Clinical I, Exam 2 - Anatomy, Positioning & Evaluation

Psoas muscles

Two large muscles adjacent to the lumbar vertebrae visible on a properly exposed AP abdomen (KUB)

Why are the psoas muscles important on a KUB?

They are indicators of proper exposure and normal soft tissue visualization

Medical prefix for stomach

Gastro-

What are the three parts of the small intestine?

-Duodenum -Jejunum -Ileum

Which portion of the small intestine is the longest?

Ileum

Which portion of the small intestine is the shortest and widest?

Duodenum

Where does the large intestine begin?

Right lower quadrant at the cecum

What valve connects the small and large intestine?

Ileocecal valve

Between which two structures is the sigmoid colon located?

Descending colon and rectum

Which organ is part of the lymphatic system but not the digestive system?

Spleen

What are the three accessory digestive organs?

-Liver -Gallbladder -Pancreas

Which organ stores and releases bile?

Gallbladder

Where is the pancreas located in relation to the stomach?

Posterior to the stomach

Is the pancreas intraperitoneal or retroperitoneal?

Retroperitoneal

Which digestive organ is retroperitoneal?

Pancreas

Why is the right kidney lower than the left?

The liver occupies space above the right kidney

Which glands are located superior to each kidney?

Suprarenal (adrenal) glands

What is the correct term for the radiographic study of the urinary system?

Intravenous urogram (IVU), not IVP

What is the peritoneum?

Double-walled serous membrane lining the abdominopelvic cavity

What does retroperitoneal mean?

Located behind the peritoneum

Name the primary retroperitoneal organs.

-Kidneys -Pancreas -Ureters -Adrenal glands

What structure supports and stabilizes the small intestine?

Mesentery

What is the mesentery?

Double fold of peritoneum attaching the small intestine to the posterior abdominal wall

What is the greater omentum?

Double fold of peritoneum connecting the greater curvature of the stomach to the transverse colon

Function of the greater omentum?

Stores fat, provides immune protection, and cushions abdominal organs

What is the central abdominal region called?

Umbilical region

Which abdominal region contains the rectum?

Pubic (hypogastric) region

Which abdominal region contains the spleen?

Left hypochondriac region

Name the four abdominal quadrants.

-RUQ -LUQ -RLQ -LLQ

Which quadrant contains the liver and gallbladder?

Right upper quadrant (RUQ)

Which quadrant contains the stomach and spleen?

Left upper quadrant (LUQ)

Which quadrant contains the cecum and appendix?

Right lower quadrant (RLQ)

Which quadrant contains the sigmoid colon?

Left lower quadrant (LLQ)

What landmark forms the inferior border of the abdomen?

Symphysis pubis

What vertebral level corresponds to the inferior costal margin?

L2-L3

What vertebral level corresponds to the iliac crest?

L4-L5 interspace

What vertebral level corresponds to the xiphoid process?

T9-T10

What landmark is commonly used to center an AP abdomen?

Iliac crest

Which landmark is used as an alternative to locate the inferior abdomen?

Greater trochanter

What does ASIS stand for?

Anterior Superior Iliac Spine

What is the ischial tuberosity?

Bony prominence of the ischium that bears weight while sitting

What is the symphysis pubis?

Cartilaginous joint joining the left and right pubic bones

What is the cecum?

Saclike first portion of the large intestine located in the RLQ

Critical Thinking: Which accessory digestive organ is NOT retroperitoneal?

Gallbladder

Critical Thinking: Which organ is both an accessory digestive organ and retroperitoneal?

Pancreas

Critical Thinking: Which abdominal region would most likely contain pain from splenic injury?

Left hypochondriac region

Critical Thinking: Which quadrant would most likely contain appendicitis?

Right lower quadrant

Critical Thinking: Which landmark is palpated to locate the CR for an AP abdomen?

Iliac crest

Critical Thinking: Which abdominal landmark corresponds to the lowest border of the abdomen?

Symphysis pubis

Critical Thinking: Why are the kidneys considered retroperitoneal?

Because they lie posterior to the peritoneal lining rather than within the peritoneal cavity

What are the two causes of voluntary motion?

-Patient breathing -Patient movement during exposure

How can voluntary motion be prevented?

Give clear breathing instructions before exposure

What is the primary cause of involuntary motion during abdominal radiography?

Peristalsis of the bowel

What is the best way to control involuntary motion?

Use the shortest exposure time possible

Which exposure factor best controls motion?

Short exposure time

Why are abdominal radiographs taken on expiration?

