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3-2-1 Code It
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ISBN:9781337660549
Author:GREEN
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Chapter14: Cpt Surgery Iv
Section: Chapter Questions
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read the article that is in the images and write the most important data
11:50 p. m. Mar 28 mar.
246 de 633
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ositioning for the abdomen is relatively straightforward,
but visualization can be difficult owing to its similarity
in densities and the presence of multiple organ systems.
There are subtle differences in tissue density of the abdomen,
with significantly less natural contrast than found in the
thorax. The abdomen depends on the gas within the gastro-
intestinal (GI) tract and the fat in the peritoneal and retro-
peritoneal areas for contrast. Contrast media are often
required to visualize differences.
Radiographic Concerns
• Appropriate kilovolt peak (kVp) and milliampere-seconds
(mAs) should be used to differentiate the various shades
of gray between organs and structures (generally use a
higher kVp for the abdomen and thorax which provides
more shades of grey, and a lower mAs (for shorter expo-
sure and thus less motion artifacts). Because of the
difference in thickness between the chest and caudal
abdomen, deep-chested dogs exhibit a marked difference
in density between the cranial and caudal halves of the
abdomen. This is especially evident in the ventrodorsal
(VD) view. Two separate exposures measured at the
thickest part of each site may be needed. If there is only
a minimal difference in anatomical thickness, a compro-
mise can be made. Using the same technique with digital
radiography may be possible for the full abdomen of
such dogs.
The two positions commonly viewed are the right or left
lateral and ventrodorsal (Box 18-1). It is important to be
consistent so that abnormalities can quickly be spotted.
Contrast studies and other situations may also require
further views.
If a right lateral view is used, the animal is lying on its
right side. Technically the correct terminology is left-
right lateral (Le-RtL), if one considers, "point of entrance
of the beam to point of exit;" however, this term is not
generally used.
Take advantage of the heel effect (the thickest part toward
the cathode) to help reduce density differences, especially
in the VD or DV views.
Use a 14 in x 17 in image receptor for large dogs. A very
large dog will likely require two radiographs-measure at
the respective cranial and caudal abdomen.
A grid must be used if the measurement exceeds 11 cm,
to prevent scatter that causes fogging, which further
decreases the contrast.
To help prevent motion artifacts, use as high a milliam-
perage setting as possible, to produce the shortest expo-
sure setting.
• Take the radiograph at the end of expiration, when a brief
pause often occurs.
CHAPTER 18 Small Animal Abdomen
BOX 18-1 Protocol for Abdominal Radiography
Routine Views
Right or left lateral
Ventrodorsal
Optional Views
Dorsoventral
Lateral decubitus
Modified lateral/lateral oblique
185
• To minimize intestinal artifacts and prevent misdiagnosis,
fast the patient (if possible) about 12 hours before and
administer a cleansing enema about 3 to 4 hours prior to
taking a radiograph, to clear the intestinal tract of fecal
matter. This preparation is more important for contrast
studies. See Chapter 25.
• To minimize radiation exposure to the personnel restrain-
ing a patient, nonmanual restraint should be utilized
whenever possible. Use of a sedative or tranquilizer may
be needed. The use f nonmanual restraint is illustrated
in most of the following positions. Try to give the patient
the illusion that it is being held by appropriate use of
sandbags, tape, and so on. For further suggestions, please
see Chapter 17.
Abdominal compression may be utilized to reduce the
thickness of the anatomical part. Compression moves an
underlying organ to improve the visualization of a sus-
pected lesion, as well as reducing the thickness which
decreases scatter radiation. Remeasure the patient after
compression has been applied, and use this new thickness
to obtain the new kVp.
TECHNICIAN NOTES
position in which it is to be
Measure the animal in the
imaged.
TECHNICIAN NOTES Have everything ready prior
to taking the exposure. This includes measuring the animal,
turning on the machine, setting the main voltage calibration
if required, having proper source-image distance, and
setting the exposures. Have the image receptors ready.
Positioning devices should be close at hand, but remove
any objects or distractions not utilized, to minimize scatter
radiation.
The patient should be clean, should have no artifacts in
the area of interest, and should be chemically restrained if
possible.
