1

ABD & CHEST 2

Rt 124 – Spring

Image Review pt 2

2

Position & Projection

• Look at blocker for PROJECTION

• Look at air/fluid levels for• Upright vs Supine vs Decubitus

• Look at Pathology:• Excessive Fluid or Air indicates pathology

and may need adjustment in technique

3Projection ?

AP

4Projection ?

AP –AXIAL (APICAL LORDOTIC

5

Projection ?

PA

Note Pathology –Rt middle lobeLt lower lobeatelectasis

6Projection ?

AP

REMEMBER TO MOVE CARDIACMONITOR

WIRES OUT OF THE WAY

Pathologynote bilateral

effusion both bases

7PROJECTION?

AP

8

LAT UPRIGHTON GURNEY

NOTE AIR /FLUID LEVELS

Note poor positioning ofCR to part(cr too low & too anterior – not at mcp

9

Position ?Projection?

AP semi upright

note – fluid

levels in RT lung

what else is needed?

Decubs –for fluid levels

10Position / Projection?

Projection – cant’ tell because no blocker

Position – LLD1) look for the humerus that is raised2) look for fluid levels3) note: poor centering for upside of image

11

Position / Projection?

Projection – AP blocker lower RTPosition – RLD 1) look for the humerus that is raised2) look for fluid levels3) poor marker placement – label of image

look for fluid levels

12 BILATERAL DECUBProjection? PA AP

LLD RLD

13

PROJECTION?POSITION?

GO BACK AND CHECK PREVIOUS

SLIDE

14

PROJECTION?POSITION?

GO BACK AND CHECK PREVIOUS

SLIDE

15

ABDOMEN -

SUPINE – UPRIGHT - LLD

16

KUB

WHAT IS THE CRITIQUE TO

JUDGE PROPER

TECHNIQUE?

17Upper abd - should center higher to include more diaphram

18Centering better for upper abd – should put blocker down – to keep out of diaphram area

19

Supine KUB –what are the white

dots?

Residual barium

20

KUB – POST CT SCAN

RESIDUAL CONTRAST IN COLON AND KIDNEYS

DARK LINE ACROSS ABDOMEN???

FROM COMPRESSED SOFT TISSUE –

TIGHT WAISTBAND OF CLOTHING

21Case example of

SUPINE – upper & KUB Upright

(repeated – diaphram clipped)

Should have collimated to upper abd – not exposed lower abd twice

22

KUB

FLAT PLATESUPINE ABD

INCLUDESENTIRE ABD

(TAKEN AT 48” SID)

23POSITION?

UPRIGHT

PROJECTION

PA –

WHAT ELSE?BLOCKER

PLACEMENT & CLOTHING

24KUBSUPINE

25

UPPER ABD

SUPINENOTE

PATHOLOGY (GB STONES)

26

UPRIGHT ABD

CRITIQUEWHAT IS THE DARK

LINE IN THE CENTER

27

PATHOLOGY&

Positioning

28Obstruction

lg bowel

29

Example:may need4 films inquadrant

to include allof abd

structures(obstruction)

30Free air in the abdomen

31

32

Position?

Look at air/fluid levels

33

LEFT LAT DECUB

34

Need at least 2 crosswise

films

35

CRITIQUE IMAGESFOR POSITIONING

COLLIMATION &CENTRAL RAY PLACEMENT

36Critique: If taken for AP chest –

CR is < too cephalic – moving clavicles above apex

37

AP Chest

CR – too cephalic PT kyhphotic –

need to change CRdirection to

maintain ┴ to sternum

38

Projection – APCritique –

collimation not centeredekg wires over chest

39

CRITIQUE

SEE EARLIER IMAGES

40

Lat gurney chest prop arms up with

sponges get ST of arms off of

chest

41

CRITIQUE

SEE EARLIER IMAGES

42

Also review images on first presentation

Written test on Tues

Lab on Thursday

43

More pathology& positioning

We will cover in more detailin GI section

44

Cecal volvulusLG bowel

obstructioncritique forpositioning

and centering

45Toxicmegacolon

46

Projection?

Postion?

PA – according to blocker

Supine – no air fluid levels

47

Projection?

AP

48

Projection?

PA

49

What is thisstep ladder

sign indicate for pathology?

Obstructionsee air-fluid

levels Position?Upright!

50Small bowel obstruction-remember to

include all areas of the abdomen

what could have improved this

image?

2 cross wise14 x 17

51

Critique for positioning& projection

52• AP Chest –• CR too low• Collimation too open• KVP too low – too

short of contrast

• Lat –• CR too forward –• Sit pt up more

53

Projection

AP

Pathology?

COPD