Gonadal shields should be used on all males of reproductive age, with upper edge of shield placed at symphysis pubis unless it obscures essential anatomy.

Fig. 9-1 Male gonadal shield (top of shield at symphysis pubis).

Females:

Ovarian gonadal shields placed correctly may be used for abdomen examinations on females of reproductive age only if such shields do not obscure essential anatomy for that examination as determined by a radiologist (shielding is especially important for children).

Fig. 9-2 Female ovarian shield (top of shield at or slightly above the level of ASIS, lower border just above symphysis pubis).

Pregnancies

Generally no radiographic procedures exposing the pelvic region should be performed during pregnancy without special instruction from a radiologist/physician.

Topographic Positioning Landmarks

Certain positioning landmarks are essential for positioning the general abdomen and specific organs within the abdomen because the borders of these organs and the upper and lower margins of the general abdomen itself are not visible from the exterior.

Abdominal borders and organ locations, however, can be determined by certain landmarks, which can be located by gentle palpation with the fingertips, being careful of painful or sensitive areas. (The patient should be informed of the purpose for this before beginning the palpation process.)

Barium Distribution and Body Positions

The air-barium distribution within the stomach and large intestine changes with various body positions. By knowing these distribution patterns, one can determine in which body position a radiograph was taken. Air always rises to the highest levels, and the heavy barium settles to the lowest levels (air is black, barium is white).

Stomach

The fundus is located more posteriorly; therefore in the supine position it would be the lowest portion of the stomach and would be filled with barium.

In both prone and erect positions, the fundus would be filled with air as seen on the drawings below, with a straight air-barium line on the erect.

Fig. 9-3 Supine (barium in fundus).

Fig. 9-4 Prone (barium in body and pylorus).

Fig. 9-5 Erect (straight-line barium-air level). Barium = white Air = black

Large Intestine

The ascending and descending portions are located more posteriorly, and thus more of these parts in general would be filled with barium (white) in the supine position and with air (black) in the prone position.

Fig. 9-6 Supine.

Fig. 9-7 Prone.

Note:

This much separation of barium and air occurs generally only with double-contrast barium-air studies.

Air-fluid levels would be seen in the erect position in which the air would rise to the highest position in each of the various sections of the large intestine, as shown in the accompanying figure.

Fig. 9-8 Erect.

Right and left decubitus projections (not shown on these drawings) also would demonstrate air-fluid levels, with air again rising to the highest portions.

AP Abdomen (KUB)^*

• 35 × 43 cm L.W. (14 × 17″)

• Grid

Fig. 9-9 KUB abdomen.

Position

• Supine, legs extended, arms at sides

• Midsagittal plane aligned and centered to centerline

• Ensure no rotation (ASISs equal distance from tabletop)

• Center of IR to level of iliac crests, ensuring that upper margin of symphysis pubis is included on lower IR margin. (A large hypersthenic patient may require that the IR be placed crosswise with a second IR centered higher.)

Central Ray:

CR ⊥, to center of IR (level of iliac crests)

SID:

40-44″ (102-113 cm)

Collimation:

To abdomen or IR borders

Respiration:

Expose at end of expiration.

Erect AP Abdomen^*

• 35 × 43 cm L.W. (14 × 17″)

• Grid

• Erect marker

Fig. 9-10 Erect AP (include diaphragm).

Position

• Erect, back against table, arms at sides

• Midsagittal plane aligned and centered to centerline

• Ensure no rotation

• Center of IR approximately 2-3″ (5-6.5 cm) above iliac crest to include diaphragm

Central Ray:

CR horizontal, to center of IR (2-3″ [5-6.5 cm] above iliac crest)

SID:

40-44″ (102-113 cm)

Collimation:

To include abdomen and diaphragm

Respiration:

Expose at end of expiration.

