Radiographic Techniques: Urinary Bladder - PDF

Radiographic techniques Urinary bladder :BY Ahmed Jasem Abass  MSC of Medical Imaging Urinary tract  The right posterior oblique projection shows the right kidney and collecting system in profile. Similarly, the left posterior oblique projection shows the left kidney in pro...

Radiographic techniques Urinary bladder :BY Ahmed Jasem Abass  MSC of Medical Imaging Urinary tract  The right posterior oblique projection shows the right kidney and collecting system in profile. Similarly, the left posterior oblique projection shows the left kidney in profile. A lateral projection may be necessary to confirm the presence of opacities anterior to the renal tract, which will be seen superimposed on the antero-posterior projection. Right posterior oblique  Position of patient and cassette  The patient lies supine on the table. The left side of the trunk and thorax is raised until the median sagittal plane is at an angle of 15–20 degrees to the table.  The patient should be in the midline of the table; and immobilized in this position.  For the kidney area alone, a 24 _ 30 cm cassette is placed transversely in the Bucky tray and centred to a level midway between the xiphisternal joint and umbilicus.  For the whole of the renal tract, a 35 _ 43-cm cassette might be required; this is centred at the level of the lower costal margin.  Direction and centring of the X-ray beam  The vertical central ray is directed to the centre of the cassette. Note Excessive rotation of the patient will show the right kidney projected over the spine. Lateral  Position of patient and cassette  The patient is turned on to the side under examination, with the hands resting near the head. The hips and knees are flexed for stability.  With the median sagittal plane parallel to the table, the vertebral column is positioned over the midline of the table.  The cassette is placed in the tray and, for the kidney area, about 5 cm superior to the lower costal margin.  Direction and centring of the X-ray beam  The vertical central ray is directed to the centre of the cassette and the exposure made on arrested expiration. Lateral Urinary bladder  Calculi within the urinary bladder can move freely particularly if the bladder is full whereas calcification and calculi outside the bladder, e.g. prostatic calculi, are immobile. AP and oblique projections can be taken to show change in relative position of calculi and bladder. To examine the bladder region, caudal angulation is required to allow for the shape of the bony pelvis and to project the symphysis below the apex of the bladder. Antero-posterior 15° caudal (Figs 10.13a, 10.13b)  Position of patient and image receptor  The patient lies supine on the Bucky table with the median sagittal plane at right-angles to, and in the midline of the table.  A 24 × 30 cm CR cassette is commonly used; this is placed transversely in the tray with its lower border 5 cm below the symphysis pubis. Then adequate collimation to demonstrate this area is required.  Direction and location of the X-ray beam  The collimated central ray is directed 15° caudally and centred in the midline 5 cm above the upper border of the symphysis pubis. (e.g. midway between the anterior superior iliac spines and upper border of the symphysis pubis). Antero-posterior 15° caudal (Figs 10.13a, 10.13b) Right or left posterior oblique (Figs 10.13c, 10.13d)  Position of patient and image receptor  From the supine position one side is raised so that the median sagittal plane is rotated through 35° to the right or left side.  To help stability, the knee in contact with the table is flexed and the raised side supported using a non-opaque pad.  The patient’s position is adjusted so that the midpoint between the symphysis pubis and the anterior superior iliac spine on the raised side is over the midline of the table/receptor.  A 24 × 30 cm CR cassette is placed longitudinally in the tray with its upper border at the level of the anterior superior iliac spines, then adequate collimation to demonstrate this area is required. Right or left posterior oblique (Figs 10.13c, 10.13d)  Direction and location of the X-ray beam  The collimated vertical central beam is directed to a point in the midline 2.5 cm above the symphysis pubis.  Alternatively a caudal angulation of 15° can be used and the receptor displaced downwards to accommodate the angulation and allow for better demonstration of the apex of the bladder. Thank You