1. Xray KUB

2. • KUB x-ray is a plain AP supine radiograph of the abdomen to assess the organs and structures of the urinary and/or gastrointestinal (GI) system
• K = Kidneys, U = Ureters, B = Bladder

3. INDICATION Diagnosis of suspected stone disease
To be a control film in anticipation of contrast administration
To assess the presence of residual contrast from a previous imaging procedure
After treatment of stone disease .
To assess the position of stents and drains
Adjunct to investigation of blunt or penetrating trauma to urinary tract

4. PROCEDURE
Bowel Preparation for the procedure: Time honored technique of being empty stomach overnight accompanied by either dulcolax or purging in form of enema.However recently it has been shown that bowel prep is not needed.
Before examination:
1) Identify the correct patient
2) Bowel preparation. Yes/No?
3) Ask pt to remove any jewelry or metal objects, and put on an x-ray gown
4 ) Female patient : pregnant or not
5 ) Empty the bladder

5. During examination:
1) Pt lie down supine on x-ray table
2) Pillow under head, hands on side, use knee support
3) Centre x-ray tube and the cassette
4) Centre the region of interest (CR for KUB: perpendicular and directed at mid sagittal line, level of illiac crest)
5) Collimation (upper border = level of T11, lower border = symphysis pubis, lateral collimated)
6) Put on gonad shield, put on marker
7) Give instruction (expiration)
8) Make exposure at the end of expiration
After Examination
1) Pt can change to his/her clothes
2) Process the film

7. Exposure
70 – 80 kVp , 20 – 30 mAs
• Good penetration – visualize bony trabecular patterns & cortical outlines of lumbar vertebra & pelvis
. • Good contrast & density – can demonstrate psoas muscle , kidneys and other soft tissues.

8. Projection & Position PROJECTION: true AP ( no rotation ) POSITION:
spinous process aligned with midline of vertebra column
distance : pedicles to spinous process same ( both side ).
sacrum center

9. HOW TO READ? #1 = Name and Date!!
Quality, exposure (too dark is over exposed)
Penetration
pt position, orientation

10. Reading a KUB Spine and bony pelvis abnormalities
Organ outline : kidneys, bladder
Soft tissues :
Psoas muscle
Soft tissue masses
Radio-opaque shadow (calculus /phleboliths / calcifications)
Bowel

11. Kidneys on abdominal X-ray
what to find -Size , shape ,position , axis and orientation.
Natural contrast between the kidneys and the low density retroperitoneal fat that surrounds them means they are often visible on an X-ray of the abdomen.
They lie at the level of T12-L3 and lateral to the psoas muscles. The right kidney is usually slightly lower than the left due to the position of the liver.
The size of the kidneys varies with the size and sex of the patient;
an average renal length equal to three to four vertebral bodies is normaL The average length of the left kidney is approximately 0.5 em greater than that of the right kidney

12. Position of Kidneys
Normal : T12-L3
RK : L1-L3
LK : T12-L2/L3

14. size discrepancies are likely to represent abnormalities if the right kidney is more than 1.5 cm longer than the left or if the left kidney is more than 2 cm longer than the right or if left kidney is 0.5cm smaller than right kidney.

15. Ureter
In searching for a ureteric stone on a plain radiograph of the abdomen, one must imagine the course of the ureter in relation to the bony skeleton.
It lies along the tips of the transverse processes, crosses in front of the sacroiliac joint, swings out to the ischial spine and then passes medially to the bladder.
An opaque shadow along this line is suspicious of calculus.
This course of the ureter is readily studied by examining a radiograph showing a radio-opaque ureteric catheter in situ.

16. Ureter

17.  the ureter is divided into three sections
upper third: from renal pelvis to the top edge of the sacrum
middle third: from the top edge to the lower edge of the sacrum
distal third: lower edge of the sacrum to the urinary bladder

19. Bladder Bladder abdominal X-ray
The bladder has variable appearance depending on how full it is. It has the same density as other soft tissue structures, due to its water content

20. Urethra

21. Psoas muscle It is obliterated in Enlarged kidney Psoas abscess
Splenic injury

22. Positive finding Calculi in kidneys and ureters
Calcification of kidneys and ureters
Vesical calculi or calcification
Urethral calculi
Prostatic calcification
Calcification of spermatic tract
Foreign bodies in urinary tract
Lesions invoving the lumbar vertebrae and bony pelvis

23. extra urinary shadows
Calcification of blood vessels(phlebolith)- focal calcifications, often with radiolucent centers (if present, a helpful sign to distinguish them from urolithiasis), round, either side of pelvis, in the distribution of pelvic veins, 2-6 mm in diameter
Two signs are helpful in distinguishing a ureteric calculus from a phlebolith:
comet-tail sign: favours a phlebolith. The sign refers to a tail of soft tissue extending from a calcification, representing the collapsed/scarred/thrombosed parent vein. When well seen it is said to have a positive predictive value of 100% 1. 
soft-tissue rim sign: favours a ureteric calculus

24. Calcification of intraabdominal organs
Calcification of costal cartilages and transverse process of lumbar vertebra
Calcified mesentric and retroperitoneal lymph nodes
Foreign bodies (surgical clips, IUDs, IVC filters)
Female genital tract
Pessaries, Tampoons
Carcinoma of ovary
Dermoid cysts of ovary

26. Source of error Errors in technique
Overexposed film
Motion artifact of the patient
Unclean cassette
Fecal material , Gas in the GI tract

27. Limitations Loaded colon may obscure small stones
Calcifications in pelvic veins or vascular structures may be confused with ureteric calculi
Radiolucent stones not visualized