KUB

unkindnesskindUrban and Civil

Nov 15, 2013 (3 years and 10 months ago)

179 views

醫用放射診斷攝影技術與標準

胸腹部


C
hest

(
游宏祥
)

PA 59

AP 60

Including Abdomen 61

Including Both Shoulder 62

Lateral 63

Oblique 64

Lordotic 65

Decubitus 66

Rib 67

Sterum 68
-
69

Sterno
-
Clavicular joint 70
-
71


Abdomen

(
陳文昌
)

Supine 72

Standing 73

Decubitus 74


KUB

Supine 75

Standing 76

Low KUB 77


Pelvis

AP 78

Including Upper Femur 79

Frog 80

Inlet 81

Outlet 82

Iliac Oblique 83

Obturator 84

Sacro
-
Iliac Joint 85


Chest P
-
A

Position technique


1.

SID=180 cm

2.

Full inhalation.

3.

Central ray in the midsag
ittal plane
to the center of the film at the level
of the seventh thoracic vertebrae.

4.

The upper border of the
detector

is
about 5 cm above the relaxed
shoulders.

5.
Position the patient for the
PA

body
position
.

Evaluation criteria


1.

Scapulae should be proj
ected
outside the lung fields.

2.

2 inch of lung apex should show
above the clavicles.

3.

Lateral aspects of the lung fields
including costophrenic angles must
including.

4.

Ten posterior ribs should be seen
above the diaphragm.

5.

Distance from the vertebra
l column
to the lateral borderof the ribs
should be equidistant on
each

side.

6. Exposure should cleary demonstrate
the lung fields.





























Ches
t

A
-
P

Position technique

1.

SID=180 or 150 cm
.
.

2.

Position the patient for the AP
body
p
osi
tion

e
ither erect or
recumbent.

3.

Central ray perpendicular to the
plane of detector direct it to the
manubrium for the lungs and to the

mid
-
sternum for the heart.

4.
Full inhalation.

Evaluation criteria


1.

Medial portion of the clavicles
should be equidistan
t from the
vertebral column.

2.

Trachea should be seen in the
midline.

3.

Lateral aspects of the lung fields
including costophrenic angles must
including.

4.

Distance from the vertebral column
to the lateral border of the ribs
should be equidistant on
each

s
ide.

5.

Exposure should cleary demonstrate
the lung fields.
































Ches
t

A
-
P

(Including Abdomen)

Position technique

1.
SID=180 or 150 cm
.

2. Position the patient for the AP body
positioneither erect or recumbent.

3. Central ray
perpendicular to the
plane of detector direct it to the
(T
10
).


Evaluation criteria


1.Medial portion of the clavicles
should be equidistant from the
vertebral column.

3.
Distance from the vertebral column
to the lateral border of the ribs
should be equid
istant on
each

side.

4.
Exposure should cleary demonstrate
the lung fields.

5.
1/2 pelvis was seen.




































xiphoid tip

lung

gas

Ches
t

A
-
P

(Including Both
S
houlder)

Position technique

1.SID=180 or 150 cm
.

2.
Position the patient for the AP body
positioneither erect or recumbent.

3.Central ray perpendicular to the plane
of detector direct it to the manubrium
for the lungs and to the mid
-
sternum
fore the heart.


Evaluation criteria

1.
Medial portion of the clavicles should
be equidistant from the v
ertebral
column.

2.
Trachea should be seen in the
midline.

3.
Lateral aspects of the lung fields
including costophrenic angles must
including.

4.Distance from the vertebral column to
the lateral borderof the ribs should be
equidistant on
each

side.

5.
Exposure should cleary demonstrate
the lung fields.

6.Including both shoulder.




















Ches
t

Lateral

Position technique

1.SID=180 cm
.

2.Turn

the patient
to a ture lateral

position

with the right or left side
against the detector
.

3. Central

ray perpendicular to and
directed to level of T
7.

(8
-
10 cm
below level of jugular notch.)

Evaluation criteria

1.
No rotation

,ribs posterior to vertebral
column should be directly
superimposed;costophrenic
anglesshould be aligned and
superimposed.

