Evaluation of the necessity of the three-film abdominal series in the diagnosis of abdominal pain.

The routine plain-film abdominal series, consisting of supine and upright abdominal radiographs and upright chest radiograph of 246 patients, who presented with abdominal pain from the emergency room of Bangkok Metropolitan Administration Medical College and Vajira Hospital from January 2000 to May 2001 were reviewed. Each radiograph was independently interpreted to detect any radiographic abnormality. Radiographic abnormalities were detected in 35 per cent on abdominal films and 13 per cent on chest films. The supine abdominal views could diagnose abnormalities in 84 per cent of these patients while the upright views diagnosed abnormalities in only 16 per cent of these cases. Most of the detectable abnormalities in the upright views were pneumoperitoneums that were clearly demonstrated on the upright chest radiographs. So elimination of the upright abdominal view from the routine plain-film abdominal series in the screening of surgical cases from medical cases could result in cost-saving and a decrease in radiation exposure without significant loss of diagnostic information.