Preface vii
Acknowledgements viii
Learning objectives checklistix
Part 1 About X-rays 1
What are X-rays? 1
How are X-rays produced? 1
How do X-rays make an image? 2
How are X-ray images (radiographs) stored? 3
Radiation hazards 3
The Ionising Radiation (Medical Exposure) Regulations 3
In women of reproductive age 3
Indications for an abdominal X-ray 4
Abdominal X-ray views 5
AP Supine abdominal X-ray 5
Other views 5
Radiograph quality 6
Inclusion 6
Exposure 6
Normal anatomy on an abdominal X-ray 8
Right and left (Figure 7) 8
Quadrants and regions (Figure 8) 8
Abdominal viscera 1 (Figure 9) 8
Abdominal viscera 2 (Figure 10) 9
Skeletal structures (Figure 11) 10
Pelvis (Figure 12) 10
Lung bases (may be visualised at the top of the abdomen) (Figure 13) 11
Bowel 1 (Figure 14) 11
Bowel 2 (Figure 15) 12
Presenting an abdominal radiograph 14
Be systematic! 14
Part 2 Overview of the ABCDE of abdominal radiographs 15
A - Air in the wrong place 16
Pneumoperitoneum (gas in the peritoneal cavity) 21
Pneumoretroperitoneum (gas in the retroperitoneal space) 26
Pneumobilia (gas in the biliary tree) 28
Portal venous gas (gas in the portal vein) 29
B - Bowel 17
Dilated small bowel 30
Dilated large bowel 34
Volvulus 37
Dilated stomach 40
Hernia 41
Bowel wall inflammation 43
Faecal loading 48
Faecal impaction 49
C - Calcification 18
Gallstones in the gallbladder (cholelithiasis) 50
Renal stones (urolithiasis) 53
Bladder stones 56
Nephrocalcinosis 57
Pancreatic calcification 58
Adrenal calcification 59
Abdominal aortic aneurysm (AAA) calcification 60
Fetus 62
Calcified structures of little clinical significance 63
Calcified costal cartilage 63
Phleboliths ('vein stones') 63
Calcified mesenteric lymph nodes 64
Calcified uterine fibroids 65
Prostate calcification 65
Abdominal aortic calcification (normal calibre) 66
Splenic artery calcification 66
D - Disability (bones and solid organs) 19
Pelvic fractures - 3 Polo rings test 67
Sclerotic and lucent bone lesions 68
Spine pathology 69
Solid organ enlargement 71
E - Everything else 20
Medical and surgical objects (iatrogenic) 73
Surgical clips/staples/sutures 73
Urinary catheter 75
Supra-pubic catheter 75
Nasogastric (NG) and nasojejunal (NJ) tubes 76
Flatus tube 77
Surgical drain 78
Nephrostomy catheter 78
Peritoneal dialysis (PD) catheter 79
Gastric band device 79
Percutaneous endoscopic gastrostomy (PEG)/ radiologically inserted gastrostomy (RIG) 80
Stoma bag 80
Stents 81
Inferior vena cava (IVC) filter 84
Intra-uterine device (IUD) 85
Pessary 85
Foreign bodies 86
Retained surgical swab 86
Swallowed objects 87
Objects inserted per-rectum (PR) 88
Clothing artefact 90
Piercings 90
Body packer 91
Lung bases 93
Self-assessment questions 94
Self-assessment answers 99
Glossary 107
Index 112
