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Indications for plain abdominal films from the Emergency Department
EP30556
Poster Title: Indications for plain abdominal films from the Emergency Department
Submitted on 12 Sep 2019
Author(s): Dr Riyaz Bana, Dr Gill Duncan
Affiliations: Ninewells Hospital, Dundee, NHS Tayside
Poster Views: 44
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Poster Information
Abstract: Aim: To ensure that requests for plain abdominal x-rays (AXR) from the emergency department are performed appropriately as advised by the Royal College of Radiologists (RCR) iRefer guidelines. The target is that 100% of AXR requests meet the guidelines.

Method: Retrospective study over a 5-week period (August to September 2018) of 50 AXR’s requested by the emergency department. The indications of the AXR, the result of the film, whether further imaging was obtained, the results of the further imaging and if the AXR proved useful in the final diagnosis were noted.

Results: Out of the 50 AXR’s; 33 were undertaken to look for obstruction; 1 was to look for perforated bowel following acute exacerbation of Crohn’s; and 4 were to look for renal calculi. 8 abdominal x-rays did not meet the RCR criteria. This gives a total compliance of 84%.

In total 27/50 patients had further imaging. Of the 11 patients that had further imaging with an initial abnormal AXR, the final diagnosis was accurately picked up on AXR in 8/11 cases. Of the 16 patients with a normal initial plain film that had further imaging, only 19% were normal with positive CT/ultrasound findings ranging from acute cholecystitis to small bowel obstruction.

Conclusion: Most of the requests were looking for obstruction and many proved to be normal on plain film, however a significant number went on to have further imaging and many had pathology that was not identifiable on plain film.
Summary: The poster highlights that many requests for abdominal x-rays are non-compliant against the standards set by the RCR. However, in addition to that, we also learnt that a significant number of patients had further imaging after a normal abdominal x-ray, with substantial pathology diagnosed on subsequent CT/ ultrasound. This leads to the question, are abdominal radiographs overused?
References: (RCR), Patient Safety - Radiation Dose in X-Ray and CT Exams. [online] Radiologyinfo.org. Available at: https://www.radiologyinfo.org/en/info.cfm?pg=safety-xray

Rcr.ac.uk. Indications for Plain Abdominal films from the Emergency Department | The Royal College of Radiologists. [online] Available at: https://www.rcr.ac.uk/audit/indications-plain-abdominal-films-emergency-department
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