Techniques for Chest and Abdomen: Awake and Sedate
World Small Animal Veterinary Association Congress Proceedings, 2019
J. Bitan; A. Jenner

Hands-Free X-Rays, North York, ON, Canada


Thoracic and abdominal radiographs are the most common radiographs taken in small animal clinics. Many clinics will do upwards of 10+ radiographic studies per week. With the ease of digital radiography, the number of radiographs taken per study has increased from the days of film.

Most patient requiring thoracic or abdominal radiographs do not require sedation—however, some patients may benefit from a sedative or analgesic. This will be discussed further in the sedation section. For awake patients, it is imperative that the patient is comfortable to allow for compliance with positioning. A comfortable patient is key to being successful with hands-free radiographs.

Remember: As technicians (or anyone non-DVM performing radiographs), we have 3 questions to ask ourselves in regard to quality of the radiograph:

1.  Exposure—Is the exposure appropriate?

2.  Inclusion—Do I have all anatomy included?

3.  Positioning—Do I have the right views, and is it straight/rotated?

Chest (Thoracic) Views

  • Thoracic radiographs should be taken on inspiration to allow for complete expansion of the lungs.
  • Two views (lateral and dorsoventral) are recommended for patients with heart failure.
  • Three views (both laterals, and ventrodorsal) are recommended for patients requiring a metastasis check or assessment of aspiration pneumonia.
  • Techniques for diagnostic thoracic radiographs should include a low mas and high kvp.

Lateral Views (Right/Left)

Dogs

Positioning Tips

  • Collimation: Point of shoulder to 13th rib, center over the heart.
  • Radiographic inclusion: Cranial to caudal tip of lungs.
  • Diagnostic quality: Straight with no rotation, ribs should be overlapping. No area of the lung should be visible above spine (rotation). Adequate collimation and contrast/density (which may need to be altered depending on disease state).

Steps

  • Place patient in lateral recumbency with a sandbag over the pelvis and neck.
  • Extend front legs forward to the comfort of the patient using sandbag or elastic extremity straps.
  • Deep chested dogs may require wedge under sternum to prevent rotation.
  • Ensure entire thorax fits in the field and collimate.
  • Large dogs may require a cranial and caudal view.
  • Acquire radiograph on inspiration if possible. Include R/L marker.

Cats

Positioning Tips

  • Collimation: Point of shoulder to just caudal of the 13th rib, center over the heart.
  • Radiographic inclusion: Cranial to caudal tip of lungs.
  • Diagnostic quality: Straight with no rotation, ribs should be overlapping. No area of the lung should be visible above spine (rotation).
  • Cats can be wrapped in a “kitty burrito” style using a simple towel for positioning if awake (see image).
  • Using a small piece of Vetrap around the extremities (front for thoracic and back for abdomen) can be helpful with keeping the elastic extremity straps in place.
  • Cat scruffers can be useful with some cats but should be left on for a maximum of 30 seconds.
    • Note: not all cats tolerate being scuffed and must be assessed prior to use.

Thorax Ventrodorsal (VD) View—Positioning Tips

  • Position: Point of shoulder to 13th rib, center at heart.
  • Radiographic inclusion: Cranial to caudal tip of lungs. Entire lung field, including caudal tips of lungs on inspiration.
  • Diagnostic quality straight—sternum overlap vertebrae.
  • Spinous process should appear as a “teardrop shape” in the center of each vertebrae.
  • Adequate collimation and contrast/density.

Steps

  • Place patient in dorsal recumbency (in a radiolucent foam trough) with sandbag over pelvis (±neck).
  • Extend front legs cranial with sandbags or elastic extremity straps.
  • Ensure head and neck are straight, as this prevents cranial rotation. Using the foam wedges can be helpful at keeping head straight and crossing the extremity straps can sometimes be helpful too.
  • Acquire radiograph on inspiration. Include R/L marker.
  • Cats tips: Same as with dogs. If using the scruffers make sure they are pointing towards the head, out of the trough.

Thorax (DV) View—Positioning Tips

  • Position: Point of shoulder to 13th rib, center at heart.
  • Radiographic inclusion: Cranial to caudal tip of lungs. Entire lung field, including caudal tips of lungs on inspiration.
  • Diagnostic quality straight—sternum overlap vertebrae.
  • Spinous process should appear as a “teardrop shape” in the center of each vertebrae.
  • Adequate collimation and contrast/density.

Steps

  • Place animal sternal (in foam trough) with sandbag over pelvis (±neck).
  • Extend front legs cranial with sandbags or ties. Ensure head/neck are straight.
  • Acquire radiograph on inspiration. Include R/L marker.

Abdomen Views—Tips

  • Foreign bodies: Left lateral abdomen views are often indicated for potential obstructive pyloric foreign body, as air will be evident in pylorus, often allowing better visualization of foreign material.

Lateral Views—Positioning Tips

  • Position: Mid thorax (6th rib) to hips, center at 13th rib.
  • Radiographic inclusion: Entire diaphragm to hips.
  • Diagnostic quality straight: Transverse processes should overlap so only one can be seen.
  • Adequate collimation and contrast/density.

Steps

  • Place animal R or L lateral recumbency with sandbag comfortably over neck and front legs (or straps).
  • Extend hind legs back and place sandbag over hind legs.
  • Left lateral more diagnostic for potential gastric foreign body, right lateral for GDV.
  • Cats can be wrapped in a “cat burrito” for positioning.

VD Views—Positioning Tips

  • Position: Mid thorax (6th rib) to hips, center at 13th rib.
  • Radiographic inclusion: Entire diaphragm to hips.
  • Diagnostic quality straight: spinous processes in middle of vertebrae.
  • Adequate collimation and contrast/density.

Steps

  • Place animal in trough in dorsal recumbency with sandbags or straps securing front legs and/or thorax. Straps or sandbags to secure hind legs.
  • Similar to thoracic positioning.

 

Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker)

J. Bitan
Hands Free X-Rays
North York, ON, Canada

A. Jenner
Hands Free X-Rays
North York, ON, Canada


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