Protocol/Info

What projection is included in an Abdomen AP (KUB) examination?

AP supine abdomen

What projections are included in an Abdomen Routine (Obstruction Series)?

AP supine and either AP erect, left lateral decubitus, or transabdominal/dorsal decubitus

What projections are included in an Abdomen Routine with Chest 1 View?

AP supine abdomen, an AP erect or appropriate decubitus abdomen, and a PA or AP erect chest

What is the purpose of an Abdomen AP (KUB) examination?

To demonstrate the size and shape of the liver, spleen, and kidneys, as well as intraabdominal calcifications or evidence of tumor masses

What is the purpose of an Abdomen Obstruction Series?

To evaluate the abdominal bowel pattern, free intraperitoneal air, and air-fluid levels

What breathing instructions are used for abdomen radiographs, and why?

Expose on suspended expiration to prevent compression of abdominal organs

What SID is normally used for abdomen projections?

40’’

What should be done if an Abdomen AP order indicates obstruction, ileus, or pneumoperitoneum and the radiologist approves additional views?

Perform an obstruction series including an erect or left lateral decubitus view, and change the EPIC order to Abdomen Routine (Obstruction Series) with the required co-sign

What should the technologist do if there is uncertainty about an abdomen obstruction-series order?

Consult the radiologist before imaging

What is the patient position for an AP supine abdomen projection?

Supine, with the midsagittal plane centered to the IR, the patient straight and without rotation, and the arms outside the exposure field

What is the technique for an AP supine abdomen projection?

85 kVp using the table IR; 10 mAs if not using AEC

What is the standard collimation for an AP supine abdomen projection in an average-sized patient?

14 × 17 inches lengthwise

Where is the IR centered for an AP supine abdomen projection?

Approximately at the level of the iliac crests, with the pubic symphysis at the bottom of the IR

Where is the central ray directed for an AP supine abdomen projection?

Perpendicular to the IR at approximately the level of the iliac crests

What anatomical landmark must be included at the inferior edge of an AP supine abdomen image?

The pubic symphysis

Why should the AP supine abdomen IR not be centered excessively low?

To include the pubic symphysis without unnecessarily excluding the upper abdominal anatomy

What marker placement is required for an AP supine abdomen projection?

An appropriate right or left anatomical side marker placed clear of the anatomy of interes

What anatomical coverage is expected on an AP supine abdomen image?

From the pubic symphysis through the upper abdomen, with additional images if needed for patient size or the clinical indication

What demonstrates proper centering on an AP supine abdomen image?

The vertebral column is centered, and the ribs, pelvis, and hips are equidistant from the image edges or collimated borders

How can rotation be evaluated on an AP supine abdomen image?

Spinous processes should be centered in the lumbar vertebrae, ischial spines should be symmetric if visible, and iliac alae should be symmetric

Toward which side is the patient rotated if one ischial spine is more visible on an AP abdomen image?

Toward the side where the ischial spine is more visible

Toward which side is the patient rotated if one iliac ala appears wider on an AP abdomen image?

Toward the side with the wider iliac ala

What soft-tissue structures should be visible on a properly exposed AP supine abdomen image?

The lateral abdominal wall, properitoneal fat layer (flank stripe), psoas muscles, lower liver border, and kidneys

What bony structures should be visible on a properly exposed AP supine abdomen image?

The inferior ribs and transverse processes of the lumbar vertebrae

When must the entire bowel pattern be included on an AP supine abdomen image?

When the examination is part of an obstruction series or ordered for nausea, vomiting, or diarrhea

What anatomy is required when an AP supine abdomen is specifically ordered to evaluate the kidneys, ureters, and bladder?

The kidneys, ureters, and bladder must be included; the entire bowel pattern is not required solely for this indication

What coverage is required for an AP supine abdomen ordered to evaluate a foreign body?

Skin to skin and from the pubic symphysis through the diaphragm

What are examples of foreign-body-related indications requiring extensive AP abdomen coverage?

MRI clearance, IUD evaluation, patency capsule, and Hinton marker evaluation

What should be done when a hypersthenic patient's entire bowel pattern will not fit side to side on an AP supine abdomen image?

Obtain two 17 × 14 inch crosswise images with approximately 1.5 inches of overlap

How is the first image positioned for a two-image AP supine abdomen examination on a hypersthenic patient?

Use 17 × 14 inch crosswise collimation and include the superior margin of the pubic symphysis at the bottom

How is the second image positioned for a two-image AP supine abdomen examination on a hypersthenic patient?

Use 17 × 14 inch crosswise collimation with approximately 1.5 inches of overlap with the first image

What alternative IR size may be used for a large-body-habitus AP supine abdomen patient at Reading Hospital?

17 × 17 inches, when equipment permits

How often should individual quadrant imaging be necessary for a large abdomen patient at Reading Hospital?

Rarely

What should be done if the upper kidneys or bowel pattern are clipped at the top of an AP supine abdomen image?

Obtain a 14 × 11 inch crosswise upper-abdomen conedown image with approximately 1.5 inches of overlap

What should ideally be included at the top of an AP abdomen upper conedown image for urinary concerns?

The costophrenic angles, to ensure the entire kidneys are included

What should be done if the bowel pattern extends beyond the side of the initial AP abdomen image?

Obtain an additional 17 × 14 inch crosswise image with approximately 1.5 inches of overlap

How can a radiographic marker assist when obtaining additional overlapping AP abdomen images?

It can indicate where the edge of the original light field was positioned

What should be done if the pubic symphysis is missing from an AP supine abdomen image but the kidneys and bowel pattern are visible?

