Evaluation Criteria Abdominal x-ray

Abdominal x-ray

Evaluation Criteria

Dr. Ahmed Alsharef Farah

Dr. Ahmed Alsharef Farah 1

AP Projection:Supine position.Evaluation Criteria:1. Anatomy

Demonstrated:Outline of liver, spleen, kidneys, and air-filled stomach and bowel segments and the arch of the symphysis pubis for the urinary bladder region.


2. Position:No rotation; iliac wings,

obturator foramina (if visible), and ischial spines appear symmetric, and outer lower rib margins are the same distance from spine (elongation of iliac wing indicates rotation in that direction).

Collimation to area of interest.Dr. Ahmed Alsharef Farah 3

3. Exposure:No motion; ribs and all

gas bubble margins appear sharp.

Sufficient exposure visualize psoas muscle outlines, lumbar transverse processes, and ribs.

Margins of liver and kidneys should be visible on smaller to average-sized patients.


PA projection:Prone position

Evaluation Criteria:1. Anatomy Demonstrated:

Outline of liver, spleen, kidneys, and air-filled stomach and bowel segments and the arch of the symphysis pubis for the urinary bladder region.


2. Position:No rotation:

iliac wings appear symmetric, and sacroiliac joints and outer lower rib margins (if visible) should be the same distance from spine.

Collimation to area of interest.




Exposure are sufficient to visualize psoas muscle outlines, lumbar transverse processes, and ribs.

Margins of liver and kidneys should be visible on smaller to average-sized patients.


Lateral position:


Diaphragm and as muchof lower abdomen as possible should be included.

Air-filled loops of bowel in abdomen with soft tissue detail should be visible in prevertebral and anterior abdomen regions.


2. Position:No rotation as evident

by superimposition of posterior ribs and posterior borders of iliac wings and bilateral ASIS.



3. Exposure:No motion; rib and gas

bubble margins appear sharp.

Lumbar vertebrae may appear about 50% underexposed with soft tissue detail visible in anterior abdomen and in prevertebral region of lower lumbar vertebra.



Air-filled stomach and loops of bowel and air-fluid levels where present.

Should include bilateral diaphragm and as much of lower abdomen as possible.

Small free, intraperitoneal crescent-shaped air bubble if present seen under right hemidiaphragm, away from gas in stomach.

AP projection:Erect position


2. Position:No rotation; iliac wings

appear symmetric, and outer rib margins are the same distance from spine.

Spine should be straight (unless scoliosis is present), aligned with center of IR.





Exposure is sufficient to visualize spine and ribs and soft tissue but not to overexpose possible intraperitoneal air in upper abdomen.

Slightly less overall density (brightness) than supine abdomen is preferred.


Skull x-ray


Lateral position:


Entire cranium visualized and superimposed parietal bones of cranium.

The entire sella turcica, including anterior and posterior clinoid processes and dorsum sellae, is also demonstrated.

The sella turcica and clivus are demonstrated in profile.


2. Position:No rotation or tilt of the

cranium is evident.Rotation is evident by

anterior and posterior separation of symmetric vertical bilateral structures such as the EAM, mandibular rami, and greater wings of the sphenoid.

Tilt is evident by superior and inferior separation of symmetric horizontal structures such as the orbital roofs (plates) and greater wings of sphenoid.


3. Exposure:Density (brightness)

and contrast are sufficient to visualize bony detail of bony structures and surrounding skull.

Sharp bony margins indicate no motion.


PA projection: 0° CR


Frontal bone, crista galli, internal auditory canals, frontal and anterior ethmoidsinuses, petrous ridges, greater and lesser wings of sphenoid, and dorsum sellaeare shown.


2. Position:No rotation is evident, as

indicated by equal distance bilaterally from lateral orbital margin to lateral cortex of skull.

Petrous ridges fill the orbits and level of the supraorbital margin.

Posterior and anterior clinoids are visualized just superior to ethmoid sinuses.



and contrast are sufficient to visualize frontal bone and surrounding bony structures.



PA axial projection:15° CR (Caldwell method) or 25° to 30° CREvaluation Criteria:1. Anatomy Demonstrated:

Greater and lesser sphenoid wings, frontal bone, superior orbital fissures, frontal and anterior Ethmoid sinuses, Supraorbitalmargins, and Crista galli are demonstrated.


PA with 25° to 30°Caudad Angle:

In addition to the structures mentioned previously, the foramen rotundum adjacent to each IOM is visualized (white arrows), and the superior orbital fissures (black arrows) are visualized within the orbits.


2. Position:No rotation as assessed by equal distance

from the midlateral orbital margins to the lateral cortex of the cranium on each side, superior orbital fissures symmetric within the orbits, and correct extension of neck (OMLalignment).

If the distance between the right lateral orbit and lateral cranial cortex is greater than the left side, the face is rotated toward the left side.

No tilt with the MS P perpendicular to IR .Dr. Ahmed Alsharef Farah 25

PA with 15° Caudad Angle:

Petrous pyramids are projected into the lower one-third of the orbits.

Supraorbital margin is visualized without superimposition.


PA with 25° to 30°Caudad Angle:

Petrous pyramids are projected at or just below the IOM to allow visualization of the entire orbital margin.



3. Exposure:Density (brightness) and contrast are

sufficient to visualize the frontal bone and sellar structures without overexposure to perimeter regions of skull.



Paranasal Sinuses


Lateral position:


All four paranasalsinus groups are shown.


2. Position:Accurately positioned

cranium without rotation or tilt.

Rotation is evident by anterior and posterior separation of symmetric bilateral structures such as the mandibular rami and greater wings of the sphenoid.


Tilt is evident by superior and inferior separation of symmetric horizontal structures such as the orbital roofs (plates) and greater wings of sphenoid.




and contrast are sufficient to visualize the sphenoid sinuses through the cranium without overexposing the maxillary and frontal sinuses.



Parietoacanthialprojection:Watersmethod (OML 37° to IR).Evaluation Criteria:1. Anatomy Demonstrated:

Maxillary sinuses with the inferior aspect visualized free from superimposing alveolar processes and petrousridges, the inferior orbital rim, and an oblique view of the frontal sinuses.


2. Position:No rotation of the

cranium is indicated by the following:(1)Equal distance from MSP (identified by the bony nasal septum) to lateral orbital margin on both sides.(2) Equal distance from the lateral orbital margin to the lateral cortex of the cranium on both sides.


Adequate extension of neck demonstrates petrous ridges just inferior to the maxillary sinuses.




and contrast are sufficient to visualize maxillary sinuses.



Open mouth Waters method:Evaluation Criteria:1. Anatomy Demonstrated:

Maxillary sinuses with the inferior aspect visualized, free from superimposing alveolar processes and petrousridges, the inferior orbital rim, an oblique view of the frontal sinuses, and the sphenoid sinuses visualized through the open mouth.


2. Position:No rotation of the cranium

is indicated by the following:(1)Equal distance from the MSP (identified by the bony nasal septum) to the lateral orbital margin on both sides.(2) Equal distance from the lateral orbital margin to the lateral cortex of the cranium on both sides


Accurate extension of the neck demonstrating petrousridges just inferior to the maxillary sinuses.




and contrast are sufficient to visualize the maxillary and sphenoid sinuses.



Thank You


Evaluation Criteria Abdominal x-ray

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