new the abdomen-technique

8/8/2019 New the ABDOMEN-Technique

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THE ABDOMENTHE ABDOMEN

TechniqueTechnique

Denise Ogilvie,Denise Ogilvie,

October 2006October 2006


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The AbdomenThe AbdomenLEARNING OBJECTIVESLEARNING OBJECTIVES

Briefly describe the following commonBriefly describe the following commonpathologies:pathologies:

pancreatitis (chronic and acute)pancreatitis (chronic and acute)small bowel obstructionsmall bowel obstructioncrohns diseasecrohns diseaseulcerative colitisulcerative colitis

diverticula (diverticulitis)diverticula (diverticulitis)cholelithiasis (cholecystitis)cholelithiasis (cholecystitis)renal obstruction and the effects ofrenal obstruction and the effects of

refluxreflux


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The AbdomenThe Abdomen

Demonstrate a basic knowledge ofDemonstrate a basic knowledge ofthe anatomy of the abdomen:the anatomy of the abdomen:

Gastrointestinal systemGastrointestinal system

Renal systemRenal systemBasic vasculatureBasic vasculature

Hepatobilary systemHepatobilary system

Demonstrate and describe theDemonstrate and describe thetechniques used to image thetechniques used to image theabdomenabdomen--including extra viewsincluding extra views


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Critique for technical accuracy,Critique for technical accuracy,images of the abdomenimages of the abdomen

Name and label the quadrants andName and label the quadrants andregional divisions of the abdomenregional divisions of the abdomen

Describe in detail the bonyDescribe in detail the bonylandmarks of the abdominal regionlandmarks of the abdominal region

Be able to identify abdominalBe able to identify abdominalstructures in transverse sectionsstructures in transverse sections


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The abdominal cavity extends fromThe abdominal cavity extends fromdiaphragm to the superior border ofdiaphragm to the superior border of

the bony pelvisthe bony pelvisContains organs of the digestiveContains organs of the digestivesystem, reproductive system, renalsystem, reproductive system, renalsystem, lymphatic systemsystem, lymphatic system

Not all visible on plain filmNot all visible on plain film--somesomeoutlinesoutlines


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Quadrants and regionsQuadrants and regions


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Abdominal seriesAbdominal series-- acute abdomenacute abdomen--supine, erect & PA chestsupine, erect & PA chest

KUBKUB--supine, renal areasupine, renal areaAlternative viewsAlternative views--lateral, left laterallateral, left lateraldecubitus, decubitusdecubitus, decubitus


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Patient PreparationPatient Preparation

Clothing removedClothing removed--no buttons and bows,no buttons and bows,

zips or bitszips or bitsClean patient gownClean patient gown

Room preparedRoom prepared

Exposure selectedExposure selected--short exp time toshort exp time toreduce involuntary movement e.g.reduce involuntary movement e.g.peristalsisperistalsis

7575--80 kvp max to show soft tissue80 kvp max to show soft tissue


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AP SUPINE PROJECTIONAP SUPINE PROJECTION

Centre tube to table bucky

Centre tube to table bucky35 x 43cm IR portrait35 x 43cm IR portrait

Patient flat on tablePatient flat on table

Centre in mid sagittal plane at levelCentre in mid sagittal plane at levelof iliac crestof iliac crest

Suspended expirationSuspended expiration


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Image CritiqueImage Critique

Bony structures seenBony structures seen-- pubic symphasis,pubic symphasis,lower ribs, pelvis, hips, straight, centredlower ribs, pelvis, hips, straight, centredspine, transverse processes of lumberspine, transverse processes of lumberspinespine

Soft tissue structures seenSoft tissue structures seen--kidneys, liver,kidneys, liver,psoas muscles, spleen, bowel gas, urinarypsoas muscles, spleen, bowel gas, urinarybladder, lateral abdominal wallsbladder, lateral abdominal walls


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No patient motionNo patient motion

Uniform densityUniform density

across abdomenacross abdomen


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AP ERECT POSITIONAP ERECT POSITION

Centre xCentre x--ray tube to erect buckyray tube to erect bucky

35 x 43cm IR portrait35 x 43cm IR portrait

Patient standing with back against uprightPatient standing with back against uprightbuckybucky

Centre midsagittal plane 5cm above theCentre midsagittal plane 5cm above thelevel of the iliac crestslevel of the iliac crests--if diaphragmsif diaphragmsneeded on imageneeded on image

If bladder needed centre to iliac crestsIf bladder needed centre to iliac crests


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Held expirationHeld expiration--organs notorgans notcompressedcompressed

Exposure may need to be increasedExposure may need to be increased--

soft tissue falls forward and down.soft tissue falls forward and down.Supine soft tissue is flattened.Supine soft tissue is flattened.