2.Chin a
nd arms should be elevated
sufficiently to prevent excessive soft
tissues from superimposing apices.

3.
Image should include lung apices at
the top and costophrenic angles on
the lower margin of the film.

4.
The hilum region should be in the
approximate cent
er of the film.

5.
No motion

,should be evidenced by
sharp outlines of the diaphragm and
lung markings.

6.
Should have sufficient exposure and
long scale contrast to visualize lung
markings through the heart shadow
and upper lung areas.


















Ches
t

Oblique

Position technique

1.
SID=180 cm
..

2.
CR perpendicular directed to level of
T7
(8 to 10cm below level of vertebra
prominens.
)

3.
Centr patient erect,rotated 45°with
left anterior shoulder against IR for
the LAO;and 45°with right anteriot
shou
lder against IR for the RAO.

4.patient’s arm flexed nearest IR a
nd
place hand on hip,palm out
.

Evaluation criteria

1.

Both lungs form the apices to the
costophrenic angles should be
included.
T
he air
-
filled trachea, great
vessels and heart outlines are bes
t
visualized on a 60 LAO. (A 45 RAO
will also visualize these structures.)

2.
Position: To evaluate for a
45°rotation , the distance form the
outer margin of the ribs to the
vertebral column on the side farthest
form the IR should be approximately
two times

the distance of the side
closest to the IR.

3.
No motion; the outline of the
diaphragm and heart should appear
sharp. Optimal exposure and contrast
visualize vascular markings
throughout lungs and rib outlines
except through the most dense


regions of the

hear.















LAO

R
AO

Ches
t

AP
Lordotic

Position technique

1.SID=180 cm
.

2.Have
patient
stand about one foot
away from detector holder and lean
back with shoulders,neck and back
of head against detector holder.

3.
Central ray perpendicular to the pla
ne
of detector direct it to the
mid
-
sternum(9cm below jugular
notch).

4.Rest both hands on hips, palms out;
roll shoulders forward.

Evaluation criteria

1.Clavicles should appear nearly
horizontal and above or superior to
apices.

2.Center of collimation fie
ld should be
mid
-
sternum with more collimation
visible on the botton
.

3.No rotation
,sternal ends of the
clavicle should be the same distance
from the vertebral column on
each

side.distance from the vertebral
column to the lateral border of the ribs
sho
uld be equidistant on
each

side.

4.No motion ,
diaphragm heart and rib
should be evidenced by sharp outlines.

5.Optimum contrast scale and exposure
should visualize the faint vascular
markings of lungs,expecially in area


of apices and upper lungs.















clavicle

apex

Ches
t Decubitus

Position technique

1.
SID=
100

cm
.

2.C
ardiac board on the cart or
radiolucent pad
n
under patintet
.

3.
Patient lying on right side for right
lateral decubitus and on left side for
left lateral
decubitus.

4.
CR horizontal,dirdcted t
o center of IR
to levelof T7.8 to 10 cm inferior to
level of jugularontch.A horizontal
beam must be used to show air
-
fluid
level or pneumothorax
.

Evaluation criteria

1.S
tructures shown: Entire lungs
including apicesand both
costophrenic angles and both l
ateral
borders of ribs should be included.

2.
Posotopm: NO rotation should have
equal distance form vertebral column
to the lateral borders of ribs on
both sides; sternoclavicular joints
should be same distance form the
vertebral column.Arms should not
s
uperimpose upper lungs.

3.
Exposure Criteria:No
motion;diaphragm,ribs andheart
borders,and lung markings should
appear sharp .Optimal contrast scale
and exposure

should result
in faint
visualization of vertebraeand ribs
through heart shadow.

















Rib

Position technique

1.
SID=180 or
100

cm
.

2.Roate patient into 45 degree posterior
or anterior oblique,affected side
closest to film on posterior oblique;
and affected sideaway from film on
anterior oblique.

3.Central ray perpendicular

to the plane
of detector, centered midway
between lateral margin of rib and
spine.

Evaluation criteria

1.A 45 degree oblique be evident in that
distance between the vertebral
column and the lateralrib margin on
the affected side should be about
twice t
he distance on the unaffected
side.

