ABDOMEN RADIOGRAPHY

DANIEL JAYAPRAKASH
Radiographer
Khorfakkhan Hospital
 Abdomen Radiography

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

•
 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
 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
 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
 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
 Membranes
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
 Regions 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)

Regions of Large Intestine
Cecum – pocket at proximal end with
Appendix
Colon
Ascending colon - on right, between
cecum and right colic flexure
Transverse colon - horizontal portion
Descending colon - left side, between
left colic flexure and
Fig 25-17
Sigmoid colon - S bend near terminal
end

Rectum – terminal end is anal canal - ending at the anus -

which has internal involuntary sphincter and external voluntary
sphincter
 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
 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
 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 .
 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
 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 .
Abdomen Radiography-Quadrants
 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

 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
Abdomen Radiography
Abd supine
 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
 Abdomen Radiography
• Erect abd & Erect chest
 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
 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
Abdomen Radiography
Lt lat decub
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

 Abdomen Radiography
• Right Posterior Oblique
 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).
NORMAL CONTRAST FILM ANATOMY