Abdominal Series__ Positioning II

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

2 & 3 Hepatic artery & portal vein

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

2 inches above the iliac crests

presence of free air is also called...?

"Pneumonoperitoneum"

AP SUPINE (KUB): Technique 32 mAs @ 80 kVp SID: 40" IR: 14 x 17 LW CR: Perpendicular, directed to iliac crest and midsagittal plane COLLIMATION: size of IR RESPIRATION: Hold on Expiration

*Hypersthenic patients may require two cross-wise projections. *Tall patients may require separate bladder image

The acute abdominal series (or aka three-way abdomen) is a common request. Generally consists of: -Supine abdomen -Upright abdomen -PA chest

*Important to visualize diaphragm and/or the symphysis pubis *Demonstrates abdominal contents, presence of free air (pneumoperitoneum), and air-fluid levels

Name the three parts of the small intestines in descending order:

- Duodenum - Jejunum - ileum

Accessory organs of the digestive system:

- Liver - Gallbladder - Pancreas

Name the six organs of the DIGESTIVE system:

- Oral cavity - Pharynx - Esophagus - Stomach - Small intestine - Large intestine

stomach, small intestine, large intestine

- Three digestive organs within the abdominal cavity

Essential Projections: Abdomen

-(AP), SUPINE, and upright positions -(PA), UPRIGHT position -Left Lateral Decubitus, AP -Dorsal Decubitus, Lateral, R or L

Tissue structures used to determine effective technique

-Lower liver border -Psoas muscles -Kidneys -Ribs -Transverse processes of lumbar vertebrae

Exposure Technique for Abdomen

-Non-contrast examinations require maximum soft tissue differentiation. (No contrast = We need to see as much as we can without the help of "more contrast". - Moderate gray scale desired kVp range that is too high will over penetrate some structures -(80 kVp is commonly used.)

Abdominal Muscles:

-The right & left hemi- diaphragms -The right & left psoas major muscles

A properly exposed abdominal radiograph will exhibit the:

1.) psoas muscles 2.) lower border of the liver 3.) transverse processes of the lumbar vertebrae 4.) kidneys 5.) ribs

3 way abdominal series (ACUTE abdominal series) -AP, supine -AP, upright, erect -PA chest *For both procedures: If patient is in too much pain to stand up, exchange the upright position for the left lateral DECUBE*

2 way abdomen series: AP- supine AP- upright *For both procedures: If patient is in too much pain to stand up, exchange the upright position for the left lateral DECUBE*

Standard SID:

40"

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?

80 kVp, 400 mA, 1/10 second, (40 mAs) 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?

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

AP upright abdomen

AP UPRIGHT: Technique 32 mAs @ 80 kVp SID: 40" IR: 14 x 17 LW CR: Perpendicular, directed 2 inches above the iliac crest and at MSP plane.

The most common image for abdominal region...?

AP supine abdomen (also called a KUB) (Kidneys, ureters, and bladder)

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

AT the iliac crests

IR Sizes:

All DECUBE - Crosswise Upright, Supine, Prone - all LW

Excess fluid in the abdomen is called what?

Ascites

Umbrella-shaped muscle that separates the abdominal from the thoracic cavity:

Diaphragm (2) L&R

Dorsal DECUBE Abdomen

IR: 14 x 17 LW Position of part: Supine, without rotation Support knees to reduce strain Arms above head CR: Enters patient on MCP at a level 2" above the iliac crests Respiration: Suspended on expiration

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?

Involuntary motion

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?

KUB

AP left lateral decubitus abdomen

LEFT LATERAL DECUB: Technique 32 mAs @ 80 kVp SID: 40" IR: 14 x 17 LW CR: Horizontal, directed 2 inches above iliac crest and at midsagittal plane COLLIMATION: size of IR RESPIRATION: Hold on Expiration

A patient in intensive care may have developed intra-abdominal bleeding. The patient is in critical condition and cannot 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?

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?

Left lateral decubitus abdomen

Muscles located on either side of the lumbar vertebral column:

Psoas Muscles (2) L&R

The Pelvic cavity contains the:

Rectum Sigmoid Urinary bladder Reproductive organs

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?

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

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?

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

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

SMALL: 10-20 mins LARGE: 5-8 mins (minimum:5)

Demonstrating intraperitoneal air:

Smaller air amount: in position for 10 to 20 minutes before radiographs are taken. Larger amount of air: in position for a minimum of 5 minutes.

The Abdominal cavity contains the:

Stomach Small intestines Large intestines Liver Gallbladder Spleen Pancreas Kidneys

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

TRUE

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

The patient was rotated into a slight RPO position.

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

True, suspend at the end of respiration.

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?

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

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

Upright AP abdomen

Another common request is a two-way abdomen series...

Usually requires: -Supine abdomen -Upright abdomen [For both procedures, a left lateral decubitus is performed INSTEAD of the upright, if patient cannot stand.]

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).

Yes, decrease the mAs.

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

false

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?

involuntary motion

"gaster" meaning:

stomach

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

true