The Abdominal X-Ray

1. Patient information
 Name, age, and sex of the patient.

2. X.ray details
 Date of the X-ray.
 Indication of the x.ray: etc. abdominal distention.
 Exposure: Confirm size of area covered.
 Type: PA or AP? (They are usually PA.)
 Supine (usual), erect, or lateral decubitus? (Look at gastric air bubble
and fluid levels.)
 Penetration (lumbar vertebrae should be visible).
Abnormalities
3. A: AIR
 Gastric fundal air (normal)
 Air under the diaphragm (perforation)
 Make a note of any clearly visible interventions or artifacts e.g. NG tube;
IUD; stents; retained surgical instruments; clothe bottoms; coins in
pockets; etc
4. B: bowels and bones
A. Small bowel
 Size: <3cm is normal (dilated >3cm)
 Position: central
 shape: volvulae convectus
 Air and air fluid level ( obstruction)
B. Large bowel
 Size: <6cm (dilated>6cm colon, >9cm rectum)
 Shape: haustral markings
 Position: peripheral
 Gas: normal in colon
 Pneumatosis intestinalis: extraluminal gas (perforation
 Fecal: mottled appearance
 Coffee bean sign: volvulus
C. Bones
 Pelvis and spine: fracture, calcification, metastasis, deformities

5. C: Consider organs and soft tissue shadows for calcification

 Inspect: liver; Spleen (usually not visualized),
 Kidneys (about three vertebrae in size, the left kidney is higher
than the right);
 Bladder: not visualized if empty; Prostate: only visualized if
calcified,
 Psoas shadow: lost in retroperitoneal inflammation or ascites.
  Calculi (kidneys, ureters, bladder, gall bladder, and biliary tree);
Pancreas; Kidneys; Abdominal aorta and arteries
6. D: diaphragm
 Position
 Hernia orifices: hiatal hernia, diaphragmatic hernia,
7. E: everything else

 interventions or artifacts e.g. NG tube; IUD; stents;

retained surgical instruments; clothe bottoms; coins in
pockets; etc

8. summarize and give your clinical impression.

Prepared by MFC.