Discuss the General ,Surface and Radiographic anatomy of the abdomen . Preparation of patient . Radiographic technique. Image evaluation. Radiation protection.

1. ABDOMEN RADIOGRAPHY
DANIEL JAYAPRAKASH
Radiographer
Khorfakkhan Hospital

2. Abdomen Radiography
Objectives:
• Discuss the General ,Surface and Radiographic
anatomy of the abdomen .
• Preparation of patient .
• Radiographic technique.
• Image evaluation.
• Radiation protection.
•

3. Introduction
• Plain films of the abdomen are used
primarily to assess calcifications and
intestinal perforation or obstruction.
• The plain radiograph is commonly used as a
preliminary radiograph for other studies
such as CT ,U/S & MRI

4. X ray Abdomen
• The most common plain radiograph of the abdomen
is an anteroposterior (AP) view with the patient in
the supine position.
• The AP view of the abdomen is also called a KUB film
because it includes the kidneys, ureters, and bladder.
• When acute abdominal disease is suspected
clinically, an erect film of the abdomen and a
posteroanterior (PA) view of the chest are also
required

5. Digestive System
The digestive system consist of
1. Oral Cavity
2. Pharynx
3. Oesophagus (muscular tube
25cms long extending from
C6 to T11.
4. Stomach
5. Small Intestine
6. Large Intestine

6. Gross Anatomy of the Stomach
1. Lesser curvature
2. Greater curvature
3. Cardia - end under the heart
4. Fundus - bulge above the esophageal opening
5. Body - largest region
6. Pylorus - J curve, inferior end, terminates in
7. Pyloric sphincter and superior end terminates in
8. Cardiac spincter.
9. Rugae – highly extendable interior folds
Figs 25-10/11

7. MembranesMembranes
Peritoneum - generic serous membrane in
abdominal cavity
Mesenteries - double sheets of peritoneum,
surrounding and suspending portions of
the digestive organs
• Greater omentum - "fatty apron", hangs
anteriorly from stomach, double layer encloses
fat
• Lesser omentum - between stomach and liver
• Mesentery proper - suspends and wraps the
small intestine
• Mesocolon - suspends and wraps the colon,
parts are
i. transverse mesocolon
ii. sigmoid mesocolon Fig. 25.4

8. Regions of Small IntestineRegions of Small Intestine
SI is longest part of dig. tube
• Duodenum (short, 12 inches)
– fixed shape & position
– Mixing bowl for chyme
• Jejunum (2.5 m long)
– Most of digestion
• Ileum (longest at 3.5 m)
– Most of absorption, ends in
• Ileocecal valve – slit valve into large intestine (colon)

9. Cecum –Cecum – pocket at proximal end with
Appendix
ColonColon
Ascending colon - on right, between
cecum and right colic flexure
Transverse colon - horizontal portion
Descending colon - left side, between
left colic flexure and
Sigmoid colon - S bend near terminal
end
Regions of Large IntestineRegions of Large Intestine
Fig 25-17
Rectum –Rectum – terminal end is anal canal - ending at the anus -
which has internal involuntary sphincter and external voluntary
sphincter

10. Abdomen Anatomy-Liver
Liver- largest gland in the
body,present in RUQ. Two
major lobes two minor
lobes.
Falciform ligament
separates larger Rt lobes
from Lt lobe ,small
quadrate lobe lies inferior
to Rt lobe and posterior to
quadrate lobe lies
caudate lobe

11. Abdomen Anatomy-CBD
Extrahepatic biliary apparatus .
Rt and Lt hepatic duct from right
and left lobe of liver unite to form
common hepatic duct .
Gallbladder – pear shaped , 7 – 10cm
long . Has three parts , fundus is
distal and middle part is body
continues proximally as cystic
duct .
Common bile duct – formed by
union of cystic duct and common
hepatic duct .it joins with
pancreatic duct and opens into
second part of duodenum at
duodenal papilla

12. Abdomen Anatomy-Pancreas
Pancreas is transversely placed between L1 and
L2. it has three parts head,body and tail .
It is partly exocrine and partly endocrine .
Endocrine part secretes insulin and glucagon .
Exocrine part secretes pancreatic juice .
The pancreatic duct opens in to second part
of duodenum .

