Exam 4 - Radiographic Procedures

abdomen + projections

abdominopelvic cavity

extends from diaphragm to bony pelvis

consisting of abdominal cavity (larger + superior) + pelvic cavity

abdominal cavity

stomach, small intestines, large intestines

liver, gallbladder, spleen

pancreas, kidneys

RUQ

liver, colon, gallbladder

LUQ

stomach, spleen

pelvic cavity

rectum, sigmoid, urinary bladder, reproductive organs

uterus, ovaries, prostate

peritonoeum

double-walled membranous sac enclosing the cavity

peritneum layers

inner layer - visceral peritoneum

outer layer - parietal peritoneum

retroperitoneum

space behind peritoneum

kidneys + pancreas lie in this space

general procedural guidelines

exposure technique

IR/collimation size

SID

ID markers

radiation protection

patient instructions

patient clothing

change out of certain clothing

jean zippers, bra clasps, hooks

collimation

make sure diaphragm to bony pelvis are in image

exposure technique

kVp range that is too high will over penetrate some structures

tissues structures used to determine effective technique

lower liver border, psoas muscles

kidneys, ribs, transverse processes of lumbar vertebrae

patient instructions

exposures for abdominal procedures made at end of expiration to avoid compression of organs

abdominal xray labeled

essential abdomen projections

AP, supine, upright positions

PA, upright

AP, left lateral decubitus

R or L lateral

lateral, R or L dorsal decubitus

what is supine referred to as?

KUB (kidneys, ureters, bladder)

common abdomen request

3- view abdomen or acute abdominal series

AP, supine

AP, upright

PA chest, upright

what does 3-view show?

demonstrates abdominal contents, presence of free air (pneumoperitoneum), and air-fluid levels

why do we get 3-view request?

severe abdominal pain

upright to see free fluid

2-view abdomen series

AP, supine

AP, upright

if someone cannot stand?

perform left lateral decubitus in place of upright for both 3 and 2 view

AP abdomen, supine

supine, w/o rotation - arms above head/chest

knees support to reduce strain

ensure diaphragm to pubic symphysis included

AP abdomen, supine CR

perpendicular to IR

enters patient on MSP at level of iliac crests

AP abdomen, supine SID

40 inches

AP abdomen supine body

hypersthenic patients may require 2 crosswise projections

overlap 2 images

AP abdomen, upright

standing, weight equally distributed

arms out of radiation field

upright to see air fluid levels

AP abdomen upright IR

IR centered 2 inches above iliac crests

includes diaphragm

if bladder is to be included - obtain second bladder image

AP abdomen upright CR

horizontal, centered to IR

enters patient on MSP at level 2 inches above iliac crests

40 in SID

PA abdomen upright

upright, weight evenly distributed

reduces gonadal dose when kidneys aren’t primary interest

anterior surface in contact w/ grid

PA abdomen upright CR

perpendicular to IR

enters pt on MSP at level of 2 inches above iliac crests

40 in SID

PA abdomen upright collimtion

radiation field 14 × 17 inches

smaller patients, collimate to w/i 1 inch of shadow of abdomen flanks

what happens to anatomy where CR hits first?

the field of anatomy gets a higher dose of radiation

AP abdomen lateral decubitus

patients too ill to stand

lateral recumbent on R or L - left mostly

AP abdomen lateral decubitus body

recumbent lateral on radiolucent pad

arms above level of diaphragm

knees flexed slightly

lie 5 min in position prior

AP abdomen lateral decubitus CR

horizontal + perpendicular to center of IR entering MSP at level 2 inches above iliac crests

when would 2 inches above iliac crests take place?

if the exam is looking for air and fluid levels

lateral abdomen

recumbent left or right

knees flexed to increase stability + comfort

flex elbows + place hands under head

lateral abdomen IR

IR centered at level of iliac crests or 2 inches above, if diaphragm is included

lateral abdomen CR

perpendicular to IR

enters on MCP at level of crest or 2 inches above crest, if diaphragm is included

lateral abdomen dorsal decubitus

when patients cannot stand or lie on their side

supine on bed or stretcher

lateral abdomen dorsal decubitus body

right or left side in contact w/ vertical grid

vertical grid centered to MCP 2 inches above iliac crests to IR

arms crossed on upper chest/behind head

support knees for comfort

lateral abdomen dorsal decubitus CR

horizontal + perpendicular to center of IR

enters MCP at 2 inches above iliac crests

AP abdomen supine image

area from pubic symphysis to upper abdomen

centered vertebral column

ribs, pelvis, hips equidistant to edge of image or collimated borders on both sides

AP abdomen supine rotation

no rotation:

spinous processes in center of lumbar

symmetrical ilia wings or alae

what do correct exposure factors help demonstrate on an AP abdomen supine?

lateral abdominal wall + properitoneal fat later (flank strip)

psoas muscles, lower border of liver, + kidneys

inferior ribs

transverse processes of lumbar vertebrae

correct AP abdomen upright

proper collimation

same criteria as supine position + diaphragm seen w/o motion

marker indicating upright position

AP abdomen left lateral decubitus image

diaphragm w/o motion

both sides of abdomen

abdominal wall, flank structures

if abdomen is too wide for image?

side down when fluid is suspected (ensure entire dependent side is included in collimated radiation field)

side up when free air is suspected

AP abdomen left lateral decubitus rotation

no rotation:

spinous processes in center of lumbar vertebrae

if visible, symmetrical ischial spines of pelvis

symmetric alae or wings of ilia

proper ID indicating which side is up

correct lateral abdomen

proper collimation

no rotation - superimposed ilia + lumbar vertebrae pedicles and open intervertebral foramina

as much of abdomen as possible when diaphragm is included

correct lateral abdomen dorsal decubitus

proper collimation

diaphragm w/o motion

patient elevated so enter abdomen showing

proper ID indicating which side is closest to IR

when do we take the image?

exposure made at the end of the 2nd expiration

when to retake an image?

artifacts like bra underwire

centered too low

hand in image

rotation - ilia wings are uneven