Abdomen and KUB for study purpose degree students bsc medical imaging technology

Radiographic positioning of abdomen and pelvic joint Rajiv Gandhi University

1. ABDOMEN and KUB
Chandana.R
Dept. Of MIT

2. Contents
Related radiological anatomy
Basic & special projection (ABDOMEN)
Basic:


AP supine
Special:


PA prone


Lateral decubitus


Erect AP


Dorsal decubitus


Lateral
Acute abdomen: Three-way series
KUB:
1.AP
2.Lat

3. ANATOMY
The abdomen cavity extend from the domes of the diaphragm upto the pelvic region.

4. QUADRANTS OF ABDOMEN
Trans pyloric plane
Trans tubercular plane
Para sagittal

5. ANATOMY OF ABDOMEN
•Gastro-Intestinal Tract
•Hepatic biliary system
•Urinary system

6. HEPATIC BILIARY SYSTEM

7. ANATOMY
Hepatic Biliary System
•Liver
•Pancreas
•Spleen
•Extra Hepatic Biliary Apparatus
a.R &L hepatic duct
b.Common Hepatic Duct
c.Gall Bladder
d.Bile duct

8. LIVER
•Largest gland of body.
•Wedge shaped, right upper quadrant
•Weight:
a)In adult male 1.4 to 1.8 kg
b)In adult female 1.2 to 1.4 kg
•Size: In adult 13 cms
•Liver has 8 lobes.

9. PANCREAS
•“J” shaped structure
•Length: 6-8 inch
•Weight: 90 gm
•Situated in posterior abdominal wall at the level of L1 and L2
vertebrae
•Parts
a)Head
b)Neck
c)Body
d)Tail

10. SPLEEN
•Situated in the left lumber region along the long axis of the
tenth rib.
•Length- 9-11 cm
•Weighs -150 grams
•Situated between the 9th and 11th ribs in the left upper
quadrant of the abdomen.

11. EXTRA HEPATIC BILIARY APPARATUS
•It consists of structures, which stores and transmit bile into
the duodenum
1.The right and left hepatic ducts
2.Common bile duct
3.Gall bladder-
a)Located at the inferior surface of the liver
b)It has fundus, body and neck.
4. Bile duct

12. ANATOMY
URINARY SYSTEM
•Kidney
•Ureter
•Urinary Bladder
•Urethra

13. KIDNEY
•Pair of excretory organs, which eliminate the waste product
of metabolism in form of urine and maintain electrolyte and
water balance.
•Situated retroperitoneally on the posterior abdominal wall, at
he level of T12-L3
•Measurements-
a)Length- 11 cm
b)Breadth-6 cm
c)Anterioposterior thickness- 3 cm

14. FUNCTION OF KIDNEY

15. INDICATIONS
• OBSTRUCTION / PERFORATION OF BOWEL
• PNEUMOPERITONEUM(presence of air or gas in abdominal cavity or peritoneal cavity)
• INTRA ABDOMINAL MASS / ANEURYSM
• RENAL PATHOLOGY
• RADIO-OPAQUE FOREIGN BODY
• PRIOR TO INTRODUCTION OF A CONTRAST MEDIUM
• CALCIFICATION / ABNORMAL COLLECTIONS LIKE ABSCESS

16. PRE REQUISITES
• HISTORY / CLINICAL DETAILS
• PROPER POSITIONING
• SIDE MARKER (right or left)
• EMPTY BLADDER
• NO METALLIC WEARINGS
• GONADAL SHIELDS

17. Patient not preparedPatient well prepared

18. RADIATION PROTECTION
•28
TH Day Rule to be followed.
•Gonad shielding whenever possible
•ALARA Principle

19. ANATOMICAL LANDMARKS
•Xiphoid tip:T9-T10
•Inferior costal rib margin:L2-L3
•Iliac crest:L4-L5
•Anterior superior iliac spine
•Greater trochanter
•Pubis Symphysis

20. AP VIEW
POSITONING
•Supine
•Align midsaggital plane
to midline of table
•Arms placed at patient’s
sides
•Centre cassette to level
of iliac crest
•Lower margin of
cassette at symphisis
pubis

21. CENTRAL RAY
Perpendicular to midline
between iliac crests
TECHNICAL FACTORS
60-70kVp
40-50mas
STRUCTURES
SHOWN
Kidneys,liver,stomach,b
owel segments,
symphysis pubis

22. •EVALUATION CRITERIA
•No rotation of pelvis.(check both ASIS are
equidistant from tabletop)
•No motion
•Optimum density and contrast

23. ABDOMOEND aOn AP ERECT VIEW
POSITIONING
•Upright
•Arms at side away
from body
•Align midsagital
plane to midline of
erect bucky
•Centre IR 2inches
above iliac crest

