Keywords:
Abdomen, Emergency, Conventional radiography, Audit and standards, Obstruction / Occlusion, Calcifications / Calculi, Foreign bodies
Authors:
Z. J. Hussain1, H. F. D'Costa2; 1Oxford/UK, 2OX3 9DU/UK
DOI:
10.1594/ecr2012/C-0877
Results
Over the one-month period,
304 plain abdominal x-rays were carried out in total.
The justification for each exam was based upon the clinical questions stated by the referrer on the request card.
No patient in this study was exposed without adequate justification being provided at the time of request.
However when assessing,
for the purposes of the audit,
the appropriateness of each investigation the wider clinical history provided by the clinicians was taken into consideration. This information was then related to the RCR guidelines (2). Overall,
exactly half (152/304) of all studies were deemed appropriate by the RCR standards taken for the purposes of this Audit.
Subgroup analysis,
found that appropriateness of request differed greatly across referrer groups (Figure 3); with 63% of surgical and only 38% of Emergency Department referrals deemed appropriate.
Of all the films included,
only 64 studies (21%) had positive findings. Of the 152 films deemed to be inappropriate,
only 13 (9%) were reported as having positive findings.
Notably,
these positive findings (Figure 1) bear little resemblance to the referring clinicians question to the radiologist (Figure 2).
When inappropriate requests are further analysed,
it was found that where positive findings were reported,
further investigations were carried out in 7 of the 13 cases. Of the 139 (90%) normal cases a further 56 patients were referred for more definitive imaging regardless (Figure 4).
With regards to appropriately requested films,
clinicians requested definitive investigations in 27 (53%) of cases after the abdominal XR revealed pathology and 36% of cases with no XR findings. One third of these investigations were also normal.