Abdomen

Course rad332

ompiled and designed by Abdelmoniem Musa, CMRS, King Saud University, Riyad ©2004

Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Copyright  2003 A Musa
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 Technical aspects

PLAIN ABDOMEN, (KUB)

The plain abdomen ( KUB ) shows the kidneys, ureters, urinary bladder and the gall bladder (usually
prior to contrast examinations like barium meal, barium enema, IVU, or cholangiography) to exclude
radiopaque renal or gall stones (calculi), abnormal intraabdominal masses, and the state of bowel
preparation. All acute abdomen conditions (emergency conditions) resulting from intestinal (bowel)
obstructions, perforations with intraperitoneal air, i.e., small free-air outside the digestive tract), will
require several projections for the abdomen in different positions.
 Technical aspects

Patient should be comforted with clean pillow under the head and a support under the knees, clean linen,
and a slim couch sponge mattress. Patient’s legs must be covered to keep him warm.
High mA and shorter exposure times must be used to freeze voluntary and involuntary organ movements
(breathing and bowel peristalsis).
Exposure is taken on second full arrested expiration ( to displace the diaphragm upward ) to give a better
view of the abdominal structures.
 Technical aspects

Gonadal shields should often be used on males (upper edge of the shield at the symphysis pubis). For
females, shields are used only where they could not obscure essential anatomical structures (the lower
border of the shield should be at the symphysis pubis).
For potential early pregnancy, the ‘10-day Rule’ (the LMP) must always be observed, unless permission
has been given by the medical specialist as to ‘ignore’ it, e.g., in the case of an emergency (e.g., trauma),
or in case of a female with a removed uterus.
 Technical aspects

Medium to maximum image contrast with maximum sharpness for soft-tissue differentiation should
be considered for the abdomen using a medium kV range (65 to 80 kV) to visualize the abdominal
structures.
Correct exposure factors should produce more gray-tone contrast that will faintly shows the lateral
borders of the psoas muscle, lower liver margin, kidneys outline, and the transverse processes of
the lumbar vertebrae.
Basic projections of the plain abdomen are: AP supine and AP erect. A PA erect chest film must
usually be done - as it clearly shows small amounts of free intraperitoneal air under the diaphragm
(subphrenic air).
 Technical aspects

Careful preliminary patient (preparation) of the intestinal and gastric contents is important for a clear
view of all the abdominal structures. For non-acute conditions, patient preparation is as follows:
(1) Patient placed on a low-residue diet for (2 days) prior to x-ray examination to prevent formation
of gas due to excessive fermentation of the intestinal contents
(2) Patient should be instructed to take some catharic ( laxative ) the night before the examination,
and a cleansing enema next morning (usually normal saline solution) not more than two hours
before the examination. The enema must be at the body’s normal temperature (37C).
 Acute abdomen

Is an ‘emergency’ case indicated for: Non-mechanical small bowel obstruction (ileus), the mechanical
bowel obstruction (from the effects of hernia or adhesions), ascites, intra-abdominal mass, and post-
surgery.
Exam is carried out with high power x-ray equipment in the x-ray department, or in wards, for patients
too ill to come to the department.

Radiographs to be taken for the acute abdomen are:

(1) Erect PA (or AP) chest to exclude basal pneumonia as a cause of upper abdominal pain
(2) AP plain supine abdomen
(3) AP Erect abdomen (or alternatively a lat decubitus)
(4) Supine decubitus (lateral for uncooperative patient)

.
 Technical aspects

REMEMBER

NEVER ..
prepare an acute
abdomen patient !
AP Plain Supine Abdomen (KUB) (Basic)

Shows pathology (bowel obstruction, ascites, calcifications, and

neoplasms). Also used as a (scout) film before any contrast
media study. A compression band must be used to reduce
size of the abdomen.
Patient supine, arms by the sides, legs flexed (or extended with
pillow under the knees).
Film: 35x43 cm.
CP: Level of iliac crest (L4), with bottom margin of the film at
the symphysis pubis.
CR: 90 vertically to film center.
AP Plain Supine Abdomen (KUB) (Basic)
PA Plain Prone Abdomen (KUB) (Basic)

