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    Plain Abdominal Radiography in Acute Abdominal

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    anisa
    1. Plain abdominal radiography was historically the primary imaging modality used to evaluate acute abdominal pain but its diagnostic value has decreased with the widespread availability of ultrasound and CT. 2. While plain films still have utility in detecting certain conditions like perforated viscus, urinary tract stones, bowel obstruction, and ingested foreign bodies, their overall sensitivity and accuracy is limited. 3. Modern guidelines recommend ordering plain abdominal radiographs more selectively and only when ultrasound or CT is not available or there is a specific clinical indication, as other modalities now provide substantially more diagnostic information.

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    Plain Abdominal Radiography in Acute Abdominal

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    anisa
    37 views27 pages
    1. Plain abdominal radiography was historically the primary imaging modality used to evaluate acute abdominal pain but its diagnostic value has decreased with the widespread availability of ultrasound and CT. 2. While plain films still have utility in detecting certain conditions like perforated viscus, urinary tract stones, bowel obstruction, and ingested foreign bodies, their overall sensitivity and accuracy is limited. 3. Modern guidelines recommend ordering plain abdominal radiographs more selectively and only when ultrasound or CT is not available or there is a specific clinical indication, as other modalities now provide substantially more diagnostic information.

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    Radiologi Abdomen

    Original Title

    Plain Abdominal Radiography in Acute Abdominal(1)

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    1. Plain abdominal radiography was historically the primary imaging modality used to evaluate acute abdominal pain but its diagnostic value has decreased with the widespread availability of ultrasound and CT. 2. While plain films still have utility in detecting certain conditions like perforated viscus, urinary tract stones, bowel obstruction, and ingested foreign bodies, their overall sensitivity and accuracy is limited. 3. Modern guidelines recommend ordering plain abdominal radiographs more selectively and only when ultrasound or CT is not available or there is a specific clinical indication, as other modalities now provide substantially more diagnostic information.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    37 views27 pages

    Plain Abdominal Radiography in Acute Abdominal

    Uploaded by

    anisa
    1. Plain abdominal radiography was historically the primary imaging modality used to evaluate acute abdominal pain but its diagnostic value has decreased with the widespread availability of ultrasound and CT. 2. While plain films still have utility in detecting certain conditions like perforated viscus, urinary tract stones, bowel obstruction, and ingested foreign bodies, their overall sensitivity and accuracy is limited. 3. Modern guidelines recommend ordering plain abdominal radiographs more selectively and only when ultrasound or CT is not available or there is a specific clinical indication, as other modalities now provide substantially more diagnostic information.

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    © All Rights Reserved
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    of 27

    JOURNAL READING

    Plain abdominal radiography in acute


    abdominal pain; past, present, and future

    Pembimbing : dr. Bekti Safarini, Sp.Rad (K)

    Oleh :
    Anisa Kartika 30101407139
    Diah Apriani 30101407165
    Journal Identity
    Judul Plain abdominal radiography in acute abdominal
    pain; past, present, and future
    (international journal of general medicine)

    Penulis Sarah L Gans, Jaap Stoker, Marja A Boermeester (


    Departmen of Surgery, Departmen Of Radiology )

    Penerbit Dove Press Journal: International Journal of General


    Medicine

    Tahun terbit 12 June 2012


    Abstrack

    Medical history
    Physial examination Acute abdomen Abdominal radiograph
    Labolatory test

    Low sensivity and accuracy

    Keywords :
    Abdominal x-ray, acute abdomen, acute abdominal pain, emergency department,
    diagnostic imaging, abdominal radiography
    Historical overview
    Historical overview
    Plain films are likely to remain the best method of imaging gas shadows for many years
    to come and computed tomography scanning, isotope studies and nuclear magnetic
    resonance are unlikely to play any major role in the initial investigation of the acute
    abdomen”

    Shortly after the discovery of the x-ray in 1895, the first x-rays were studied for
    medical purposes by Wilhelm Rontgen. During the decades that followed, x-rays were
    mainly used for detecting fractures and foreign bodies and gradually for the evaluation
    of various other diseases, such as acute abdominal pain
    Historical overview
    Study at virginia university
    1972 (4%) 1992 (5%) 2007 (6,6%)

    1972  Plain abdominal radiography was the only


    diagnostic imaging modality (43%)

    1992, plain abdominal radiography was ordered


    in 30% of all patients

    2007  the use of ultrasound and CT


    was widespread
    and the use of plain abdominal radiography
    decreased (21%)
    Factor can contribute :
    1. establishment of emergency
    medicine faculties

    Diagnostic accuracy improved 2. increased possibilities


    over the years due to for laboratory testing
    increased use of CT and ultrasound
    3. The widespread
    availability of
    various diagnostic modalities

