2. Abdominal Radiography
• Sometimes called “plain
films” (images) of the
abdomen.
• The most common image is
an anteroposterior (AP)
supine abdomen, also
sometimes called a KUB.
• Taken without the use of
contrast media.
• Commonly are taken before
abdominal examinations are
performed with the use of
contrast media to rule out
certain pathologies.
3. Abdominal Radiography
Acute abdominal series
Certain acute or emergency conditions of the
abdomen may develop from conditions such
as bowel obstruction, perforations involving
free intraperitoneal air (air outside the
digestive tract), excessive fluid in the
abdomen, or a possible intra-abdominal
mass. These acute or emergency conditions
require what is commonly called an “acute
abdominal series,” or a “two-way” or “three-
way abdomen” series, wherein several
abdominal radiographs are taken in different
positions to demonstrate air-fluid levels or
free air or both within the abdominal cavity.
Abdominal radiography
requires an understanding of
anatomy and relationships of
the organs and structures
within the abdominopelvic
cavity.
4. Abdominal Radiography
ABDOMINAL MUSCLES
Many muscles are associated with
the abdominopelvic cavity. The
three that are most important in
abdominal radiography are the
diaphragm and the right and left
psoas major.
5. Abdominal Radiography
ABDOMINAL MUSCLES
• The diaphragm is an umbrella-
shaped muscle that separates the
abdominal cavity from the thoracic
cavity.
• The diaphragm must be perfectly
motionless during radiography of
either the abdomen or the chest.
Motion of the patient’s diaphragm
can be stopped when appropriate
breathing instructions are given to
the patient.
6. Abdominal Radiography
ABDOMINAL MUSCLES
• The two psoas major muscles are
located on either side of the
lumbar vertebral column. The
lateral borders of these two
muscles should be faintly visible
on a diagnostic abdominal
radiograph of a small to average-
sized patient when correct
exposure factors are used
7.
8. Abdominal Radiography
DIGESTIVE SYSTEM
The six organs of the digestive system are
as follows:
1. Oral cavity
2. Pharynx
3. Esophagus
4. Stomach
5. Small intestine
6. Large intestine
9. Abdominal Radiography
DIGESTIVE SYSTEM
Stomach
• The stomach is the first organ of
the digestive system that is
located within the abdominal
cavity.
• The stomach is an expandable
reservoir for swallowed food and
fluids.
• The size and shape of the
stomach vary depending on the
volume of its contents and on the
body habitus.
10. Abdominal Radiography
DIGESTIVE SYSTEM
Stomach
• Gastro is a common combining
form denoting a relationship to the
stomach (the Greek word gaster
means “stomach”).
• The term gastrointestinal (GI) tract
or system describes the entire
digestive system, starting with the
stomach and continuing through
the small and large intestines.
11. Abdominal Radiography
DIGESTIVE SYSTEM
Small intestine
The small intestine continues from
the stomach as a long, tubelike
convoluted structure about 4.5 to 5.5
m (15 to 18 feet) in length.
• Duodenum (A) The first portion of
the small intestine, the duodenum,
is the shortest but widest in
diameter of the three segments.
12. DIGESTIVE SYSTEM
Small intestine
Duodenum (A)
• It is about 25 cm (10 inches) in length.
When filled with contrast medium, the
duodenum looks like the letter C. The
proximal portion of the duodenum is
called the duodenal bulb, or cap.
• It has a characteristic shape that
usually is well seen on barium studies
of the upper GI tract. Ducts from the
liver, gallbladder, and pancreas drain
into the duodenum.
Abdominal Organ Systems
14. DIGESTIVE SYSTEM
Small intestine
Jejunum and ileum (B and C) The
remainder of the small bowel lies in the
central and lower abdomen.
• The first two-fifths following the
duodenum is called the jejunum, and
the distal three-fifths is called the ileum.
The orifice (valve) between the distal
ileum and the cecum portion of the
large intestine is the ileocecal valve.
Abdominal Organ Systems
15. Abdominal Organ Systems
DIGESTIVE SYSTEM
Small intestine
Radiograph of stomach and small
intestine
• Air seldom is seen filling the entire
stomach or small intestine on a plain
abdominal radiograph of a healthy,
ambulatory adult.
