2. ANATOMY
The abdominal cavity extends from under surface of
diaphragm above and pelvic inlet below.
It is bounded anteriorly and laterally by the abdominal
muscles, lower ribs and iliac bones and posteriorly by
the posterior abdominal muscles and lumbar vertebrae.
It is lined by peritoneum.
3. ANATOMY
• For the purpose of describing the location of viscera
,the abdomen is divided into nine regions by two
transverse planes(transpyloric and transtubercular)
and two parasagittal planes(right lateral and left
lateral).
• Transpyloric plane passes midway between
xipisternal joint and umbilicus.
• Transtubercular plane passes between the tubercles
of the iliac crests and the body of L5 vertebrae near
its upper border.
• The right and left lateral planes corresponds to the
mid-clavicular or mammary lines.
4.
5. ANATOMY
It contains the greater part of
alimentary tract.
Some of the accessory organs
to digestion;the liver,pancreas
and spleen.
Some of urinary organs ;the
kidneys ,upper part of the
ureters and suprarenal glands.
6.
7. Patient
Preparation
Careful preliminary pt
preparation of the intestinal and
gastric contents is important for
a clear view of all the abdominal
structures.
For non-acute conditions ,pt
preparation is as follows:
pt placed in low residue diet for 2
days prior to examination to
prevent formation of gas due to
excessive fermentation of
intestinal contents.
8. EXPOSURE
TECHNIQUE
• In examination of abdomen
without a contrast medium, it is
necessary to obtain maximum
soft tissue differentiation.
• Exposure factor should thus be
adjusted to produce a radiograph
with moderate grey tones.
• A sharply demonstrated outline of
the psoas muscles ,lower border
of liver ,kidneys ,ribs and spinous
processes of lumber vertebra are
the best criteria for judging the
quality of an abdominal
radiograph.
9. IMMOBILIZATION
One of the prime requisite in abdominal
examination is the prevention of
movement ,both voluntary and non-
voluntary.
To prevent muscles contraction ,the pt
must be adjusted in a comfortable
position so that he can relax.
A compression band may be applied
across the abdomen for immobilization
but not compression.
The exposure should be made 1-2 sec
after suspension of respiration to allow
involuntary movement of viscera to
subside.
10. RADIATION
PROTECTION
Gonadal shields should be used but
not when there is possibility that
important radiological signs may be
hidden.
The pregnancy rule should be
observed unless it has been decided
to ignore it .in case of emergency.
Repeat examination should be
avoided to limit radiation dose by
performing well-planned procedure.
13. AP–SUPINE (KUB)
Pt supine , with mid sagittal
plane at perpendicular.
Pelvis adjusted so that ASIS
are equidistant from the
table.
Cassette placed
longitudinally so that the
symphysis pubis is included.
Arms placed alongside the
trunk or above the head.
14. • superiorly to include the hemidiaphragms
• inferiorly to include 2/3rd bladder
• lateral to the skin margins
Collimation
• 14 x 17”
Detector size
• 70-80 KVp
• 30-60 mAS
Exposure
Suspended inspiration
• 100 cm
SID
15. Image criteria
• Whole of abdomen from
upper abdomen to symphysis
pubis.
• Lateral abdominal wall and
the properitoneal fat layer.
• Psoas muscles,lower border of
liver and the kidneys.
• Ribs and spinous processes of
the lumbar vertebra.
16. PA-
Erect
Indications
• This view is valuable in
visualizing gas-fluid levels and
free gas in the abdominal cavity
as it allows the assessment
of ascites, perforation, intra-
abdominal masses, ileus,
or postoperative complications.
17. PA-Erect
The patient is standing, with
ventral abdomen toward the
image detector
No rotation of shoulders or
pelvis
Should include the entire
transverse width of the
patient (if possible; if not,
two radiographs may be
obtained)
18. • superiorly to include the hemidiaphragms
• inferiorly to include 2/3rd bladder
• lateral to the skin margins
Collimation
• 14 x 17”
Detector size
• 70-80 KVp
• 30-60 mAS
Exposure
Suspended inspiration
• 100 cm
SID
19. Image Criteria
• The abdomen should be
free from rotation with
symmetry of the:
• ribs (superior)
• iliac crests (middle)
• obturator
foramen (inferior)
• No blurring of the bowel
gas due to respiratory
motion
20. AP-ERECT
Pt stands with the back against
the vertical bucky & Pt legs
separated well apart to maintain
a comfortable position.
The MSP is adjusted at right
angle and coincident with the
midline of the IR.
The pelvis is adjusted so that the
anterior superior iliac spines are
equidistant.
21. • superiorly to include the hemidiaphragms
• inferiorly to include 2/3rd bladder
• lateral to the skin margins
Collimation
• 14 x 17”
Detector size
• 70-80 KVp
• 30-50 mAS
Exposure
Suspended inspiration
• 100 cm
SID
22. • Image criteria
• Both domes of
diaphragm to ensure
that any free air in the
peritoneal cavity is
demonstrated.
• Lateral abdominal wall
and peritoneal fat.
