The Three-Way Abdomen are the following Projections:

abdominal seriesDepartmental Routine when performing Acute Abdominal Series:
Determine whether departmental protocol includes an erect PA chest as part of acute abdominal series routine. Minimum positions must include at least one erect or decubitus horizontal beam projection abdomen, in addition to AP supine.

Specific Clinical Indications for Acute Abdominal Series:

Ileus (non-mechanical small bowel obstruction) or mechanical ileus (obstruction of bowel from hernia, adhesions, ect.)
Ascites (Abnormal fluid accumulation in abdomen)
Perforated hollow viscus (such as bowel or stomach, evident by free intraperitoneal air)
Intraabdominal mass (neoplasms - benign or malignant)

AP Supine

abdominal series
Post-op (abdominal surgery)
Erect (or Lateral Decubitus) Abdomen
Remember to take erect images first if patient comes to the department in an erect position.

Image Receptor, Collimation, and Shielding:

35 x 43 cm (14 x 17 inches), Moving or stationary grids; collimation and shielding as described on preceding pages

Patient and Part Positioning:
Note that most department routines for the erect abdominal include centering high to demonstrate possible free intraperitoneal air under the diaphragm even if a PA chest is included in the series.

Breathing instructions:

pa chestChest is taken on full inspiration; abdomen is taken in expiration.

Central Ray:

CR to level of illiac crest on supine and approximately 5cm (2inches) above level of crest to include diaphragm on erect or decubitus.

Note: Left lateral decubitus - replaces erect positon if the patient is too ill to stand.
Horizontal beam is necessary for visualization of air-fluid levels
Erect PA chest or AP erect abdomen best visualizes free air under diaphragm.
For decubitus, patient should be upright or on the side for a minimum of 5 minutes before exposure, with 10 to 20 minutes preferred to demonstrate potential small amounts of intraperitoneal air