-Reduces diaphragm motion -Allows abdominal organs to spread out -Improves visualization of abdominal anatomy

When should exposure be made for an AP abdomen?

At the end of expiration

Where is the CR centered for a supine AP abdomen (KUB)?

At the level of the iliac crest (L4-L5)

Where is the CR centered for an AP erect abdomen?

1-2 inches (5 cm) above the iliac crest

Why is the CR centered higher for an erect abdomen?

To include the diaphragm for evaluation of free intraperitoneal air

What SID is recommended for abdominal radiography?

40 inches (100 cm)

What kVp is recommended for a digital AP abdomen?

80-85 kVp with a grid

What exposure technique is recommended for a sthenic adult abdomen?

Approximately 78-85 kVp with a grid and 40-inch SID

What contrast scale is recommended for abdominal radiography?

Long-scale contrast

Why is long-scale contrast used for abdominal imaging?

To visualize subtle soft tissue density differences

Why is close collimation important in digital abdominal imaging?

Reduces scatter and improves image quality

Should a side marker always be placed before exposure?

Yes. Never add side markers during post-processing

Why should side markers never be added after exposure?

Because of conditions such as situs inversus that reverse normal anatomy

What is situs inversus?

Congenital condition in which organs are located on the opposite side of the body

Should gonadal shielding always be used for abdomen radiography?

No. Do not use if it obscures anatomy of interest

Why is gonadal shielding often difficult in females?

The ovaries are internal and difficult to shield without obscuring anatomy

How is female gonadal shielding positioned?

Top at or slightly above the ASIS and bottom at the symphysis pubis (when permitted by policy)

When should gonadal shielding NOT be used?

If it obscures anatomy needed for diagnosis

What should be placed under geriatric patients during abdomen exams?

A radiolucent pad for comfort

Is the umbilicus a reliable landmark for bariatric patients?

No

How should the IR be oriented for most bariatric abdomen studies?

Landscape

What is the recommended overlap when using two IRs for bariatric patients?

1-2 inches (3-5 cm)

Which body habitus often requires two landscape IRs?

Hypersthenic

Which body habitus may require two portrait IRs?

Asthenic

Why may hypersthenic patients require two IRs?

The abdomen is broad and wide

Why may asthenic patients require two IRs?

The abdomen is long and narrow

What is essential when imaging pediatric patients?

-Short exposure time -Immobilization if needed -Close collimation

What should be removed before abdominal imaging?

Clothing, jewelry, and all radiopaque objects

What should the patient wear during abdominal radiography?

A hospital gown

What is the purpose of proper collimation?

Reduce patient dose and improve image quality

Should collimation borders be visible on all four sides of every adult abdomen?

No, anatomy should not be sacrificed simply to show borders

What anatomy must be included on a KUB?

Entire abdomen from diaphragm (or kidneys) through the symphysis pubis

What anatomy must be included if a PA chest is NOT performed for an acute abdomen series?

The diaphragm on the erect abdomen

How is rotation evaluated on a KUB?

-Symmetric iliac wings -Symmetric obturator foramina -Centered spinous processes

What does a wider right iliac wing indicate?

Rotation toward the right

What indicates no rotation on an AP abdomen?

Symmetric iliac wings and obturator foramina with centered spinous processes

Critical Thinking: A KUB cuts off the kidneys but includes the symphysis pubis in a bariatric patient. What should the technologist do?

Repeat using two landscape-oriented IRs with 1-2 inch overlap

Critical Thinking: A female patient with kidney stones has gonadal shielding covering the pelvis. What should the technologist do?

Repeat without gonadal shielding because anatomy is obscured

Critical Thinking: Why is expiration preferred over inspiration for abdominal imaging?

Expiration elevates the diaphragm and provides more room for abdominal organs, improving visualization

Critical Thinking: Why is a short exposure time preferred for abdomen imaging?

To minimize blur from involuntary bowel motion (peristalsis)

Critical Thinking: Why should side markers never be added after exposure?

Anatomic variations such as situs inversus could result in incorrect labeling

Critical Thinking: Why is close collimation especially important with digital imaging?

Digital systems can compensate for exposure but cannot recover image quality lost from scatter radiation

What are the three projections of a routine acute abdomen (three-way) series?

-AP supine abdomen -AP erect abdomen (or left lateral decubitus if unable to stand) -PA erect chest

What are the two projections of a two-way abdomen series?

-AP supine abdomen -AP erect abdomen (or left lateral decubitus if unable to stand)

What projection replaces the erect abdomen if the patient cannot stand?

Left lateral decubitus abdomen