Abdomen x-ray (AXR) is a commonly requested radiographic examination for non-specific acute abdominal pain. However, recent evidence indicates one in three patients are discharged from A&E without a diagnosis for their abdominal pain [1], questioning the role of AXRs in this clinical pathway. An average dose of an AXR is 0.7-1.3mSv [2-4] and if the AXR does not provide sufficient information for a diagnosis, further imaging will be needed which associates with a higher healthcare cost, rate of complications, mortality and readmission [1, 5-8]. More...

A literature review of studies and guidelines, dated from 1964 to 2018, was conducted, looking at AXR's effectiveness. The algorithm was constructed based on BMJ best practice guidelines and was coded with Python 3 [9].

The position of AXR in the diagnostic pathway of abdominal pain has not yet reached a verdict and was described as "catch 22" [10], as AXR can be used to prevent high radiation exposure of CT or as a boost of referrers' confidence, while further imaging is often needed after AXR. Despite the documented ineffectiveness of AXR for supporting a definitive diagnosis or leading to a correct treatment alternation[3, 5, 11-20] and the advancement in CT and ultrasound, there was no dramatic decrease of the...

The conflicting evidence-base reflects the complexity of the use of AXR, and the issues around guidelines and departmental cultures. More research on this topic is required in the context of the resource usage and radiation risk involved in AXRs. An algorithm was constructed using BMJ Best Practice guidelines to assist referrals for acute abdominal pain [25-29] (Fig 4). This by no means challenges the referrers, but here as guidance and a prompt. However, this study suffered from a few limitations. A standardised search strategy was...

W. Tam; Exeter/UK - nothing to disclose

1. Artigas Martín JM, Martí de Gracia M, Rodríguez Torres C, Marquina Martíne D, Parrilla Herranz P. Radiografía del abdomen en Urgencias. ¿Una exploración para el recuerdo? Radiología. 2015 September-October; 57(5). 2. Public Health England. Patient dose information: guidance. [Online].; 2008 [cited 2017 October 21. Available from:HYPERLINK "https://www.gov.uk/government/publications/medical-radiation-patient-doses/patient-dose-information-guidance"https://www.gov.uk/government/publications/medical-radiation-patient-doses/patient-dose-information-guidance. 3. Sreedharan S, Fiorentino M, Sinha S. Plain abdominal radiography in acute abdominal pain—is it really necessary? Emergency Radiology. 2014 December; 21(6). 4. Haller O, Karlsson L, Nyman R. Can low-dose abdominal CT replace abdominal plain film...