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Abdominal Radiography

Abdominal Radiography. Intended Learning outcomes. The student should be able to apprehend clinical aspects of abdominal radiographic positioning and techniques. Abdomen Views. The A-P lumbopelvic view may demonstrate abdominal pathologies and disease. Don’t just look at the spine.

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Abdominal Radiography

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  1. Abdominal Radiography

  2. Intended Learning outcomes • The student should be able to apprehend clinical aspects of abdominal radiographic positioning and techniques.

  3. 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.

  4. Bowel preparation • Preliminary bowel preparation in non acute patients is administered with a combination of laxatives, enemas, and controlled diet

  5. 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.

  6. Kidney Stone

  7. 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.

  8. 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.

  9. 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.

  10. P-A Chest Erect • Free Air in the abdomen will be seen under the diaphragms. • Air in stomach will be seen.

  11. 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.

  12. 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.

  13. 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

  14. 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

  15. 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.

  16. 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.

  17. 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.

  18. 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

  19. KUB or A-P Abdomen Film • Both kidneys should be seen. • Psoas muscles seen • Symphysis pubis seen

  20. 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.

  21. 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

  22. 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.

  23. 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

  24. 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.

  25. 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.

  26. 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

  27. 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.

  28. 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.

  29. 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.

  30. 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.

  31. 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.

  32. 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

  33. 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

  34. 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.

  35. Chest Decubitus View • Breathing Instructions: Full and deep inspiration • Make exposure and let patient breathe and relax.

  36. 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

  37. Assignment • One student will be selected for assignment.

  38. Suggested Readings • Clark’s Radiographic positioning and techniques.

  39. Questions. • What are the technical radiographic steps for adequate abdominal radiography?

  40. Thank You

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