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Current abdominal X-rays practice in accident and emergency

Tam, W. ORCID: 0000-0002-6241-4810 (2023). Current abdominal X-rays practice in accident and emergency. Journal of Medical Imaging and Radiation Sciences, 55(2), pp. 297-306. doi: 10.1016/j.jmir.2023.07.018


Introduction: Previous literature reviews revealed that abdominal X-rays (AXR) performed for the accident and emergency department (A&E), had low sensitivity, high further imaging and non-alignment rate to the Royal College of Radiologists (RCR) guidelines. A study was performed to investigate the current practice with the aim of making recommendations to improve practice, which can reduce patients’ radiation exposures, while can re-routing resources to other priorities.

Methods: A study was performed in one of the UK’s largest A&Es, in accordance with the RCR guidelines. All the AXR requests from A&E, regardless of the patient’s age, within a 28-day period, were retrospectively assessed. Non-A&E patients and abandoned examinations due to uncooperative patients were excluded. The total number of AXR requests received by the A&E imaging department was 169, with 28/169 falling into the exclusion criteria.

Results: Of the 141 included requests, five unjustified requests were correctly rejected. The remaining 136 requests were accepted and performed, though only 115/136 (84.6%) of these were justified. The most common justified and unjustified indications were obstruction and renal stones, respectively. Only 4% of reported AXR had pathological abnormalities, while 45/136 patients had further imaging.

Conclusions: The small proportion of significant findings echoed previous studies, suggesting an AXR overuse. Over 80% of non-compliant requests were performed, and awareness of the justification guidelines can be increased by clinical governance, posters, or an algorithm previously presented. The 32.4% further imaging rate recorded in this study, as opposed to the 73.7% reported in previous literature, merits attention.

Implications to practice: Stopping the overuse of AXR can minimise the radiation dose received and relieve the mounting pressure in imaging and reporting, which can serve other patients who would benefit from the services otherwise.

Publication Type: Article
Additional Information: This article is available under the Creative Commons CC-BY-NC-ND license and permits non-commercial use of the work as published, without adaptation or alteration provided the work is fully attributed.
Publisher Keywords: Abdominal X-ray, Accident & emergency, Overuse, Radiation protection, Abdominal pain
Subjects: R Medicine > RC Internal medicine
Departments: School of Health & Psychological Sciences > Midwifery & Radiography
SWORD Depositor:
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