Diagnostic Imaging Pathways - Abdominal Plain X-Ray (Indications)
Population Covered By The Guidance
This pathway provides guidance on the indications for a plain abdominal x-ray in adult patients.
Date reviewed: January 2012
Date of next review: January 2015
Quick User Guide
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The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
|SYMBOL||RRL||EFFECTIVE DOSE RANGE|
|Minimal||< 1 millisieverts|
- Indications for plain Abdominal X-Ray are:
- Suspected bowel obstruction.
- Suspected perforation.
- Suspected foreign body.
- Mod-severe undifferentiated abdominal pain.
- Renal tract calculi follow-up.
- Eisenberg R, Heineken P, Hedgcock MW et al. Evaluation of plain abdominal radiographs in the diagnosis of abdominal pain. Ann Intern Med. 1982;97:257-61. (Level II evidence) View the reference
- McCook TA, Ravin CE, Rice RP. Abdominal radiography in the emergency department: A prospective analysis. Ann Emerg Med. 1982;11(1):7-8. (Level II evidence)
- Kellow ZS, MacInnes M, Kurzencwyg D, Rawal S, Jaffer R, Kovacina B, et al. The role of abdominal radiography in the evaluation of the nontrauma emergency patient. Radiology. 2008;248(3):887-93. (Level III evidence)
- Lee P. The plain x-ray in acute abdomen : a surgeon's evaluation. Br J Surg. 1976;63:763-6. (Level III evidence)
- Karkhanis S, Medcalf J. Plain abdomen radiographs: the right view? Eur J Emerg Med. 2009;16(5):267-70. (Level III evidence)
- Morris-Stiff G, Stiff R, Morris-Stiff H. Abdominal radiograph requesting in the setting of acute abdominal pain: temporal trends and appropriateness of requesting. Ann R Coll Surg Engl. 2006;88(3):270-4. (Level II evidence) View the reference
- Feyler S, Williamson V, King D. Plain abdominal radiographs in acute medical emergencies: an abused investigation? Postgrad Med J. 2002;78(916):94-6. (Level II evidence).
- Jelinek G, Bangham N. Reducing the use of plain abdominal radiographs in an emergency department. Arch Emerg Med. 1990;7:241-5. (Level II evidence) View the reference
- Smith JE, Hall EJ. The use of plain abdominal x rays in the emergency department. Emerg Med J. 2009;26(3):160-3. (Review article)
- Maglinte D, Reyes B, Harmon B, Kelvin F, Turner WW, Hage JE, et al. Reliability and role of plain film radiography and CT in the diagnosis of small-bowel obstruction. AJR Am J Roentgenol. 1996;167(6):1451-5. (Level III evidence)
- Ahn SH, Mayo-Smith WW, Murphy BL, Reinert SE, Cronan JJ. Acute nontraumatic abdominal pain in adult patients: abdominal radiography compared with CT evaluation. Radiology. 2002;225(1):159-64. (Level III evidence)
- Suri S, Gupta S, Sudhakar P, Venkataramu N, Sood B, Wig J. Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction. Acta Radiol. 1999;40:422-8. (Level II evidence)
- Rothrock S, Green S, Hummel C. Plain abdominal radiography in the detection of major disease in children: a prospective analysis. Ann Emerg Med. 1992 21(12):1423-9. (Level II evidence).
- Levine MS, Scheiner JD, Rubesin SE, Laufer I, Herlinger H. Diagnosis of pneumoperitoneum on supine abdominal radiographs. AJR Am J Roentgenol. 1991;156:731-5. (Level III evidence)
- Chiu YH, Chen JD, Tiu CM, Chou YH, Yen DH, Huang CI, et al. Reappraisal of radiographic signs of pneumoperitoneum at emergency department. Am J Emerg Med. 2009;27(3):320-7. (Level III evidence)
- Anyanwu A, Moalypour S. Are abdominal radiographs still overutilized in the assessment of acute abdominal pain? A district general hospital audit. J R Coll Surg Edinb. 1998;43(4):267-70. (Level III evidence)
- Campbell J, Gunn A. Plain abdominal radiographs and acute abdominal pain. Br J Surg. 1988;75(6):554-6. (Level III evidence)
- McCook T, Ravin C, Rice R. Abdominal radiography in the emergency department: a prospective analysis. Ann Emerg Med. 1982;11:7-8. (Level II evidence)
- Brewer BJ, Golden GT, Hitch DC, Rudolf LE, Wangensteen SL. Abdominal pain. An analysis of 1,000 consecutive cases in a University Hospital emergency room. Am J Surg. 1976;131(2):219-23. (Level II evidence) View the reference
- Kester D, Andrassy R, Aust J. The value and cost effectiveness of abdominal roentgenograms in the evaluation of stab wounds to the abdomen. Surg Gynecol Obstet. 1986;162(4):337-9. (Level III evidence)
- Smith DS, Bonadio WA, Losek JD, Walsh-Kelly CM, Hennes HM, Glaeser PW, et al.The role of abdominal x-rays in the diagnosis and management of intussusception. Pediatr Emerg Care. 1992 8(6):325-7. (Review article)
- Greene C.Indications for plain abdominal radiography in the emergency department. Ann Emerg Med. 1986;15(3):257-60. (Review article)
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