2.No motion of the rib margins should
be evident on the radiography.

3.The axillary portion of the ribs,
involving the side of injury (above or
below diaphragm),should be
elongated, cleary seen and included

in the colli
mation field.




















Sternum

(RAO)

Position technique

1.
SID=100cm.

2.
RAO position average 15 to 20
degrees.

3.
Central ray perpendiculary to the
midsternal area.

4.
The vertical central ray is centred so
the emerging beam exits at a point

on
the sternum midway between the
xiphisternum and the sternal notch,
on the dorsal skin surface this is
approximately 5 cm lateral to the
spinous processes on the raised side
at the level of the palpable 8th
thoracic verebral spinous process.


Evaluatio
n criteria

1.ID and anatomical markers must be
present

and correct in the appropriate
area of the film.

2.Optimal exposure should penetrate all
the

bone structures and contrast
should be low enough to visualise
fully the bone and soft tissue

structures.

3.
The complete structure of manubrium,
sternum and xiphisternum should be
projected just clear of the spine.


















Sterum (Lat)

Position technique

1.
SID=1
00

cm
.

2.The horizontal central ray is centered
to the body of the sternum
immediately

below the

skin surface
midway between the sternal notch
and xiphisternum.


Evaluation criteria

1.ID and anatomical markers must be
present and correct in the appropriate
area of the film.

2.Optimal exposure should penetrate all
the

bone structures and co
ntrast
should be low enough to visualize
fully the bone and soft tissue

structures.

3.The complete structure of manubrium,
sternum and xiphisternum should be
projected

just clear of ribs and in true
lateral position.








.

















PA Sternoclavicular joints Projection

Position technique

1.
SID=
100
cm
..

2.The patient is prone, with the

chin
resting on the table,or upright, facing
the buckyholder.both arms are placed
along the sides.The sternoclavicular
joints are centered to t
he detector.

3.Central ray perpendicular to the plane
of detector entering 3 inches inferior
to the C7 spinous process and
passing through the manubrium .


Evaluation criteria

1.The medial end of the clavicles and
the sternoclavicular joints should be
well

demonstrated.theres hould be no
body rotation, as evidenced by
visualization of both joints.Body
rotation will obscure one joint by
superimposition over the spine.






.


















Serendipity Axil Sternoclavicular joint
Projection

Position technique

1.
SID=
150
cm
.

2.The patient is supine

on the table with
the cassette under the head and neck.

3.Angled 40 degree cephalad,entering
at the sternal angle.




Evaluation criteria

1.An axil projection of the
sternoclavicular joints shoul
d be
demonstrated..

2.The medial end of the clavicles
should be projected superior to the
first rib but

will be superimposed
over the cervical spine.

3.The medial end of the clavicle will be
superiorly displaced with anterior

dislocation and inferiorly dis
placed
with posterior dislocation



















Abdomen Supine

Position technique


1.

SID=100cm

2.

Arms at patient’s sides, away from
body
.

3.

Upright, legs slightly, back against
table device.

4.

Supine with midsagittal plane
centered to midline of wall table.

5.

No rotation of pelvis or shoulders.

6.

Central ray into 2 in. (5 cm) above
the iliac crest
s to include diaphragm.

Evaluation criteria


1.

Vertebral column should be aligned
to center of radiography.

2.

No rotation: Pelvis and lumbar
vertebrae should appear symmetrical.

3.

Lateral collimation margins should
be visible for most patients unless
such would
cut off essential
abdominal anatomy.

4.

No motion: ribs, diaphragm and gas
bubble margins appear sharp.

5.

Should have sufficient exposure and
long scale contrast to visualize psoas
muscle outlines, lumbar transverse
processes and ribs small to average
sized pat
ients, unless these areas are
obscured by gas in bowel.


























Abdomen Standing

Position technique


1.

SID=100cm

2.

Arms at patient’s sides
,
away from
body
.

3.

Midsagittal plane of body centered
to midline of table.

4.

No rotation of pelvis or shoulders.

5.

Central ray into 2 in. (5 cm) above
the iliac crests to include diaphragm.

Evaluation criteria


1.