AP Supine and AP Erect Abdomen

Evaluation Criteria

Anatomy Demonstrated:

• AP supine: Outline of liver, spleen, psoas muscles, and kidneys to include symphysis pubis lower abdomen

• AP erect: Bilateral diaphragm and significant portion of lower abdomen

Fig. 9-11 AP supine.

Position:

• AP supine and erect: No rotation; symmetry of iliac wings and outer, lower rib margins

Exposure:

• Optimal density (brightness) and contrast to visualize psoas muscles and lumbar transverse processes

• Air-fluid levels seen if present

• Liver margins and kidneys visible on patients of average size; no motion

Fig. 9-12 AP erect.

Abdomen^*

Lateral Decubitus (AP)

• 35 × 43 cm C.W. (14 × 17″)

• Grid

• Decubitus marker

• Arrow marker to include upside

• Patient should be on side a minimum of 5 minutes before exposure; 10 to 20 minutes is preferred.

Fig. 9-13 Left lateral decubitus (AP).

Position

• Lock wheels of stretcher

• Patient on side (on decubitus board or support to elevate downside abdomen), knees partially flexed, arms up near head

• Adjust patient and stretcher so center of IR and table (and CR) is approximately 2″ (5 cm) above level of iliac crest (to include diaphragm)

• Adjust height of IR to ensure that upside of abdomen is included for possible free air

Central Ray:

CR horizontal, to center of IR

SID:

40-44″ (102-113 cm)

Collimation:

Entire abdomen and diaphragm

Respiration:

Expose at end of expiration.

Abdomen^*

Dorsal Decubitus (Lateral)

• 35 × 43 cm C.W. (14 × 17″)

• Grid

• Include decubitus marker

Fig. 9-14 Dorsal decubitus (R lateral).

Position

• Patient supine (on decubitus board or support to elevate posterior abdomen), side against table, arms above head

• Secure stretcher (lock wheels)

• Center of IR and table (and CR) at level of iliac crest (2″ above iliac crest to include diaphragm)

• Adjust height of IR to align midcoronal plane to centerline of IR

Central Ray:

CR horizontal, to center of IR

SID:

40-44″ (102-113 cm)

Collimation:

To abdomen or IR borders

Respiration:

Expose at end of expiration.

Lateral and Dorsal Decubitus Abdomen

Evaluation Criteria

Anatomy Demonstrated:

• Lateral decubitus: Abdomen visualized to include air-filled stomach and bowel and upside diaphragm

• Dorsal decubitus: Abdomen visualized to include bilateral diaphragm

Position:

• Lateral decubitus: No rotation; symmetry of iliac wings and spine straight

• Dorsal decubitus: No rotation; symmetry of iliac wings and diaphragm. Intervertebral joint spaces and vertebral bodies should be visible.

Fig. 9-15 Lateral decubitus.

Fig. 9-16 Dorsal decubitus.

Exposure:

• Optimal density (brightness) and contrast to visualize soft tissue structures and lumbar spine

• Soft tissue structures and any intraperitoneal air demonstrated on patients of average size; no motion

AP Pediatric Abdomen (KUB)^*

• 18 × 24, 24 × 30, or 30 × 35 cm L.W.

• Screen <10 cm, grid >10 cm

Fig. 9-17 Child AP abdomen (KUB).

Position (Infant)

• Immobilize arms above head (use stockinette, Ace bandage, tape, or sandbags).

• Immobilize legs with Ace bandage or tape and sandbags.

• Center IR to CR.

• Shield gonads if possible.

Parental Assistance for Infant:

Use only if necessary. Supply with lead apron and gloves, and have parent hold arms above head with one hand and legs with other hand, preventing rotation.

Central Ray:

Newborns to 1 year old: CR to 1″ or 2.5 cm above umbilicus. Older child: CR to level of umbilicus.

SID:

40-44″ (102-113 cm)

Collimation:

On four sides to abdominal borders

Respiration:

Expose on expiration or when abdomen has least movement. If crying, time exposures at full expiration.

