

Pneumoperitoneum

The pancreas is located anteriorly or posteriorly to the stomach?

Posteriorly

The organs located posteriorly to, or behind, the serous membrane lining of the abdominopelvic cavity are referred to as_____________?

Retroperitoneal

Match the following structures to the correct location of the peritoneum: Adrenal Glands

Retroperitoneum

Match the following structures to the correct location of the peritoneum: Ascending and descending colon

Retroperitoneum

Match the following structures to the correct location of the peritoneum: Duodenum

Retroperitoneum

Match the following structures to the correct location of the peritoneum: Kidneys

Retroperitoneum

Match the following structures to the correct location of the peritoneum: Pancreas

Retroperitoneum

Identify which quadrant the organ is in: Appendix

Right Lower

The large intestine begins in the _____________quadrant with a saclike area called the ___________________.

Right Lower Quadrant Cecum

Identify which quadrant the organ is in: Liver

Right Upper