Patient should be upright for at leastPatient should be upright for at least10 minutes so any air in the10 minutes so any air in theperitoneum has time to rise and beperitoneum has time to rise and beseen under the diaphragmsseen under the diaphragms


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Image CritiqueImage Critique

Same as supine abdomenSame as supine abdomenSame film density as supineSame film density as supine

An erect markerAn erect marker

SequenceSequence--PA chest, erect abdo,PA chest, erect abdo,supine abdosupine abdo


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Supine ErectSupine Erect


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RenalRenal

Often referred to as KUBOften referred to as KUBSupine abdomen as well as conedSupine abdomen as well as coneddown area of kidneysdown area of kidneys

Taken on inspirationTaken on inspiration30 x 40cm IR landscape in table30 x 40cm IR landscape in tablebuckybucky


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Centre midsagittal plane approx 4Centre midsagittal plane approx 4finger down from xiphisternumfinger down from xiphisternum(7cm)(7cm)

Iliac crest at bottom ofIRIliac crest at bottom ofIR


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Renal AreaRenal Area


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Left Lateral DecubitusLeft Lateral Decubitus

Can be AP or PACan be AP or PAPatient too ill to stand or sitPatient too ill to stand or sit

Lie patient onto left sideLie patient onto left side

If possible wait a few minutes toIf possible wait a few minutes toallow any free air to riseallow any free air to rise


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Place a radiolucent sponge underPlace a radiolucent sponge underright side to elevate so all abdomenright side to elevate so all abdomencan be seencan be seen

Arms elevated away from bodyArms elevated away from body

Knees slightly bent forward forKnees slightly bent forward forsupport.support.

Centre to iliac crestsCentre to iliac crestsMay need slightly higher centring toMay need slightly higher centring tohave diaphragms on filmhave diaphragms on film


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Stationary grid or upright buckyStationary grid or upright bucky

Suspended expiationSuspended expiation

Right lateral decub may be requestedRight lateral decub may be requestedof if patient cant lie on left sideof if patient cant lie on left side

Wedge filterWedge filter--even densityeven density

Held expirationHeld expiration35 x 43cm IR lengthwise with35 x 43cm IR lengthwise withrespect to the patientrespect to the patient


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Film CritiqueFilm Critique

No rotation

No rotationDiaphragm on film, symphasis pubisDiaphragm on film, symphasis pubis

if possibleif possible

Both sides of abdomen on filmBoth sides of abdomen on film

Even densityEven density

Appropriate markersAppropriate markers


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DecubitusDecubitus

Used when patient totallyUsed when patient totallyunmoveableunmoveable

Left or right side against uprightLeft or right side against upright

bucky or usingIR

with stationarybucky or usingIR

with stationarygridgrid

Elevate arms away from bodyElevate arms away from body


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Centre long axis ofIR to midcoronalCentre long axis ofIR to midcoronalplane 5cm above iliac crestplane 5cm above iliac crest

Held expirationHeld expirationCan show air fluid levels in theCan show air fluid levels in theabdomen as well as look for aorticabdomen as well as look for aorticaneurysmaneurysm


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DiaphragmDiaphragm no motionno motionEven density to show region ofEven density to show region ofinterest. Filterinterest. Filter

MarkersMarkers


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LateralLateral

Looking at prevertebral structuresLooking at prevertebral structures--aortaaorta--aneurysm or foreign bodyaneurysm or foreign body

Patient rotated onto their sidePatient rotated onto their side

Knees bent forward slightly forKnees bent forward slightly forsupportsupport

Arms elevated away from bodyArms elevated away from body


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Centre IR at level of iliac crest orCentre IR at level of iliac crest or5cm above to show diaphragm in the5cm above to show diaphragm in themid coronal planemid coronal plane

Held expirationHeld expiration

35 x 43cm IR along long axis of body35 x 43cm IR along long axis of body


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Show abdominal contents with evenShow abdominal contents with evendensitydensity--filterfilter

No rotationNo rotation

Lateral lumber spineLateral lumber spineSame as lateral decubitusSame as lateral decubitus


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What can you see?What can you see?


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Shampoo Bottle!Shampoo Bottle!


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ReferencesReferences

Merrills Atlas ofRadiographicMerrills Atlas ofRadiographicPositions and Radiologic ProceduresPositions and Radiologic Procedures1010thth edn vol2edn vol2

McQuillen Martensen RadiographicMcQuillen Martensen RadiographicImage Analysis 2Image Analysis 2ndnd ednedn

Hagler The Pocket Rad Tech 1993Hagler The Pocket Rad Tech 1993

Eisenberg ComprehensiveEisenberg ComprehensiveRadiographic Pathology 2Radiographic Pathology 2ndnd ednedn


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