AP Erect Pediatric Abdomen^*

• 18 × 24, 24 × 30, or 30 × 35 cm L.W.

• Screen <10 cm, Grid >10 cm

Position

• Patient seated, legs through openings

• Arms above head, side body clamps firmly in place

• Lead shield at level of symphysis pubis, center IR to CR

Fig. 9-18 Utilizing Pigg-O-Stat.

Parental Assistance:

If necessary, have parent hold arms overhead with one hand, and with other hand hold legs to prevent rotation of pelvis or thorax (provide with lead apron and gloves).

Central Ray:

Newborn to 1 year old: CR to 1″ (2.5 cm) above umbilicus. Older child: CR to level of umbilicus.

SID:

40-44″ (102-113 cm)

Collimation:

On four sides to abdominal borders

Respiration:

Expose on expiration, or during least movement.

AP Supine and Erect Pediatric Abdomen

Fig. 9-19 AP supine abdomen.

Fig. 9-20 Erect AP abdomen.

Evaluation Criteria

Anatomy Demonstrated:

• AP supine and erect: Soft tissue and gas-filled structures; air-fluid levels on erect

Position:

• AP supine and erect: Diaphragm to symphysis pubis included if possible

Exposure:

• Optimal density (brightness) and contrast to visualize soft tissue structures and skeletal structures; no motion

Esophagogram—RAO^*

• 35 × 43 cm L.W. (14 × 17″)

• Grid

Position

• Recumbent or erect, recumbent preferred for better filling of esophagus

• Rotate 35°–40° from prone position onto right side, right arm down, left arm up; hold cup with left hand, straw in mouth.

• Center thorax to centerline.

• Top of IR ≈2″ (5 cm) above level of shoulder

Fig. 9-21 35°–40° RAO for esophagus (barium swallow).

Central Ray:

CR ⊥, to center of IR (≈3″ or 7 cm distal to jugular notch at T6 level)

SID:

40-44″ (102-113 cm)

Collimation:

To area of interest (≈5-6″ [12-15 cm] wide)

Respiration:

With thin barium, expose while swallowing (after 3 or 4 swallows). With thick barium, expose immediately after swallowing (while holding breath).

Esophagogram—Lateral^*

• 35 × 43 cm L.W. (14 × 17″)

• Grid

Fig. 9-22 R lateral esophagogram (barium swallow) in “swimmer’s” position.

Position

• Recumbent or erect, recumbent preferred

• Right lateral position, right arm and shoulder up and forward (holding cup), left arm and shoulder down and back

• Center midcoronal plane to centerline.

• Top of IR ≈2″ (5 cm) above top of shoulder

Central Ray:

CR ⊥, to center of IR (≈3″ or 7 cm distal to jugular notch at T6 level)

SID:

40-44″ (102-113 cm) or 72″ (183 cm) if performed erect

Collimation:

To area of interest (5-6″ [12-15 cm] wide)

Respiration:

With thin barium, expose while swallowing (after 3 or 4 swallows). With thick barium, expose immediately after swallowing, while holding breath.

RAO and Lateral Esophagogram

Fig. 9-23 RAO esophagogram.

Fig. 9-24 Lateral esophagogram.

Evaluation Criteria

Anatomy Demonstrated:

• RAO: Esophagus visible between vertebral column and heart

• Lateral: Entire esophagus seen between thoracic spine and heart

Position:

• RAO: Entire esophagus lined with contrast media and not superimposed over spine

• Lateral: No rotation; superimposition of posterior ribs, entire esophagus lined with contrast media

Exposure:

• Optimal density (brightness) and contrast to visualize borders of contrast-filled esophagus

• Sharp structural margins; no motion

Esophagogram—AP (PA)^*

• 35 × 43 cm L.W. (14 × 17″)

• Grid

Fig. 9-25 AP esophagogram (barium swallow).

