For teaching Undergraduate Anatomy students in Phase 1 MBBS

1. X-rays of abdomen
Dr. Hironmoy Roy
Associate Professor
Deptt. of Anatomy, IPGME&R

2. Few terminologies
• -graphy = the procedure
• -gram = the machine/the procedure
• -graph= the report

3. How to mount a x-ray film
Follow the clues
• Name of the patient/institution
• R/L
• Date
Verify with expected anatomy
Clip properly with confidence

4. How to describe a x-ray film
Mention
• Straight/Contrast (if, single or double)
• View
• Region concerned
• Side (left/right)
• of whom? (see the name of the patient)
• date of exposure (search on the film)

5. example
• This is a straight x-ray of chest in postero-anterior
view of Mr. Abdul taken on 23rd November’2008.
• This is a double contrast-barium meal & follow-
through x-ray of Mr. Arun Mondol taken on 3rd
January’ 2001.
• This is a straight x-ray of skull in lateral view of
Smt. Sabita Sen taken on 3rd March’1998.
…….like these.

6. X-ray for Abdomen
• Straight x-ray-
i) Antero-posterior view
ii) Lateral view
• Contrast x-ray-
i) Single contrast (medium only)
ii) Double contrast (medium +air)

8. • Straight x-ray
Abdomen
• in antero-posterior
view
• Q. Vertebra counting
• Q. Sacroilliac joints
• Q. Psoas shadow
• Q. Kidney shadow

9. Digestive system
Urinary system
Genital system

10. 1. DIGESTIVE SYSTEM
• Barium containing
1. Barium sulphate
2. Micropaque
3. Baritop(+CO2)
4. EZ-paque
• Iodine containing
1. Gastro-graffin
2. Gastro-conray

11. Contrast X-ray of GI system
• MC ly used= Barium Sulphate (BaSO4)
• Procedure-
a) Administered orally:-
i) Ba swallow~ for esophagus
ii) Ba meal~ for stomach
iii) Ba follow through~ for gut
b) Administered per rectal:-
i) Ba enema~ for large gut
ii) Small bowel enema~ for small gut

12. • Indications :
To examine the mucosa (diagnostic)
To relieve intussusceptions (therapeutic)
• Contraindications :
Severely ill patient
Past H/O allergy

13. Preparation for Ba contrast x-ray
• Bowel evacuent /purgative at last night
• NPM since morning
• Pro-kinetic
• Administered before taking Barium
• Barium administered orally
• Gas forming agent is given ,if double-contrast
x-rays are planned.

14. 1. Ba swallow
• For pharynx and esophagus
• Ba is administered orally
• Film taken immediately

15. Barium swallow x-ray
in left lateral view
showing esophagus in the
thorax with few of the
adjacent structures ;
having no
obvious abnormalities.
Q. Heart shadow
Q. Lungs shadow
Q. Vertebrae
Q. Notch in esophageal shadow
Q. Copulae of Diaphragm

16. 2. Ba meal
• Ba is administered orally
• Serial films are to be taken starting from 2
mins interval, Ba takes 2-3 mins to reach
stomach
• It fills the pylorus within 30 mins
• Takes 1.30 hrs to cross pylorus

17. Barium meal x-ray
in antero-posterior view
showing stomach &
duodenum in the abdomen
with few of the adjacent
structures ;
having no
obvious abnormalities.
Q. Gastric curvatures
Q. Fundic gas
Q. Incisura
Q. Pylorus
Q. Duodonal cap

18. Fundic
gas
Duodenal Cap
(D1)
Body
Pylorus
Incisura
angularis
C loop of Duodenum

19. 3. Ba meal follow through
C/M= Barium SO4
reaches
a) Jejunum by 1 hr,
b)Terminal iliem by 3.5 hrs
c) Caecum by 4.5 hrs
d)Heapatic flexure 6.5 hrs
e) Splenic flexures 9 hrs
f) Decending colon 11 hrs
g) Pelvic colon 12 hrs
h) Rectum 18 hrs

20. ‘Barium meal & follow
through’ x-ray
in antero-posterior view
showing stomach & small
intestine in abdomen with
few of the adjacent
structures ;
having no obvious
abnormalities.
Q. Stomach
Q. Duodenum
Q. Jejunum
Q. Ileum

21. Feathery
jejunum
Valvulae
conniventes
No Valvulae
conniventes
No haustrations

22. How to distinguish
Ba-meal follow through of colon
and
Ba-enema
Ba-meal follow through
of colon
1. Almost 3 hrs late film
2. Small bowel can be seen
3. Sacculations normal
Ba-enema
1. Almost immediate film
2. Rectum most dense
3. Homogeneously dense
4. Sacculations get blunt
5. Contrast media rarely
cross ileo-caecal
junction

23. Who are they?
Enema
Ba meal follow-through in colon
It is a 6½ hrs film

24. 2. Uro-grahy
• Purpose: to judge the normal anatomy as well as
physiology of urinary system.
• Type:
Intravenous [Route of administration: intravenous]
Retrograde [Route of administration: per urethral]
• Media used:
Conray 280/420/480
Urographin 30/45/60/76
Diatrozoate
• Dose : 50ml (adult); 1.5 ml/kg (child)

25. IVU/IVP
Time of x-ray Phase What to see
1 min Nephrogram Shape of the Kidney
5 mins Pyelogram Major and Minor calyces
10 mins Pelvis + Ureter
30 mins Bladder
Micturating Urethra
Post-void Retention in Bladder

26. 1
1
2
2
3
3
1=Cupping: minor calyx
2=Major calyx
3= Pelvis of ureter

27. Intravenous urograph ,
film taken approximately
after 30 minutes; showing
bilateral kidneys, ureters
and bladder with few of
their the adjacent
structures ;
having no
obvious abnormalities
except spondilytis
affecting L4 vertebra.
Q. Kidney shadows
Q. Constrictions of ureter

28. Intravenous urograph ,
film taken approximately
after 30 minutes;
showing bilateral kidneys,
ureters and bladder with
few of their the adjacent
structures ;
having partial obstruction
in right ureter.

29. 3. HYSTERO-SALPINGO-GRAM

30. To study
i) Interior of uterus
ii) Continuity of
fallopian tube

31. A special x-ray
Straight x-ray abdomen
A-P view of a pregnant
Lady showing the
foetus-in-utero.
# Maternal spine
# maternal pelvis
$ baby’s head
$ baby’s spine
$ baby’s femur