Slide 1: How do you approach reading an abdominal radiograph? According to the ACR appropriateness criteria, the relatively low sensitivity of abdominal radiographs compared to CT makes them less useful for evaluating abdominal pain, but they may be helpful in certain situations. They shine in quickly identify foreign bodies and are moderately helpful when questioning bowel obstruction.

Slide 2: Step 1: Evaluate the position of lines and tubes. The highlighted items are an enteric tube (blue) and a rectal temperature probe (purple). See our other posts on identification and appropriate placement of lines/tubes.

Slide 3: Step 2: Evaluate bowel gas. The small bowel (blue) is within the central portion of the abdomen. It can be smooth walled, look like small bubbles, or feature lines spanning the lumen, called valvulae conniventes. The colon (purple) is around the periphery of the abdomen and can be identified by the small “nicks” along the wall called haustra.

Slide 4: Step 3: Evaluate the soft tissue shadows. Evaluate the soft tissue shadows for masses or calcifications. These can give clues to underlying pathology such as tumors, hematomas, and stones. These can be difficult to see on radiography, so sometimes disruption or mass effect on the normal distribution of bowel gas clues you in on an underlying mass.

Slide 5: Step 4: Evaluate the bones. Evaluate for fractures, deformities and degenerative changes in the follow bony structures. Ribs, spine, hip/pelvis.

Slide 6: Let’s review! Remember the four step approach to abdominal radiographs. 1. Lines and tubes. 2. Bowel gas. 3. Soft tissue shadows. 4. Bones