Radiographic Anatomy of the Abdomen

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Questions and Answers

What is the upper transverse plane in the abdomen called?

Midclavicular plane

Transtubercular plane

Umbilical plane

Transpyloric plane (correct)

Which of the following divides the abdomen into nine regions?

Sagittal planes only

Transverse planes and vertical planes (correct)

Frontal planes only

Horizontal planes and oblique planes

What is a factor that affects the position of organs in the abdomen?

Phase of respiration (correct)

Favorite food choice

Age of the individual only

Color of clothing

The lower transverse plane is referred to as the:

Transtubercular plane Signup and view all the answers

In which body type is the dome of the diaphragm positioned high?

Hypersthenic type Signup and view all the answers

The region located centrally below the epigastric region is known as the:

Hypogastric region Signup and view all the answers

What is the best description of the hypersthenic body build?

Massively built with a high diaphragm Signup and view all the answers

The parasagittal planes in the abdomen primarily serve to:

Divide the abdomen vertically Signup and view all the answers

What is a characteristic feature of the asthenic body type?

Narrow thorax with a low diaphragm Signup and view all the answers

Which condition is NOT typically indicated for a radiographic examination of the abdomen?

Routine chest pain Signup and view all the answers

Which body part should be included in the coverage of a plain radiograph of the abdomen?

Lateral fat stripe Signup and view all the answers

What is a critical requirement for obtaining radiographic images of the abdomen?

Maximum image sharpness and contrast Signup and view all the answers

Which of the following body types is described as having proportions tending towards being broad but not as broad as hypersthenic?

Sthenic Signup and view all the answers

What should be demonstrated in a radiograph of the urinary tract?

Kidneys, ureters, and bladder Signup and view all the answers

Which imaging protocol is used prior to introducing contrast media?

Intravenous pyelography Signup and view all the answers

Why is gonad shielding used during abdominal radiography?

To protect reproductive organs from radiation Signup and view all the answers

What position should the patient be in during the imaging process?

Supine with the median sagittal plane coincident with the mid-line of the table Signup and view all the answers

Where should the center of the image receptor be positioned?

At a point located 1 cm below the iliac crests Signup and view all the answers

What is the recommended exposure technique for abdominal radiographs?

Make the exposure on arrested respiration Signup and view all the answers

Which common fault may result from a patient's size during imaging?

Failure to include the region inferior to the symphysis pubis Signup and view all the answers

How can respiratory movement unsharpness be minimized?

Rehearse the arrested breathing technique before exposure Signup and view all the answers

What adjustment may be necessary if rotation occurs due to patient discomfort?

Repeat the imaging with the patient in a more comfortable position Signup and view all the answers

What potential artifacts may interfere with the imaging results if the patient remains clothed?

Presence of buttons or pocket contents Signup and view all the answers

What is the ideal method to include both the upper and lower abdominal regions when necessary?

Using two separate images with cassettes placed transversely Signup and view all the answers

What is the primary position of the patient when performing an antero-posterior projection?

Supine with the median sagittal plane at right angles to the table Signup and view all the answers

In which direction should the collimated horizontal central beam be directed for a lateral projection of a supine patient?

At right angles to the lateral aspect of the trunk Signup and view all the answers

What should be included when positioning the 35 × 43 cm CR grid cassette against a patient's back for imaging?

The thorax to the level of mid-sternum and as much of the abdomen as possible Signup and view all the answers

What anatomical structures are visualized using plain radiography of the abdominal and pelvic cavity?

Outline of the kidneys surrounded by perirenal fat Signup and view all the answers

What is the correct positioning of the patient’s arms for a lateral projection when lying supine?

Resting by their sides slightly away from the trunk Signup and view all the answers

Which pathology can be identified through radiography of the urinary tract?

Gas within the urinary tract Signup and view all the answers

When a patient is unable to sit or be rolled onto their side, which projection technique is used?

Lateral projection while supine Signup and view all the answers

What must be avoided when taking lateral images of a supine patient?

Projection of the anterior wall of the trunk off the resultant image Signup and view all the answers

What is indicative of small bowel obstruction as seen on the abdomen radiograph?

Distended small bowel loops with faecal loading Signup and view all the answers

What position should a patient be in for an antero-posterior erect radiograph?

Standing with legs placed well apart Signup and view all the answers

When positioning a patient for an antero-posterior left lateral decubitus X-ray, what should be done to confirm the presence of sub diaphragmatic gas?

The patient should remain lying for at least 10 minutes before exposure Signup and view all the answers

Where should the upper edge of the CR cassette be positioned for an erect abdomen X-ray?

At the level of the mid-sternum Signup and view all the answers

What is the purpose of placing the median sagittal plane at right-angles to the midline of the vertical Bucky?

To achieve accurate alignment for imaging Signup and view all the answers

In an antero-posterior left lateral decubitus view, where is free gas primarily located?

Between the lateral margin of the liver and the right lateral abdominal wall Signup and view all the answers

What should be done if the patient cannot be positioned in an erect stance during an abdominal X-ray?

