Abdominal

Positioning in
Radiography

Introduction

The abdominal cavity extends from the

under surface of the diaphragm above to
the pelvic inlet below.

Nine regions of the abdominal

cavity

Transpyloric plane
is midway b/w
supra sternal notch
& symphisis pubis
& posteriorly
through body of L
1 anteriorly
through tip of rt &
Lt 9th costal
cartilage.

Trans tubercular plane at

the level of tubercles of
iliac crest anteriorly
upper border of L5
posteriorly.
2 Parasaggital planes at
right angles to transverse
planes passing through a
point midway b/w ant sup
iliac spine and symphysis
pubis dividing abdominal
cavity into 9 regions.

Referral criteria
Intestinal obstruction
Perforation
Renal pathology
Acute abdomen
Foreign body localization
Toxic mega colon
Aortic aneurysm.
Prior to introduction of contrast medium.

Image Parameters
Maximum image contrast and sharpness
should be obtained so that adjacent soft
tissues can be differentiated.
Standard imaging table and a moving grid is
usually used.
Patient is immobilized and exposure is made
on arrested respiration usually after full
expiration.

Essential image characteristics

Coverage of the whole abdomen to include

diaphragm to pubic symphysis.
Visualization of the whole urinary tract i.e KUB.
Sharp reproduction of bones and the interface
between air filled bowel and surrounding soft
tissues with no overlying artefacts e.g.
clothing.
In calculus disease good tissue differentiation
is necessary to visualize small or low opacity
stones.

Radiation Protection:
Pregnancy rule: unless it has been decided
to ignore pregnancy in case of emergency.
Gonad shielding.
Follow a well planned procedure to avoid
repetition and thus limit patient exposure.

A-P Projection of Abdomen

1,11th rib.
2,Vertebral body (TH 12).
3,Gas in stomach.
4,Gas in colon (splenic flexure).
5,Gas in transverse colon.
6,Gas in sigmoid.
7,Sacrum.
8,Sacroiliac joint.
9,Femoral head.
10,Gas in cecum
11,Iliac crest.
12,Gas in colon (hepatic flexure).
13,Psoas margin.

Antero posterior supine

position of patient and cassette
Patient supine with
the MSP(median
sagittal plane) at
right angle and
coincident with the
midline of the table.
Pelvis adjusted so
that ant sup iliac
spines are
equidistant.

Cassette is placed longitudinally in the

cassette tray and positioned such that the
symphysis pubis is included in the lower
part of the film.
Centre of the cassette is 1cm below the line
joining the iliac crests.

Direction and Centring of X ray

Beam
Vertical central ray is
directed to the
centre of the
cassette.
Exposure is made on
arrested respiration.
Bowel pattern should
be demonstrated
with minimal un
sharpness.

Evaluation criteria of a good AP

projection

Take Home Lesson

Large abdomen- use immobilization band to
compress soft tissue and reduce scatter.
Beam should be collimated according to
size of cassette.
Ensure markers are included on cassette.
If patient too ill use stationary grid and
cassette is placed in tray under trolley. Lead
rubber is placed under cassette to reduce
grid cut off.

Common Faults and

Remedies
Failure to include symphysis and diaphragm
on same image maybe due to large patient
- two images are acquired.
Failure to visualize the lateral extent of
abdominal cavity due - to pt size and poor
positioning.
Respiratory movement un sharpnessrehearsal of breathing technique before
exposure.

Patient rotation when patient is in bed.

Underexposure patient size or incorrect
exposure control.
Artefacts buttons or pocket contents.
Grid cut off trolley or ward patients
vertical central beam is at 90 degrees and
cantered at middle of grid cassette.

Poor image contrast:

high kvp
poor collimation
stationary grid
poor abdominal compression

AP Erect Patient Standing

Patient with back
against erect Bucky
legs well apart so that
patient is steady.
The MSP is adjusted at
90 degrees and
coincident with
midline of table.
Pelvis is adjusted such
that the ant sup iliac
spines are equidistant.

The cassette is placed in the Bucky tray

with its upper edge at level of middle of
body of sternum so that the diaphragms are
included.

Direction and Centering of X

Ray Beam
Horizontal beam is directed so that it is
coincident with the centre of the cassette in
the midline.
An exposure is made in full expiration.

Notes
Exposure factors
High mA
Short exposure time
7-10 kvp more than for supine
In case of suspected perforation patient
should be kept erect for at least 20 mins
prior to exposure to allow free gas to rise.

Other Common Positions

A-p erect patient sitting.
A p left lateral decubitus.
Lateral dorsal decubitus.

Thank You