46% (
Transcribed Image Text:11:50 p. m. Mar 28 mar. 246 de 633 web.whatsapp.com ositioning for the abdomen is relatively straightforward, but visualization can be difficult owing to its similarity in densities and the presence of multiple organ systems. There are subtle differences in tissue density of the abdomen, with significantly less natural contrast than found in the thorax. The abdomen depends on the gas within the gastro- intestinal (GI) tract and the fat in the peritoneal and retro- peritoneal areas for contrast. Contrast media are often required to visualize differences. Radiographic Concerns • Appropriate kilovolt peak (kVp) and milliampere-seconds (mAs) should be used to differentiate the various shades of gray between organs and structures (generally use a higher kVp for the abdomen and thorax which provides more shades of grey, and a lower mAs (for shorter expo- sure and thus less motion artifacts). Because of the difference in thickness between the chest and caudal abdomen, deep-chested dogs exhibit a marked difference in density between the cranial and caudal halves of the abdomen. This is especially evident in the ventrodorsal (VD) view. Two separate exposures measured at the thickest part of each site may be needed. If there is only a minimal difference in anatomical thickness, a compro- mise can be made. Using the same technique with digital radiography may be possible for the full abdomen of such dogs. The two positions commonly viewed are the right or left lateral and ventrodorsal (Box 18-1). It is important to be consistent so that abnormalities can quickly be spotted. Contrast studies and other situations may also require further views. If a right lateral view is used, the animal is lying on its right side. Technically the correct terminology is left- right lateral (Le-RtL), if one considers, "point of entrance of the beam to point of exit;" however, this term is not generally used. Take advantage of the heel effect (the thickest part toward the cathode) to help reduce density differences, especially in the VD or DV views. Use a 14 in x 17 in image receptor for large dogs. A very large dog will likely require two radiographs-measure at the respective cranial and caudal abdomen. A grid must be used if the measurement exceeds 11 cm, to prevent scatter that causes fogging, which further decreases the contrast. To help prevent motion artifacts, use as high a milliam- perage setting as possible, to produce the shortest expo- sure setting. • Take the radiograph at the end of expiration, when a brief pause often occurs. CHAPTER 18 Small Animal Abdomen BOX 18-1 Protocol for Abdominal Radiography Routine Views Right or left lateral Ventrodorsal Optional Views Dorsoventral Lateral decubitus Modified lateral/lateral oblique 185 • To minimize intestinal artifacts and prevent misdiagnosis, fast the patient (if possible) about 12 hours before and administer a cleansing enema about 3 to 4 hours prior to taking a radiograph, to clear the intestinal tract of fecal matter. This preparation is more important for contrast studies. See Chapter 25. • To minimize radiation exposure to the personnel restrain- ing a patient, nonmanual restraint should be utilized whenever possible. Use of a sedative or tranquilizer may be needed. The use f nonmanual restraint is illustrated in most of the following positions. Try to give the patient the illusion that it is being held by appropriate use of sandbags, tape, and so on. For further suggestions, please see Chapter 17. Abdominal compression may be utilized to reduce the thickness of the anatomical part. Compression moves an underlying organ to improve the visualization of a sus- pected lesion, as well as reducing the thickness which decreases scatter radiation. Remeasure the patient after compression has been applied, and use this new thickness to obtain the new kVp. TECHNICIAN NOTES position in which it is to be Measure the animal in the imaged. TECHNICIAN NOTES Have everything ready prior to taking the exposure. This includes measuring the animal, turning on the machine, setting the main voltage calibration if required, having proper source-image distance, and setting the exposures. Have the image receptors ready. Positioning devices should be close at hand, but remove any objects or distractions not utilized, to minimize scatter radiation. The patient should be clean, should have no artifacts in the area of interest, and should be chemically restrained if possible. 46% (
11:50 p. m. Mar 28 mar.
186
Positions
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PART TWO Radiographic Positioning and Related Anatomy
Lateral
Positioning
Place in: Right lateral recumbency. This tends to be the
conventional position.
Head: Keep in a natural position; hold appropriately with
a sandbag over the neck. Be careful not to restrict
breathing.
Forelimbs: Pull cranially and sandbag. Place a small foam
pad between the forelimbs to help eliminate rotation of
the cranial abdomen.
Hind Limbs: Pull together caudally and sandbag, to prevent
superimposition of the femoral muscles, which can mask
portions of the urinary bladder and prostate. Place a foam
pad of suitable thickness between the femurs to help
eliminate rotation of the caudal abdomen and pelvis.
Sternum: Elevate with wedged sponges so the sternum is at
the same plane as the thoracic vertebrae.
Comments and Tips
Place any ID or markers on the ventral aspect of the
abdomen.
