Positioning 2: Ch. 16 and a little of Ch. 17

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

2 inches above the iliac crests

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

False, that's one of the criteria!!

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

10 to 20 minutes

Lateral projection with pt place in dorsal decubitus, where should the CR enter the pt?

2" anterior to the MCP and 2" above the iliac crests

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

The contrast of an AP projection image of the abdomen must be sufficient to demonstrate the soft tissues of the: lower border of the liver kidneys psoas muscles

ALl of them. all 3, even the psoas

Which projection does not demonstrate free air levels within the abdomen?

AP projection with the pt supine

Which projection should be used to demonstrate free air within the abdominal cavity when the patient is unable to stand for an upright abdomen image?

AP projection, left lateral decub position

Gallbladder placement in the body varies depending on:

Body habitus This could be habit-us, but you playing

Two minor lobes evident on visceral surface

Caudate lobe and Quadate lobe

the ___________ duct unites with the ________ duct to form common bile duct

Cystic, common hepatic

which position of the abdomen requires that the patient be supine and that the CR be directed to a lateral side of the pt, entering slightly anterior to the MCP?

Dorsal decubitus.

________ artery supplies oxygenated blood from abdominal aiorta

Hepatic artery!!!

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 (kidney, ureters, bladder)

Which radiographic position of the abdomen requires that the patient be placed in the lateral recumbent position on their left side and that the horizontal CR be directed along the MSP, entering the anterior surface of the pt's abdomen at the level of iliac crests?

Left lateral decubitis. I hate how they write this

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

the portion of the peritoneum that function to support the viscera of the abdomen in position are the

Mesentery and omenta folds

For the KUB image, when should respiration be suspended, and what effect will that have on the pt?

On full expiration, elevate the diaphragm

the abdomen is divided into 2 cavities. The inferior cavity is the:

Pelvic

Which structure should be examined to see whether the patient was rotated for a lateral projection of the abdomen?

Pelvis and lumbar vertebrae

which structure forms the mesentery and omenta folds?

Peritoneum

______ vein carries blood from digestive system to be filtered by the liver

Portal vein!

Primary function of liver?

Production of bile

A hypersthenic patient comes to the radiology department for a KUB (kidneys, ureters, bladder). 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 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.

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.

which side must be demonstrated on an AP abdomen with the patient positioned left lateral decubitus when a pneumoperitoneum is suspected?

Right Side

which 3 projections usually comprise the acute abdomen series for ambulatory patients?

Supine KUB, AP upright abdomen, and PA chest

Why is it desirable to include the diaphragm in the upright abdomen image?

To demonstrate free air in the abdomen

For the AP upright abdomen image of an adult of average size, why should the centering be slightly higher than the centering level used for the supine KUB image?

To include the diaphragm

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

True, cuz they got big torsoses

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

True, suspend at end of expiration

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

For the lateral projection with the patient placed in the dorsal decubitus position, which procedure should be performed to ensure that the entire abdomen is included on the image?

Use the support cushions to elevate the patient

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.

the liver, stomach, and pancreas are located in the:

abdominal cavity

Common bile duct joins the pancreatic duct join together and empty into the __________ via the _______________ _______ (ampulla of Vater)

duodenum, hepatopancreatic ampulla

the ____________ ___________ separates the lobes of the liver

falciform ligament

2 blood supplies:

hepatic artery and portal vein

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

hepatic artery and portal vein

Sphincter of Oddi

hepatopancreatic sphincter

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

iliac crests

To which level of the pt should the CR be centered for the KUB?

iliac crests. KUB--> iliac crests

percutaneous transhepatic cholangiography

performed on pt w/jaundice when the duct system has been demonstrated as dilated by CT or sonography, but the cause is unclear. (May also be used to place a drainage catheter to treat obstructive jaundice)

A properly exposed abdominal radiograph will exhibit the: 1.) psoas muscles 2.) lower border of the liver 3.) transverse processes of the lumbar vertebrae

psoas muscles, lower border of the liver and the transverse processes of the lumbar vertebrae

Area behind the peritoneum?

retroperitoneum! Kidneys and pancreas hang out here

For AP supine abdomen, tall patients may require a ___________ ____________ __________ and hypersthenic patients may require ____ __________ __________

seperate bladder image, 2 cross-wise projections

What is the major advantage of the PA projection of the abdomen over the AP projection of the abdomen?

the PA projection reduces the exposure dose to the gonads. Your nuts won't get zapped (as much) with the PA

How is proper patient alignment evaluated on an AP projection, supine (KUB) image of the abdomen?

the vertebral column is centered in the collimated field.