24. CENTRAL RAY
Directed horizontally to
2inches above level of
iliac crests
TECHNICAL FACTORS
SID 100cm
50-60kVp
90-100mas
STRUCTURES SHOWN
Stomach,bowel
segments,bilateral
diaphragm

25. EVALUATION CRITERIA
•No rotation of pelvis
•No motion
•Optimum density and contrast

26. dANOMAdDKOEUaNUD aOn LATERAL DECUBITUS VIEW
POSITIONING
•Lateral recumbent
•Knees partially flexed
•Arms up near head
•Centre IR to 2inches
above the level of iliac
crests
•Adjust height of cassette
to centre midsaggital
plane of patient to centre
of IR

27. CENTRAL RAY
Directed horizontally to
2inches above level
of iliac crests
TECHNICAL FACTORS
SID 100cm
50-60kVp
90-100mas
STRUCTURES
SHOWN
Stomach,bowel
segments,bilateral
diaphragm

28. EVALUATION CRITERIA
•No rotation of pelvis
•No motion
•Optimum density and contrast

29. KMAdDKOEUaNUD aOn DORSAL DECUBITUS VIEW
Supine
•Arms up beside
head,knees flexed
•Centre image
receptor 2inches
above iliac crest
and midcoronal
plane.

30. CENTRAL RAY
Directed horizontally to
2inches above level of
iliac crests
TECHNICAL FACTORS
SID 100cm
50-60kVp
90-100mas
STRUCTURES SHOWN
Diaphragm,as much of
lower abdomen as
possible to be
included,air filled bowel
loops

31. EVALUATION CRITERIA
•No rotation of pelvis
•No motion
•Optimum density and contrast

32. PA VIEW
POSITIONING
Prone
Align midsagital plane to mid-line of table
Arms up beside head
Centre IR at level of iliac crest

33. CENTRAL RAY
Perpendicular to midline
between iliac crests
TECHNICAL FACTORS
SID 100cm
60-70kVp
40-50mas
STRUCTURES
SHOWN
Kidneys,stomach,bowel
segments,symphysis
pubis

34. •EVALUATION CRITERIA
•No rotation of pelvis.(check both ASIS are
equidistant from tabletop)
•No motion
•Optimum density and contrast

35. dANOMAdD aOn LATERAL VIEW
POSITIONING
•Lateral recumbent
•Elbows flexed,knees and
hips partially flexed
•Pillow can be placed
between knees to maintain
lateral position
•IR is centered to 2inches
above the level of iliac crests
in midcoronal plane

36. CENTRAL RAY
Directed horizontally to
2inches above level of
iliac crests
TECHNICAL FACTORS
SID 100cm
50-60kVp
90-100mas
STRUCTURES SHOWN
Diaphragm,as much of
lower abdomen as
possible to be included,
air filled bowel loops

37. EVALUATION CRITERIA
•No rotation of pelvis
•No motion
•Optimum density and contrast

38. Acute abdomen

39. DEFINITION:
Acute abdomen:

The acute abdomen may be defined generally as
an intra abdominal process causing severe pain
and often requiring surgical intervention. It is a
condition that requires a fairly immediate
judgment or decision as to management.

40. Causes:-
Inflammatory
Mechanical
Neoplastic
Vascular
Congenital defects
Traumatic

41. Special Indication:-
Ascities
Intra peritoneal air
Intra abdominal mass
Paralitic ileus
Intussusception
Post operative (abdominal surgery)
Vovulus

42. ASCITES:-
Accumulation of fluid within the peritoneal cavity, is also
seen as a result of portal hypertension
and the leakage of
excessive fluid from
the portal capillaries.

43. VOLUVOLUS
INTUSSUSCEPTION
A volvulus is a bowel obstruction in which a loop of
bowel has abnormally
twisted on itself)
Invagination of one part of small
intestine into aonother part

44. ASCITES:-
U
L
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X-RAY

45. Distention of abdomen due
to free intra peritoneal air
Perforated hollow viscous:-

46. Air in the peritonial
cavity:

47. INTRA ABDOMINAL MASS:-
NEOPLASM- benign or malignent

48. PARALITIC ILEUS
Types :
a) Mechanical ileus
(obstruction of bowel from hernia,
adhesion,etc..)
b) Non mechanical small bowel
obstruction

49. IMMOBILIZATION
•Main aim is to prevent voluntary & involuntary movement.
•Patient kept in comfortable position so patient can relax.
•Breathing instruction should be given properly.
•Compression band can be given for immobilization but not the
compression.

50. Landmarks

51. •Xiphoid process(T9-T10):tip of xiphoid
process is inferior process of sternum. It
corresponds to superior margin of
abdomen
•Iliac crest(L4-L5): corresponds to level
of midabdomen
•Symphysis pubis:anterior junction of
2pelvic bones.It corresponds to inferior
margin of abdomen.
•Ischial tuberosity: corresponds to
inferior margin of PA abdomen.

