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. Conditions such as kidney stone, abdominal aortic aneurysms, vascular calcifications and gallstones can be identified on the A-P lumbopelvic view.

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

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.

Kidney Stone

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.

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.

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.

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

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.

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.

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

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

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.

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.

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.

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

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

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.

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

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.

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

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.

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.

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

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.

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.

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.

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.

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.

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

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

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.

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

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

Assignment One student will be selected for assignment.

Suggested Readings Clark’s Radiographic positioning and techniques.

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

Thank You