Radiographic Imaging - Supine and Erect Abdomen Projections

Summary

Tyler Sler demonstrates how to perform an abdominal radiography series for a patient with “therosis of the liver.” The video walks through patient preparation (gown, two identifiers, pregnancy check) and step-by-step positioning for the supine KUB and upright abdominal projections. Key technical details are emphasized: 40" SID, 14×17" cassette lengthwise, marker placement, shielding, proper centering at the iliac crest (and 2" above for upright to include diaphragms), palpation of anatomical landmarks (ASIS, symphysis pubis), patient measurement, AEC use with all three chambers, and exposing on suspended exhalation. Practical tips for alignment and patient comfort are included.

Takeaways

• 😀 Proper patient preparation includes having the patient remove all clothing and wear a gown to avoid artifacts in imaging.
• 😀 It's important to gather a thorough patient history and confirm at least two patient identifiers, such as full name and date of birth.
• 😀 If the patient is female, check for the possibility of pregnancy before proceeding with the exam.
• 😀 For the supine abdominal projection (KUB), the patient should be positioned on the table with the cassette aligned to the Bucky.
• 😀 The tube should be aligned with the Bucky, and the patient should be shielded (psychologically, if needed).
• 😀 Centering for the supine abdominal projection should be at the level of the iliac crest, aligned with the mid-sagittal plane.
• 😀 If the iliac crest is difficult to find, palpating the ASIS or having the patient exhale can help locate the correct positioning.
• 😀 Measure the patient to set the proper exposure factors before taking the image. The AC technique should be used with all three chambers activated.
• 😀 The symphysis pubis should remain in the light field and be visible on the image, ensuring correct positioning.
• 😀 The exposure should be made on suspended exhalation: instruct the patient to breathe in, breathe out, and hold their breath during exposure.
• 😀 The upright abdomen projection is similar to the supine one but with slight variations, such as adjusting for both hemi-diaphragms and setting the light field 2 inches above the iliac crest.
• 😀 For the upright abdomen projection, position the patient with their back against the wall Bucky and measure using the light field center to set exposure correctly.
• 😀 The upright abdomen projection should also be done on suspended exhalation and the AC technique should be used on the wall Bucky.

Q & A

What is the primary pathology discussed in the script?

The primary pathology discussed is cirrhosis of the liver, which is relevant to the abdominal imaging series being performed.

Why is patient preparation important in this procedure?

Patient preparation is essential to avoid artifacts from clothing, which could interfere with the imaging. Additionally, a thorough patient history is important for accurate assessment and ensuring the patient’s safety.

What are the two patient identifiers typically used before starting the imaging process?

The two patient identifiers typically used are the patient's full name and their date of birth.

What should be checked for female patients before performing abdominal imaging?

For female patients, it is important to check if there is any possibility of pregnancy to ensure the safety of the procedure.

What is the purpose of positioning the patient in the supine position for the KUB projection?

The supine position is used to obtain the KUB (Kidney, Ureter, and Bladder) projection, which provides a clear view of the abdomen for diagnosing issues related to these organs.

How do you identify the correct location for centering the X-ray beam during the supine abdomen projection?

To center the X-ray beam correctly, the technician should align it with the level of the iliac crest and the mid-sagittal plane. This can be done by palpating the iliac crest or using the ASIS (Anterior Superior Iliac Spine) as a reference point.

What technique should be used to position the patient for an accurate abdominal image?

Before taking the exposure, the technician should ensure the symphysis pubis is within the light field, as it is required to be visible in the image. The patient should also be asked to suspend their breath after exhalation.

What are the key differences between the supine and erect abdominal projections?

The erect abdominal projection involves the patient standing and places the X-ray beam 2 inches above the iliac crest, ensuring both hemi-diaphragms are captured. The supine projection centers at the iliac crest and uses a horizontal beam.

How can the technician check if the patient is positioned correctly for the upright abdomen projection?

To verify the correct positioning, the technician should ensure the top of the light field is aligned with the patient’s axilla (armpit) region and that both diaphragm regions are captured in the image.

Why is it important to measure the patient before setting exposure factors?

Measuring the patient ensures that the correct exposure factors are set based on the size and body composition of the patient, which helps produce clear and accurate images.