52. Radilogical Projections:-
AP- supine
AP –standing (erect)
PA -chest
Left lateral decubitus

53. NEVER …
prepare an acute abdomen patient ……… !!!
REMEMBER

54. AP SUPINE
•Pathology Demonstrated:-
–Including bowel obstruction
–Neoplasm
–Calcification
–Ascites

55. Patient positioning:-
•Supine with midsagital plane centered to
midline of table and or cassette.
•Arms placed at patients side ,away from the
body.
•Place a support under the knees to relieve
strain & avoid motion.

56. P
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p
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:

57. Part Positioning:
•Center the IR at the level of the iliac crests &
lower border at pubic symphysis.
•Diaphragm should be included as well.
•No rotation of pelvis & shoulder.
•Exposure should be made at the end of the
expiration so that the abdominal organs are not
compressed.

58. Technical factors:-
•IR size - 35 x 43(14 x 17)
•70 to 80 kv range
•mA-200
•mAs-60-70
•SID-100cm

59. Central ray
•Perpendicular to the IR at the level of iliac crests.
Collimation
•Collimate properly to size of 14 x 17.
•For smaller patient collimate upto within 1 inch of
shadow of abdomen.

60. Left kidney
Left iliac crest
Sacrum
Coccyx
Symphysis pubis
Lumbar spine
Stomach
A
P
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P
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STRUCTURES SEEN:-

62. Evaluation Criteria:-
•Outline of liver
•Spleen
•Kidneys
•Air filled stomach
•Arch of symphysis pubis for the urinary
bladder.
•No rotation of spinous process, ischial spines.
•No motion of diaphragm.
•proper visualization of soft tissues.

63. ABDOMEN
AP- ERECT
Pathology Demonstrated:
abnormal mass
Air fluid levels
accumulation of intra peritoneal air.

64. Patient Position:-
•Mid sagittal plane of body centred to midline
of table or erect bucky
•Arm slightly away from the body
•Upright , leg slightly spread , back against
table or grid surface.
•Center or IR 2 inches above the level of iliac
crests to include diaphragm.

66. Technical factors:-
IR size - 35 x 43(14 x 17)
70 to 80 kV range
mA-200
mAs-60-70
SID-100cm

67. Central Ray
Horinzontal ray
perpendicular to the IR.
2 inches above the level
of iliac crests to include
diaphragm.

68. Structures Seen

69. Evaluation criteria:-
Outline of liver
Spleen
Kidneys
Air filled stomach
Arch of symphysis pubis for the urinary bladder.

70. LEFT LATERAL DECUBITUS:-
Pathology Demonstrated
Abdominal mass
Air fluid levels
Intra peritoneal air

71. Patient Positioning:-
Lateral recumbent firmly against table or vertical
grid device.
Patient lying on the table, put a radiolucent pad
under him to lift him so that patient comes in
middle of IR.

72. Let patient to lie down in same position for several
minutes so that air will rise up to the highest level
Knees partially flexed
Arms up near head

74. Part positioning
•Centre of IR and CR are approximately 2 inches
(5 cm) above level of iliac crest (to include
diaphragm )
•Ensure no rotation of pelvis or shoulder
•Adjust height of cassette to centre midsagittal
plane of patient to centre of IR

75. Technical factors
•IR size 35 x 43 (14 x 17)
•70 to 80 kv range
•SID-100cm
•mA-200
•mAs-60-70
•Place proper marker

76. Central ray
2 inches above level of iliac crest
Minimum SID:40 inches(1oo cm)

77. Structures Seen:-

78. Air filled stomach
Loops of stomach
Air fluid levels where present
Diaphragm without motion.
Marker should be seen.
Evaluation criteria:-

79. CHEST PA
Patient positioning
Patient is positioned facing the cassette with the
chin extended
The feet are placed slightly apart
the shoulders are rotated forward and pressed
downwards in contact with the cassette .

80. Part positioning:-
•Midsagital plane should be perpendicular to the
IR.
•Upper border of IR should cover till the root of
neck to cover apex of lungs.
•Lower border should cover the diaphragm.

81. Technical factors:
•IR size-14x 17 inches.
•SID-180cms
•kVp:65-75
•mA:200
•mAS:8-10
•Proper marker

82. Central ray
•At the level of 4
th
thoracic vertebra.
•Proper collimation should be given.

83. S
t
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S
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:
-

84. Evaluation criteria
Right clavicle (A),
right scapula (B),
right fourth anterior rib (C),
right eighth rib (D),
right costophrenic angle (E),
left lung apex (F),
aortic arch (G),
hilum (H),
heart (I),
left lung base (J),
Fundic air(k)
right hemi diaphragm (white
arrow).

85. Radiation protection:-
•Proper collimation
•Proper shielding should be given.

86. Thank You