Position

• Supine or erect, supine preferred (may be taken PA if erect)

• Center patient to centerline.

• Top of IR ≈2″ (5 cm) above top of shoulder

• Left arm at side, holding cup with right hand, straw in mouth

Central Ray:

CR ⊥, to center of IR (≈3″ or 7 cm distal to jugular notch at T6)

SID:

40-44″ (102-113 cm) or 72″ (183 cm) if performed erect

Collimation:

To area of interest (5-6″ [12-15 cm] wide)

Respiration:

With thin barium, expose while swallowing (after 3 or 4 swallows). With thick barium, expose immediately after swallowing, while holding breath.

Upper GI—PA^*

• 35 × 43 cm L.W. (14 × 17″), 30 × 35 cm (11 × 14″), or 24 × 30 cm (10 × 12″), L.W.

• Grid

Fig. 9-26 PA upper GI (stomach).

Position

• Prone, arms up beside head

• Align and center patient and IR to CR.

Central Ray:

CR ⊥, centered as follows:

Sthenic: Center ≈1″ (2.5 cm) above lower rib margin (level of L1) and ≈1″ (2.5 cm) to left of vertebral column

Hypersthenic: Center 2″ (5 cm) higher

Asthenic: Center ≈2″ (5 cm) lower and nearer midline

SID:

40-44″ (102-113 cm)

Collimation:

To outer margins of IR or to area of interest

Respiration:

Expose at end of expiration.

Upper GI—RAO^*

• 30 × 35 cm (11 × 14″) or 24 × 30 cm (10 × 12″) L.W.

• Grid

Fig. 9-27 40°–70° RAO, upper GI (stomach).

Position

• Semiprone, rotate 40°–70° from prone toward right side

• Right arm down, left arm up, partially flex left hip and knee

• Align and center patient to CR

Central Ray:

CR ⊥, to duodenal bulb region

Sthenic: Center ≈1″ (2.5 cm) above lower ribs and midway between vertebrae and left lateral abdominal border, 45°–55° oblique from prone

Hypersthenic: Center 1-2″ (3-5 cm) higher, ≈70° oblique

Asthenic: Center ≈2″ (5 cm) lower, ≈40° oblique

SID:

40-44″ (102-113 cm)

Collimation:

To outer margins of IR or to area of interest

Respiration:

Expose at end of expiration.

PA and RAO Upper GI

Evaluation Criteria

Anatomy Demonstrated:

• PA: Entire stomach and duodenum

• RAO: Entire stomach and C-loop of duodenum

Fig. 9-28 PA.

Position:

• PA: Body and pylorus are barium-filled; body and pylorus are centered

• RAO: Pylorus and duodenal bulb barium-filled; duodenal bulb in profile

Exposure:

• Optimal density (brightness) and contrast to visualize gastric folds without overexposing other structures

• Sharp structural margins; no motion

Fig. 9-29 RAO.

Upper GI—Lateral^*

• 30 × 35 cm L.W. (11 × 14″) or 24 × 30 cm L.W. (10 × 12″)

• Grid

Fig. 9-30 Right lateral upper GI (stomach).

Position

• Patient on right side, arms up, hips and knees partially flexed

• Align and center patient and IR to CR.

Central Ray:

CR ⊥, to region of pylorus as follows:

Sthenic: Center to margin of ribs, and to anterior ⅓ of abdomen

Hypersthenic: Center ≈2″ (5 cm) higher

Asthenic: Center ≈2″ (5 cm) lower

SID:

40-44″ (102-113 cm)

Collimation:

To outer margins of IR or to area of interest

Respiration:

Expose at end of expiration.

Upper GI—AP^*

• 30 × 35 cm L.W. (11 × 14″) or 24 × 30 cm L.W. (10 × 12″)

• Grid

Fig. 9-31 AP supine Trendelenburg, upper GI (stomach) (Trendelenburg position best demonstrates hiatal hernia).

