TTP8.18 Indications For Abdominal X-Ray: Are We Following the Limited Guidance Recommended In I-Refer Criteria of The Royal College of Radiologists?

Introduction It has been observed that numerous requests for plain abdominal radiographs (AXRs) do not align with the RCR iRefer guidelines. Requesting AXR only when they are indicated would enhance patient care by lowering radiation exposure, as 1 AXR has an equivalent dose of radiation as 35 chest X-rays. This will also ensure quicker access to more appropriate imaging. Aim The aim of this audit was to reduce x-ray radiation exposure along with better utilization of x-ray services and faster access to more appropriate imaging. Method This audit was conducted in a district hospital in the UK. The data was collected retrospectively for the first cycle. During the first cycle, the total number of abdominal x-ray (AXR) was 98 over the period of 8 days, whereas the second cycle included 100 patients. The exclusion criteria was AXR for post-gastrografin, PEG tube position check, gynaecology, paediatrics, GP, and unknown sources. Results Whereas the first cycle showed the adherence to i-Refer criteria of 81.63%, the second cycle revealed 94% of AXR was performed according to the i-Refer. The wrong AXR requests involved right abdominal tenderness, ongoing diarrhea, faecal loading, bowel perforation, and PR bleeding. The intervention after the first cycle was to educate all clinicians performing referrals on the correct RCR guidelines for appropriate referrals for abdominal x-rays. Conclusion Although AXR is a crucial imaging tool in the emergency department, it should be utilized judiciously since radiation exposure and cost implications are concerned.