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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