Position

• Supine, arms at side

• Align and center patient and IR to CR.

Central Ray:

CR ⊥, centered to 2.5-5 cm (1-2″) to left of MSP

Sthenic: Center to level of L1 (midway between xiphoid process and level of lower lateral ribs)

Hypersthenic: Center ≈2.5 cm (1″) higher

Asthenic: Center ≈5 cm (2″) lower and nearer midline

SID:

40-44″ (102-113 cm)

Collimation:

To outer IR margins or to area of interest

Respiration:

Expose at end of expiration.

Lateral and AP Upper GI

Evaluation Criteria

Anatomy Demonstrated:

• Lateral: Entire stomach and duodenum and retrogastric space demonstrated

• AP: Entire stomach and C-loop of duodenum; diaphragm included to r/o hiatal hernia

Fig. 9-32 Lateral upper GI.

Position:

• Lateral: Pylorus and C-loop of duodenum demonstrated. No rotation; evident by aligned vertebral bodies

• AP: Fundus barium-filled and centered

Exposure:

• Optimal density (brightness) and contrast to visualize gastric folds without overexposing other structures

• Sharp structural margins; no motion

Fig. 9-33 AP upper GI.

Upper GI—LPO^*

• 30 × 35 cm L.W. (11 × 14″) or 24 × 30 cm L.W. (10 × 12″)

• Grid

Fig. 9-34 30°–60° LPO, upper GI (stomach).

Position

• Semisupine, 30°–60° oblique,^* left side down, partially flex right knee

• Center patient and IR to CR

Central Ray:

CR ⊥, centered to left half of abdomen

Sthenic: Center to L1 (midway between xiphoid process and level of lower lateral ribs), 45° oblique

Hypersthenic: Center 2.5 cm (1″) higher, 60° oblique

Asthenic: ≈5 cm (2″) lower and nearer midline, 30°

SID:

40-44″ (102-113 cm)

Collimation:

To outer IR margins or to area of interest

Respiration:

Expose at end of expiration.

LPO Upper GI

Evaluation Criteria

Anatomy Demonstrated:

• Entire stomach and duodenum; unobstructed view of duodenal bulb

Fig. 9-35 LPO upper GI.

Position:

• Fundus is barium-filled; gas-filled duodenal bulb seen for double-contrast study

• Duodenal bulb in profile

Exposure:

• Optimal density (brightness) and contrast to visualize gastric folds without overexposing other structures

• Sharp structural and gastric organ margins; no motion

Small Bowel Series—PA^*

A common routine includes images at 15- or 30-minute intervals until barium reaches ileocecal valve.

• 35 × 43 cm L.W. (14 × 17″)

• Grid

Fig. 9-36 PA small bowel (15 or 30 min).

Position

• Prone preferred (may be taken AP supine if necessary)

• MSP aligned to centerline; no rotation

• Center patient and IR to iliac crest (center higher on early IRs).

Central Ray:

CR ⊥, to center of IR, ≈2″ (5 cm) above level of iliac crest for early IRs (15 or 30 min), and at iliac crest for later images

SID:

40-44″ (102-113 cm)

Collimation:

To outer margins of IR or to area of interest

Respiration:

Expose at end of full expiration.

Barium Enema—PA or AP^*

• 35 × 43 cm L.W. (14 × 17″)

• Grid

Fig. 9-37 PA barium enema.

Position

• Patient prone (PA) or supine (AP); work quickly

• Patient aligned and centered to centerline; no rotation

• Center IR to level of iliac crest (see Note).

Central Ray:

CR ⊥, to center of IR, at level of iliac crest

Note:

For large or hypersthenic patients, the use of two IRs may be necessary, placed crosswise if the entire colon is to be included (one centered for lower abdomen and one for upper abdomen).

SID:

40-44″ (102-113 cm)

Collimation:

To outer IR borders or to area of interest

Respiration:

Expose at full expiration.

