Adaptive Abdomen Flashcards
What needs to be included on the AP projection of the Abdomen
Diaphragm/Abdomen to Pubic Symphysis, Flank Line
What is the flank line
A thin layer of fat that surrounds the peritoneum
How does the flank line appear on an image
Radiolucent stripes on either side of the abdomen. Much like fat pads appear on other projections
Why is it necessary to see the flank line
It can indicate infectious, inflammatory, neoplastic, and traumatic processes that involve the peritoneal cavity
What may you need to consider when imaging an obese patient
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
Do you need to include all soft tissue of a patient when imaging an abdomen
No, often when there is extra soft tissue it does not change the location of the organs dramatically
Do male or female bodies tend to have minimal changes to organ placement when obese
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.
How is mAs affected when there is an increase of 4cm
Double the mAs for every 4cm
Do you use a grid for a chest xray
yes
Do you use a grid for a foot xray
no
Do you use a grid for an elbow xray
sometimes
Do you use a grid for a knee xray
yes
Do you use a grid for a humerus xray
Sometimes
Is it better to have high mAs and low kV or high kV and low mAs
High kV and low mAs. This protects patients against high ESE
How do you adjust technical factors if a patient has suspected internal bleeding
Increase the technical factors. If there is pooled blood it will obscure anatomy more so a higher technique is needed to penetrate properly
Can you move a patient on spinal precautions
No, maintain immobilization. If movement is necessary have the physician or a nurse move the patient
What signs should you be hypervigilant of in a trauma patient
Shock and internal hemorrhage
Do you use a grid for a portable abdomen xray
yes
Where should the center of the IR be for a portable abdomen
At the level of the iliac crest. Adjust to ensure the pubic symphysis is included in the image
What angle is the CR for a portable abdomen
Perpendicular to the IR, ideally entering at level of iliac crest BUT adjust to include all anatomy
List 4 ways to tell if an abdomen image is acceptable
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
Should a Left Lateral Decubitus be imaged AP or PA
Either is acceptable
Are knees straight or bent when doing a Left LAT DECUB.
Slightly bent
How do you ensure arms are not obscuring image in Left LAT. DECUB.
Raise the arms above the head if possible, or at least above the abdomen
What is the SID for a Left LAT.DECUB.
100/110cm HOWEVER some sites will use 180cm
Why do we perform a LEFT lateral decubitus and not a RIGHT
So the gastric bubble is not mistaken for pathology
What is an additional benefit of using Left Lateral Decubitus aside from the gastric bubble?
The liver will be of uniform density
How long should patients lie in a position before exposing
5min minimum
When doing a LLD where should the IR and grid be placed
5cm (2”) superior to iliac crest. Make sure diaphragms are included.
Where should CR be for LLD
Perpendicular to the IR, aligned to MSP 5cm(2”) superior to the iliac crest
Do we need to annotate the LLD
Yes, annotate “Decubitus” or use your arrow marker to indicate which direction is up
Are there breathing instructions for LLD
Expose on expiration
What are three evaluation criteria for LLD
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)
What should you consider doing when positioning a LLD to prevent bed artifacts
Elevate the patient on a sponge
What anatomy should be included on a pediatric supine abdomen
Pubic symph to upper abdomen
Where should an infant’s arms be for a pediatric supine abdomen
above their head. Some will keep them there themselves, other times a nurse or parent will need to hold them
When do you expose for a peds supine abdomen
Expose at the end of an expiration
What is the purpose of a lateral dorsal decubitus
To visualize free air and the air fluid levels when a patient is unable to do a left lateral decubitus
What types of patients are most often having a dorsal decubitus image
neonates
When do you expose a dorsal decubitus image
expiration
What do you want to see on a dorsal decubitus image
diaphragms with no motion, prevertebral space, and free air or fluid
