Will Plain Abdominal Radiographs become Obsolete?
The Royal College of Radiologists recommend plain abdominal radiographs in the evaluation of suspected bowel obstruction or perforation, inflammatory bowel disease flare ups, acute and chronic pancreatitis, foreign bodies and blunt or penetrating abdominal injuries. Other possible indications include suspected ureteric colic, constipation and palpable abdominal masses.
Kellow et al conducted a large retrospective analysis of interpretation of plain abdominal radiographs in 874 non-trauma patients. Forty-six percent of abdominal radiographs were
interpreted as non-specific whilst 72% of patients with normal abdominal radiographs, who went on to have further imaging, had subsequent abnormalities.
Other studies have replicated similar results outlining interpretation of plain abdominal radiographs as inaccurate and non-specific. Computed tomography, as expected, has been shown to be more sensitive compared to plain abdominal radiographs. Despite this, plain abdominal radiographs are sensitive in selected patients – those with bowel obstruction, viscus perforation, foreign bodies and ureteric calculi.
Thus, one might argue that CT should be used first line, in certain instances if available, given its greater sensitivity in picking up pathology; however, one must remember that the radiation dose of CT should be considered as it is approximately ten times that of a plain abdominal film.
While we rely heavily on ionising radiation for both diagnosis and intervention, it is not without risk. It can damage tissues and promote carcinogenesis. Stochastic and deterministic effects are two effects of ionising radiation. Stochastic effect quantifies the probability of carcinogenesis occurrence and is proportional to the dose.
Radiol Open J. 2017; 2(2): 32-37. doi: 10.17140/ROJ-2-116