Shows pathology (bowel obstruction, ascites, calcifications, and

neoplasms). Also used as scout) film before any contrast media
study. It is less desirable than AP (for the kidneys) because of
the increased OFD.
Patient prone, arms up beside the head, both legs extended,
support under knees & heels
Film: 35x43 cm.
CP: Level of iliac crests (L4) with bottom margin of film at the
symphysis pubis.
CR: 90 vertically to film center
PA Plain Prone Abdomen (KUB) (Basic)
Lateral Abdomen (KUB) (Special)

Shows soft-tissue masses, umbilical hernia, aortic aneurysm, and

calcifications.

Patient in lateral recumbent, elbows flexed, arms up, knees partially

flexed, a pillow between both knees, another pillow under head.
Film: 35x43 cm.
CP: Level of iliac crests (L4), bottom margin of film at symphysis
pubis.
CR: 90 vertically to film center.
Lateral Abdomen (KUB) (Special)
AP Erect Abdomen (KUB) (Special)

Shows abnormal masses, air-fluid levels, and subphrenic air.

Patient upright, back against cassette, arms at the sides, film

center 2 inches above iliac crest (to include the diaphragm)
or, top of cassette at the level of the axilla.

Film: 35x43 cm.

CP: 2 inches above level of iliac crests.
CR: 90 horizontally to film center.
NB/ Patient must be upright for 5 minutes before the exposure
is made to allow for intraperitoneal gas settling . For weak
patients, a lateral decubitus is generally recommended.
AP Erect Abdomen (KUB) (Special)
Lateral Decubitus Abdomen (AP) (Special)

Shows any masses, possible accumulations of intraperitoneal air,

air-fluid levels, patient should be for at least 5 minutes on his side.
Patient in lateral recumbent on a radiolucent cotton pad, back to a
vertical cassette, knees partially flexed, arms near the head.
Film: 35x43 cm.
CP: Two inches above the level of the iliac crests, the diaphragm
must be included.
CR: 90 horizontally to film center.
Lateral Decubitus Abdomen (AP) (Special)
Dorsal Decubitus Abdomen (Lateral view) (Special)

Shows masses, possible accumulations of gas, air-fluid levels,

aneurysms (widening and dilation of arterial, venous, or of the
cardiac walls).
Patient supine on a radiolucent pad, side against a vertical film,
arms up beside the head, support under the knees.
Film: 35x43 cm.
CP: 2 inches above level of iliac crests, diaphragm must be
included.
CR: 90 horizontally to film center
AP Supine Liver + Diaphragm (Basic)

Shows abnormal calcification of the liver (e.g., hydatid cysts), and

intra-hepatic or subphrenic abscesses.

Patient supine, film lower margin at the level of upper the part of
the iliac crests such that the diaphragm is included, exposure on
full arrested expiration.
Film: 35x43 cm (cross-wise).
CP: Two inches above level of iliac crests, diaphragm must be
included.
CR: 90 vertically to film center.
Intra-hepatic/Subphrenic Abscess (Special)

Shows fluid with free-air under the right hemidiaphragm.

Patient positions:
(a) erect (standing or sitting)
(b) Left lateral decubitus
CR: Horizontally 90 in both cases to the vertical
cassette
 TABLE 2 (Exposure Factors)
PROJECTION kVp mAs
AP Plain Supine Abdomen (KUB) 80 22
PA Plain Prone Abdomen (KUB) 80 22
Lateral Abdomen (KUB) 80 60
AP Erect Abdomen (KUB) 80 30
Lateral Decubitus (AP) Abdomen 80 30
Dorsal Decubitus (Lat) Abdomen 80 60
AP Supine Liver and Diaphragm 80 22
Intra-hepatic/Subphrenic Abscess 80 22