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115 Cards in this Set

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Other common names for AP supine abdomen
1. KUB
2. Flat plate
3. Scout
4. Prelim (preliminary film)
What are AP supine abdomen X-rays used for?
1. r/o certain pathologies
2. check bowel prep prior to contrast studies (may require centering changes)
3. check positioning and technique prior to contrast studies
Acute Abdomen Series are performed on who?
Patients with acute abdominal pain or distress
Indications for performing an Acute Abdominal Series?
looking for air/fluid levels, accumulations of intestinal gas, or the presence of free air in the abdominal cavity:
1. perforated intesting (hollow viscus) 2. intestinal obstruction 3. abdominal infection 4. intra-abdominal mass 5. ascites 6. Post-op abdominal surgery
Ambulatory patient
Patient can stand unaided = 3-way abdomen series {3-view}
a. PA chest (standard criteria)
b. AP Upright Abdomen (to include diaphragm
c. AP Supine Abdomen
Non-ambulatory patient
Patient CAN NOT stand unaided = 2-way abdomen series {2-view}
a. AP Supine Abdomen
b. Lt. Lateral Decubitus Abdomen (to include diaphragm & side up) or Dorsal Decubitus Abdomen
Abdominal Muscles
1.) Diaphragm
2.) Psoas (major) Muscles
Digestive System includes?
Oral Cavity, Pharynx, Esophagus, Stomach, Small Intestine (duodenum, jejunum & ileum) and Large intestine
Subdivisions of the stomach
a. fundus
b. body
c. pyloric antrum
How long is the small intestine?
15-18 feet (extends from pyloric orifice to ileocecal valve)
Openings of the Stomach
a. cardiac orifice (esophagogastric junction)
b. pyloric orifice (pylorus)
Stuctures w/in Stomach
a. rugae
b. gastric canal
The small intestines is divided into what three main parts?
Duodenum, Jejunum (2/5ths), Ileum (3/5ths)
Duodenum
duodenal bulb or cap, shortest & wides portion, 10" (25 cm) in length, C-loop, Ligament of Treitz
Large Intesting (haustra) contains?
ileocecal valve, cecum, appendix, ascending colon, right colic (hepatic) flexure, transverse colon, left colic (splenic) flexure, sescending colon, rectum and anus
Does the pancreas show up on radiographs?
not usually, it is posterior to the stomach
What are the accessory digestive organs?
Pancreas, Liver and Spleen
Structure of the spleen
head, body and tail
Function of the spleen
endocrine - hormone: insulin
exocrine - digestive juices
Stomach is mainly in which quadrant?
LUQ
The liver is mainly in which quadrant?
RUQ
Structure of the liver
right lobe, left lobe and divided by Falciform ligament
Function of the liver
chemical factory, over 3,000 chemical reactions & balances.
Waste by product - bile: used in digestion of fat
Associated structures & organs of the liver
Gallbladder & Bile Ducts (rt & lt. hepatic ducts, common hepatic duct, cystic duct, common bile duct and sphincter of Oddi
The spleen is mainly in which quadrant?
LUQ
Function of the spleen
NOT part of digestive system, part of lymphatic system, RBC
Trauma to the spleen
laceration or rupture (can be fatal if untreated)
Urinary system contains?
2 Kidney's, 2 Ureters, bladder, urethra and also included but not part of system: suprarenal (adrenal) glands: endocrine
Urinary system function
Eliminartion of waste and regulation of waste
Urinary system examinations
1.) excretory urogram (EU or XU) or intravenous Urogram (IVU)
2.) IVP (or intravenous Pyelogram is technically improper terminology)
Parietal peritoneum covers?
abdominal wall
Visceral peritoneum covers?
mesentry double fold that surrounds abdominal organs & omentum double fold that stabilize and support abdominal organs
space between peritoneum is?
Peritoneal cavity
Quadrants
RUQ, RLQ, LUQ and LLQ
Lines of division for quadrants?
