Abdominal X-ray

What it does

Abdominal X-ray reads the plain abdominal film and the acute abdominal series: supine abdomen, erect abdomen and erect chest. It is still a frequent first test in emergency departments and in children, where CT is limited, and it is mostly read at night by ED doctors and surgeons.

The run describes the bowel gas pattern with measured loop diameters and air–fluid levels, looks for free intraperitoneal air under the diaphragm and along the bowel wall, finds radio-opaque calculi along the urinary tract, and localises swallowed objects. Free air and swallowed foreign bodies, a button battery above all, are returned as critical results at the top of the read.

Intended use

Decision support for the clinician deciding whether an acute abdomen needs urgent surgical review or a CT: a measured obstruction pattern, a free-air answer and a foreign-body position, each with its evidence marked on the image. A supine film alone can hide free air, so the result says which views were read.

Who it is for

Emergency physicians, general and paediatric surgeons, paediatricians, urologists and radiologists. Developers can call the run from an ED worklist or a teleradiology service to put critical abdominal films first.

Accepted input

• DICOM CR or DX abdominal radiographs: supine, erect, KUB, and left-lateral decubitus films.
• Acute abdominal series: the abdominal films together with an erect chest radiograph in one upload.
• Children's films for swallowed objects, including chest and abdomen on one image.

Requirements

Requirement	Why
An erect chest or erect abdominal film, or a left-lateral decubitus view	Free air rises under the diaphragm or along the flank; a supine film alone can hide it
A supine abdominal film	Loop diameters and the gas pattern are measured on the supine view
Pixel spacing	Loop diameters and stone size in centimetres or millimetres
Patient position and view tags	Erect, supine and decubitus films are read differently

Overlapping bowel loops, contrast residue from earlier studies and a gasless abdomen are flagged where they limit the read.

Optional context

Symptoms (vomiting, distension, absolute constipation), prior surgery, renal colic or a witnessed ingestion in clinical_context sharpen the guidance.

The result

A JSON result in sections, with measurements and positions as structured values and boxes on the films.

Section	Content
Free air	Pneumoperitoneum: subdiaphragmatic air and Rigler sign, returned as a critical result
Bowel obstruction	Small- and large-bowel obstruction probability, maximal loop diameters and air–fluid levels
Urinary stones	Radio-opaque calculi in the kidney, ureter or bladder, with size and location
Foreign bodies	Ingested object, button-battery (double-ring) flag and level: oesophagus, stomach or beyond
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

Standards

• DICOM: TID 1500 Measurement Report for loop diameters and stone sizes; GSPS overlays for boxes and measurement lines; Encapsulated PDF for the human-readable summary.
• Bowel calibre: the 3-6-9 rule (small bowel 3 cm, colon 6 cm, caecum 9 cm) sets the dilatation flags.
• Critical results: free-air and foreign-body findings are marked for immediate communication.
• Terminology: RadLex and SNOMED CT codes for findings and anatomy.