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Abdominal Radiography

Clinical indications
o Rupture/perforation of abdominal viscera
o Obstruction
o Infection
o Pathologies
Pneumoperitoneum (free of intraperitoneal air)
Air/fluid levels
Cholelithiasis and urolithiasis
(biliary and renal calculi)
Ascites (build up of fluid in abdomen)
Usually caused by fluid in liver
Volvulus (twist of bowel upon itself)
4 quadrants of the abdomen
o RUQ- right upper quadrant
o LUQ- left lower quadrant
o RLQ- right lower quadrant
o LLQ- left lower quadrant
9 regions of the abdomen

Clinical indication
o Xiphiod- T9-T10 for locating MSP, superior
o Inferior costal margin- L2-L3, lower part of ribs
o Iliac crest- L4-L5
o Greater trochanter at level of symphysis pubis
Radiographic positions
o Supine/KUB/ flat plate
o Erect

o Lateral decubitus
o Obliques

o Most frequently performed for initial and f/u evaluation of
most pathologies
o Also performed as the scout image for upper and lower
G.I. series; excretory urography; biliary procedures
Positioning criteria
o Patient placed in supine position with MSP centered to mid
o Central ray directed perpendicular to iliac crest (must
include symphasis pubis)
o kVp range 80 for digital
o Gonadal shield for a male
o Apply breast shield for a female
o Correct respiratory phase on exhalation
Pushes the diagram up
Decrease peristaltic activity (gets rid of motion)
AP recumbent supine KUB
Looking for symmetry at the top and
If they have scoliosis you cant go by the

Image evaluation
o Spine in center of film with no rotation (spine and ilia)
o Includes all anatomy from upper renal poles, psoas to
symphasis pubis
o Evidence of cross-wise collimation (most adults you use the
entire length but you do not need the whole width of the
Erect/upright position
o Done for air/fluid levels
o Rule out atopic organs
Situs Inversus is when intestines are reversed
Dextrocardia- just the heart on the reversed side

o Must include diaphragms

o Patient should be positioned PA if kidneys not of primary
interest to reduce breast/godnal dose
This needs to be done first when this is ordered
Unless the renal system is involved then it is always
PA because it reduces significant gonad and breast
o Allow 10 min for air/fluid levels to develop
Positioning criteria
o Patient positioned PA on vertical table or upright unit with
MSP centered to film
o Central ray directed perpendicular and 2 inches superior to
iliac crest
o Respiratory phase on full exhalation
o Increase kVp 6-10
o Shield gonadal region
PA Erect

Erect abdomen

Image evaluation
o Spine is centered with no rotation
o Anatomy includes from diaphragm to interiorly
Lateral decubitis

o Left lateral preferred

Immediately turn on left side if in a stretcher
Do left lateral so you get rid of gastric bubble only
goes as far as stomach and if there is free air then it
goes into diaphram
o Alternate for erect or if required by protocol
o Allow 10 mins for air/fluid separation
o Central ray directed to MSP and 2 inches superior to iliac
o Full exhalation
o Same exposure as erect
o Side marker on down side
o Put marker near pelvic

Intestinal obstruction
o Can be mechanical or malfunction
o Common mechanical causes include:
Surgical adhesions
Diverticulitis - when diverticulum (balloon shaped
coming out from wall of lower intestine) bursts
Foreign body
Malfunction causes
o Appendicitis
o Gastroenteritis
o Narcotics
o Sedatives
Treatment for obstructions
o Admission to hospital to treat cause
o Insertion of nasogastric tube (NG tube) to alleviate
o Goes through nose and into throat
o Surgery

Rogue- folds in the stomach

Plicae circulares/ Valvulae Conniventes - small folds in
small intestine
Housetra- small folds in the large intestine