A Comprehensive Guide to Abdomen Lateral Decubitus View: Techniques and Applications

Introduction

Are you a healthcare professional looking to enhance your knowledge of imaging techniques? Or perhaps a patient who wants to understand more about the lateral decubitus view for abdominal imaging? Look no further! In this comprehensive guide, we will explore the abdomen lateral decubitus view, its techniques, applications, and key considerations.

What is Abdomen Lateral Decubitus View?

Radiographic imaging studies commonly utilize the abdomen lateral decubitus view to evaluate abdominal organs such as the liver, spleen, kidneys, and intestines. The term “decubitus” refers to the patient lying on their side, either left or right, with the side of interest facing upwards. The lateral decubitus view allows for better visualization of free air or fluid levels in the abdomen, which can be useful in detecting various pathologies.

Techniques for Abdomen Lateral Decubitus View

Radiographers may perform the abdomen lateral decubitus view using different techniques, depending on the specific clinical scenario and patient positioning. Some commonly used techniques include:

Abdomen Lateral Decubitus
~AP Abdomen Left Lateral Decubitus Position~

01. Left Lateral Decubitus View: 

In this technique, the patient lies on their left side with the left arm extended overhead and the right arm placed on the right side of the body. The left side of the abdomen is in contact with the imaging table, while the right side of the abdomen is facing upwards. Directs the X-ray beam horizontally from the anterior to the posterior side, passing through the left lateral abdomen.

02. Right Lateral Decubitus View: 

In this technique, the patient lies on their right side with the right arm extended overhead and the left arm placed on the left side of the body. The right side of the abdomen is in contact with the imaging table, while the left side of the abdomen is facing upwards. Directs the X-ray beam horizontally from the anterior to the posterior side, passing through the right lateral abdomen.

Applications of Abdomen Lateral Decubitus View

The abdomen lateral decubitus view has various applications in clinical practice. Some of the common indications for performing this imaging projection include:

01. Detection of Free Air: 

The abdomen lateral decubitus view is particularly useful in detecting free air in the abdomen, which can be an important sign of gastrointestinal perforation or other intra-abdominal injuries. Free air appears as radiolucent (dark) areas on the X-ray, which can be easily visualized in the lateral decubitus position.

02. Assessment of Fluid Levels: 

The lateral decubitus view can also help in assessing the distribution and quantity of fluid in the abdomen. Radiologists can detect fluid levels as radio-opaque (bright) areas on the X-ray, providing valuable information about the presence and extent of ascites, hemoperitoneum, or other fluid collections.

03. Evaluation of Abdominal Organs: 

The abdomen lateral decubitus view can provide additional information about the size, shape, and position of abdominal organs, such as the liver, spleen, kidneys, and intestines. This can be helpful in diagnosing conditions such as organ enlargement, masses, or displacements.

Key Considerations for Abdomen Lateral Decubitus View

There are several key considerations to keep in mind when performing or interpreting the abdomen lateral decubitus view:

01. Patient Positioning:

  • Proper patient positioning is crucial for obtaining accurate and reliable results. The radiographer should ensure that the patient is lying on the correct side (left or right) as per the clinical indication, and properly position the patient’s arms to avoid interference with the X-ray beam.
  • Should slightly flex the patient’s knees and superimpose them to provide stabilization..
  • Should elevate the patient’s arms and place them alongside the patient’s head.. The scapulae¬†should lie in the same vertical plane

Note : Before films are obtained, the patient should be in the left side down position for at least 10 minutes. This position allows air / fluid to rise out of the lesser sac of the peritoneal cavity (where it may be located) and accumulate beneath the iliac crest or over the right margin of the liver

02. Exposure Factors: 

  • 70-80 kVp range
  • mAs 30
Pediatric AP Abdomen Right Lateral Decubitus X-Ray, Right Lateral Decubitus, Lateral Decubitus
Pediatric AP Abdomen Right Lateral Decubitus X-Ray

Film holder placement

Should position the long axis of the film parallel to the long axis of the body and ensure that the film is centered to the CR. A 14 x 17 inch (35 x 43 cm) film or IR should be positioned lengthwise, with its lower edge at the symphysis pubis. Crosswise cassette placement is appropriate if the patient is very large. The proximal margin of the cassette should be approximately at the level of the axilla.

Central ray (CR)

The CR is directed to the midpoint of the mid-sagittal plane at the level of the iliac crest, in some patients a slightly higher CR, 2 inches (5 cm) above the iliac crest may be needed to include the diaphragms. The CR is directed perpendicular to the film.

Collimation

Collimation is adjusted to center mid-sagittal plane of the patient to the IR margins, making sure that the upper side of the abdomen is clearly included.

Imaging Technique

  • Film or IR size: 14 x 17 inches (35 x 43 cm) lengthwise
  • Moving or stationary grid
  • 70-80 kVp range
  • mAs 30
  • Sk 396
  • cm 21

Evaluation Criteria for a Good left Lateral Decubitus Projection

1. Proper alignment — the vertebral column should be in the midline position. The ribs,¬†pelvis, and hips should be equidistant to the edge of the radiograph.¬†

2. Proper exposure — slightly less overall density than the supine abdomen projection. 

Exposure should be sufficient to visualize spine, ribs, and soft tissues. 

3. No motion — the diaphragm should appear sharp bilaterally.

4. No rotation — spinous processes in the center of the vertebral column and¬†symmetric iliac wings.

5. Proper collimation and CR — The image should include the area from the upper¬†border of the pubic symphysis to the diaphragm and upper side of the abdomen¬†should be clearly included.¬†

6. Appropriate markers should be placed indicating the position.

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