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Abdomen (PA erect view)

Dr Ayla Al Kabbani and Dr Matt A. Morgan ◉ et al.

The PA erect abdominal radiograph is often obtained in conjunction with the AP supine abdominal view in the acute abdominal series of radiographs. When used together it is a valuable projection in assessing air fluid levels, and free air in the abdominal cavity.

The erect abdominal radiograph has virtually disappeared from clinical practice in the United Kingdom, with studies dating back to the 1980s affirming that the erect projection rarely changed management ².

On this page:

Article:

Patient position
Technical factors
Image technical evaluation
Practical points
Related articles
References

Images:

Cases and figures

Patient position

the patient is standing, with ventral abdomen toward the image detector
no rotation of shoulders or pelvis
should include the entire transverse width of the patient (if possible; if not, two radiographs may be obtained)
hands can be placed around the detector or on top

Technical factors

posteroanterior projection
suspended inspiration (departmentally dependent)
centring point
- 5 cm above the iliac crest at the midsaggital plane
collimation
- superiorly to include the diaphragms
- to include as much of the abdomen as possible
- lateral to the skin margins
orientation
- portrait
detector size
- 35 cm x 43 cm or 43 cm x 35 cm
exposure
- 70-80 kVp
- 30-50 mAs
SID
- 100 cm
grid
- yes

Image technical evaluation

lateral abdominal wall should be included
inferior pubic rami should be included inferiorly
the diaphragm must be included superiorly
the abdomen should be free from rotation with symmetry of the:
- ribs (superior)
- iliac crests (middle)
- obturator foramen (inferior)
no blurring of the bowel gas due to respiratory motion

Practical points

Often this view is done in teaching hospitals where a plethora of teams will need to interpret an acute abdominal series. Patients who truly require an acute abdominal series will be in a lot of pain and quite unwell, a PA erect view may not be possible, these cases consider a lateral decubitus projection (see figure 2). It is paramount you include the diaphragms in this projection, to aid assessment of free gas in the abdominal cavity. Often you will cover the lower portion of the abdomen in the supine AP projection.

References

Radiographic views

pediatric radiography
radiographic positioning and terminology
systematic radiographic technical evaluation
chest radiography
pediatric chest radiography
abdominal radiography
pediatric abdominal radiography
- neonate supine view
upper limb radiography
lower limb radiography
- pelvic girdle radiography
- thigh and leg radiography
- ankle and foot radiography
skull radiography
paranasal sinus and facial bone radiography
- facial bones
  - lateral
  - Waters view
- Caldwell view (angled skull PA view)
- nasal bones
- zygomatic arches
- orbits
  - parieto-orbital view
  - Waters view
- paranasal sinuses
- temporal bones
  - axiolateral oblique view
  - AP axial view
  - Stenvers view
  - modified Stenvers view
  - temporal bones submentovertex (SMV) view
dental radiography
- orthopantomography (OPG)
- mandible
- temporomandibular joints
spine radiography

Article information

rID: 38091

System: Gastrointestinal

Section: Radiography

Tag: refs, snippet title

Synonyms or Alternate Spellings:

Abdominal x ray (PA erect view)

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Cases and figures

Case 1: PA erect viewCase 1: PA erect view

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Case 2: Erect viewCase 2: Erect view

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Case 3: Small bowel obstructionCase 3: Small bowel obstruction

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Case 4: Small bowel obstructionCase 4: Small bowel obstruction

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Case 5: PneumoperitoneumCase 5: Pneumoperitoneum

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