Adaptive Abdomen

Question 1

What needs to be included on the AP projection of the Abdomen

Answer 1

Diaphragm/Abdomen to Pubic Symphysis, Flank Line

Question 2

What is the flank line

Answer 2

A thin layer of fat that surrounds the peritoneum

Question 3

How does the flank line appear on an image

Answer 3

Radiolucent stripes on either side of the abdomen. Much like fat pads appear on other projections

Question 4

Why is it necessary to see the flank line

Answer 4

It can indicate infectious, inflammatory, neoplastic, and traumatic processes that involve the peritoneal cavity

Question 5

What may you need to consider when imaging an obese patient

Answer 5

Weight limit of table, if the patient’s anatomy will fit on one image, if CT machine will accommodate patient size, how many people will be required to safely transport patient

Question 6

Do you need to include all soft tissue of a patient when imaging an abdomen

Answer 6

No, often when there is extra soft tissue it does not change the location of the organs dramatically

Question 7

Do male or female bodies tend to have minimal changes to organ placement when obese

Answer 7

Female bodies tend to have less organ shifting when obese. This is because male bodies often have more visceral fat which moves the organs more, and female bodies usually have more surface fat which simply lies on top of existing organ placement.

Question 8

How is mAs affected when there is an increase of 4cm

Answer 8

Double the mAs for every 4cm

Question 9

Do you use a grid for a chest xray

Answer 9

yes

Question 10

Do you use a grid for a foot xray

Answer 10

no

Question 11

Do you use a grid for an elbow xray

Answer 11

sometimes

Question 12

Do you use a grid for a knee xray

Answer 12

yes

Question 13

Do you use a grid for a humerus xray

Answer 13

Sometimes

Question 14

Is it better to have high mAs and low kV or high kV and low mAs

Answer 14

High kV and low mAs. This protects patients against high ESE

Question 15

How do you adjust technical factors if a patient has suspected internal bleeding

Answer 15

Increase the technical factors. If there is pooled blood it will obscure anatomy more so a higher technique is needed to penetrate properly

Question 16

Can you move a patient on spinal precautions

Answer 16

No, maintain immobilization. If movement is necessary have the physician or a nurse move the patient

Question 17

What signs should you be hypervigilant of in a trauma patient

Answer 17

Shock and internal hemorrhage

Question 18

Do you use a grid for a portable abdomen xray

Answer 18

yes

Question 19

Where should the center of the IR be for a portable abdomen

Answer 19

At the level of the iliac crest. Adjust to ensure the pubic symphysis is included in the image

Question 20

What angle is the CR for a portable abdomen

Answer 20

Perpendicular to the IR, ideally entering at level of iliac crest BUT adjust to include all anatomy

Question 21

List 4 ways to tell if an abdomen image is acceptable

Answer 21

1)You can see from diaphragm to symph
2)Outlines of all abdominal viscera are visible (flank lines)
3) No rotation (check iliac wings and spinous processes)
4) The correct markers are used and within collimation

Question 22

Should a Left Lateral Decubitus be imaged AP or PA

Answer 22

Either is acceptable

Question 23

Are knees straight or bent when doing a Left LAT DECUB.

Answer 23

Slightly bent

Question 24

How do you ensure arms are not obscuring image in Left LAT. DECUB.

Answer 24

Raise the arms above the head if possible, or at least above the abdomen

Question 25

What is the SID for a Left LAT.DECUB.

Answer 25

100/110cm HOWEVER some sites will use 180cm

Question 26

Why do we perform a LEFT lateral decubitus and not a RIGHT

Answer 26

So the gastric bubble is not mistaken for pathology

Question 27

What is an additional benefit of using Left Lateral Decubitus aside from the gastric bubble?

Answer 27

The liver will be of uniform density

Question 28

How long should patients lie in a position before exposing

Answer 28

5min minimum

Question 29

When doing a LLD where should the IR and grid be placed

Answer 29

5cm (2”) superior to iliac crest. Make sure diaphragms are included.

Question 30

Where should CR be for LLD

Answer 30

Perpendicular to the IR, aligned to MSP 5cm(2”) superior to the iliac crest

Question 31

Do we need to annotate the LLD

Answer 31

Yes, annotate “Decubitus” or use your arrow marker to indicate which direction is up

Question 32

Are there breathing instructions for LLD

Answer 32

Expose on expiration

Question 33

What are three evaluation criteria for LLD

Answer 33

1)Entire diaphragm is demonstrated without motion
2)No rotation, check spinous processes and iliac ala
3) Air fluid levels and free air should be perceptible (present or not present)

Question 34

What should you consider doing when positioning a LLD to prevent bed artifacts

Answer 34

Elevate the patient on a sponge

Question 35

What anatomy should be included on a pediatric supine abdomen

Answer 35

Pubic symph to upper abdomen

Question 36

Where should an infant’s arms be for a pediatric supine abdomen

Answer 36

above their head. Some will keep them there themselves, other times a nurse or parent will need to hold them

Question 37

When do you expose for a peds supine abdomen

Answer 37

Expose at the end of an expiration

Question 38

What is the purpose of a lateral dorsal decubitus

Answer 38

To visualize free air and the air fluid levels when a patient is unable to do a left lateral decubitus

Question 39

What types of patients are most often having a dorsal decubitus image

Answer 39

neonates

Question 40

When do you expose a dorsal decubitus image

Answer 40

expiration

Question 41

What do you want to see on a dorsal decubitus image

Answer 41

diaphragms with no motion, prevertebral space, and free air or fluid