Vertebral colu
mn should be aligned
to center of radiography.

2.

No rotation: Pelvis and lumbar
vertebrae should appear symmetrical.

3.

Lateral collimation margins should
be visible for most patients unless
such would cut off essential
abdominal anatomy.

4.

No motion: ribs, diaph
ragm and gas
bubble margins appear sharp.

5.

Should have sufficient exposure and
long scale contrast to visualize psoas
muscle outlines, lumbar transverse
processes and ribs small to average
sized patients, unless these areas are
obscured by gas in bowel.





















Abdomen Decubitus

Position technique


1.

SID=100cm

2.

Lateral recumbent on radiolucent pad, back firmly against table.

3.

Knees partially flexed, one on top of the other to stabilize patient.

4.

Arms up near head, provide clean pillow.

5.

Midsagitt
al plane of body centered to midline of table.

6.

Insure no rotation of pelvis or shoulders.

7.

Central ray into 2 in. (5 cm) above the iliac crests to include diaphragm.

8.

Patient should be on side a minimum of 5 minutes before exposure.

9.

Left lateral Decubitus be
st demonstrates free air within abdominal cavity in the
area of the liver in the right upper abdomen.

Evaluation criteria


1.

Upper margin of radiograph should include the diaphragm.

2.

No rotation: Pelvis should appear symmetrical with right and left iliac wings
appearing equal in size and shape, and the outer margins of the ribs should be the
same distance from the vertebral col
umn.


3.

If both sides con not be included, the upper side must be included.

4.

No motion: ribs, diaphragm and gas shadow margins appear sharp.

5.

Overall exposure and density should appear slightly less than supine abdomen to
better visualize air
-
fluid levels and
free intra
-
abdominal air if present.





76


















77

KUB Supine

Position technique


1.

SID

100 cm

2.

Arms at patient’s sides,away from
body
.

3.

Supine with midsagittal plane
centered to midline of table.

4.

No rotation of pelvis or shoulders.

5.

Central ray into iliac crests.

Evaluation criteria


1.

Lower margin of radiography
should include at the sym
physis
pubis.

2.

Upper abdomen should be included
visualizing the upper margins of the
kidneys .

3.

Vertebral column should be aligned
to center of radiography.

4.

No rotation: Pelvis and lumbar
vertebrae should appear symmetrical.

5.

Should have sufficient exposure a
nd
long scale contrast to visualize psoas
muscle outlines, lumbar transverse
processes and ribs. Margins of liver
and kidneys should be visible on
smaller to average size patients.




















76

KUB Standing

Position technique


1.

SID

100 cm

2.

Arms at patient’s sides

away from
body
.

3.

Upright, legs slightly, back against
table device.

4.

Midsagittal plane of body centered
to midline of wall table.

5.

No rotation of pelvis or shoulders.

6.

Central ray into iliac crests.

Evaluation criteria


1.

Lo
wer margin of radiography
should include at the symphysis
pubis.

2.

Upper abdomen should be included
visualizing the upper margins of
the kidneys .

3.

Vertebral column should be aligned
to center of radiography.

4.

No rotation: Pelvis and lumbar
vertebrae should ap
pear
symmetrical.

5.

Should have sufficient exposure
and long scale contrast to visualize
psoas muscle outlines, lumbar
transverse processes and ribs.
Margins of liver and kidneys
should be visible on smaller to
average size patients.




















77

Low

KUB

Position technique


1.

SID=100cm

2.

Arms at patient’s sides
,
away from
body
.

3.

Supine with midsagittal plane
centered to midline of table.

4.

No rotation of pelvis or shoulders.

5.

Central ray into iliac crests inferior
2~3 cm.

Evaluation criteria


1.

Lower margin of

radiography
should include at the symphysis
pubis.

2.

Upper abdomen should be included
visualizing the upper margins of the
kidneys .

3.

Vertebral column should be aligned
to center of radiography.

4.

No rotation: Pelvis and lumbar
vertebrae should appear
symmetri
cal.

5.

Should have sufficient exposure and
long scale contrast to visualize
psoas muscle outlines, lumbar
transverse processes and ribs.
Margins of liver and kidneys should
be visible on smaller to average size
patients.























