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Introduction to Normal
om na a ograp c
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De artment of Radiolo
Vancouver General Hospital
Dr. Savvas Nicolaou
Director of ER/Trauma Radiology
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Objectives
GI Tract• Stomach• ma n es ne
• Large intestine• Liver• Spleen
GU System• Kidneys
• Bladder
Bones• Sacroiliac joint, Symphysis Pubis, Iliac crest, Femoral heads , Hip Joint• Vertebral bodies
• Pedicles, Transverse process, spinous process
Muscles• Psoas ma or
Be able to identify which abdominal organs are intraperitoneal andretroperitoneal
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Anatomy Review
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Anatomical Planes
Sagittal
Axial/Transverse
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Basic Abdominal Anatomy
• Abdomen extends from inferior margin of
thorax to the superior margin of pelvisand lower limb
• Peritoneum lines the abdominal cavity
• Forms the mesenteries thatsuspen s v scera
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Basic Abdominal Anatomy
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BOWEL
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Basic Radiographic Terminology
• Attenuation describes the absor tion of X-ra s as the
traverse structures
Lucency = low attenuation
appear black
e.g., air
pac ty = g attenuat on appear white
. .,
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Abdomen
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Radiography
radiographs, and are
demonstrated on this ima e
Soft Tissue
Fat
Air - fat - water - bone - metal
MetalBone
Lower HigherAttenuation
• Note that THICK structures
Air
THIN structures of the same
composition
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Patient Positioning
Supine
Erect
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GASTROINTESTINAL SYSTEMInterpreting the Abdominal Radiograph
Routine “3 Views”:
Supine AP abdomen Erect AP abdomen Erect chest x-ray
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GASTROINTESTINAL SYSTEMInterpreting the Abdominal Radiograph
Routine “3 Views”:
Supine AP abdomen
• Most useful for detecting bowel
gas patterns
• Eg. dilated bowels, intra-abdominal luid
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GASTROINTESTINAL SYSTEMInterpreting the Abdominal Radiograph
Routine “3 Views”:
• Most useful for detecting free air,
Erect AP abdomen
air-fluid levels and bowel gas
patterns• Eg. Bowel obstruction
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GASTROINTESTINAL SYSTEMInterpreting the Abdominal Radiograph
Routine “3 Views”:
• Most useful in detecting intra-
Erect chest x-ray
peritoneal air (air under the
diaphragm)• May demonstrate thoracic
disease causing abdominal pain
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Normal gastric air bubble with air fluid level
Air Under the Diaphragm PathologyNormal gastric air bubble with air fluid level
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APPROACH TO EVALUATING A PLAIN ABDOMINAL FILM
3 :
SOFT TISSUES – ABDOMINALVISCERA
BOWEL GAS PATTERN
BONES- SKELETAL ELEMENTS
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LiverSpleen
Stomach
Left kidneypedicle
Hepaticflexure
Left psoas
margin
p nous process
Left sacroiliac joint
Left hi oint
Symphisis pubis
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Soft Tissue
LiverSpleen
Left kidne
Stomach
Hepaticflexure
Left psoas
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ENLARGED SPLEEN
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Bone
Spinous
Pedicle
Right iliac
crest
Left
Right
acetabulum
sacroiliac joint
Right femoral
head
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Bowel Gas
Bowel Gas
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GAS PATTERN – Air Inside the Bowel Lumen
Property Small Bowel Large Bowel
Location Central Peripheral (Picture Frame)
Circular Folds Haustra , sacculations
Folds Uninterrupted folds cross entire width(Valvulae Conniventes)
Interrupted: folds do not crossentire width
Maximumdiameter
3cm9cm at cecum,10cm or more abnormalMax 6cm transverse colon if morethan 6 abnormal
Maximum foldthickness
3mm 5mm
Rarely contains solid fecal material Commonly contains solid fecal
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LARGE BOWEL SMALL BOWEL
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Small vs. Large Intestine
Small Intestine Large Intestine
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Multiple
dilated loopsof small bow el
indicat in a
Valvulae conniventes –
small bow el mucosal
small bow el
obstruction
folds
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Valvulaeconn ven es –
small bow elmucosal folds
small bow el obst ruction
numerous small bow el airfluid levels
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Small bowel mucosal folds circumferential valvulae conniventes (plicaesemicircularis)
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Large bowel folds - haustra
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Spleen
Left kidney
Stomach
Spinousprocess
Left
e c e
Left
joint
Rectum
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Liver
Hepatic
flexure
Right iliac
crest
Ri ht
acetabulum
head
R di h 3D R t ti
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Radiograph vs. 3D Reconstruction
3D Reconstruction
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3D Reconstruction
1. Liver
2. Spleen
3. Kidneys
4. Psoas muscle
5. Sacrum3
1
36. Rectum
7. Vertebral Body
8. Femoral Head
4
7
4
5
68 8
Radiograph Superimposition on 3D Reconstruction
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Radiograph Superimposition on 3D Reconstruction
1. Liver
2. S leen21
3
3. Kidneys
4. Psoas muscle
3
1
3
4
.
6. Rectum
7. Vertebral Body4
7
4
5
.
5
668 8
Radiograph Superimposition on 3D Reconstruction
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Radiograph Superimposition on 3D Reconstruction
1. Liver
2. S leen
3. Kidneys
4. Psoas muscle
2
3
1
3 .
6. Rectum
7. Vertebral Body4
7
4
.
9. Ilium
5
99
68 8
Radiograph Superimposition on 3D Reconstruction
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Radiograph Superimposition on 3D Reconstruction
1. Liver
2. S leen
3. Left kidney
4. Psoas muscle
34
.
6. Rectum
7. Vertebral Body
47
5
.
9. Ilium9
9
6 88
Radiograph vs 3D Reconstruction
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Radiograph vs. 3D Reconstruction
Radiograph vs. 3D Reconstruction
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Radiograph vs. 3D Reconstruction
3D Reconstruction
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3D Reconstruction
.2. Vertebral Body
3. Ilium4. Sacrum
1 1
5. Femoral Head2
33
5
Radiograph vs. 3D Reconstruction
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g p
11
.2. Vertebral Body
3. Ilium4. Sacrum
25. Femoral Head
33
5
Radiograph vs. 3D Reconstruction
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g p
11
.2. Vertebral Body
3. Ilium4. Sacrum
25. Femoral Head
33
5
Radiograph vs. 3D Reconstruction
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211. Liver
2. Spleen
33
3. Left kidney
4. Psoas muscle5. Sacrum
47
6. Rectum
7. Vertebral Body
8. Femoral Head
59
9
9. Ilium
68
8
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Coronal view
31
3
2 4
7
6
4
6
1. Liver 5. Descending colon.
3. Stomach
4. Small intestine
.7. Ascending colon
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Coronal view
11 3
2
2
. omac2. Psoas muscles
3. Spleen
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Coronal view
2
21
3
44
3
57
66
1. Liver 5. Gluteal muscles.
3. Left kidney
4. Psoas muscle
.7. Sacrum
C l i
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Coronal view
21
1 23
3
4
5
6
.2. Spleen3. Left kidney
.5. Illium6. Femoral Head
FINAL REVIEW OF PLAIN XRAY ANATOMY
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LiverSpleen
Stomach