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
Purpose
The plain film has an increasingly limited role in the assessment of patients presenting with non-traumatic abdominal pain (1).
Its use,
purely anecdotally,
appears to be more in determining appropriateness for discharge of patients in the acute setting.
It is often used defensively in medicine or to buy time.
The aim of this study was to determine the appropriateness and subsequently the value of this high-dose and low positive and negative predictive value investigation,
with an aim to producing a streamlined list of indications,
through the audit of current practice against Royal College of Radiology Guidance (2). If this were a new modality,
we would not begin to use it so widely without rigorous research to assess its value and indications.
Anecdotally,
current guidance (2) for clinicians has been identified as vague and too broad to be helpful to the referrer.
This study looks to streamline the use of the abdominal plain film,
thus improving patient safety by reducing the number of unnecessary exposures and also provide a cost-saving benefit (each abdominal film exposes the patient to a radiation dose equivalent of approximately 20 PA chest radiographs).
Recent audits and literature reviews (3,4) have shown an excess of inappropriate referrals and state,
each in their own way,
that for an investigation to be of use to a clinician it ought to add weight to their diagnosis or positively alter management.
By limiting the use of plain abdominal XR to defined clinical scenarios it will continue to remain relevant in modern imaging.