78

Pelvis AP

Position technique


1.

SID=100 cm

2.

Align midsagittal plane of patient to
center line of table.

3.

Knees partially flexed, one on top of
the other to stabilize patient.

4.

Insure that pelvis is no rotation; the
distance from table
-
top to each
ASIS(anterior superio
r iliac spine)
should be equal.

5.

Separate legs and feet, then
internally rotate long axes of feet and
lower limbs 15
-
20°.

6.

Central ray into a point midway
between the level of the ASIS and
superior border of the symphysis
pubis.

Evaluation criteria


1.

Entire p
elvis and proximal femora
should be included and centered on
film.

2.

Collimation borders will be minimal
on larger patients. Smaller patients
should show equal lateral collimation
borders just lateral to greater
trochanters.

3.

No rotation: The iliac ala or win
gs
should appear symmetrical. The right
and left ischial spines should appear
equal in size as well as the two
obturator foramina.


4.

Lesser trochanters should not be
visible at all or only tips be visible,
and greater trochanters should appear
in size and s
hape.

5.

Optimum exposure will visualize L5
and sacrum area and margins of the
femoral heads and acetabula as seen
through overlying pelvic structures
without overexposing the ischium
and pubic bones. Trabecular marking
of proximal femora and pelvic
structure
s will appear clear and
sharp.











79

Pelvis Including Upper Femur

Position technique


1.

SID=100 cm

2.

Align midsagittal plane of patient to
center line of table.

3.

Knees partially flexed, one on top of
the other to stabilize patient.

4.

Insure that pelvis is no rotation; the
distance from table
-
top to each
ASIS(anterior superior iliac spine)
shoul
d be equal.

5.

Separate legs and feet, then
internally rotate long axes of feet and
lower limbs 15
-
20°.

6.

Both feet between into Pb rule.

7.

Central ray into the symphysis
pubis.

Evaluation criteria


1.

Entire pelvis and proximal femora
should be included and center
ed on
film.

2.

Collimation borders will be minimal
on larger patients. Smaller patients
should show equal lateral collimation
borders just lateral to greater
trochanters.

3.

No rotation: The iliac ala or wings
should appear symmetrical. The right
and left ischia
l spines should appear
equal in size as well as the two
obturator foramina.


4.

Lesser trochanters should not be
visible at all or only tips be visible,
and greater trochanters should appear
in size and shape.

5.

Optimum exposure will visualize L5
and sacrum are
a and margins of the
femoral heads and acetabula as seen
through overlying pelvic structures
without overexposing the ischium
and pubic bones. Trabecular marking
of proximal femora and pelvic
structures will appear clear and
sharp.











80

Pelvis Fr
og

Position technique


1.

SID=100 cm

2.

Align patient to midline of table,
pelvis be no rotated.

3.

Flex both hips and knees as far as is
comfortable.

4.

Place the plantar surfaces of feet
together and abduct both thighs as far
as possible.

5.

Central ray into a point midway
between the leve
l of the ASIS and
superior border of the symphysis
pubis (40° from vertical if possible
but more importantly insure that both
thighs are abducted the same
amount).

Evaluation criteria


1.

The pelvic girdle should be center to
the film or collimation field fro
m
right to left with the mid point being
at about 1 in. (2.5cm) superior to the
symphysis pubis.

2.

No rotation: as evidenced by the
symmetrical appearance of the pelvic
bone, especially the ala of the ilium
and the two obturator foramina.

3.

Lesser trochanters
should appear
equal in size as projected beyond the
lower or medial margin of the
femora.

4.

The femoral heads, necks and


greater trochanters should appear
symmetrical if both thighs were
abducted equally.

5.

Optimum exposure will visualize
the margins of the
femoral heads and
acetabula as seen through overlying
pelvic structures without
overexposing the ischium and pubic
bones. Trabecular marking of
proximal femora and pelvic
structures will appear clear and
sharp.












81

Pelvis Inlet

Position techn
ique


1.

Align midsagittal plane to midline
of table.

2.

The patient is supine, with legs
extended.

3.

