2. Abdominal X-Ray Views
The two most commonly requested films are:
• Anteroposterior (AP) supine
• Anteroposterior (AP) erect, or horizontal beam view.
Other views include
• Lateral decubitus—horizontal beam view with the patient rolled onto one
side. A useful alternative to the erect AP view if patient is unable to sit or
stand
• KUB (kidneys, ureters, bladder)—follow-up passage of renal tract calculi.
3. If a supine-position - place support under the knee to relieve the strain
on the patient.
For upright-position radiograph, the patient’s back should be against
the grid device, legs slightly spread, with body weight distributed
equally on both feet.
In both positions, the midsagittal plane of the body should be centered
to the midline of the grid device.
Position of the patient
4. A. Abdominal landmark - iliac crest level of the mid-
abdomen (L4-L5).
B. For the supine position, the cassette or image receptor (IR) is centered to
the iliac crest and the lower abdomen is generally included on the lower
margin of the cassette.
C. For the upright position, the cassette is centered (5 cm) above the level of
the iliac crest, or high enough to include the diaphragm.
D. Maximal relaxation of the abdominal musculature is important in
reducing film artifact caused by motion. Relaxation of the abdominal
musculature is facilitated by supporting and slightly flexing the patient’s
knees.
E. Ask the patient to take a deep breath, exhale completely, and then hold
the position while not inhaling. This moves the diaphragm to a superior
position that results in better visualization of the abdominal viscera.
Position of abdomen
5. • Imaging technique
• Film or IR size: 14 x 17 inches (35 x 43
cm) lengthwise
• Moving or stationary grid
• 65-80 kVp range
• mAs 30
Imaging
6. Name, Date
Position of film and view
Adequate area covered or not?
Bowel Preparation
Pre-Peritoneal fat lines
Visualized organs are normal in size
Visualized bones and joints are normal
Visualized shadows are normal
Any Radio opacity
Any Artifacts
Any Calcification
Things to look for:
10. Bones on Abdominal X-Ray
L1
L2
L3
L4
L5
Ribs
Sacrum
Pelvic bone
Femur
T12
Ischial Spine
11. • useful for certain defined pathology such as abnormal ‘gases,
masses, bones and stones’.
• undifferentiated abdominal pain with a provisional diagnosis of:
• Toxic megacolon in acute IBD
• Bowel obstruction (50% sensitive for acute obstruction)
• Bowel ischaemia
• Perforation of a viscus with abdominal free air
• KUB for renal tract calculi: 80–90% sensitivity if radiolucent stone >3 mm
diameter.
• Foreign body
• Radio-opaque medical related abdominal ingestions
• Radio-dense Tablets
• Iron tablets
• Potassium Chloride (KCL Tablets)
• Metals
• Mercury
• Iatrogenic
• Barium
Indications for Abdominal X-ray
There should be no rotation of the shoulder and pelvis.Place the patient's arms at the sides and away from the body.
Kilovoltage is related to contrast. As kVp increases contrast decrease. As kVp increases the energy of the electrons in the x-ray tube increasing both the energy of the x-ray beam and the probability that more electrons will produce x-rays. If the x-ray energy increases the x-rays can penetrate more anatomy and more beams hit the film all around, causing everything to get darker.mAs controls how many electrons are produced at the cathode. The more electrons produced at the cathode the more x-rays that will be produced at the anode. The more x-ray beams then more x-rays will hit at each part of the x-ray where it was already hitting. Since mAs has nothing to do with the energy of the beam it won't penetrate any different parts of the body, just make the parts it already is darker.
Dulcolax - Bisacodyl belongs to the class of medications called stimulant laxatives.GASEX - symptomatic control and relief of dyspepsia, indigestion, flatulence, abdominal distension and belching; Pre-radiographic bowel preparation for abdominal x-rays.
Liver – Right upper quadrant, Superior edge of liver forms the Right hemi diaphragm contourHepatic Flexure – Sharp bend b/w ascending colon & transverse colon (adjacent to liver)Spleen – Left upper quadrant immediately superior to Left KidneySmall Bowel – Central position in abdomen. PlicaCircularis (ValvulaeConniventes) are thin, circular, folds of mucosa & seen across full width of lumen (diameter 2.5-3.5 cm)Large Bowel – Retroperitoneal structure of colon (ascending colon, descending colon, rectum) are relatively constant in position. Longitudinal muscles (taenia coli) & circular muscles form sacculations called HAUSTRA. (diameter of 3-5 cm)
Kidney – Visible because of Natural Contrast b/w kidneys and low density retroperitoneal fat that surrounds them. - Lie at the level of T12 to L3 lateral to psoas muscle - Right Kidney lower than Left due to position of liver Ureter – Transverse processes of lumbar vertebrae marks the course of ureter.
Psoas Shadow – psoas muscle arise from transverse process of Lumbar Vertebrae and combine with iliacus muscle. Together these powerful muscles form iliopsoas tendon which attaches to lesser trochanter of femur. (Iliopsoas – flexors of hip)We don’t see Iliacus muscle on X-Ray as it lie over iliac bone.
Bones – As soft organs landmarkKidney (T12-L3)Transverse process of lumbar vertebrae marks the course of ureter.Ischial Spine corresponds to vesico-ureteric junctionLook for fracture, scoliosis, degenerative disease, tumors.
