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PATIENT PREPARATION
-All clothing removed
-Opaque objects removed
-Hospital gown worn
-Cover patient for warmth and modesty
When to expose?
on expiration
-Inspiration compresses abdominal organs (diaphragm lowers)
- Collimation: only the abdominal area
How to place IR markers?
For decubs also use marker to indicate side up
Abdominal EXPOSURE FACTORS
Analog/Digital kVp (70-80)
Short exposure time
- Less chance of motion
Adequate mAs/AEC multiple chambers
grid
Minimum SID of 40"

ABDOMEN IMAGING
Routine
- AP supine (KUB)
Special
- PA prone
- Lateral decubitus (AP)
- AP erect
- Dorsal decubitus (lateral)
AP ABDOMEN
Patient supine
No rotation of shoulders or pelvis
- Both ASIS equal distance from tabletop
Center to iliac crest and mid sag
- Patients with a long torso may need two images
Expose on expiration
- Decreases compression (better visualization) of internal organs

EVALUATION CRITERIA- AP ABDOMEN
Anatomy visualized
- liver, spleen, kidneys
- Psoas muscles
- Air-filled stomach and bowel segments
Symphysis pubis visible
No rotation
No motion

PA ABDOMEN
CR and IR to iliac crest

CRITERIA (PA ABDOMEN)
Symphysis pubis visible
Kidneys and lower liver margin included
No rotation
No motion
Exposure factors optimal
Image should be annotated/labeled "PA"

LEFT LATERAL DECUBITUS POSITION- WHEN DOING FOR AIR AND FLUID LEVELS, THE LIVER WILL BE SURROUNDED BY FREE AIR.
CR 2 inches (5 cm) above iliac crest and mid sag
Body against IR- no gap (OID will increase mag)
CR is horizonal to demonstrate air fluid levels
- Air rises, fluid falls
- Let patient rest in position for at least 5 minutes to allow for air to rise
No rotation of pelvis and shoulder
Arms up and off abdomen
Include elevated (right) side of abdomen
Expose on expiration

EVALUATION CRITERIA- LEFT DECUB ABDOMEN
-Diaphragm demonstrated
-Both sides of body included
-No rotation
-No motion

ERECT AP ABDOMEN- AIR WILL RISE UNDER THE DIAPHRAGMS
CR 2 inches (5 cm) above iliac crest and mid sag
Arms by sides and away from abdomen
No rotation of shoulders and pelvis
Exposure taken on expiration

EVALUATION CRITERIA- ERECT ABDOMEN
Diaphragm included
No rotation
No motion

DORSAL DECUBITUS- LEFT LATERAL POSITION PICTURED BELOW
Patient supine and place right or left side against the IR
- Place lead marker for side against IR
CR 2 inches (5 cm) above iliac crest to midcoronal plane
Arms above head
Exposure made on expiration

EVALUATION CRITERIA: DORSAL DECUBITUS RIGHT LATERAL POSITION
Diaphragm included
No rotation
No motion

CLINICAL INDICATIONS FOR ACUTE ABDOMEN SERIES
Ileus
Ascites- fluid
Perforated hollow viscus
Intra-abdominal mass
Post-op (abdominal surgery)
If patient comes to department upright, perform those images first
3-Way (aka Obstruction Series)
PA chest
AP erect or left lateral decub
- Must include diaphragm
AP supine
2-Way (aka Abdomen Complete)
AP supine
AP erect or left lateral decubitus
- Must include diaphragm