• This radiograph shows the stomach,
small intestine, and proximal large
intestine because they are filled with
radiopaque barium sulfate
16. Large intestine
• The sixth and last organ of digestion
• Ileocecal valve
• Cecum
• The appendix (vermiform appendix)
• Ascending colon
• Right colic flexure
• Transverse colon
• Left colic flexure
• Sigmoid colon – s-shape
• Rectum – the final 15 cm (6 inches)
• Anus
Abdominal Organ Systems
17. Abdominal Organ Systems
Large intestine
Three accessory organs of digestion, also
located in the abdominal cavity, are the:
1. pancreas
2. liver
3. gallbladder
18. Urinary System
The urinary system is another
important abdominal system.
The urinary system comprises the
following:
2 kidneys
2 ureters
1 urinary bladder
1 urethra
19. EXCRETORY OR INTRAVENOUS
UROGRAM
is a radiographic examination of the
urinary system performed with
intravenous contrast medium.
During this examination, the hollow
organs of this system are visualized
with use of the contrast medium that
has been filtered from the blood flow by
the kidneys. The organs as labeled are
the left kidney, the left proximal ureter,
the left distal ureter before emptying
into the urinary bladder, and the right
kidney.
Urinary System
20. EXCRETORY OR INTRAVENOUS
UROGRAM
NOTE: The term intravenous pyelogram
(IVP) often was used in the past for this
examination. However, this is not an
accurate term for this examination
because pyelo refers to the renal pelvis
of the kidney, and an excretory or
intravenous urogram includes a study of
the entire urinary tract, which comprises
the total collecting system. (The terms
excretory urogram [EU] and intravenous
urogram [IVU] are both current and
correct terms, but intravenous urogram is
the term that is used most commonly.)
Urinary System
21. Abdominal Cavity
Four important terms that describe the
anatomy of the abdominal cavity appear on
the drawings to the right and are described
subsequently.
These four terms are:
1. Peritoneum
2. Mesentery
3. Omentum
4. Mesocolon
22. Quadrants and Regions
RUQ LUQ
RLQ LLQ
To facilitate description of the locations of
various organs or other structures within
the abdominopelvic cavity, the abdomen
may be divided into four quadrants or
nine regions.
23. Quadrants and Regions
FOUR ABDOMINAL QUADRANTS
If two imaginary perpendicular planes (at
right angles) were passed through the
abdomen at the umbilicus (or navel), they
would divide the abdomen into four
quadrants.
RUQ LUQ
RLQ LLQ
One plane would be transverse through the
abdomen at the level of the umbilicus, which
on most people is at the level of the
intervertebral disk between L4 and L5 (fourth
and fifth lumbar vertebrae), which is about at
the level of the iliac crests on a female.
24. Quadrants and Regions
FOUR ABDOMINAL QUADRANTS
NOTE: The four-quadrant system is used most
frequently in radiography for localizing a
particular organ or for describing the location
of abdominal pain or other symptoms. RUQ
RLQ
LUQ
LLQ
26. NINE ABDOMINAL REGIONS
Transpyloric plane
Transtubercular plane
Horizontal/transverse planse:
Transpyloric plane - level of the lower border of
L1
Transtubercular plane - is at the level of L5
Right and left lateral planes
are parallel to the
midsagittal plane and are
located midway between it
and each anterior superior
iliac spine (ASIS)
27. NINE ABDOMINAL REGIONS
Transpyloric plane
Transtubercular plane
1. Right hypochondriac
2. Epigastric
3. Left hypochondriac
4. Right lateral (lumbar)
5. Umbilical
6. Left lateral (lumbar)
7. Right inguinal (iliac)
8. Pubic (hypogastric)
9. Left inguinal (iliac)
28. TOPOGRAPHIC LANDMARKS
Abdominal borders and organs within the
abdomen are not visible from the exterior,
and because these soft tissue organs
cannot be palpated directly, certain bony
landmarks are used for this purpose.
NOTE: Palpation must be done gently
because the patient may have painful or
sensitive areas within the abdomen and
pelvis. Also, ensure that the patient is
informed of the purpose of palpation before
beginning.