1.) transverse plane at umbilicus
2.) mid-sagittal plane
Nine abdominal regions
Upper: Rt. & Lt. Hypochondriac, epigastric
Middle: Rt. & Lt. Lateral, Umbilical
Lower: Rt. & Lt. Inguinal (iliac), Pubic (hypogastric)
Lines of division for 9 regions
1.) 2 sagittal planes halfway between ASIS and mid-sagittal
2.) 2 transverse planes: lower border L1 and body L5
Topographical Landmark:
Xyphoid Tip
T9/T10
Topographical Landmark:
Inferior Costal margin:
(book says L2-L3); More common L3
Topographical Landmark:
Iliac Crest
L4/L5 interspace
Topographical Landmark:
ASIS (ant. sup. iliac spine)
S1
Topographical Landmark:
Greater Trochanter of Femur:
1-1.5" above symphysis pubis
Topographical Landmark:
Symphysis Pubis
4-4.5" Below ASIS
Topographical Landmark:
Ischial tuberosity
(bony structure you sit on)
1-1.5" below symphysis pubis
Topographical Landmark:
Vertebra1 Column
Lumbar - 5
Sacrum - 5 fused
Coccyx - 3-5 fused
how much can organs vary?
6-8 in. in position, both transversely & horizontally
Asthenic
10% - extremely slender (poor tone)
Thorax & organs long & narrow, diaphragm is low, stomach low extending well below iliac crest heart long and narrow, gb low & verticle, colon folds onto itself.
General patient prep for Abdominal x-ray
1.) remove all clothing & opaque objects
2.) give patient hospital gown & explain how to put it on (opening in back)
3.) Shoes & socks may be left on
kVp for abdominal x-rays
a.) General survey: 70-80
b.) Contrast media: iodinated IV - 70-80, Iodinated Gastro- 90 max.
c.) Barium & Air: 90
d.) Barium: 110 - 120
AEC Sensors for Ab Xray
All three sensors, if can only select one or the other, use center sensor
Structures shown in AP supine abdomen?
liver, spleen, abnormal masses, calcifications or accumulations of gas, pelvis, lumbar spine, sacrum, coccyx, lower ribs and hip joints
Technical Factors for AP supine abdominal
Film size: 14x17 in (35x43cm) lengthwise, blocker down.
Grid: yes
kVp Range: 70-80
SID: 44"
Sheilding for AP supine Abdominal?
Use gonad shielding (will vary per dept.)
Where should arms be for abdominal xray?
at sides or above head
How should the body be positioned for AP supine abdominal?
centered transversely on the table, no tilt, no rotation
Central Ray for AP Supine Abdomen?
Iliac Crest, Mid-sagittal
Collimation for AP supine abdomen?
transversely to lat. cost. margins, longitudinal max. diaphragm & ischial tuberosity
Respiration for AP supine abdomen?
full expiration (can vary w/ procedure)
Evaluation Criteria for AP supine, what needs to be included?
Symphysis pubis & up
Spine needs to be centered to the film how?
transversely
how to evaluate rotation for AP supine?
Upper - lateral costal margins equal distance to spine
lower - coccyx & symphysis pubis in line or pelvis symmetrical
6 points to evaluate density on AP supine
skin line
liver shadow
kidney shadow
psoas muscles
transverse processes
spinous processes through the vertebral bodies
how to evaluate penetration on AP supine
ribs through the diaphragm or ribs through liver shadow. spinous processes through the vertebral bodies. head of femur seen through the acetabulum.
Marker placement
side (anatomical) preferred in hip area.
positional marker if other than supine - placement same as side marker
Lateral Decubitus abdomen
a.) patient in true left lateral position
What is the CR for Lt. Lat. Decub Abdomen?
2-3" above iliac crest, mid-sagittal, include diaphragm and side up
what is the central ray for AP erect abdomen?
2-3" above iliac crest, mid-sagittal, include diaphragm
Structures shown in a dorsal decub abdomen? (aka ventral decub abdomen)
abnormal masses
accumulations of gas or air fluid levels
aneurysms
calcifications of aorta or other vessels
umbilical hernias
Film size for dorsal decub abdomen
14x17, long axis film, blocker down
kVp range for dorsal decub. abdomen
70-80
SID for dorsal decub abdomen?
44"
mAs for dorsal decub abdomen?
x4 AP or 4 cm rule
CR for Dorsal Decub abdomen
2-3" above iliac crest, mid-coronal
respiration for dorsal decub abdomen?
end of full inspiration
Evaluation criteria for dorsal decub abodmen?
diaphragm and anterior surface (post. surface for ventral decub)
posterior borders of bertebral bodies superimposed and no motion.
Acute Abdomen 3 view series includes?
PA chest
AP Erect abdomen
AP Supine abodmen
Acute Abdomen 2 view series includes?
Lt. Lateral Decub
AP supine abdomen
At what level of the spine is the Xiphoid Tip?
