ABDOMEN RADIOGRAPHY

DANIEL JAYAPRAKASHRadiographer

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 SystemThe digestive system consist of 1. Oral Cavity 2. Pharynx3. Oesophagus (muscular tube

25cms long extending from C6 to T11.

4. Stomach5. Small Intestine6. Large Intestine

Gross Anatomy of the Stomach1. 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

MembranesMembranesPeritoneum - generic serous membrane in abdominal cavityMesenteries - double sheets of peritoneum,

surrounding and suspending portions ofthe 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 arei. transverse mesocolonii. sigmoid mesocolon Fig. 25.4

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)

Cecum – Cecum – pocket at proximal end with Appendix

ColonColonAscending 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

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-PancreasPancreas 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 KIDNEYSKidney- 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 RadiographyAbd 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