Abdominal X-ray - System and anatomy Image data and quality Show
Key points
Patient and image dataYou should always check that the image data refers to the correct patient and that the X-ray is the current examination. Check the image data to see if it is a standard Anterior-Posterior (AP) supine projection. Supine Anterior-Posterior (AP) projectionHover on/off image to show/hide findings Tap on/off image to show/hide findings Click image to align with top of page Supine Anterior-Posterior (AP) projection
If perforation of the bowel is suspected then an ERECT chest X-ray must be requested. This is the most sensitive plain radiographic study to detect the presence of free gas in the abdomen. Erect Chest X-ray - PneumoperitoneumHover on/off image to show/hide findings Tap on/off image to show/hide findings Click image to align with top of page Erect Chest X-ray - Pneumoperitoneum
Occasionally patients are too ill to be positioned erect. In this case a CT scan may be appropriate, or a 'decubitus' radiograph can be obtained. For a decubitus image the patient lies on their side and X-rays pass through the body from back to front. For a 'left decubitus' the patient lies on their left. Decubitus positioningHover on/off image to show/hide findings Tap on/off image to show/hide findings Click image to align with top of page Decubitus positioning
Abdominal X-rays provide limited information at the best of times. Often anatomical structures are not clearly demonstrated, and abnormalities can be obscured by normal anatomical structures. For example, small renal stones may be obscured by overlying bowel. When an image is
of low quality there is often little that can be improved and therefore repeating images is usually unfruitful. The whole abdomen should be included. Often two images are required to view the entire abdomen from the diaphragm to the hernial orifices, and from left to right abdominal walls. Large patients may require more images. Which of the following might be used to demonstrate a pneumoperitoneum? A. upright, AP projection What are the membranes that line the wall of the Abdomen? Peritoneum and Retroperitoneum What two layers consist of the Peritoneum? What cavity is postrior to the Peritoneum? What two organs lie in the space of the Retroperitoneum? What do you want to see in an Abdominal Image, High contrast or Moderate contrast? What are some Radiation Protection procedures regarding Abdominal Images? -Shielding pediatric patients & patients of reproductive age Essential Projections for Abdomen -AP supine and upright positions What positions does the 3-way abdomen or acute abdominal series consist of? -Ap supine What is another common request for Abdomen procedures? Two-view abdomen series consisting of AP supine and AP upright If a patient can not stand for an upright position, what do you do? Position patient in Left lateral Decubitus AP Supine is often referred to as what? Kidneys, Ureters, and Bladdar Positioning for AP Abdomen supine Supine, without rotation and support knees to reduce strain of back Where is the IR centered for AP supine? Centered at the level of iliac crests (check that pubic symphysis is included) How is the CR in relation to the IR in an AP supine position? -CR is perpendicular to the IR How can you tell if pubic symphysis is included in an AP supine? Feel for Greater Trochanter; this is in alignment w. the pubic symphysis Mesentery and Omentum (folds) The folds of the peritoneum that function to support the viscera of the abdomen in position To which level of the patient should the CR be centered for the KUB? For the AP upright abdomen image of an adult of average size, why should the centering be slightly higher than the centering level used for the supine KUB image? Why is it desirable to include the diaphragm in the upright Abdomen image? To demonstrate free air in the abdomen Which projection does not demonstrate free air levels within the abdomen? a. AP supine What is the major advantage of the PA projection of the abdomen over the AP projection of the abdomen? PA projection reduces the exposure to the gonads What is pneumoperitoneum? Presence of air in the peritoneal cavity
Where do you center the IR for Decubitus position? where do you center the IR for Upright positiono? What does a three-way abdomen (acute abdominal) series demonstrate in the abdomen? Abdominal contents, presence of free air, and air fluid levels Why would a 3 Abdominal series be ordered? To evaluate bowel gas or to rule out free air, bowl obstruction, and infection in abdomen How can you evaluate rotation on a KUB? AP ABDOMEN SUPINE How can you evaluate rotation on a KUB? AP ABDOMEN SUPINE Patient position for AP upright -Standing upright, w. back in contact w. vertical grid If you need to include the bladdar in an AP upright position, where do you center the IR? Center IR to the iliac crest When is PA done instead of AP? When thinking about dose; when trying to minimize dose thyroid, breasts, etc. Left Lateral Decubitus Position *Performed in place of upright position for patients who are too ill to stand CR alignment for Left Lateral Decubitus
Directed Horizontal and perpendicular to center of IR Lateral Abdomen Patient Position -Recumbent right or left lateral Where is IR centered in the Lateral Abdomen? At level of iliac crests or 2 in above if diaphragm is included -Perpendicular to IR What position is used if patient cannot stand or lie on their side? Lateral Abdomen, Dorsal Decubitus Describe Lateral Dorsal Decubitus - Patient lies on CR for Lateral Abdomen, Dorsal decubitus -Horizontal and
perpendicular to center of IR Image evaluation of AP Supine -Evidence of proper collimation How to identify proper alignment for AP supine? -Centered vertebral column What is pneumoperitoneum? abnormal presence of air or other gas in the peritoneal cavity The abdominopelvic cavity is enclosed in a double-walled seromembranous sac called .... What are the tissue structures that are used to determine effective technique? Lower liver border, psoas muscles, kidneys, ribs, and transverse processes of lumbar vertebrae What positions have the CR directed horizontal and perpendicular to the center of the IR? -Lateral, dorsal decubitus What position has the CR horizontal and 2 in. above the iliac crest? -AP upright How is the CR displayed in relation to the IR in an AP supine position? CR is perpendicular to the IR at level of iliac crests How is the CR displayed in relation to the IR in a PA upright? CR is directed
horizontal and perpendicular to the center of the IR How is the CR displayed in relation to the IR in a Lateral Projection? Perpendicular to the IR and entering the MCP plane at iliac crest level or 2 in. above iliac crest level How is the CR displayed in relation to the IR in a Dorsal Decubitus position? CR is directted horizontally and perpendicular to the center of the CR. In an acute abdomen series (three-way seriess), what image should be substituted for the upright abdomen radiograph when the patient is unable to stand? Which projections of the abdomen would be used to demonstrate pneumoperitoneum?The lateral decubitus abdominal radiograph is used to identify free intraperitoneal gas (pneumoperitoneum).
What position should be used to demonstrate free air in the abdomen when the patient is unable to stand?The dorsal decubitus (right or left) position is a good alternative to obtaining a lateral decubitus or erect abdominal x-ray image when a patient cannot stand or lie on their side. It can provide information regarding pneumoperitoneum and air fluid levels in cases of suspected acute abdominal trauma.
What position should the patient be placed for an AP projection of the abdomen?The anteroposterior (AP) radiograph taken with the patient in a supine position is the basis of the majority of plain-film examinations of the abdomen.
How is pneumoperitoneum diagnosed?Pneumoperitoneum is the presence of air or gas in the abdominal (peritoneal) cavity. It is usually detected on x-ray, but small amounts of free peritoneal air may be missed and are often detected on computerized tomography (CT).
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Which projections and positions may be used to demonstrate a pneumoperitoneum on a patient who is too ill to stand?
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