Ch3, Review Exercise C
Broad hypersthenic patient may need
Two 14 X 17 IRs placed landscape, one centered lower to include symphysis pubis 1-2 inch overlap
Which decubitus position best demonstrates possible aneurysms, calcifications of the aorta, or umbilical hernias?
dorsal decubitus position
Exposure for an AP projection of the abdomen should be taken on ___.
end of expiration
The medical prefix for stomach is
gastro
what structure is a double fold of peritoneum that connects the transverse colon to the greater curvature of the stomach?
greater omentum
Why may the PA projection of a KUB generally be less desirable than the AP projection?
if kidney are of primary interest, increased OID
Which topographic landmark is found at the level of L2-L3?
inferior costal rib margin
Why is it recommended to take abdominal radiographs at the end of patient expiration?
it helps allow involuntary motion of bowel to cease
gonadal shielding should NOT be used during abdomen radiography if
it obscures essential anatomy
which projection best demonstrates a possible aortic aneurysm in the prevertebral region of the abdomen?
lateral position of abdomen
Which decubitus position of the abdomen best demonstrates intraperitoneal air in the abdomen?
left lateral decubitis
what positioning routine should be used for an acute abdominal series if patient is too ill to stand?
left lateral decubitus instead of erect
what structure helps stabilize and support the small intestine?
mesentery
retroperitoneal
organs located posteriorly to, or behind, the serious membrane lining of the abdominopelvic cavity
what is the primary cause for involuntary motion in the abdomen?
peristaltic movement of the bowel
The two large muscles found in the posterior abdomen adjacent to the lumbar vertebra that are usually visible on an anteroposterior (AP) radiograph are called the
psoas muscles
the large intestine begins in the _______ quadrant with a saclike area called the ________
right lower, cecum
What is the best mechanism to control involuntary motion?
short exposure time
which of the following organs is not directly associated with the digestive system?
spleen
the prominence of the greater trochanter is at about the same level as the ________ symphysis pubis, and the lower margins of the ischial tuberosities are about _______ inches distal to the symphysis pubis
superior boarder, 0.4-1.5 inches (1-4 cm)
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
Which type of body habitus typically requires two images with the image receptor placed portrait rather than landscape for a entire abdomen
tall hyposthenic or asthenic
peritoneum
the double wall membrane that lines the abdominopelvic cavity
why is the right kidney found in a more inferior position than the left kidney?
the presence of the liver on the right
excretory urogram (EU) intravenous urogram (IVU)
the radiographic study of the entire urinary system
which of the following organs is considered part of the lymphatic system?
the spleen
which endocrine glands are superomedial to each kidney?
the two suprarenal (adrenal) glands
why should a patient be placed in the decubitus position for a minimum of 5 minutes before exposure?
to allow air to rise or abnormal fluids to accumalate
volvulus
twisting of the bowel on itself, causing obstruction -large amount of air trapped in sigmoid colon with a tapered narrowing at the site of obstruction
what is the name for the abdominal region found directly in the middle of the abdomen
umbilical
the pancreas is located ______ to the stomach
posterior
what abdominal region contains the rectum?
Pubic
The central ray is centered to the level of the _______ for a supine AP projection of the abdomen.
Ialac crest
which portion of the small intestine is considered to be the longest?
Ileum
the sigmoid colon is located between the ________ and ________ of the large intestine
descending colon, rectum
______is used to evaluate patients with acute appendicitis
ultrasound
The six digestive system organs
1. oral cavity 2. pharynx 3. esophagus 4. stomach 5. small intestine 6. large intestine
Rotation can be determined on a KUB radiograph by the loss of symmetric appearance of:
-iliac wings, ischial spines and obturator tormina
Positioning
Kvp range 70-85 60-75 for children MAs- IR size- 14 X 17 IR at iliac crest or two inches above
what technical considerations are essential when performing abdomen studies on a young pediatric patient?
-short exposure times -high-speed image receptor -reduced kVp and mAs
the iliac crest is at the level of the ______ vertebra?
L4-L5
what projections are commonly performed for an acute abdominal series or three-way abdomen series?
-AP supine -AP erect -PA chest (best demonstrates free air under diaphragm)
what is the recommended overlap when using 2 landscape placed image receptors for a AP projection of a supine abdomen of an obese patient
1-2 in overlap
list 3 parts of the small intestine
1. Duodenum 2. Jejunum 3. Ileum
list the three accessory digestive organs
1. Pancreas 2. Liver 3. Gallbladder
what are the two causes of voluntary motion?