PA (AP) Barium Enema

Evaluation Criteria

Anatomy Demonstrated:

• Entire large intestine demonstrated, including left colic flexure and rectum

Position:

• Transverse colon primarily filled with barium (PA) and gas-filled with AP

• No rotation; evident by symmetry of ala of ilium and lumbar vertebra

Fig. 9-38 PA single-contrast BE.

Exposure:

• Optimal density (brightness) and contrast to visualize mucosa without overexposing other structures

• Sharp structural margins; no motion

Barium Enema—RAO and LAO^*

(or RPO and LPO)

Both right and left oblique projections are commonly taken.

• 35 × 43 cm L.W. (14 × 17″)

• Grid

Fig. 9-39 35°–45° RAO barium enema.

Position

• Semiprone (PA) or semisupine (AP), rotated 35°–45°

• Align and center abdomen to centerline.

• IR centered to level of iliac crest (include rectal area)

Central Ray:

CR ⊥ to center of IR (at level of iliac crest)

Fig. 9-40 35°–45° LPO.

Note:

Many patients require a second IR centered ≈2″ (5 cm) higher if the left colic flexure is to be included—most important on LAO or RPO (determine departmental routine).

SID:

40-44″ (102-113 cm)

Collimation:

To outer IR borders or to area of interest

Respiration:

Expose at expiration.

Oblique Barium Enema

Evaluation Criteria

Anatomy Demonstrated:

• LPO/RAO: Right colic flexure, ascending, and sigmoid colon

• RPO/LAO: Left colic flexure and descending colon

Position:

• LPO/RAO: Right colic flexure and ascending colon in profile

• RPO/LAO: Left colic flexure in profile, and descending colon in profile

Fig. 9-41 RAO (centered high).

Fig. 9-42 RPO.

Exposure:

• Appropriate technique (brightness) to visualize mucosa without overexposing other structures

• Sharp structural margins; no motion

Barium Enema—Lateral Rectum (Ventral Decubitus)^*

Alternative ventral decubitus projection is often performed for double-contrast studies.

• 24 × 30 cm L.W. (10 × 12″) or 30 × 35 cm L.W. (11 × 14″)

• Grid

• Compensating filter for ventral decubitus lateral

Fig. 9-43 Left lateral for rectum.

Position

• Recumbent in true lateral position; work quickly

• Center midaxillary plane to centerline, with knees and hips partially flexed

• Center patient and IR to CR.

Fig. 9-44 Ventral decubitus lateral rectum (alternate projection with double-contrast examination).

Central Ray:

CR ⊥, to level of ASIS, centered to midcoronal plane (midway between ASIS and posterior sacrum). CR is horizontal for ventral decubitus.

SID:

40-44″ (102-113 cm)

Collimation:

To outer IR borders or to area of interest

Respiration:

Expose at expiration.

Barium Enema—Lateral Decubitus^*

Both right and left lateral decubitus are commonly taken as part of a double-contrast series.

• 35 × 43 cm L.W. to patient (14 × 17″)

• Grid (portable grid or Bucky)

• Compensating filter placed on upside of abdomen

Fig. 9-45 Right lateral decubitus (AP).

Position

• Patient on side, arms up, knees partially flexed, back against grid cassette or table

• MSP aligned and centered to centerline of IR (and CR); no rotation (lock wheels if stretcher is used)

• IR centered to level of iliac crest

Central Ray:

CR horizontal to center of IR (to level of iliac crest at midsagittal plane)

SID:

40-44″ (102-113 cm)

Collimation:

To outer IR borders or to area of interest

Respiration:

Expose at full expiration.

Barium Enema—AP (PA)^*

Axial (Butterfly Position)

• 30 × 35 cm L.W. (11 × 14″) or 24 × 30 cm L.W. (10 × 12″)

• Grid

Fig. 9-46 AP—CR 30°–45° cephalad.