29. SEVEN LANDMARKS OF THE
ABDOMEN
1. Xiphoid process (level of T9-T10)
2. Inferior costal (rib) margin (level of L2-L3)
3. Iliac crest (level of L4-L5 vertebral interspace):
4. Anterior superior iliac spine (ASIS)
5. Greater trochanter
6. Symphysis pubis
7. Ischial tuberosity
Each kidney drains via its own ureter to the single urinary bladder.
The bladder, which is situated above and behind the symphysis pubis, stores urine. Under voluntary control, the stored urine passes to the exterior via the urethra.
The two suprarenal (adrenal) glands of the endocrine system are located at the superomedial portion of each kidney. (Adrenal glands produce hormones that help regulate your metabolism, immune system, blood pressure, response to stress and other essential functions.)
The bean-shaped kidneys are located on either side of the lumbar vertebral column.
The right kidney usually is situated a little lower than the left one because of the presence of the large liver on the right.
Waste materials and excess water are eliminated from the blood by the kidneys and are transported through the ureters to the
urinary bladder.
Technologists should be familiar with the locations
and names of these nine regions. However, in general, locating
most structures and organs within the four-quadrant system is sufficient
for radiographic purposes because of variables that affect
specific locations of organs, such as body habitus, body position,
and age
Transtubercle = passes iliac tubercles
The tip of the xiphoid process is the most distal or inferior process of the sternum.
This landmark can best be palpated by first gently pressing on the soft abdomen below the distal sternum, then moving upward carefully against the firm, distal margin of the xiphoid process.
This landmark approximates the superior anterior portion of the diaphragm, which is also the superior margin of the abdomen. However, this is not a primary landmark for positioning the abdomen because of variation in body types and the importance of including all of the lower abdomen on most radiographic images of the abdomen
This landmark is used to locate upper abdominal organs, such as the gallbladder and stomach.
The crest of the ilium is the uppermost portion of the curved border of the ilium.
The iliac crest can be palpated easily by pressing inward and downward along the midlateral margin of the abdomen.
The uppermost or most superior portion of this crest is the most commonly used abdominal landmark and corresponds approximately to the level of the midabdomen, which is also at or just slightly below the level of the umbilicus on most people. If the center of the cassette or image receptor (IR) is centered to this level, the lower abdominal area generally is included on the lower margin of the IR.
NOTE: Ensuring that the entire upper abdomen, including the diaphragm, is included on the IR requires centering about 5 cm (2 inches) above the level of the crest for most patients, which usually cuts off some of the important lower abdomen.
A second IR centered lower would be required to include this lower region.
The ASIS can be found by locating the iliac crest, then palpating anteriorly and inferiorly until a prominent projection or “bump” is felt (more prominent
on females). This landmark is commonly used for positioning of pelvic and vertebral structures but can also serve as a secondary landmark for general abdominal positioning.
This landmark is more easily palpated on thin patients.
Gentle but very firm palpation generally is required to feel the movement of the trochanter with one hand, while rotating the leg internally and externally at the knee area with the other hand. This is not as precise a landmark as the other bony landmarks of the pelvis, but the prominence of the greater trochanter is at about the same level as the superior border of the symphysis.
With practice, the greater trochanter can be used as a secondary landmark for abdominal positioning..
The symphysis pubis is the anterior junction (joint) of the two pelvic bones.
The most superior anterior portion of the pubis can be palpated when the patient is in a supine position.
This landmark corresponds to the inferior margin of the abdomen. However, palpation of this area may be embarrassing to some patients.
With practice, the level of the symphysis pubis or the lower margin of the abdomen can be identified by palpating the greater trochanter with reference to the iliac crest as being at the level of the center of the cassette or IR; this places the lower margin of the IR at the symphysis pubis.
This landmark can be used to determine the lower margin on a PA abdomen with the patient in a prone position.
These two bony prominences, which can be palpated most easily on thin patients, bear most of the weight of the trunk when one is seated.
The lower margins of the ischial tuberosities are about 1 to 4 cm (1 ½ inches) below or distal to the symphysis pubis.
This landmark may be used for positioning a PA projection of the colon when the rectal area is to be included on the IR.
However, this may be uncomfortable and embarrassing for the patient, and other landmarks can and should be used when possible.