1. breathing 2 movement
to ensure that the diaphragm is included on an erect abdomen projection, the CR should be at the level of _________, which places the top of the 14- x 17- inch (35-x43- cm) IR at the level of the_____
5cm above iliac crest, axilla
7) 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 would be performed with the correct exposure factors to visualize the possible stone.
8) Situation: 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 determine the extent of the bleeding?
A bedside portable left lateral decubitus projection could be performed to demonstrate any fluid levels in the abdomen.
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
adynamic (paralytic) ileus
Bowel obstruction caused by a lack of intestinal peristalsis
With the use of iodinated contrast media, _____ is able to distinguish between a simple cyst or tumor of the liver.
CT
gonadal shielding for ______ may be impossible for studies of the lower adbominopelvic region
Females
Pneumoperitoneum
Free air or gas in the peritoneal cavity -Thin crest-shaped radiolucency underneath diaphragm
What scale of contrast is recommended for visualization of the abdominal structures on an abdominal x-ray?
Long scale
1) A KUB radiograph reveals 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?
No, A KUB must include the symphysis pubis on the radiograph to ensure that the bladder is seen. The positioning error involves centering of the central ray to the iliac crest. The technologist should also palpate the symphysis pubis ( if permitted by institutional policy) or greater trochanter to ensure that it is above the bottom of the cassette.
what projection of the abdomen requires a kVp setting of 110-125?
PA, erect chest for free air under diaphragm
what abdominal structure is not visible on a properly exposed KUB?
Pancreas
4) A radiograph of an AP abdomen reveals the left iliac wing is more narrowed than the right. What specific positioning error caused this?
Patient was rotated into a slight right posterior oblique (RPO) position. ( The downside ilium will appear wider).
intussusception
Telescoping of a section of bowel into another loop of bowel -air filled coil-spring appearance
3) A radiographic image of an AP projection of the abdomen demonstrates motion. The following exposure factors were selected : 78 kV, 200 mA, 2/10 second, grid, and 40 in ( 102 cm) SID. The technologist is sure that the patient did not breathe or move during the exposure. What may have caused this blurriness? What can be done to correct this problem on the repeat exposure?
The blurriness may be caused by involuntary motion. To control this motion, the technologist needs to increase the miliamperage and decrease the exposure time ( e.g. 400 mA at 1/10 second).
2) A radiograph of an AP projection of an average-size adult abdomen was produced using the following exposure factors: 90 kV, 400 mA, 1/10 second, grid, and 40 inch ( 102 cm) SID using 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 considerations will enhance the visibility of these structure on the repeat exposure?
The selected kV ( 90kV) was too high. The technologist needs to lower the kV to between 70 to 80 kV. The milliamperage and exposure time can be altered to maintain the density.
5) 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. What specific positioning routine should be used?
The three-way acute abdominal series, including the anteroposterior (AP) supine and erect abdomen and posteroanterior (PA) erect chest projections
6) Situation: 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?
The two-way acute abdomen series: AP supine abdomen and left lateral decubitus
The preferred imaging modality for examining the gallbladder quickly is:
Ultrasound
9) Situation : A patient with a history of ascites comes to the radiology department. Which one of the following positions best demonstrates this condition?
a) The erect AP abdomen position best demonstrates air fluid levels. Ascites produces free fluid in the intraperitoneal cavity
ascites
abnormal accumulation of fluid in the peritoneal cavity -general abdominal haziness
12) Situation: A patient comes from the ER with a large distended abdomen caused by an ileus. The physician suspects
b) Decrease the mAs. Because trapped air is easier to penetrated than soft tissue with x-rays, reducing the mAs will prevent overexposing the radiograph.
10) 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 stone. What is the next step the technologist should take?
b) Repeat the exposure without using gonadal shielding. Because the patient may have renal calculi in the distal ureters and urinary bladder, gonadal shielding cannot be used.
13) Situation: A child goes to radiology for an abdomen study. It is possible that he swallowed a coin. The ER physicians believes it may be in the upper GI tract. Which of the following routines would best identify the location of the coin?
c) KUB and lateral abdomen. With any foreign body study, two projections 90 degrees opposite is recommended to pinpoint the location of the foreign body.
voluntary motion can best be prevented by what
careful breathing instructions to the patient
ulcerative colitis
chronic inflammation of the colon with ulcerations -deep air filled mucosal protrusions of colon wall
Crohn's disease
chronic inflammation of the intestinal wall that may result in bowel obstruction -distended loops of air-filled small intestine
11) Situation: 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 kidney, is cut off. What is the next step the technologist should take?
d) Repeat the exposure using two 14 x 17 in cassette placed crosswise. The hypersthenic patient often requires this type of IR placement for abdomen studies
