abdomen

• Abdominal Region

  Used to help describe the locations of various structures within the abdominopelvic cavity
• Abdominal Quadrant

  Used to help describe the locations of various structures within the abdominopelvic cavity
• Structures and Organs in Abdominopelvic Cavity

  • Digestive system
  • Urinary system
  • Reproductive system

  
• Structures in Abdominopelvic Cavity

  • Vertebral Column – Lumbar (L1-L5), sacrum, coccyx
  • Abdominal Muscles – Diaphragm, R and L psoas major muscles
  • Pelvic Bone – Ilium, ischium and pubic
  • Accessory Digestive Organ – Pancreas, liver, gallbladder

  
• Accessory Organs

  • Liver, biliary, pancreas and spleen

  
• KUB examination

  Examination of kidney, ureter, bladder
• Clinical Indications for Abdominal X-ray

  • Urinary calculus: stones in kidney, ureter, bladder, or urethra
  • Gallstones: stones in gallbladder
  • Bowel obstruction
  • Swallowing foreign bodies : coins, pins
  • Bowel perforations
  • Enlarged abdominal organs : hepatomegaly, spleenomegaly
  • Abdominal masses : calcified mass,tumor, lesion
  • Accumulation of abdominal fluid in case of heart failure, liver failure, renal failure, peritonitis, or traumatic injury

  
• Surface Landmarks

  • Iliac crest
  • Anterior superior iliac spine (ASIS)
  • Greater trochanter of femur
  • Ischial tuberosity
  • Symphysis pubis
• Patient Preparation

  • Complete undress except for panties, wear hospital gown with the opening at the back
  • Area of interest must be free of radiopaque objects
  • Ask LMP for female (women of childbearing age)
  • Explanation of breathing technique: Exposure taken on deep arrested EXPIRATION, Rehearse with patient, Use shortest exposure time possible to minimize effect of involuntary movement (peristalsis) of the bowel
  • If radiograph is taken for preliminary or control for contrast study, bowel preparation is needed to free the abdominal cavity from fecal matter and/or bowel gas
• Radiographic Considerations

  • General positioning – comfortable as possible; pillow under the head and support the knees and ankles. Use clean linen and cover the patient's legs for warmth and protect their modesty
  • Radiation protection – apply as long as it does not interfere with region of interest. Ovarian shield if indicated should be placed at the level of ASIS down to the symphysis
• Exposure Factors for Abdominal Radiograph

  • Medium kVp: 60 – 80 kVp
  • Short exposure time – less than 0.5s
  • Adequate mAs for sufficient density: 20 – 30 mAs
• Abdominal Projections

  • AP Supine
  • AP Erect
  • PA Prone
  • Left Lateral Decubitus (AP)
  • Dorsal Decubitus (L Lat)
• Technical Factors

  • Film size : 14x17 in (35x43 cm), lengthwise
  • Exp. factors : 60-80 kVp , mAs: 20-30 (grid)
  • FFD/SID : 100 cm
  • Shielding : Lead apron or gonad shield to protect gonad (if necessary – not superimpose with ROI)
  • Respiration : Suspended expiration
• AP Supine

  General survey of the abdominopelvic cavity when air-fluid level is not suspected
• AP Supine Patient Position

  • Patient supine. Prone can be used if kidneys are not the subject of importance
  • Pillow under head and pad under knees for comfort. Hands on upper thorax
  • Long axis of pt // long axis of table
  • Gentle pull on both legs to make sure patient straight – look from head or foot
• AP Supine Part Position

  • MSP perpendicular and centered to table midline
  • Ensure no rotation – Both ASIS equidistant from table; both shoulder also equidistant from table
• AP Supine Central Ray

  • Vertical beam centered to MSP at level of iliac crest
  • Cassette centered to central ray. Make sure that symphysis pubis is included in film
• AP Supine Collimation

  • Superior – below diaphragm
  • Inferior – symphysis pubis
  • Lateral – lateral wall of abdomen
• AP Supine Breathing

  • Arrested expiration
• Structures seen on AP Supine

  • Liver
  • Psoas major muscle
  • Kidney
  • Transverse process
  • Spinous process
  • Gas in stomach
  • Iliac crest
  • Symphysis pubis
  • Outline of lateral skin margin
  • Ala of ilium
  • Hip joint
• Evaluation Criteria for AP Supine

