AXR

Question 1

Introduction

Answer 1

Patient demographics

Previous films for comparison

Question 2

Radiograph details

Answer 2

Date
Type (supine, upright, lateral decubitus)
Adequacy - area (diaphragm to pelvis), rotation, penetration

Question 3

Interpretation (BOB) - Bowel

Answer 3

Small bowel - identify by central position and plicae circulares, should be < 3cm in diameter
Large bowel: identify by peripheral position, faecal contents, haustra, should be < 6cm
Faeces: mottled appaerance
Gas (normal in fundus and large bowel only): extra luminal indicated perforation, check in rectum if obstruction expected (presence makes complete obstruction unlikely)
Fluid levels seen in perforation / infection

Question 4

Interpretation (BOB) - Other organs

Answer 4

Soft tissue shadows (may be seen) - liver, spleen, kidneys, gallbladder, psoas shadow

Calcification of pancreas (chronic pancreatitis), abdominal aorta or renal stones / gallstones

Question 5

Interpretation (BOB) - Bones

Answer 5

Spine and pelvis: Paget’s disease (cotton wool lytic / sclerotic pattern); metastases (lytic / sclerotic lesions), OA (LOSS), vertebral #

Question 6

To complete

Answer 6

‘To complete my analysis I would examine previous films and ascertain the clinical history’
If suspicion of perf then get erect CXR
Summarise and suggest ddx

Question 7

Common peritoneum

Answer 7

Small bowel obstruction: small bowel distention > 3cm, no gas in large bowel, fluid levels if erect
Large bowel obstruction: large bowel distention > 6cm
Toxic megacolon: colonic dilation without obstruction, associated with colitis
Volvulus: twisting of bowel on its mesentery, causing coffee-bean appearance if sigmoid volvulus or fetal appearance if caecal
Urinary stones
Pneumoperitoneum (due to viscus perforation or recent surgery): Rigler’s double wall sign - both sides of bowel wall visible due to air outside the bowel