Fig. 9-47 35° LPO axial—CR 30°–45° cephalad.

Position

Supine (AP) or Prone (PA):

Patient aligned and centered to centerline

Alternate Oblique:

LPO or RAO: Oblique patient 30°–40°

Central Ray:

CR 30°–40° cephalad for AP; 30°–40° caudad for PA

AP: CR to 2″ (5 cm) inferior to ASIS

PA: CR to enter at level of ASIS

LPO: CR 2″ (5 cm) inferior and 2″ (5 cm) medial to right ASIS

SID:

40-44″ (102-113 cm)

Collimation:

To area of interest

Respiration:

Expose at full expiration.

Lateral Decubitus and AP/PA Axial Barium Enema

Evaluation Criteria

Anatomy Demonstrated:

• Lateral decubitus: Entire large intestine demonstrated

• AP/PA axial: Elongated views of rectosigmoid colon

Position:

• Lateral decubitus: No rotation evident by symmetry of pelvis and ribs

• AP/PA axial: Less overlap between rectum and sigmoid colon

Fig. 9-48 Left lateral decubitus.

Fig. 9-49 AP axial.

Exposure:

• Appropriate technique (brightness) to visualize mucosa without overexposing other structures

• Sharp structural margins; no motion

Intravenous Urogram^*

AP Scout and Series

• 35 × 43 cm L.W. (14 × 17″); 28 × 35 cm (11 × 14″) C.W. for nephrotomography

• Grid

• Include minute marker

• Note that early images may include nephrotomography.

• Shield gonads for males

Fig. 9-50 AP IVU.

Position

• Supine, midsagittal plane aligned and centered to centerline, support placed under knees, no rotation

Central Ray:

CR ⊥, to center of IR, at level of iliac crest, or 1-2″ (3-5 cm) above crests on long-torso patients with second smaller IR crosswise for bladder area, to include symphysis pubis on lower border of IR

SID:

40-44″ (102-113 cm)

Collimation:

To outer margins of IR or area of interest

Respiration:

Expose at end of full expiration.

Intravenous Urogram^*

RPO and LPO

Both R and L posterior oblique projections should be part of routine.

• 35 × 43 cm L.W. (14 × 17″)

• Grid

• Include minute marker

• Shield gonads for males.

Fig. 9-51 30°—RPO.

Position

• Semisupine, 30° oblique to right (or left), flex elevated knee and elbow as shown for support (place angled support under back if needed)

• Align and center abdomen to centerline.

• Center IR to level of iliac crest.

Central Ray:

CR ⊥, to center of IR, at level of iliac crest

SID:

40-44″ (102-113 cm)

Collimation:

To outer margins of IR or to area of interest

Respiration:

Expose at end of full expiration.

AP and Posterior Oblique IVU

Evaluation Criteria

Anatomy Demonstrated:

• AP and oblique: Entire urinary system visualized from renal shadows to symphysis pubis

Position:

• AP: No rotation; evident by symmetry of iliac wings; symphysis pubis and top of kidneys included

• Oblique: Kidney on elevated side in profile; downside ureter away from spine

Exposure:

• Appropriate technique (brightness) and contrast to visualize kidneys and ureters without overexposing other structures; no motion

• Minute and side markers visible

Fig. 9-52 AP—10 minute.

Fig. 9-53 30°—RPO.
(From Frank ED, Long BW, Smith BJ: Merrill’s atlas of radiographic positioning and procedures, ed 12, St. Louis, 2012, Elsevier.)

Intravenous Urogram^*

AP Erect Postvoid

• 35 × 43 cm L.W. (14 × 17″)

• Grid

• Erect and postvoid markers

Fig. 9-54 AP erect postvoid.

Position

• Erect, midsagittal plane aligned and centered to centerline, no rotation

• Center IR to iliac crest—ensure that bladder area, including the symphysis pubis, is included at lower IR margin.

