Servicio de Radiodiagnóstico, Hospital Universitario de La Princesa, Madrid, Spain.
Servicio de Radiodiagnóstico, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain.
Radiologia (Engl Ed). 2024 Jul-Aug;66(4):307-313. doi: 10.1016/j.rxeng.2023.01.012. Epub 2024 Jul 17.
The use of abdominal radiography (AXR) apparently continues to be widespread despite its limited indications, the potential radiation and unnecessary costs associated. In addition, the interpretation and its report seem variable and not always performed by a radiologist. Our objective is to analyze the use, adequacy and usefulness of AXR in the emergency of a tertiary referral hospital.
We retrospectively reviewed all the AXR performed in January 2020 in the emergency of our centre, as well as the patient's demographics and medical records, technical quality of the radiographs, indications according to the SERAM (Spanish Society of Radiology) Appropriateness Guidelines, presence of a formal radiology report, and impact on the clinical management of the patient. Of all non-appropriated AXR we calculated the radiation received by the patients and its extra costs.
In January 2020, 429 AXR (9.1% of all radiographies) were performed in the emergency of our centre. The most frequent indication was abdominal pain (40%, n = 176), followed by low back pain (21.4%, n = 92). 12.4% of AXR requested did not include any clinical information. Most of the AXR (79.6%) had sufficient technical quality. 61.3% (n = 263) of the AXR performed were not indicated, assuming an average unjustified radiation dose per patient of 0.50 ± 0.33 mSv, and a total additional cost of 6575;. Only 6% of the inadequate AXRs led to a change in the clinical management of the patient, compared to 29% of the adequate AXR (p < 0.001). Only 3% of the AXR had a formal radiology report.
AXR is still common in the emergency setting, although most of them might be inadequate according to the SERAM Appropriateness Guidelines. Its use should be optimized to avoid unnecessary radiation and costs. Radiologists must have a more active participation in the management of AXR.
尽管腹部放射摄影（AXR）的适应证有限，且存在潜在辐射和不必要的费用，但它的应用显然仍很广泛。此外，AXR 的解读及其报告似乎存在差异，且并不总是由放射科医生进行。我们的目的是分析三级转诊医院急诊中 AXR 的使用、充分性和有用性。
我们回顾性分析了 2020 年 1 月在我院急诊科进行的所有 AXR 以及患者的人口统计学和病历资料、射线照相的技术质量、根据 SERAM（西班牙放射学会）适宜性指南的适应证、正式放射学报告的存在情况，以及对患者临床管理的影响。对于所有不适当的 AXR，我们计算了患者接受的辐射量及其额外费用。
2020 年 1 月，我院急诊科共进行了 429 例 AXR（占所有射线照相的 9.1%）。最常见的适应证是腹痛（40%，n=176），其次是腰痛（21.4%，n=92）。12.4%的 AXR 请求未包含任何临床信息。大多数 AXR（79.6%）具有足够的技术质量。61.3%（n=263）的 AXR 是不必要的，假设每位患者平均不合理的辐射剂量为 0.50±0.33mSv，总额外费用为 6575 欧元；仅 6%的不充分 AXR 导致患者的临床管理发生改变，而充分 AXR 为 29%（p<0.001）。只有 3%的 AXR 有正式的放射学报告。
尽管 AXR 仍常用于急诊科，但根据 SERAM 适宜性指南，其中大部分可能是不适当的。应优化其使用，以避免不必要的辐射和费用。放射科医生必须更积极地参与 AXR 的管理。