13. ANATOMY KIDNEYS
Kidney- lies retroperitoneal at the
level of T12-L3 .
Each kidney is composed of three
million uriniferous tubules . Each
tubules has two parts (a) secretory
part (b) collecting tubule
Ureter – it’s a narrow thick muscular
tube which conveys urine from
kidney in to bladder.it is 25cms long
Urinary Bladder – it’s a muscular
reservoir of urine which lies in the
pelvic cavity . Its capacity is 250ml

14. Surface Anatomy-Quadrants & Regions
• Upper transverse
plane.
• Lower transverse
plane.
• Sagittal planes at right
angles to transverse
planes divide the
abdomen into four
quadrants and nine
regions .

15. Abdomen Radiography-Quadrants

16. Abdomen Radiography
Patient preparation- pt should have low residue diet and
laxatives (bisacodyl 10mg) two preceding nights prior to
examination
2. Incase of emergency no bowel preparation possible.
3.Pt is changed into a clean gown.
4.All radio opaque items to be removed from area of interest
.
5. Explain the procedure

17. Abdomen Supine -Technique
Position Supine,without rotation of pelvis and
torso,pt centred to midline of table,
Central ray At iliac crest(L4)
FFD/SID,Grid,IR size 100cms,grid,35x43cms
Exposure High MA & short time,Kvp of 60-75
Respiration Exposure in suspended expiration
Collimation To include symphysis pubis and rest
of abdomen

18. Abdomen Radiography
Abd supine

19. Abdomen Erect-Technique
positioning Pt erect with back to wall bucky ,no rotation
of torso and pelvis, midsagittal plane centered
to midline of bucky,arms abducted
Central ray At L3 (lower costal margin) on midsagittal
plane
Exposure High MA with short time and Kvp range of 60-
75
FFD/SID,Grid,IR size 100cms,grid,34x43cms potrait
Respiration Exposure in suspended expiration
Collimation Superiorly from diaphragm below and laterally
to show skin
Radiation protection Gonadal in males , department protocol for
females

20. Abdomen Radiography
• Erect abd & Erect chest

21. Abdomen Lt Lat Decubitus Technique
Position Lying on left side,no rotation of
torso&pelvis,centred to bucky,both
hands above head
Central ray Directed to MSP at L3
FFD/SID,Grid, IR size 100cms,grid, 35x43cms potrait
Exposure High MA with short time and Kvp
range of 60-75
Respiration In suspended expiration
Collimation From diaphragm
downwards,laterally to show skin

22. Abdomen Lateral -Technique
Position Pt supine , arms raised, grid
cassette suported vertically by side
of patient , upper border of cassette
at midsternum level .
Central ray Horizontal ray 5cms above iliac
crust
FFD/SID,Grid,IR size 100cms ,grid , 35x43cms
Exposure High MA with short time and Kvp
range of 60 – 75
Respiration Exposure in arrested respiration
Collimation From midsternum and as much
abdomen as possible

23. Abdomen Radiography
Lt lat decub

24. Abdomen Post Oblique-Technique
Position From supine pt rotated 20-30 to side
of interest
Central ray Midway between sternoxiphisternal
joint and umblicus
FFD/SID,Grid,IR size 100cms,Grid, 35x43cms
Exposure High MA and short time,a Kvp range
of 60-75
Respiration Exposure in arrested expiration
Collimation To include kineys

25. Abdomen Radiography
• Right Posterior Oblique

26. Abdomen - plain film Anatomy
A Normal plain
film of the abdomen. The
lower margins of the
posterior portion of the liver,
the hepatic angle (H), and
the lower part of the spleen
(S) are delineated by a fat
shadow. Both kidneys (K)
and the psoas muscle
shadows (arrowheads) are
outlined by a fat shadow. The
properitoneal fat stripe is also
shown bilaterally (arrows).

27. NORMAL CONTRAST FILM ANATOMY