Abdomen Procedures (10/4/2023 & 10/9/2023)

What quadrant are the liver and gallbladder in?

RUQ

What quadrant are the stomach and spleen in?

LUQ

What are some indications/reasons for a supine abdomen x-ray?

1. evaluate gas patterns/constipation

2. evaluate placement of lines/tubes

3. foreign bodies

What is the kVp range for an AP supine abdomen?

70-90 kVp

Proper kV should demonstrate good soft tissue differentiation of ___

psoas muscles, lower liver, kidneys, transverse processes

How can you check for rotation on an abdomen x-ray?

spinous processes, obturator foramen, iliac wings, ischial spines

Explain the respiration for an abdomen image

on expiration (so organs are in their true position)

What are the 4 common abdomen routines?

1. 1 view (AP supine)

2. KUB (urinary)

3. 2 view (AP supine and upright)

4. abdomen series

Explain centering for an AP/PA abdomen

centered at MSP and at level of iliac crest with the bottom edge at pubic symphysis

What is the SID for an AP/PA abdomen x-ray?

40 inches

Should you mark at the bottom or top of an abdomen image?

bottom

Identify the images needed for the different body habituses

asthenic: 1 LW

hyposthenic: T-shot

sthenic: 2 CW

hypersthenic: quadrants

The pubic symphysis is about ___ inches below the ASIS

3

The pubic symphysis is at the same level as the ___

greater trochanter

The PA projection of the abdomen is used for ___

urinary and small bowel radiographs

KUB is only done in which position?

AP supine

A KUB needs to include from the ___ to the ___

top of kidneys to the pubic symphysis

How long should a patient stand before an AP upright image of the abdomen?

ideally 10-15, AT LEAST 5

Where should you center an AP upright abdomen x-ray?

MSP and 2 inches above iliac crest (top of IR should be at axilla)

An upright abdomen needs to include from the ___ to the ___

diaphragm to ASIS

Does an upright or supine abdomen x-ray need a higher technique?

upright

What are some reasons for doing an upright abdomen?

obstructions, perforation, infection

What does an abdomen series consist of?

PA CXR, upright abdomen, supine abdomen

How should a patient lay for an AP or PA decubitus abdomen?

• always left side down (due to location of free air)

• arms above head

• lay for at least 5 minutes

Explain the centering for a left lateral decubitus abdomen

• central ray is a horizontal beam with SID 40 inches

• centered at MSP and 2 inches above iliac crest (need to include diaphragm)

• marker on side down

A(n) ___ abdomen image needs to include the pubic symphysis

supine

What are some things that a decubitus abdomen can demonstrate?

• intraperitoneal gas/free air

• fluid levels

• diaphragm

Explain patient positioning for a lateral abdomen

• lateral recumbent position (either right or left)

• arms above head

• partially flex knees and hips

Explain centering for a lateral abdomen

• MCP is perpendicular to IR

• MSP is parallel to IR

• centered at crest and MCP

  • may need 2 inches above crest to include diaphragm

• SID 40 inches

What are some things a lateral abdomen can demonstrate?

• foreign bodies

• intra-abdominal calcifications

• tumor masses

• aortic aneurysms/calcification

What is the largest vessel in the human body?

aorta

Explain patient position for a dorsal/ventral decubitus abdomen

• arms above head

• built up if necessary

• can be either right or left lateral (mark side closest to IR)

Explain centering for dorsal decubitus position

• horizontal beam

• centered slightly anterior to MCP and 2 inches above crest

• SID 40 inches

What are some things that a dorsal decubitus position can demonstrate?

air fluid levels, dilation of small bowel loops, aneurysm, aorta calcification

Dorsal decubitus abdomens are most commonly done on what type of patient?

NICU babies

Explain patient positioning for an AP oblique abdomen x-ray

• supine; rotated

• shoulders and hips rotated the same amount

• arms out of the field

Explain centering for AP oblique abdomen x-rays

• center at iliac crest and 2 inches lateral from midline (toward elevated side)

• SID 40 inches

The kidneys sit at a ___ angle with the MCP

30-35^o

Explain the AP urinary oblique image

• 30-35^o patient rotation

• side up kidney will be parallel to IR and will be best demonstrated

• side down kidney is perpendicular to IR

Explain the PA urinary oblique image

• 30-35^o patient rotation

• side down kidney will be parallel to IR and will be best demonstrated

• side up kidney is perpendicular to IR

The best view of the left kidney will be in either the ___ or ___ position

RPO or LAO

The best view of the right kidney will be in either the ___ or ___ position

LPO or RAO

Explain technique for AP abdomen/KUB images

70-90 kVp

20 mAs

Explain technique for upright/L lat decub abdomen images

70-90 kVp

32 mAs