Abdominal Radiography

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Intended Learning outcomes

• The student should be able to apprehend clinical aspects of abdominal radiographic positioning and techniques.

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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

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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.

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Kidney Stone

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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.

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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.

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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.

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P-A Chest Erect

• Free Air in the abdomen will be seen under the diaphragms.

• Air in stomach will be seen.

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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.

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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.

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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

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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

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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.

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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.

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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.

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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

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KUB or A-P Abdomen Film

• Both kidneys should be seen.

• Psoas muscles seen

• Symphysis pubis seen

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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.

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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

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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.

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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

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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.

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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.

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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

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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.

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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.

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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.

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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.

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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.

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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

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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

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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.

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Chest Decubitus View

• Breathing Instructions: Full and deep inspiration

• Make exposure and let patient breathe and relax.

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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.

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Suggested Readings

• Clark’s Radiographic positioning and techniques.

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Questions.

• What are the technical radiographic steps for adequate abdominal radiography?

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Thank You