Obtain another 14 × 17 inch image centered lower to include the pubic symphysis

What is the EKG lead protocol for routine AP supine abdomen imaging?

EKG leads, wires, and patches may remain; pull wires over the chest and keep them separated rather than coiled in the image

What is the EKG lead protocol for an AP supine abdomen ordered for kidney stones?

Remove the EKG leads, wires, and patches

What anatomical coverage is required for an AP supine abdomen performed for MRI screening?

The entire abdominopelvic cavity, skin to skin, and from the diaphragm through the pubic symphysis

What must be removed before an AP supine abdomen performed for MRI screening?

The heart monitor and leads

What should be done if the diaphragm is clipped on an AP supine abdomen performed for MRI screening?

Check whether a chest radiograph was obtained within the previous 24 hours before repeating the abdomen image

Is an additional AP abdomen image required for MRI screening if the diaphragm is clipped but a chest radiograph from the past 24 hours includes it?

No. A repeat is unnecessary; document the chest radiograph information in EPIC

How do exposure and positioning factors for an MRI-screening AP supine abdomen compare with a routine AP supine abdomen?

All other factors are the same, except the required full anatomical coverage and removal of monitoring equipment

What is the technique for an AP erect abdomen projection?

85 kVp using the erect IR; 10 mAs if not using AEC

What is the patient position for an AP erect abdomen projection?

Erect, with the midsagittal plane centered to the IR, no rotation, and the arms outside the exposure field

What collimation is used for an AP erect abdomen projection?

14 × 17 inches lengthwise or crosswise depending on patient body habitus

What collimation orientation is used for an average-sized or thin patient during an AP erect abdomen projection?

14 × 17 inches lengthwise

What collimation orientation is used for an AP erect abdomen projection on a patient with a large or wide thorax?

17 × 14 inches crosswise

Where is the central ray directed for an AP erect abdomen projection?

Perpendicular to the erect IR along the midsagittal plane, approximately 2 inches above the iliac crests or high enough to include the entire diaphragm

How is AP erect abdomen centering adjusted for a tall, thin patient?

Center lower because tall, thin patients generally have longer lungs

How is AP erect abdomen centering adjusted for a short, wide patient?

Center higher because short, wide patients generally have shorter lungs

What markers are required for an AP erect abdomen projection?

An appropriate right or left anatomical side marker and an Erect marker or electronic annotation

What is the purpose of an AP erect abdomen projection?

To demonstrate the size and shape of the liver, spleen, and kidneys, as well as free air and air-fluid levels

What superior anatomy must be included on an AP erect abdomen image?

The entire diaphragm without motion, with minimal lung tissue visible

What demonstrates proper alignment on an AP erect abdomen image?

The vertebral column is centered, ribs, pelvis, and hips are equidistant from the image edges, and rotation indicators are symmetric

What should be assessed before positioning a patient for an AP erect abdomen projection?

Whether the patient can stand safely, especially if dizzy or affected by pain medication

What projection should replace an AP erect abdomen if the patient cannot stand safely?

Left lateral decubitus

What projection should be used if the patient cannot stand and cannot lie on the left side for an obstruction series?

Transabdominal/dorsal decubitus

How should EKG leads be positioned for an AP erect abdomen projection?

Pull the leads down the middle and away from the diaphragm

Can AP erect abdomen images be obtained portable, in a bed, or on a litter at Reading Hospital?

Yes, provided the patient is positioned appropriately and the image meets the facility's requirements

What percentage of a portable, bed, or litter AP erect abdomen image must contain the abdomen?

At least 70% of the image

How upright should a patient be for a portable, bed, or litter AP erect abdomen projection?

As close to 90 degrees upright as possible to demonstrate air-fluid levels

Is a semi-erect abdomen projection acceptable at Reading Hospital?

No. If a true erect position cannot be achieved, obtain a left lateral decubitus image

When is a left lateral decubitus abdomen projection performed?

When the patient cannot stand for an erect abdomen projection

What is the technique for a left lateral decubitus abdomen projection?

85 kVp using the erect IR; 11 mAs if not using AEC

What is the standard SID for a left lateral decubitus abdomen projection?

40 inches; 56 inches may be used for a bariatric litter or body habitus when necessary, but 40 inches must be attempted first

What is the collimation for a left lateral decubitus abdomen projection?

17 × 14 inches crosswise

How is the patient positioned for a left lateral decubitus abdomen projection?

Left side down in a lateral recumbent position, AP or PA, with the body in a true lateral position parallel to the IR

How should the arms be positioned for a left lateral decubitus abdomen projection?

Above the diaphragm so they do not overlap abdominal contents

How should the knees be positioned for a left lateral decubitus abdomen projection?

Slightly flexed to stabilize the patient

How close should the patient be to the IR for a left lateral decubitus abdomen projection?

The stomach or back should be as close to the IR as possible, depending on AP or PA positioning

How long does Merrill's recommend leaving the patient in the left lateral decubitus position before exposure, and why?

Approximately 5 minutes to allow free air to rise

Where is the central ray directed for a left lateral decubitus abdomen projection?

Perpendicular to the IR, approximately 2 inches above the iliac crests

How is the IR aligned for a left lateral decubitus abdomen projection?

Adjust the height so its long axis is centered to the midsagittal plane, with minimal light above the upper side of the abdomen

What anatomical side marker is required for a left lateral decubitus abdomen projection?

A right marker on the upside, identifying the patient's right side

What additional annotation is required for a left lateral decubitus abdomen projection?

An electronic Decubitus annotation