Pediatric abdomen (AP supine view)
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The AP supine abdominal radiograph is a routine view when imaging the pediatric abdomen. This view may be taken alongside the PA erect and lateral decubitus views. As radiation protection is an essential consideration in pediatrics, some departmental protocols may only perform one view (either the AP supine or PA erect view) depending on the clinical indications 1.
This view is useful in assessing gastrointestinal or genitourinary pathologies, including bowel obstructions, intussusception and calcifications.
patient is supine with no rotation of the shoulders and hips
remove any radiopaque items (e.g. ECG dots, diaper, shiny decorative clothing)
take the x-ray in full inspiration
patient is placed on top of the detector
the midsagittal plane (xiphisternum) at the level of the iliac crest
laterally to the lateral abdominal wall
superior to the diaphragm
inferior to the inferior pubic rami
it is not advised to collimate too tightly laterally in case of missing bowel loops and/or organs 2
will vary depending on the child's body habitus
if patient thickness is above 10 cm, use of a grid is advisable 3
Image technical evaluation
lateral abdominal wall
inferior pubic rami inferiorly
the abdomen should be free from rotation with symmetry of the:
iliac crests (middle)
obturator foramen (inferior)
no blurring of the bowel gas due to respiratory motion
pediatric patients may feel uncomfortable when bony landmarks are felt for, therefore an appropriate explanation to the patient beforehand is ideal for improving patient comfort
to achieve sufficient inspiration, using child-appropriate language will be useful
e.g. 'breathe in, as if you are about to go diving underwater!', 'breathe in, as if you are about to blow out a birthday candle!'
It is important for the image to be free from movement artefact and rotation to avoid repeated x-rays.
it may be necessary for the parent or radiographer to hold the patient in position
sometimes it is only necessary to keep the child's arms away from the abdominal area; in these cases, sandbags, pillows or velcro straps could be used to keep the arms down
techniques will vary based on the department