Ch3, Review Exercise C

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.

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.

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.

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).

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

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

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.

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