Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh,

Copyright 2003 A Musa

Abdomen Radiography

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Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Copyright 2003 A Musa
PLEASE TURN ALL CELL PHONES
TO SILENT MODE
Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Copyright 2003 A Musa
3
By the end of this Lecture the student will be able to:

- List and identify the different regions and organs related to abdomen
- State the common indications for plain abdomen radiography
- List the basic and Optional projections for radiographing the abdomen
- Discus the correct body position, part position, central ray, and
center point for specific positions of abdomen
- Critique and evaluate radiographs of abdomen based on (position,
collimation and central ray, exposure, and structure best shown)


Learning Objectives

Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Copyright 2003 A Musa
4
Basic
Text book of radiographic positioning and related anatomy;
edition
th
6
th,
5 Kenneth L.Bontrager,
Optional
Merrills Atlas of Radiographic Positions and Radiologic
Procedures, Frank P.W. Ballinger, E.D.
Positioning in Radiography: By k.C.Clarke.



Websites

/ radiography.net - http://www.e







References

Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Copyright 2003 A Musa




















Abdomen Anatomy


Abdomino-pelvic cavity

Abdomen

diaphragm to pelvic inlet

Pelvic cavity
pelvic inlet to floor muscles of the
cavity
Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Copyright 2003 A Musa
Abdomen divisions
4 Quadrants (clinically)
9 Regions (anatomically)




















Abdomen Anatomy

Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Copyright 2003 A Musa
Bones

lower ribs & T11-T12
lumbar spine (5)
sacrum & coccyx
pelvis
Iliac portion
Ischial portion
Pubic portion
Femur
Head & neck
Trochanters























Abdomen Anatomy

Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Copyright 2003 A Musa
Topographic marks

Anterior superior iliac spine (ASIS)
Greater trochanters of femur
Iliac crest (At level of L4-5)
Symphysis pubis























Abdomen Anatomy

Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Copyright 2003 A Musa
9
Digestive System (gastrointestinal; GI tract)
Stomach
A. Fundus
(gas bubble present in erect position)
B. Body
C. Pyloric Antrum
Small intestines
(small bowel)
A. duodenum
("c" shape; bulb)
B. jejunum
C. ileum




















Abdomen Anatomy

Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Copyright 2003 A Musa

Large intestine (colon)
A. Caecum (valve; appendix)
B. Ascending colon
C. Hepatic flexure
D. Transverse colon
E. Splenic flexure
F. Descending colon
G. Sigmoid colon (flexure)
H. Rectum (valve)

Other GI tract organs
A. Liver
B. Gall bladder
C. Pancreas
Urinary organs and major
vessels
A. Kidneys
B. Ureters
C. Urinary bladder & urethra
D. Abdominal Aorta
E. Inferior vena cava




















Abdomen Anatomy

PLAIN ABDOMEN, (KUB)
The plain abdomen ( KUB ) shows the kidneys, ureters, urinary bladder and
gall bladder (usually prior to contrast studies such as barium meal, barium
enema, IVU) to exclude radiopaque renal or gall stones (calculi), abnormal
intra abdominal masses, and the state of bowel preparation.
All acute abdomen emergency conditions resulting from intestinal (bowel)
obstructions, perforations with intraperitoneal air, i.e., small free-air outside
the digestive tract), will require several projections for the abdomen in different
positions.




















Technical aspects


Patient should be comforted with clean pillow under the head and a support under
the knees, and a slim couch sponge mattress. Patients legs must be covered to
keep him warm.
High mA and shorter exposure times should be used to freeze voluntary and
involuntary organ movements (breathing and bowel peristalsis).

Exposure is taken on second full arrested expiration ( to displace the diaphragm
upward ). This will give a better view of the abdominal structures.

Gonad shields should often be used on males (upper edge of the shield at the
Symphysis pubis).For females, shields are used only where they could not
obscure essential anatomical structures (lower border of the shield should be at the
Symphysis pubis).

For potential early pregnancy, the 10-day Rule (the LMP) must always be
observed, unless permission has been given by the medical specialist as to ignore
it as in the case of an emergency (e.g., trauma), or in case of a female with a
removed uterus (hysterectomy).





















Technical aspects


Medium to maximum image contrast with maximum sharpness for soft-tissue
differentiation should be considered for the abdomen using a medium kV
range (65 to 80 kV) to visualize the abdominal structures.

Correct exposure factors should produce more gray-tone contrast that will
faintly shows the lateral borders of Psoas muscle, lower liver margin, kidneys
outline, and the transverse processes of the lumbar vertebrae.

Basic projections of the plain abdomen are: AP supine and AP erect. A PA
erect chest film must usually be done as it clearly shows small amounts of
free intraperitoneal air under the diaphragm (sub- Phrenic air).




















