Plain Abdominal Radiographs: Can we Interpret Them?

Abstract

INTRODUCTION Plain abdominal radiographs commonly form a part of medical assessments. Most of these films are interpreted by the clinicians who order them. Interpretation of these films plays an important diagnostic role and, therefore, influences the decision for admission and subsequent management of these patients. The aim of this study was to find out how well doctors in different specialties and grades interpreted plain abdominal radiographs. MATERIALS AND METHODS A total of 76 doctors from the Departments of Accident & Emergency, Medicine, Surgery and Radiology (17, 32, 23 and 4, respectively) participated in the study which involved giving a diagnosis for each of 14 plain abdominal radiographs (5 ‘normal’ and 9 ‘abnormal’). They were also asked the upper limit of normal dimensions of small bowel and large bowel. One point was awarded for correctly identifying whether a radiograph was normal/abnormal, 1 point for the correct diagnosis and 1 point for the correct bowel dimensions, giving a total score of 30. RESULTS Mean scores out of 30 for specialties were as follows: Accident & Emergency 13.1 (range, 2–22), Medicine 11.2 (range, 2–23), Surgery 15.0 (range, 8–24) and Radiology 17.0 (range, 14–20; P = 0.241). Mean scores out of 30 for different grades of doctors were as follows: pre-registration house officers 10.8 (range, 4–20), senior house officers 13.0 (range, 2–22), registrars/staff grades 13.8 (range, 2–23) and consultants 17.3 (range, 12–24; P = 0.028). Fifteen out of 76 (19.7%) doctors correctly identified the upper limit of normal dimension of small bowel; 24 out of 76 (31.6%) correctly identified the upper limit of normal dimension of large bowel. DISCUSSION The level of seniority positively correlated with skills of plain abdominal radiograph interpretation. A large number of doctors were unable to give the correct upper limit of normal dimensions for small and large bowel. CONCLUSIONS All doctors could benefit from further training in the interpretation of plain abdominal radiographs. This could perhaps take place as formal teaching sessions and be included in induction programmes. Until then, plain abdominal films should ideally be reported by radiologists where there are clinical uncertainties; important management decisions made by junior doctors based on these films should at least be confirmed with a registrar, if not a consultant.