Imaging - AXR

Question 1

Before interpreting an AXR, what information do you want to check?

Answer 1

• Confirm details - Name, DOB, Date/Time of film, Previous films
• Assess image type and quality
  
  • Projection
  • Exposure

Question 2

What projection is an AXR normally?

Answer 2

AP - either supine or erect

Question 3

What do you want to assess on an abdo X-ray in terms of exposure?

Answer 3

Whole abdomen is visible from diaphragm to pelvis.

Question 4

What systematic approach can you use to interpret an AXR?

Answer 4

BBCA

• Bowel and other organs
• Bones
• Calcification
• Artefact

Question 5

What are characteristic features of the small bowel on AXR?

Answer 5

• Usually lies more centrally
• Valvulae conniventes seen across the full width of the bowel.

Question 6

What are features of large bowel on AXR?

Answer 6

• Tends to be peripheral
• Haustra
• Plicae semilunaris
• Faeces may be present

Question 7

What are features of small bowel obstruction in AXR?

Answer 7

• Dilatation of the small bowel (>3cm).
• Valvulae conniventes are much more visible - “coiled spring appearance”.

Question 8

What is the normal diameter of small bowel in AXR?

Answer 8

Approximately 3cm

Question 9

What are features of large bowel obstruction on AXR?

Answer 9

• Dilated peripheral bowel > 6cm
• Specific signs
  
  • Coffee bean - sigmoid volvulus

Question 10

What is rigler’s sign?

Answer 10

Normally only the inner wall of the bowel is visible on an AXR -> Pneumoperitoneum may cause both sides of the bowel wall to be visible (rigler’s sign)

Question 11

What are features of inflmmatory bowel disease on AXR?

Answer 11

• Thumb-printing – mucosal thickening of the haustra due to inflammation and oedema causing them to appear like thumb prints projecting into the lumen
• Lead-pipe (featureless) colon – loss of normal haustral markings secondary to chronic colitis
• Toxic megacolon – colonic dilatation without obstruction associated with colitis

Question 12

What organ structures would you want to look at on AXR?

Answer 12

• Bowels - small and large
• Lung bases
• Liver
• Gallbladder
• Stomach
• Psoad muscle
• Kidneys
• Spleen
• Bladder

Question 13

What bones are commonly seen on AXR?

Answer 13

• Ribs
• Lumbar vertebrae
• Sacrum
• Coccyx
• Pelvis
• Proximal femurs

Question 14

What would you be looking for on AXR when assessing calcification and artefact?

Answer 14

Any signs of

• Calcified gallstones in the RUQ
• Renal stones/staghorn calculi
• Pancreatic calcification
• Vascular calcification
• Costochondral calcification
• Contrast (e.g. following a barium meal)
• Surgical clips
• Naval jewellery artefact over the approximate location of the umbilicus

Question 15

How would you present an abdominal X-ray?

Answer 15

BBCA format - Example as follows:

“This is a supine AP abdominal radiograph of Jayne Lister, date of birth 11/4/1970. The film is of good quality with appropriate exposure. No prior imaging is available for comparison. (BOWEL) Both the small and large bowel appear within normal limits. Other abdominal viscera appear normal within the limits of this projection. (BONE)No obvious bony pathology is identified.(CALCIFICATION/ARTEFACT) No abnormal calcification or artefact is seen. In summary this is a normal plain radiograph of the abdomen.”