T9 or T10
At what level of the spine is the Inferior Costal Margin?
L3
At what level of the spine is the Iliac Crest?
L4 L5 Interspace
What does ASIS stand for?
Anterior Superior Iliac Spine
What is the name of the large muscles found in the posterior abdomen adjacent to the lumbar vertebra which are usually visible on an AP Abdomen radiograph?
Psoas
What is the medical terminology prefix for stomach?
Gastro-
List the three parts of the small intestine.
jejunum, duodenum, ileum
List the three parts or divisions of the stomach.
Body, Fundus, Pylorus
In which quadrant is the spleen?
LUQ
What is the name of the region in the far upper right corner?
right hypochondriac
What is the name of the region in the middle of the top row?
epigastric
What is the name of the region in the middle of the middle row?
umbilical
What is the name of the region in the middle of the bottom row?
hypogastric
The double-walled membrane lining the abdominopelvic cavity is called the:
peritoneum
What is the name of the region in the middle of the top row?
epigastric
What is the name of the region in the middle of the middle row?
umbilical
What is the name of the region in the middle of the bottom row?
hypogastric
The double-walled membrane lining the abdominopelvic cavity is called the:
peritoneum
For all abdominal projections/positions for air-fluid levels or free air the Central Ray is altered in two ways. List them.
center 2-3" above crest, horizontal beam
What projections/positions are done for an acute abdomen series on an ambulatory (walking) patient?
AP Erect Abdomen, PA Chest, AP Supine Abdomen
What projections/positions are done for an acute abdomen series on a non-ambulatory patient
AP Supine Abdomen , Left Lateral Decub
What must be included on all abdominal projections or positions for air-fluid levels, abnormal accumulations of intestinal gas, or free air that is NOT required to be included in an AP supine abdomen?
diaphragm
Your instructor says for all abdominal projections or positions for air-fluid levels, abnormal accumulations of intestinal gas, or free air what phase of respiration should be the exposure be made?
inspiration
List the six clinical indications for doing an Acute Abdominal Series.
perforated hollow viscus, intra-abdominal mass, Ascities , abdominal infection, obstruction, post-op abdominal surgery
A radiographic image of an upright abdomen taken to R/O (rule out) free air in the abdomen, reveals that the symphysis pubis is cut off. Is this an acceptable image?
yes
A radiographic image of an AP Abdomen reveals that there is blurriness seen in areas on the image.The following exposure factors were selected: 80 kVp, 200 mA, 0.2 sec., table bucky, 44 in. SID.The technologist states that they are sure that the patient didn't breathe or move during the exposure. What may have caused this blurriness?
involuntary motion
A radiographic image of an AP Abdomen reveals that the left iliac wing is narrower than the right side. What specific positioning error was committed?
rotation
A patient enters the ER with a possible bowel obstruction. The ER physician has ordered an acute abdominal series. The patient is able to stand. What specific positioning routine should be performed?
3 view abdomen series
A patient enters the ER with a possible perforated duodenal ulcer. The ER physician is concerned about the presence of free air in the abdomen. The patient is in severe pain and can not stand. What positioning routine would be performed to diagnose this condition?
2 view abdomen series
A patient in intensive care may have developed intra-abdominal bleeding. He is in critical condition and can't come to radiology. The physician has ordered a portable study of the abdomen. What specific position or projection can be performed to determine the extent of the bleeding?
left lateral decub, dorsal decub
An AP Supine Abdomen is ordered on a patient who is wider than the IR when positioned lengthwise, and is longer than the IR when positioned crosswise. What would you do? (You are the only technologists in the department.)
do splits
What is the central ray for an AP supine abdomen, if the diaphragm is NOT included?
iliac crest, mid-sagittal
On a radiographic image of an AP Abdomen what is the check point for rotation? 1) upper abdomen 2) lower abdomen
Symphysis Pubis and coccyx in line, lateral costal margins equal distant to spine, pelvis symetrical
On a radiographic image of an AP Abdomen what are the three check points the judge penetration?
see ribs through the liver, see spinous processes through the vertebral bodies, see head of femur in the acetabulum
What is the kVp range for an AP Abdomen?
70-80
What is the size of an IR for an adult AP abdomen?
14 x 17 in.
For an AP abdomen image what are the six check points for density?
kidney shadow, psoas muscles, liver shadow, transverse processes, skin line, spinous processes
Where is the best place to place your side marker (R/L) on the IR for an AP abdomen?
lower right corner