The inaugural lecture of the Exeter Surgical Society provided by the much acclaimed Mr Jamie Dunn (SpR Urology).

1. Exeter Surgical Society
Mr Jamie Dunn BVSc MBChB MRCVS MRCS
Why do I always starting writing things at half past nine on a Saturday evening
when all I really want to do is learn how to use Netflix...hummm

3. Abdominal Radiographs
1. How is an x-ray image created?
2. What are the relative X-ray doses?
3. Do we know enough core abdominal
anatomy for interpretation?
4. Do we have a system for reviewing
abdominal radiographs?
Finally lets review some interesting
radiographs...

5. How is the image created...
1. X-ray Source
2. Target Penetrance
3. Reduce scatter
4. Convert x-rays to an
image
Understand that the image
created is a two dimensional
rendering of a three
dimensional structure...
Think Pixels...

6. Image Quality Issues
• Lack of personal data
• Lack of side marking
• Patient positioning
• Image exposure
• Movement blurr

8. Relative X-ray dose
Chest X-Ray
Test mSv Equiv
Abdo X-Ray
CT KUB Chest X-ray 0.1 10 days
CT Urogram Abdominal X-ray 0.7 2 months
CT KUB 1.4 mSv 4 months
CT Abdo/Pelvis 12 mSv 3.5 Years
Transatlantic
Flight: 0.05 mSv
CT Urogram 20 mSv 7 Years

9. Reviewing Abdominal films
1) Identify subject and date and orientation.
2) Comment on technical flaws preventing
interpretation.
3) Is the image / scan contrast enhanced?
4) Comment on any specific abnormalities.
5) The rest......
Don’t be baffled into saying nothing ....don’t umm and arrh and don’t point...
Try not to be so distracted by the amazing that you miss something else...

14. Bowel Pathology
Distinguishing small verses large bowel...
Thinking about distension / obstruction...
Thinking about perforation
Thinking about bowel bowel wall inflammation

15. Small Bowel:
5 cm Max Diameter...
Valvulae Conniventes
• Circular folds reach
around the whole
circumference of the
small intestine

16. Large Bowel:
10 cm Max Diameter
Haustra
• Haustra of the large
bowel do not cross
the entire lumen on
imaging

23. Consider a case...
• 45 Male • Observations
• 7/7 grumbling abdominal pain – Pulse 105
radiating into his back – BP 178/100
– RR 16
• Acute exacerbation at 15.15
– Sats 100% (A)
today
• Attended ED via ambulance at
15.37 • Abg
– Ph 7.34
• PMH – PO2 16.7
– Asthma – PCo2 2.41
– Bicarb 24
– Planter fasciitis (on
diclofenac) – Base Excess -4.5

27. Consider a case...
• 45 Male • Observations
• Weight loss for 3/12 – Pulse 86
– BP 145/85
• Change in bowel habit
– RR 14
including diarrhoea and
– Sats 100% (A)
melena
• Attended general take after GP
referral today • Abg
– Ph 7.34
• PMH – PO2 14.2
– Asthma – PCo2 4.71
– Bicarb 22
– Planter fasciitis (on
diclofenac) – Base Excess 1.0

30. Ureteric Colic
Most renal and Ureteric stones are
made from calcium...
Calcium is radio-dense...
Look for stone’s on plain x-ray KUB
initially
Can Anyone tell me why I can
sometimes see stones on CT but
not on plain x-ray?
Consider a Case...

33. Other Stuff....

41. In Conclusion...
• You Understand how a radiograph is
created.
• You Know the important things to look for in
an Abdominal radiograph.
• You have had practice a describing what
you can see.