Download KUB RADIOGRAPHY REVISITED

KURSUS ‘UPDATE IN RADIOGRAPHY 2015’
08-09 JUNE 2015
AUDITORIUM HQE, KK
KUB RADIOGRAPHY
REVISITED
Felecia Lumin
Juru X-Ray U41
Hospital Keningau
DEFINITION
• KUB x-ray is a plain AP supine radiograph
of the abdomen to assess the organs and
structures
of
the
urinary
and/or
gastrointestinal (GI) system
• K = Kidneys, U = Ureters, B = Bladder
ANATOMY
4 Quadrants of abdomen
9 regions of abdomen
Abdomen Regions
Organs
Right Hypochondriac
Liver, Gallbladder, Right Kidney, Small
Intestine
Left Hypochondriac
Spleen, Colon, Left Kidney, Pancreas
Epigastric
Stomach, Liver, Pancreas, Duodenum,
Spleen, Adrenal Glands
Right Lumbar
Gallbladder, Liver, Right Colon
Left Lumbar
Descending Colon, Left Kidney
Umbilical
Umbilicus, Jejunum, Ileum, Duodenum
Right Iliac
Appendix, Cecum
Left Iliac
Descending Colon, Sigmoid Colon
Hypogastric
Urinary Bladder, Sigmoid Colon, Female
Reproductive Organs
HUMAN URINARY SYSTEM
INDICATIONS
• To determine the size, shape, and position of the
kidneys and bladder
• To detect obvious abnormalities of the urinary system,
such as kidney stones
• To
help
differentiate
between
urologic
and
gastrointestinal diseases, which both produce abdominal
pain
• As a scout image for contrast study
• Follow up procedure after the placement of devices such
as ureteral stents,etc.
Renal calculi
Bladder stone
ureteral stone
CONTRAINDICATION
• Pregnancy
PATIENT PREPARATION
Bowel preparation
• 2 days before examination – soft diet i.e
porridge
• 1 day before examination, take 3 dulcolax
tab at 1pm and 8pm.
• Fasting at least 6 hours before
examination
RADIATION PROTECTION
• Use gonad shields on males with the upper edge
of shield carefully placed at the sp.
• For females, use gonad shield only if such
shielding does not obscure essential anatomy as
determined by doctor)
• Collimation
Before examination:
1)
Identify the correct patient
2)
Bowel preparation. Yes/No?
3)
Ask pt to remove any jewelry or metal objects, and put on an x-ray
gown
During examination:
1)
Pt lie down supine on x-ray table
2)
Pillow under head, hands on side, use knee support
3)
Centre x-ray tube and the cassette
4)
Centre the region of interest (CR for KUB: perpendicular and
directed to center of IR at mid sagittal line, level of illiac crest)
5)
SID = 100cm, Grid = Yes
6)
7)
8)
9)
10)
Collimation (upper border = level of T11-T12, lower border =
symphysis pubis, lateral collimated)
Put on gonad shield, put on marker
Exposure factor ( KvP = 70-80, mAs = 20-30)
Give instruction (expiration)
Make exposure at the end of expiration
After Examination
1)
Pt can change to his/her clothes
2)
Process the film
IMAGE EVALUATION
(P.A.C.E.M.A.N)
[P] Projection & Position
•
projection : true AP ( no rotation )
 spinous process aligned with midline of vertebra column
 distance pedicles to spinous process same ( both side ).
 sacrum center & aligned with sp.
•
position :
 supine – CR = level of iliac crest ( lower border include sp )
[A] Area
•
•
Film on expiration – to push down abdominal organs.
No artifacts ( zip , belt , coin in pocket , bra clip ,.. )
[C] Collimation
•
•
•
•
•
CR : MSP , in about the level of iliac crest ( L4 ) supine
SID = 100 cm
Inferior border- include sp
Lateral collimated but must include kidneys
Superior border in about level of T11-T12.
[E] Exposure
• 70 – 80 kVp , 20 – 30 mAs
• Good penetration – visualize bony trabecular patterns &
cortical outlines of lumbar vertebra & pelvis.
• Good contrast & density – can demonstrate psoas
muscle , kidneys and other soft tissues.
[M]
Marker
• Rt or Lt marker on the correct side of pt , inferior film.
• Not superimpose to ROI .
[A] Alignment
• Lengthwise film ( 14x17 inch film ).
• Peadiatric pt can uses smaller film.
[N] Name
• Pt name , pt number , date , hospital name
• Inferior film ( not superimpose to ROI ).
PACEMAN?
REFERENCES
•
•
•
•
•
Frank, E. D., Long, B. W. & Smith, B. J. 2007. Merrill’s Atlas of Radiographic
Positioning & Procedures. 11th edition. Volume 2 & 3. USA. Mosby Elsevier.
Bontrager, K.L. & Lampignano, J.P.2005. Textbook Of Radiographic Positioning And
Related Anatomy. 6th edition.USA. Mosby Elsevier.
http:// www.spandidos-publications.com
http:// www.radiopaedia.org
http://www.healthcommunities.com