Abdominal (lateral view)

The lateral view abdominal radiograph is a less common projection of the abdomen, it is different from the lateral decubitus view of the abdomen and looks more like a lateral lumbar spine view.

Indications

This projection is often requested as a useful problem-solving view that can complement frontal views of the abdomen, often utilized in the context of foreign bodies or to better visualize lines such as a shunt (or a part of a dedicated shunt series).

Patient position

• the patient may be either erect or recumbent, with her or his side against the detector
• legs may be flexed for balance
• arms raised
• lower bound of the field of view should contain the inferior pubic ramus
• the x-ray is taken in full inspiration

Technical factors

• supine lateral projection
•  centering point
  • the midcoronal plane at the level of the iliac crest
• collimation
  • anterior-posterior to the skin margins 
  • superior to the diaphragm
  • inferior to the level inferior pubic rami
• orientation
  • portrait
• detector size
  • 35 cm x 43 cm
• exposure
  • 70-80 kVp
  • 30-120 mAs; AEC should be used if available
• SID
  • 100 cm
• grid
  • yes

Image technical evaluation 

• the projection can be confirmed lateral via the lateral appearance of the vertebral bodies
• skin border is not burnt out (a filter may be required to address this) 
• no blurring of the bowel gas due to respiratory motion 

Practical points

• the lateral abdomen can be useful to visualize rectal gas and differentiate colonic ileus from a distal colonic obstruction however it does not offer much information about bowel gas from the frontal view 
• this projection can be done erect or supine, often used to localize foreign bodies or as part of a shunt series when there is a high degree of winding of the line