Technical aspects


Careful preliminary patient preparation of the intestinal and gastric contents is
important for a clear view of all abdominal structures. For non-acute conditions,
patient preparation is as follows:

(1) Patient placed on a low-residue diet for (2 days) prior to x-ray examination
to prevent formation of gas due to the excessive fermentation of the
intestinal contents

(2) Patient should be instructed to take some ( laxative ) the night before
the examination, and a cleansing enema next morning (usually normal saline
solution) not more than two hours before the examination. The enema must
be at the bodys normal temperature (37C).




















Technical aspects

Acute abdomen


Is an EMERGENCY case indicated for: Non-mechanical small bowel
obstruction (ileus), the mechanical bowel obstruction (from the effects of
hernia or adhesions), ascites, intra-abdominal mass, and post-surgery.

Exam is carried out with high power x-ray equipment in the x-ray department,
or in wards, for patients too ill to come to the department.

Radiographs to be taken for the acute abdomen are:

(1) Erect PA (or AP) chest to exclude basal pneumonia as a cause of upper
abdominal pain.
(2) AP plain supine abdomen.
(3) AP Erect abdomen (or, alternatively, a lateral decubitus).
(4) Supine decubitus (lateral recumbent if the patient is uncooperative).


.


Technical aspects



REMEMBER

NEVER ..
prepare an acute
abdomen patient !



Patient supine, arms by the sides, legs flexed (or
extended with pillow under the knees).
A compression band must be used to reduce size of
the abdomen.






















AP Plain Supine Abdomen (KUB) Basic

Shows pathology (bowel obstruction, ascites, calcifications, neoplasm's). Also used as a (scout)
film before any contrast media study.
Body and Part Position
Film: 35x43 cm.
CR: 90 vertically to film center.
CP: Level of iliac crest (L4), with bottom margin
of the film at the Symphysis pubis.

Patient prone, arms up beside the head, both legs extended,
support under knees & heels.
Also used as (scout) film before contrast media studies. It is
less desirable than AP (for the kidneys) because of the
increased OFD.
























PA Plain Supine Abdomen (KUB) Basic

Film: 35x43 cm.

CR: 90 vertically to film center

CP: Level of iliac crests (L4) with bottom margin of film at
the Symphysis pubis.
Body and Part Position
Shows pathology (bowel obstruction, ascites, calcifications, neoplasm's). Also used as a (scout)
film before any contrast media study.

Patient in lateral recumbent, elbows flexed, arms
up, knees partially flexed, a pillow between both
knees, another pillow under head.





















Lateral Recumbent Abdomen (KUB) Special

Shows soft-tissue masses, umbilical hernia, aortic aneurysm, and calcifications.
Film: 35x43 cm.

CR: 90 vertically to film center.
CP: Level of iliac crests (L4), bottom margin of
film at Symphysis pubis.
Body and Part Position

Patient upright, back against cassette, arms at the
sides, film center 2 inches above iliac crest (to
include the diaphragm) or, top of cassette at the
level of the axilla.





















AP Erect Abdomen (KUB) ( Special)

Shows abnormal masses, air-fluid levels, and subphrenic air.
Film: 35x43 cm.
CR: 90 horizontally to film center.
CP: 5 cm above level of iliac crests.

NB/
Patient must be upright for 5 minutes before the
exposure is made to allow for intraperitoneal gas
settling.
For weak patients, a lateral decubitus is generally
recommended.
Body and Part Position

Patient in lateral recumbent on a radiolucent cotton
pad, back to a vertical cassette, knees partially flexed,
arms near the head.






















Lateral Decubitus Abdomen (AP) Special

Shows any masses, possible accumulations of intraperitoneal air, air-fluid levels, patient should be
for at least 5 minutes on his side.
Film: 35x43 cm.
CR: 90 horizontally to film center.
CP: 5 cm above the level of the iliac crests, the
diaphragm must be included.
Body and Part Position
Patient supine on a radiolucent pad, side against a
vertical film, arms up beside the head, support under
the knees.




















Dorsal Decubitus Abdomen (Lat.) Special

Shows masses, possible accumulations of gas, air-fluid levels, aneurysms (widening and dilation of
arterial, venous, or of the cardiac walls).
Body and Part Position
Film: 35x43 cm.
CR: 90 horizontally to film center
CP: 5 cm above level of iliac crests, diaphragm
must be included.
Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Copyright 2003 A Musa




















Abdomen Radiography

Film evaluation
No rotation
symmetry of pelvis & spine
Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Copyright 2003 A Musa
Complete anatomy with no motion
vertebral column in center of image
Symphysis pubis at bottom of image
kidneys, liver, spleen at top of image




















Abdomen Radiography

Film evaluation
Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Copyright 2003 A Musa




















Abdomen Radiography

Film evaluation
density & contrast adequate
to see
Psoas muscles
lumbar transverse
processes
ribs
kidney & liver margins
Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Copyright 2003 A Musa
The End
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