RadteraXR Acute Abdomen Series (Obstruction/Free-air Series)
XRNo contrastAbdomen & Pelvis
Indications
- Acute abdominal pain
- Suspected bowel obstruction or ileus
- Suspected free intraperitoneal air/perforation
- Suspected toxic megacolon
- Postoperative ileus evaluation
Patient prep
- Gown; remove radiopaque objects over abdomen
- No preparation; performed acutely
Contrast
None / non-contrast
Technique
- Three-view series: supine abdomen, upright abdomen, and upright PA chest
- Supine: CR perpendicular at iliac crests
- Upright abdomen: CR horizontal, centered ~2 inches above iliac crest to include diaphragms
- Upright chest: CR to T7 (detects free air under diaphragm)
- SID 40 inches abdomen, 72 inches chest; grid; kVp ~70-80 abdomen
- If patient cannot stand, substitute left lateral decubitus abdomen (5-min equilibration, horizontal beam)
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | AP supine abdomen | Frontal | CR at iliac crests; evaluates bowel gas distribution and distention |
| 2 | AP upright abdomen | Frontal | Horizontal CR ~2 inches above crest to include both hemidiaphragms; demonstrates air-fluid levels |
| 3 | PA upright chest | Frontal | CR to T7, SID 72 inches; best view for free air beneath diaphragm and to exclude thoracic causes |
Key points
- Left lateral decubitus abdomen replaces upright if patient cannot stand (free air rises over liver, away from gastric bubble); allow 5 minutes in position before exposure
- Upright images require patient erect 5-10 minutes for air to rise
- Some institutions call this the '3-way' or 'obstruction series'
- Dorsal decubitus (lateral) view may be added
References
• Bontrager's Handbook - Acute Abdomen Series
• Merrill's Atlas Vol 2 - Abdomen (Acute Abdomen)
• Radiopaedia: Acute abdominal series link
• WikEM: Acute abdominal series
• Merrill's Atlas Vol 2 - Abdomen (Acute Abdomen)
• Radiopaedia: Acute abdominal series link
• WikEM: Acute abdominal series
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.