Central Ray:

CR ⊥, to center of IR (at level of iliac crests or ≈1″ or 2.5 cm lower than crest to include bladder area)

SID:

40-44″ (102-113 cm)

Collimation:

To outer margins of IR or to area of interest

Respiration:

Expose at end of full expiration.

Cystogram—AP^*

• 30 × 35 cm L.W. (11 × 14″)

• Grid

Position

• Supine, midsagittal plane aligned and centered to centerline, legs fully extended

• Center IR to projected CR.

Fig. 9-55 AP—CR 10°–15° caudad.

Central Ray:

CR 10°–15° caudad, centered to ≈2″ (5 cm) superior to symphysis pubis at MSP (projects pubis inferiorly to better visualize bladder region)

SID:

40-44″ (102-113 cm)

Collimation:

To outer margins of IR or area of interest

Respiration:

Expose at end of full expiration.

Cystogram—Posterior Obliques^*

(RPO, LPO, and Optional Lateral)

Note: Cystogram routine may not include a lateral because of high gonadal dose.

• 30 × 35 cm L.W. (11 × 14″)

• Grid

Fig. 9-56 45° RPO.

Position

• Semisupine, 45°–60° oblique (60° oblique best demonstrates posterolateral bladder and UV junction)

• Flex elevated arm and leg to support this position.

• Center patient and IR to CR.

Central Ray:

CR ⊥, to ≈2″ (5 cm) superior to symphysis pubis, and 2″ (5 cm) medial to elevated ASIS

Fig. 9-57 Optional lateral. —CR ⊥, 2″ (5 cm) superior and post to symphysis pubis.

SID:

40-44″ (102-113 cm)

Collimation:

To margins of IR or area of interest

Respiration:

Expose at expiration.

AP and Posterior Oblique Cystogram

Fig. 9-58 AP 10°–15° caudad.

Fig. 9-59 45° posterior oblique.

Evaluation Criteria

Anatomy Demonstrated:

• AP: Distal ureters, bladder, and proximal urethra

• Oblique: Distal ureters, bladder, and proximal urethra

Position:

• AP: Urinary bladder not superimposed by pubic bones

• Oblique: Urinary bladder not superimposed by partially flexed leg

Exposure:

• Appropriate technique (brightness) to visualize urinary bladder without overexposing other structures; no motion

^*Bontrager Textbook, 8th ed, p. 116.

^*Bontrager Textbook, 8th ed, p. 119.

^*Bontrager Textbook, 8th ed, p. 118.

^*Bontrager Textbook, 8th ed, p. 120.

^*Bontrager Textbook, 8th ed, p. 644.

^*Bontrager Textbook, 8th ed, p. 645.

^*Bontrager Textbook, 8th ed, p. 478.

^*Bontrager Textbook, 8th ed, p. 479.

^*Bontrager Textbook, 8th ed, p. 480.

^*Bontrager Textbook, 8th ed, p. 483.

^*Bontrager Textbook, 8th ed, p. 482.

^*Bontrager Textbook, 8th ed, p. 484.

^*Bontrager Textbook, 8th ed, p. 486.

^*Bontrager Textbook, 8th ed, p. 485.

^*More rotation for hypersthenic patients

^*Bontrager Textbook, 8th ed, p. 513.

^*Bontrager Textbook, 8th ed, p. 515.

^*Bontrager Textbook, 8th ed, pp. 516 and 517.

^*Bontrager Textbook, 8th ed, p. 519.

^*Bontrager Textbook, 8th ed, p. 520.

^*Bontrager Textbook, 8th ed, p. 523.

^*Bontrager Textbook, 8th ed, p. 554.

^*Bontrager Textbook, 8th ed, p. 556.

^*Bontrager Textbook, 8th ed, p. 557.

^*Bontrager Textbook, 8th ed, p. 559.

Abdomen and Common Contrast Media Procedures