Use the left lateral decubitus position to confirm sub diaphragmatic gas Signup and view all the answers

What must be ensured regarding the patient's knees when seated for an abdomen X-ray?

They should be flexed without obscuring the lower abdomen Signup and view all the answers

Study Notes

Radiographic Techniques

Abdomen regions and image parameters include AP supine, PA erect, and lateral views.
Techniques were presented by Ahmed Jasem Abass, MSC of Medical Imaging.

Abdominal Cavity

The abdominal cavity extends from the diaphragm to the pelvic inlet, and is surrounded by abdominal walls.
The abdomen is divided into nine regions using two transverse and two parasagittal planes.

Planes of the Abdomen (Fig 10-1a)

The transpyloric plane is approximately midway between the xiphisternum and the umbilicus, passing through the tips of the 9th costal cartilages and the pylorus of the stomach.
The transtubercular plane is positioned at the level of the tubercles of the iliac crest anteriorly and near the 5th lumbar vertebrae posteriorly.
Two parasagittal planes run vertically, passing midway between the anterior superior iliac spine and the symphysis pubis.

Body Build Types

Individuals are categorized into hypersthenic, sthenic, hyposthenic, and asthenic body builds based on their proportions.
Hypersthenic individuals have a massively built body, with a high diaphragm and wide costal angle, resulting in a wider upper abdomen.
Asthenic individuals are thin and slender, with a narrow thorax and low diaphragm position.

Most Common Referral Criteria

Radiographic examinations of the abdomen and pelvis are performed for various reasons, including bowel obstruction, perforation, renal pathology, acute abdominal pain, foreign body localization, toxic megacolon, and aortic aneurysm.
Prior to contrast medium procedures, imaging may be performed to identify the presence of radio-opaque renal or gall stones, or calcification, or abnormal gas collections.

Typical Imaging Protocols

Recommended projections include basic antero-posterior (AP) supine and supplementary AP erect, AP or PA lateral decubitus, and lateral dorsal decubitus.

Image Parameters

Ensuring adequate coverage, including the diaphragm and the inferior symphysis pubis and lateral fat stripe;
High resolution and sufficient contrast to delineate the interface between air-filled bowels and surrounding soft tissues; complete visualization of the urinary tract (from kidneys to bladder).

Radiation Protection

Pregnancy exclusion is crucial unless in emergencies.
Gonad shielding is recommended for males.
A 35 x 43 cm CR cassette is typically used.
The patient must lie supine with the median sagittal plane aligned with the table's mid-line.
The pelvis is adjusted to align the anterior superior iliac spines equidistant from the tabletop.
Image receptor placement ensures the region below the symphysis pubis is visible..

Patient Positioning (Fig 10.6a,b)

The X-ray beam is positioned horizontally and centrally collimated to the image receptor.
Ideal exposure is made on arrested respiration during full expiration, allowing abdominal contents to settle naturally.

Normal Abdominal Radiograph Faults (Fig 10.7a,b)

Imaging may fail to include the inferior regions of the diaphragm or symphysis pubis due to patient size.
Respiratory movement during imaging may cause unsharpness, requiring arrested breathing practice. Rotation may be caused by patient discomfort.
The presence of artifacts like buttons or pockets in clothed patients should be noted.

Antero-posterior (AP) Erect Projection

If possible, patients are examined standing or seated against a Bucky, using a 35 x 43 cm CR cassette to include the diaphragms.
Legs should be positioned apart for stable standing position; care with seated patients to avoid knee obstruction.
The mediansagittal plane is adjusted to be perpendicular to the Bucky.

Antero-posterior—Left Lateral Decubitus

This projection is suitable for visualizing sub-diaphragmatic gas, and suspected bowel issues, when ultrasound or CT are not available or inappropriate.
The patient lies on their left side, with their elbows flexed and hands near their head, and remain in this position for 10 minutes before the exposure. The x ray beam is positioned centred to the anterior aspect of the patient's body.

Lateral–Dorsal Decubitus (Supine)

When a patient cannot sit or be turned to one side, the lateral projection is undertaken with the patient remaining supine.
A 35 x 43 cm CR cassette is supported vertically against the patient's side to include the thorax to the mid-sternum, and as much of the abdomen as possible.

Urinary Tract (Kidneys, Ureters, Bladder)

Plain radiography of the abdominal and pelvic cavity is often performed to examine the kidneys, surrounded by perirenal fat, the psoas muscles, opaque kidney stones, calcifications within the kidneys or bladder, gas presence, and acute abdominal pathology.

Antero-posterior Projection (Figs 10.10a,b)

The patient lies in a supine position on the X-ray table.
Hands can be placed on the chest or at the patient's sides (away from the trunk).
The Bucky or 35 x 43 cm CR cassette includes the region from the upper kidney poles to the symphysis pubis.
The center of the receptor should be approximately 1 cm below the line connecting the iliac crests to include the symphysis pubis.

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Description

Test your knowledge on the anatomical divisions and body types relevant to abdominal radiography. This quiz covers essential concepts such as transverse planes, body types, and critical requirements for radiographic imaging in the abdomen. Perfect for students and professionals in medical imaging.