    Diagnosing the underlying cause of acute abdominal pain


    remains a challenge despite the increase in diagnostic accuracy over the years
    Place of plain abdominal x-ray
    in current diagnostic workup
    Place of plain abdominal x-ray
    in current diagnostic workup

    Further diagnostic
    diagnosis based
    workup such as imaging
    solely on a patient’s medical history,
    is therefore mandatory
    physical examination, and laboratory tests
    in patients
    is not reliable enough
    suspected of
    an urgent medical condition

    Abdominal radiograph

    UK and
    US guidelines advise consideration of abdominal radiography
    in case of hospital admission and or surgery in patients
    presenting with acute abdominal pain
    One study compared the initial diagnosis after clinical
    evaluation and plain radiography with the final diagnosis

    The improvement in accuracy of plain abdominal radiography


    combined with clinical
    examination was not significant (P = 0.14)

    In 117 of the
    1021 patients (11%), the treating physician changed the initial
    clinical diagnosis after plain abdominal radiography, and these
    changes were accurate in only 39 cases (22%)
    high percentage of
    plain abdominal radiographs without abnormal or specific
    findings on several study

    Two studies demonstrated that 77% and 78% of all only 83 of


    requested plain abdominal radiographs 871 patients (10%), a specific
    showed no abnormal diagnostic abnormality was
    findings noted on plain abdominal radiography

    The additional value of plain abdominal radiographs is disputed.


    It is suggest ordering
    plain abdominal radiographs for specific indications only

    Specific indications :
    1. suspicion of perforated viscus,
    2. urinary tract stones,
    3. bowel obstruction,
    4. and ingested foreign body.
    Detection of free air and perforated
    viscus
    The combination of abdominal pain and a pneumoperitoneum,
    even in the absence of other clinical signs, will usually
    lead to a laparotomy in search of a perforated viscus

    Plain abdominal radiography should be the first diagnostic modality


    used in suspicion of a perforated viscus

    compared the diagnosis


    of patients suspected
    of perforated viscus before and a compared ultrasonography-
    fter plain abdominal plain abdominal radiography
    in detection
    radiography : of pneumoperitoneum: CT has proven to be the most
    accurate diagnostic
    Sensitivity of
    modality in the evaluation
    165 patients had suspicion
    of pneumoperitoneum after of pneumoperitoneum
    abdominal radiography in detecting
    ultrasonography,157 intraoperatively.
    pneumoperitoneum was plain radiography, 126 (120 of cases)
    low (15%)
    Detection of urinary tract stones
    The standard imaging modality for detecting urinary tract
    stones should ideally provide information about size, site,
    and composition of the ureteral stone and presence of ureteral
    obstruction

    sensitivity
    ranging from 44% up to 77% and specificity in detection of
    stones from 80% to 87%

    Another study concluded that plain abdominal radiography


    had a sensitivity of 45% and specificity of 77% for detection
    of ureteral calculi

    The
    advantage of CT over plain abdominal radiography is that
    an alternative diagnosis may be presented if the suspicion
    of urolithiasis is not confirmed
    Detection of bowel obstruction
    Bowel obstruction is a common cause of acute abdominal
    pain

    The sensitivity of plain abdominal


    Plain abdominal-CT
    radiography
    Total obstruktive: CT demonstrated a
    after clinical evaluation
    sensitivity of 100% compared with 46%
    was significantly higher
    Partial : 100% compared with
    than that of clinical evaluation alone
    30% for plain abdominal radiography.
    (74% versus 57%,
    respectively)
    Detection of ingested foreign body
    Diagnostic imaging is not always necessary in cases of
    ingested foreign bodies.

    Plain radiography has been suggested as a standard


    method for localization of foreign bodies.

    Plain abdominal radiography demonstrates a sensitivity of 90%, specificity of


    100%, and accuracy of 100% for ingested foreign bodies, but
    the foreign body has to be radio-opaque to be seen on plain
    abdominal radiography

    There is no evidence available as to


    whether CT has a higher sensitivity and specificity
    than plain abdominal radiography in the case of ingested foreign bodies
    In diagnostic workup
    In spite of the recent proliferation of other imaging
    techniques, plain films still retain their position as one of the
    most useful initial investigations

    Imaging techniques such as CT and ultrasound have


    been shown to increase diagnostic accuracy substantially,
    and consequently have significantly decreased the added
    diagnostic value of plain abdominal radiography in a
    clinical setting
    Conclusion
    Based on the abundant available evidence, major advances

    in diagnostic imaging, and changes in the management of

    certain diseases, we can conclude that there is no place for

    plain abdominal radiography in the workup of adult patients

    with acute abdominal pain in current practice


    THANKYOU

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