Insure no rotation pelvis; the
distance from table
-
top to each
ASIS(anterior superior iliac spine)
should be equal.

4.

Tube 35~40° cauded, central ray at
the level of th
e anterior superior iliac
spine.

Evaluation criteria


1.

No rotation: Obturator foramina be
close in film.

2.

Elongated and magnified pubic and
ischial bones superimposed over the
sacrum and coccyx should be
centered to film.

3.

Lateral margins of collimation fiel
d
should extend equally on both side to
just lateral to the femoral heads and
acetabula.

4.

An axial projection of the pelvic
ring should be demonstrated. When
the anterior and posterior portions are
properly exposed, the iliac wings are
often obscured by exc
essive
radiographic density.

5.

Optimum exposure will visualize
the margins of the femoral heads and

acetabula as seen through overlying
pelvic structures without
overexposing the ischium and pubic
bones. Trabecular marking of
proximal femora and pelvic
str
uctures will appear clear and
sharp.

6.

Medially superimposed superior and
inferior ram of the pubic bones.














35
-
40°


82

Pelvis Outlet

Position technique


1.

Align midsagittal plane to midline
of table.

2.

The patient is supine, with legs
extended.

3.

Insure no
rotation pelvis; the
distance from table
-
top to each
ASIS(anterior superior iliac spine)
should be equal.

4.

Tube 35~45° cephalad, central ray at
the inferior aspect of the symphysis
pubic.

Evaluation criteria


1.

No rotation: Obturator foramina be
open in film.

2.

Elongated and magnified pubic and
ischial bones superimposed over the
sacrum and coccyx should be
centered to film.

3.

Lateral margins of collimation field
should extend equally on both side to
just lateral to the femoral heads and
acetabula.

4.

Mach of the ili
ac wings are
obscured by superimposition of the
acetabular portions.

5.

Optimum exposure will visualize
the margins of the femoral heads and
acetabula as seen through overlying
pelvic structures without
overexposing the ischium and pubic


bones. Trabecular m
arking of
proximal femora and pelvic
structures will appear clear and
sharp.

6.

Pubic and ischial bones magnified
with pubic bones superimposed over
the sacrum and coccyx.
















83

Pelvis Iliac Oblique

Position technique


1.

SID=100 cm

2.

The patient i
s placed in a 45°
posterior oblique body position, with
the side of interest down (Closest to
the table).

3.

Central ray perpendicular to the
table, entering the symphysis pubic.

Evaluation criteria


1.

The affected side down (iliac
oblique) position should dem
onstrate
the posterior (ilioischial) column and
anterior rim of the affected
acetabulum. The iliac wing of the
affected side should be seen without
foreshortening.

2.

Femoral head in profile to show the
concave area of the fovea capitis.

3.

superoposterior wal
l of the
acetabulum.




























84

Pelvis Obturator

Position technique


1.

SID=100 cm

2.

The patient is placed in a 45°
posterior oblique body position, with
the side of interest up (farthest from
table).

3.

Central ray perpendicular to the
table, entering 2 in. inferior to the
anterior superior iliac spine of the
side up (affected s
ide).

Evaluation criteria


1.

The affected side down (obturator
oblique) position should demonstrate
the posterior (iliopubic) column and
anterior rim of the affected
acetabulum. The iliac wing of the
affected side should be seen without
foreshortening.

2.

Ac
etabula in profile.

3.

Ilium, ischium, and pubic bones not
overlapping the acetabular region.


























85

Sacro
-
Iliac Joint

Position technique


1.

SID=100 cm

2.

Turn into 25
-
30° posterior oblique, side of interest is elevated.

3.

LPO will visualize

right joint.

4.

RPO will visualize left joint.

5.

Use some angle measuring device to insure correct and consist angles on both
oblique.

6.

Place support under elevated hip and flex elevated knee. Ask patient to reach
across and grasp edge of table to help maintain

this position.

7.

Central ray to level of ASIS.

Evaluation criteria


1.

Joint space on side of interest should appear open.

2.

The ala of the ilium and the sacrum should have no overlap indicating the correct
obliquity.

3.

Optimum exposure will clearly visualize the
margins of the joint space along its
entirety.











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