Post on 19-Jan-2016
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Abdominal Radiography
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Intended Learning outcomes
• The student should be able to apprehend clinical aspects of abdominal radiographic positioning and techniques.
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Abdomen Views
• The A-P lumbopelvic view may demonstrate abdominal pathologies and disease. Don’t just look at the spine.
• Conditions such as kidney stone, abdominal aortic aneurysms, vascular calcifications and gallstones can be identified on the A-P lumbopelvic view.
Bowel preparation
• Preliminary bowel preparation in non acute patients is administered with a combination of laxatives, enemas, and controlled diet
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Patient Preparation
• Ask the patient to remove all clothing and put on a hospital gown. If the patient cannot do so, remove any opaque objects in the clothing that can cause artifacts in the area to be x-rayed.
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Kidney Stone
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Abdomen Views
• The KUB or recumbent abdomen view is used to identify many abdominal conditions.
• It must demonstrate the Kidneys, path of the Ureters and Bladder.
• Often kidney stone are seen on this view.
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Abdomen Views
• Kidney stones can present with very similar symptoms as a low back injury.
• The KUB is better for seeing stones because the air and fluid levels are not seen since it is taken recumbent.
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Acute Abdomen Series
• Study is a non-contrast survey of the acute abdomen. The exam consists of:
• P-A Chest erect
• Erect or Up right Abdomen
• KUB
• If patient can not stand, left lateral decubitus view of abdomen may be done.
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P-A Chest Erect
• Free Air in the abdomen will be seen under the diaphragms.
• Air in stomach will be seen.
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Erect or Upright Abdomen
• Free Air in the abdomen will be seen under the diaphragms.
• Air in stomach will be seen.
• Bowel gas pattern and fluid levels seen.
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Erect or Upright Abdomen
• Free Air in the abdomen will be seen under the diaphragms.
• Air in stomach will be seen.
• Bowel gas pattern and fluid levels seen.
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KUB or A-P Abdomen
• Should see the gas patterns present in the bowel.
• Look for calcifications or other abnormalities in the abdomen.
• Note stent from kidney to bladder
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KUB or A-P Abdomen
• Measure: A-P at umbilicus
• Protection: Males: Bell or apron draped over testes. Females: None, may take P-A view
• SID: 40” to table Bucky• Film: 14” x 17” regular
I.D. up
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KUB or A-P Abdomen
• Position table in the room. Align the vertical central ray to the center line of the table.
• Lock the table wheel lock.• Have patient lie on back
on the table.• Make sure the table did
not move when patient got on table.
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KUB or A-P Abdomen
• Locate the umbilicus. Have patient move on the table until the umbilicus is aligned with the vertical central ray.
• Locate the symphysis pubis and position bell or drape apron below the symphysis pubis.
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KUB or A-P Abdomen
• Locate the iliac crest.• Horizontal CR: 1” to 1.5”
below the iliac crest or midway between the crest and ASIS.
• Vertical CR: mid sagittal• Center film to
horizontal CR.• Collimation: slightly less
than film size.
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KUB or A-P Abdomen
• Breathing Instructions : Full Expiration
• Make exposure and let patient breathe and relax.
• A sponge may be placed under the patient’s knees to relieve the pressure on the spine
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KUB or A-P Abdomen Film
• Both kidneys should be seen.
• Psoas muscles seen
• Symphysis pubis seen
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KUB ERROR
• Horizontal CR was not low enough to get pubis on film.
• Symphysis pubis not seen because bell was positioned too high. A stone could be missed.
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Upright Abdomen
• Measure: A-P at umbilicus
• Protection: Bell for males; female: none or taken P-A
• SID: 40” Bucky• No tube angle• Film: 14” x 17” regular
I.D. up
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Upright Abdomen
• Bell placed below level of pubis.
• Patient stands facing tube with back next to Bucky.
• Method 1• Locate xiphoid process• Position top of film 2.5”
above the xiphoid process.
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Upright Abdomen
• Horizontal CR centered to film
• Method 2• Horizontal CR: 2”
above the iliac crest• Film centered to
horizontal CR.• Vertical CR: mid
sagittal
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Upright Abdomen
• Collimation: slightly less than film size
• Breathing Instructions: Full expiration
• Make exposure and let patient relax.
• Note: patient needs to be erect for 10 minutes before taking film.
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Upright Abdomen Film
• Domes of diaphragms must be seen
• Gas pattern and air fluid levels of abdomen may be evaluated.
• Note fluid level in stomach.
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Decubitus Abdomen
• Measure: A-P at umbilicus
• Protection: Males apron draped over testes. Female: None or do P-A
• SID: 40” to Bucky• No tube angle• Film: 17” x 14” regular
I.D. up
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Decubitus Abdomen
• Place table next to Bucky• Align bottom of film just
below table to to assure that the dependent side will be on film.
• Have patient lie on table with their left side down.
• Patient to stay in this position for about 10 minutes.
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Decubitus Abdomen
• Horizontal CR: along mid sagittal plane.
• Vertical CR: 2.5” lateral and superior to the iliac crest
• Move table or patient to align vertical CR.
• Collimation: slightly less than film size.
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Decubitus Abdomen
• Breathing Instructions: Full Expiration
• Make exposure and let patient breathe and relax.
• Note : P-A positioning. The key to decubitus views is alignment of bottom of film with table top.
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Decubitus Abdomen Film
• Right side diaphragm must be seen to detect abdominal free air.
• It is easier to see air around liver border.
• Arrow marker on film to document side up.
• Gas and fluid level patterns in abdomen can be evaluated.
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Chest Decubitus View
• Chest decubitus views are taken to evaluate pleural and pericardial effusions.
• In the lung, fluid will pool in the dependent side. In the hilar and pericardium, fluid will be seen in the side up.
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Chest Decubitus View
• Measure: A-P at mid chest
• Protection: Lead apron draped over abdomen
• SID: 72” Bucky• No tube angle (90
degrees)• Film: 17” x 14” regular
I.D. up. Small patient: 14” x 17” I.D. up
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Chest Decubitus View
• Table placed next to wall Bucky with bottom of film just below the table top.
• Patient placed on table lying on the side where the effusion is suspected.
• Patient should be facing tube.
• Patient needs to stay on side for 10 minutes
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Chest Decubitus View
• Horizontal CR: mid-sagittal plane
• Vertical CR: mid chest• Note view can be taken
P-A if patient can get arm straight over their head. It is important to avoid any lordotic angle of chest.
• Collimation: less than film size.
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Chest Decubitus View
• Breathing Instructions: Full and deep inspiration
• Make exposure and let patient breathe and relax.
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Chest Decubitus Film
• All of lung fields should be seen.
• Arrow marker should be used to note the side up
• Deep inspiration (below 10th ribs) is very important to see true extent of any effusion
Assignment
• One student will be selected for assignment.
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Suggested Readings
• Clark’s Radiographic positioning and techniques.
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Questions.
• What are the technical radiographic steps for adequate abdominal radiography?
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Thank You