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Patient identifiers
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Date & time of film
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Indication & previous imaging
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Quality: Projection (usually AP supine), Exposure (full width, diaphragm to pelvis), Penetration (Lumber Vertebrae visible)
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Obvious abnormalities, foreign bodies & artefacts (e.g. drains)
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Reviews small bowel: valvulae conniventes (traverse full width)
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Reviews large bowel: haustra (thicker & partial width)
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Checks sizes: small bowel (less than 3cm), large bowel (less than 6cm) & caecum (less than 9cm)
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Comments on faeces visibility
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Looks for signs of perforation: air under diagram and Rigler's double wall sign
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Reviews lung bases, stomach
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Reviews hepatobiliary structures & spleen (commenting on size)
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Reviews aorta (less than 3cm is normal) and kidney & bladder areas
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Reviews bones for fractures/deformities
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Consider the following questions:
When would you order an erect film?
When bowel preforation is suspected evidenced by free abdominal gas (e.g. air under diaphragm)
What are the features of inflammatory bowel disease?
When bowel preforation is suspected evidenced by free abdominal gas (e.g. air under diaphragm)
What are the features of inflammatory bowel disease?
- Leadpipe appearance (featureless colon i.e. no haustra)
- Thumbprinting (mucosal thickening due to inflammation)
- Toxic megacolon (dilated colon presenting with abdominal pain & sepsis)
- Twisting of bowel resulting in bowel obstruction
- Sigmoid volvulus: characteristic "coffee bean" sign