Pathology
What are the clinical indications regarding the abdomen?
- Rupture / Perforation of Abdominal Viscera
- Obstruction
- Infection
- Pathologies
Explain how a patient needs to be prepped for an Abdomen X-Ray.
- Patient Info: Name, D.O.B., Pregnancy, location of pain, etc.
- All clothing removed except underwear (plain t-shirt okay)
- Opaque objects removed
- Hospital gown with the opening in the back
- Pillow for head
KUB/Supine
Positioning Criteria
- Patient supine position with Mid-Sagittal plane to mid-table (facing up)
- CR directed perpendicular to iliac crest and MSP
Evaluation
- Spine in center of film with no rotation (spine and ilia)
- Includes all anatomy from upper renal poles, psoas to the symphysis pubis
- Evidence of crosswise collimation
What is Retroperitoneal Air?
Free Air in Abdomen
- Air rises to uppermost limit
- Note free air seen on Erect image under diaphragm
- Air will rise to upside on decubitus image
Name the quadrants of the abdomen
Right upper quadrant, Left upper quadrant, Right lower quadrant, Left lower quadrant
Name some common pathologies regarding the abdomen.
- Pneumoperitoneum ("Free" Intraperitoneal Air)
- Air / Fluid Levels
- Cholelithiasis & Urolithiasis
- Ascites
- Volvulus
- Intussusception
- Male patients should get gonad shielding placed just below the light field
- Female patients need breast shield for supine images, gonad shielding for upright
PA/Prone
Positioning Criteria
- Patient prone position with MSP centered to mid-table
- CR directed perpendicular to iliac crest and MSP
Image Evaluation
- Spine in center of film with no rotation (spine and ilia)
- Includes all anatomy from upper renal poles psoas to the symphysis pubis
- Evidence of crosswise collimation
What is Ascitis?
- Distended Abdomen
- Diffusely increased density of abdomen
- Poor definition of soft tissue shadows (psoas, liver, spleen)
- Increased separation of small bowel loops
Name the 9 abdominal regions
Right hypochondrium, epigastrium, Left hypochondrium, Right lateral, Umbilical, Left Lateral, Right Inguinal, Hypogastrium, Left Inguinal
How can we tell the difference between a Supine vs Erect image?
The air-fluid level is distinct in an erect image (straight lines)
What are the breathing instructions for an Abdomen X-Ray?
Exhalation
"Take a breath in, blow all the air out, hold it out don't breathe"
Erect/Upright
- Done for Air / Fluid levels
- R/O Atopic Organs
- CR centered 2" above iliac crest and at MSP (must include diaphragms)
- Patient should be positioned PA if kidneys not of primary interest
- Allow 5-10 mins for air/fluid levels to develop
What IR size is needed for Abdomen X-Rays?
14 x 17 IR
(Horizontal / Landscaping positioning of the cassette)
Lateral Decubitus
Positioning Criteria
- Left Lateral preferred in the PA position
- Alternate for erect when the patient is too ill to stand
- Allow 5-10 mins for air/fluid separation
- Arms above the level of the diaphragm
- Knees slightly flexed for stability
- CR directed to MSP and 2" superior to the iliac crest
Image Evaluation
- Diaphragm seen without motion
- Both sides of the abdomen visible
- No rotation of patient (Spinous process in the center of L-spine, Pelvis Symmetry)
- Properly placed marker placement, indicating the side up
What are the SID, kVp, and Grids needed for an Abdomen X-Ray?
- SID = 40"
- kVp = 75-90 kVp pending body habits
(if barium study increase kVp to at least 120 kVp)
- Grid should be used to improve the quality of the image, Table and Wall bucky have grid, if doing portably, should use grid
How do we collimate?
- full length of IR to capture kidneys and bladder