Diagnostic Imaging Pathways - Abdominal Plain X-Ray (Indications)

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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

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Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.

No radiation None 0
Minimal radiation Minimal < 1 millisieverts
Low radiation Low 1-5mSv
Medium radiation Medium 5-10 mSv
High radiation High >10 mSv


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Teaching Points

Teaching Points

  • Indications of Plain Abdominal X-Ray are:
    • Suspected Bowel Obstruction.
    • Suspected Perforation.
    • Suspected Foreign Body.
    • Mod-Severe Undifferentiated Abdo Pain.
    • Renal Tract Calculi follow-up.



  1. 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)Click here to view reference
  2. McCook TA, Ravin CE, Rice RP. Abdominal radiography in the emergency department: A prospective analysis. Annals of Emergency Medicine. 1982;11(1): 7-8.(Level II evidence)
  3. 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)
  4. Lee P. The plain x-ray in acute abdomen : a surgeon's evaluation. British Journal of Surgery. 1976;63:763-6.(Level III evidence)
  5. Karkhanis S, Medcalf J. Plain abdomen radiographs: the right view? Eur J Emerg Med. 2009 Oct;16(5):267-70.(Level III evidence)
  6. 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 May;88(3):270-4. (Level II evidence). Click here to view reference
  7. Feyler S, Williamson V, King D. Plain abdominal radiographs in acute medical emergencies: an abused investigation? Postgrad Med J. 2002 Feb;78(916):94-6. (Level II evidence).
  8. Jelinek G, Bangham N. Reducing the use of plain abdominal radiographs in an emergency department. Archives of Emergency Medicine. 1990;7:241-5. (Level II evidence)Click here to view reference
  9. Smith JE, Hall EJ. The use of plain abdominal x rays in the emergency department. Emergency Medicine Journal. 2009;26(3):160-3.(Review article)
  10. 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. Am J Roentgenol. 1996;167(6):1451-5.(Level III evidence)
  11. 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)
  12. 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)
  13. 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).
  14. Levine MS, Scheiner JD, Rubesin SE, Laufer I, Herlinger H. Diagnosis of pneumoperitoneum on supine abdominal radiographs. American Journal of Roentgenology 1991;156:731-5.(Level III evidence)
  15. Chiu YH, Chen JD, Tiu CM, Chou YH, Yen DH, Huang CI, et al. Reappraisal of radiographic signs of pneumoperitoneum at emergency department. American Journal of Emergency Medicine 2009;27(3):320-7.(Level III evidence)
  16. 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)
  17. Campbell J, Gunn A. Plain abdominal radiographs and acute abdominal pain. Br J Surg. 1988;75(6):554-6.(Level III evidence)
  18. 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)
  19. 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. The American journal of surgery. 1976;131(2):219-23.(Level II evidence) Click here to view reference
  20. 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 Apr;162(4):337-9.(Level III evidence)
  21. 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. Pediatric Emergency Care. 1992 Dec;8(6):325-7.(Review Article)
  22. Greene C.Indications for plain abdominal radiography in the emergency department. Ann Emerg Med. 1986 Mar;15(3):257-60.(Review Article)

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