• Psoas muscle ,lower
border of liver and
kidneys shadows.
23. LATERAL
• Pt turned onto the side
of examination ,with
hands resting near the
head. the hips and
knees are flexed for
stability.
• With MSP parallel to the
table ,the vertebral
column(abt 8 cm
anterior to the posterior
skin surface)positioned
over the midline of the
table.
24. • superiorly to include the hemidiaphragms
• inferiorly to include 2/3rd bladder
• lateral to the skin margins
Collimation
• 14 x 17”
Detector size
• 75-90 KVp
• 50-70 mAS
Exposure
Suspended inspiration
• 100 cm
SID
25. • Image criteria
• The pre-vertebral space
along with abdominal
aorta.
• Any other intra
abdominal calcifications
or tumor masses should
be clearly visible.
26. LATERAL DECUBITUS
• Indications
• Used to identify free intraperitoneal gas
(pneumoperitoneum). It can be performed
when the patient is unable to safety lay in the
lateral decubitus position or to be transferred
to, or other imaging modalities (e.g. CT) are
not available
• The most useful position for detecting free
intraperitoneal air is the left lateral
decubitus position
27. LATERAL
DECUBITUS-
AP
Pt in lateral recumbent position.
Elbows and arms flexed and hand resting head.
Cassette positioned in vertical bucky against
the posterior aspect of the trunk.
28. • superiorly to include the hemidiaphragms
• inferiorly to include 2/3rd bladder
• lateral to the skin margins
Collimation
• 14 x 17”
Detector size
• 70-80 KVp
• 30-50 mAS
Exposure
Suspended inspiration
• 100 cm
SID
29. • Image criteria:
• Air fluid levels when an erect abdomen cannot
be obtained.
• Lung area above dome of diaphragm.
• Lateral abdominal wall and peritoneal fat.
31. • superiorly to include the hemidiaphragms
• inferiorly to include 2/3rd bladder
• lateral to the skin margins
Collimation
• 14 x 17”
Detector size
• 75-85 KVp
• 50-70 mAS
Exposure
Suspended inspiration
• 100 cm
SID
32. • Image criteria:
• Thorax to the level of mid-sternum and as much
of the abdomen as possible.
• Pre-vertebral space for determining the air fluid
levels in abdomen.
• Lung area above dome of diaphragm ,without
motion,
33. OBLIQUE
• Indications
• This view is normally performed when
foreign bodies or lines within the
• Generally used in radiological
media
34. Patient
position
• The patient is laying 30 degrees either
LAO or RAO, often on a 30-degree
wedge to ease of positioning
• Patients should be changed into a
hospital gown, with radiopaque items
(e.g. belts, zippers) removed
35. • superiorly to include the hemidiaphragms
• inferiorly to include 2/3rd bladder
• lateral to the skin margins
Collimation
• 14 x 17”
Detector size
• 75-85 KVp
• 50-70 mAS
Exposure
Suspended inspiration
• 100 cm
SID
36. lateral abdominal wall
should be included
inferior pubic rami should be
included inferiorly
if possible, the diaphragm
should be included
superiorly
adequate rotation can be
confirmed via the presence
of the 'Scotty dog' sign of the
lumbar spine
IMAGE CRITERIA
37. QUESTIONS????
What are the basic views of
abdomen radiography?
What is main indication of
abdomen radiography?
How can we perform radiation
protection in abdominal x-ray?
38. REFERENCES
• CLARK’S Positioning in
radiography.
• Merril’s atlas of radiographic
positioning.
• Encyclopedia of
radiographic positioning.
The peritoneum is the serous membrane that lines the abdominal cavity.
Transpyloric line
Transtubercular
Mid-clavicular
psoas muscle is located in the lower lumbar region of the spine and extends through the pelvis to the femur.
-pt should be instructed to take some laxative the night before the examination.
In full arrested expiration(to displace diaphragm upward) to give a better view of abdominal structures.
In arrested inspiration all abdominal organ in normal anatomical position
radiological examination that can take place throughout the cycle of 28 days until a patient experiences a missed period and suitable for low dose radiological examination (chest x-ray).
-abdominal and pelvic x-ray exams only during the 10 days following the onset of menstruation.
Centering of beam
Vertical central ray directed approx at the level of a point 1 cm below the line joining the iliac crest.
Bowel gas pattern with minimal unsharpness.
Whole of urinary tract should be visualized.
centering point
5 cm above the iliac crest at the midsagittal plane
centering point
5 cm above the iliac crest at the midsagittal plane
Side identification marker placed properly.
Center = Vertical central ray is directed to lower inter costal margin
FOREIGN BODY
Center = The horizontal central ray is directed perpendicular to the midpoint at the level of the iliac crest.
Psoas muscles ,lower border of liver and kidneys shadows.
No rotation.
Centering of beam:
The horizontal central ray is directed to the lateral aspect of the trunk so that it is at right-angles to the cassette and centered to it.
centering point
the midsagittal place (equidistant from each ASIS) at the level of the iliac crest
no blurring of the bowel gas due to respiratory motion