MEASURE: Caudal aspect of 13th rib-at the thickest area
(unless interested in a specific region).
CENTRAL RAY: Canine: Over caudal aspect of 13th rib at
level of L2-L3.
Feline: Two to three fingerbreadths caudal to 13th rib.
BORDERS: Collimate cranially from the caudal aspect of T7
(full diaphragm and heart apex) and caudally to the greater
trochanter to include the coxofemoral joints.
FIGURE 18-1 Proper positioning for the lateral abdomen view of a
canine.
• Ensure that the sternum and spine are on the same plane
and parallel to the image receptor; the central ray is per-
pendicular to both.
Expose immediately at the end phase of expiration.
During expiration there is maximum amount of space for
the abdominal contents as the lungs contract and the
diaphragm relaxes.
Focal radiographs using gentle pressure with a compres-
sion paddle such as a wooden spoon or plastic paddle
may effectively isolate organs such as the kidneys in a VD
position. Remember to remeasure the patient because
the decreased thickness will allow for a lower kVp and
thus more contrast.
• There is better longitudinal separation of the kidneys' in
a right lateral view, and the spleen is more consistently
identified. Left lateral is preferable in vomiting patients,
because gas is moved to the pyloric antrum and can
potentially highlight a foreign body.
• A left lateral view may also be required in contrast studies,
after the administration of contrast media.
TECHNICIAN NOTES Remember to go through
your mental check list before pushing the exposure button.
See Chapter 17.
TECHNICIAN NOTES To get maximum expiration:
• If the patient is panting, cup or blow on the nose to
momentarily stop breathing.
• Put light pressure on the
expiration.
abdomen to facilitate
Breathe with the animal for few breaths to determine
proper point of exposure. Have the rotor depressed
(initial button of a two-step process) so that the moment
breathing is paused the exposure can be taken.
46%
Transcribed Image Text:11:50 p. m. Mar 28 mar. 186 Positions web.whatsapp.com PART TWO Radiographic Positioning and Related Anatomy Lateral Positioning Place in: Right lateral recumbency. This tends to be the conventional position. Head: Keep in a natural position; hold appropriately with a sandbag over the neck. Be careful not to restrict breathing. Forelimbs: Pull cranially and sandbag. Place a small foam pad between the forelimbs to help eliminate rotation of the cranial abdomen. Hind Limbs: Pull together caudally and sandbag, to prevent superimposition of the femoral muscles, which can mask portions of the urinary bladder and prostate. Place a foam pad of suitable thickness between the femurs to help eliminate rotation of the caudal abdomen and pelvis. Sternum: Elevate with wedged sponges so the sternum is at the same plane as the thoracic vertebrae. Comments and Tips Place any ID or markers on the ventral aspect of the abdomen. MEASURE: Caudal aspect of 13th rib-at the thickest area (unless interested in a specific region). CENTRAL RAY: Canine: Over caudal aspect of 13th rib at level of L2-L3. Feline: Two to three fingerbreadths caudal to 13th rib. BORDERS: Collimate cranially from the caudal aspect of T7 (full diaphragm and heart apex) and caudally to the greater trochanter to include the coxofemoral joints. FIGURE 18-1 Proper positioning for the lateral abdomen view of a canine. • Ensure that the sternum and spine are on the same plane and parallel to the image receptor; the central ray is per- pendicular to both. Expose immediately at the end phase of expiration. During expiration there is maximum amount of space for the abdominal contents as the lungs contract and the diaphragm relaxes. Focal radiographs using gentle pressure with a compres- sion paddle such as a wooden spoon or plastic paddle may effectively isolate organs such as the kidneys in a VD position. Remember to remeasure the patient because the decreased thickness will allow for a lower kVp and thus more contrast. • There is better longitudinal separation of the kidneys' in a right lateral view, and the spleen is more consistently identified. Left lateral is preferable in vomiting patients, because gas is moved to the pyloric antrum and can potentially highlight a foreign body. • A left lateral view may also be required in contrast studies, after the administration of contrast media. TECHNICIAN NOTES Remember to go through your mental check list before pushing the exposure button. See Chapter 17. TECHNICIAN NOTES To get maximum expiration: • If the patient is panting, cup or blow on the nose to momentarily stop breathing. • Put light pressure on the expiration. abdomen to facilitate Breathe with the animal for few breaths to determine proper point of exposure. Have the rotor depressed (initial button of a two-step process) so that the moment breathing is paused the exposure can be taken. 46%
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