Abdominal X-rays

Question 1

Abdominal x ray projections?

Answer 1

1. Supine 99%
2. Erect
3. Lateral decubitus

Question 2

Film specifics?

Answer 2

Name of Patient
Age & Date of Birth
Location of Patient
Date Taken
Film Number (if applicable)

Question 3

Fil technical factors?

Answer 3

Type of projection (Supine is standard)
Markings of any special techniques used

Question 4

Black bits?

Answer 4

Intra-luminal gas can be normal.
Extra-luminal gas is abnormal.
- However, intra-luminal gas can be abnormal if it is in the wrong place or if too much is seen.

Question 5

Normal intestinal sizes?

Answer 5

The maximum normal diameter of the large bowel is 55mm.
Small bowel should be no more than 35mm in diameter.
The caecum is not said to be dilated unless wider than 80mm

Question 6

Black bits in AXR?

Answer 6

Intra-luminal gas can be normal.
Extra-luminal gas is abnormal.
However, intra-luminal gas can be abnormal if it is in the wrong place or if too much is seen

Question 7

Intra luminal gas?

Answer 7

It is usual to see small volumes of gas throughout the GI tract and the absence in one region may in itself represent pathology.
The natural presence of gas within the bowel allows assessment of caliber - although the amount varies between individuals

Question 8

Distinguishing between large and small bowel by looking at bowel wall markings?

Answer 8

The haustra of the large bowel extend only a third of the way across the bowel from each side, whereas the valvulae conniventes of the small bowel tranverse the complete distance.

Question 9

Extraluminal gas?

Answer 9

When an bowel is obstructed, or any other gas containing structure perforates, its contained gas becomes extra-luminal. Extra-luminal gas is never normal, but may be seen following intra-abdominal surgery or endoscopic retrograde cholangio-pancreatography (ERCP).

Question 10

Causes of extraluminal gas?

Answer 10

Post Abdominal Surgery/ERCP
Perforation of viscus (eg. bowel, stomach)
Gallstone ileus
Cholangitis (infection with gas forming organisms)
Abscess
Note: An erect CXR (not AXR) is the best projection to diagnose a pneumoperitoneum (gas in the peritoneal cavity).

Question 11

White bits?

Answer 11

calcified structures

Question 12

3 types of calcifications?

Answer 12

1. Calcium that is an abnormal structure - eg. gallstones and renal calculi
2. Calcium that is within a normal structure but represents pathology - eg. nephrocalcinosis,
3. Calcium that is within a normal structure but is harmless - eg. lymph node calcification

Question 13

Grey bits?

Answer 13

soft tissue
Soft tissues represent most of the contents of the abdomen and feature heavily in the AXR. However, these tissues are poorly seen when compared to other imaging techniques such as ultrasound or CT.

The kidneys, spleen, liver and bladder (if filled) can be seen in addition to psoas muscle shadows and abdominal fat.

Question 14

Bright white bits?

Answer 14

foreign bodies

Question 15

Chest xray interpretation?

Answer 15

type and projection in xray
Name and date
Film quality
ABCDE assessment