  • Symphysis pubis, upper poles of kidneys and lateral margins of abdomen within collimated area
  • Renal shadows, psoas major muscle, transverse process of lumbar spine, and inferior margin of liver clearly visualized on an optimally exposed radiograph
  • No rotation – Pelvis and lumbar vertebrae appear symmetrical (R and L wings appear equal in shape, size and spinous process in center of vertebrae)
  • Spine should be straight and in center of film longitudinally
  • No motion – ribs and gas bubble margins appear sharp
  • Gas in small and large intestine (if there are any)

  
• AP Erect

  To evaluate air-fluid levels and the presence of free air in the abdominal cavity
• AP Erect Patient Position

  • Patient in erect position with posterior aspect against wall unit; unable patient – seated on stool, stretcher or bed
  • Arms at the side (outside beam field)
• AP Erect Part Position

  • MSP is centered to the wall unit midline, with compression band used if necessary
  • Ensure no rotation at superior and inferior abdomen
• AP Erect Central Ray

  • Horizontal beam centered to MSP at level 2-3 in (5-7.5 cm) above iliac crest
  • Cassette centered to central ray. Upper border of cassette at level of axilla – to make sure diaphragm will be in the collimated beam
• AP Erect Collimation

  • Superior – diaphragm (upper beam at xifisternum)
  • Lateral – lateral wall of abdomen
  • Inferior – above symphysis pubis
• AP Erect Breathing

  • Arrested expiration
• Structures seen on AP Erect

  • Diaphragm
  • Liver
  • Psoas major muscle
  • Kidney
  • Transverse process
  • Spinous process
  • Gas in stomach
  • Gas in small and large intestine (if there are any)
  • Iliac crest
  • Outline of lateral skin margin
  • Part of Ala of ilium
• Evaluation Criteria for AP Erect

  • Diaphragm, upper poles of kidneys and lateral margins of abdomen within collimated area
  • Renal shadows, psoas major muscle, transverse process of lumbar spine, and inferior margin of liver clearly visualized on an optimally exposed radiograph
  • No rotation – Pelvis and lumbar vertebrae appear symmetrical (R and L wings appear equal in shape, size and spinous process in center of vertebrae)
  • Spine should be straight and in center of film longitudinally
  • No motion – ribs and gas bubble margins appear sharp
  • Air-fluid levels should be adequately exposed and demonstrated

  
• Left Lateral Decubitus

  To evaluate air-fluid levels and the presence of free air in the abdominal cavity for patient who is unable to assume erect position
• Left Lateral Decubitus Technical Factors

  • Film – 35x43 cm – lengthwise
  • Grid – stationary
  • kVp – medium (70-80); mAs - 20-30
  • FFD – 100 cm
  • Shielding - Gonad shield for male patient (if ROI is not obscured)
• Left Lateral Decubitus Patient Position

  • Patient lying on his left side with radiolucent pad under left lateral wall of thorax and abdomen
  • L and R leg on top of each other with both knees partially flex
  • Arms raised above head – not included in the beam field
• Left Lateral Decubitus Part Position

  • Thorax and pelvis in true lateral position – check from head or foot

  
• ibs and gas bubble

  • Margins appear sharp
• Air-fluid levels

  Should be adequately exposed and demonstrated
• Other Abdominal Projection

  Left Lateral Decubitus
• Left Lateral Decubitus


  • Film – 35x43 cm – lengthwise
  • Grid – stationary
  • kVp – medium (70-80); mAs - 20-30
  • FFD – 100 cm
• Shielding


  • Gonad shield for male patient (if ROI is not obscured)
• Patient Position


  1. Patient lying on his left side with radiolucent pad under left lateral wall of thorax and abdomen

  2. L and R leg on top of each other with both knees partially flex.

  3. Arms raised above head – not included in the beam field
• Part Position


  1. Thorax and pelvis in true lateral position – check from head or foot – shoulders and hips superimposed.

  2. A plane 2-3 in superior to iliac crest is centered to cassette which is at patient posterior aspect. MSP aligned and perpendicular to film midline.

  3. Superior border of cassette at level of patient's axilla.