The uncontrasted abdominal X-ray (ASP) is one of the most commonly performed radiological exams in emergency departments, despite its increasingly limited indications and significant radiation exposure. The information obtained is often insufficient to help clinicians make the right treatment decisions. This exam also carries a significant cost, even though its cost-benefit ratio has never been demonstrated. Finally, new radiological techniques, such as low-dose CT scans, provide more relevant information while exposing patients to radiation levels similar to those of an uncontrasted abdominal X-ray.
As a result, the indications for uncontrasted abdominal X-rays in emergency departments are becoming increasingly restrictive. However, despite international recommendations, this procedure is still performed too frequently in emergency departments. A recent study conducted in the emergency departments of La Tour Hospital and the Geneva University Hospitals (HUG) revealed that ASPs were performed on 1,997 patients across the two Geneva emergency departments (1,810 at HUG and 187 at La Tour), and that the majority of indications did not comply with international guidelines. Based on French recommendations, only 11.8% of the ASPs performed were appropriate, and only 46.2% complied with Australian and British guidelines.
In an effort to improve the quality of care, we will implement local recommendations and training programs for emergency physicians working in these departments to reduce our patients’ exposure to unnecessary and potentially harmful radiation. This aligns perfectly with the Choosing Wisely campaigns, where cost reduction is not a priority but can become a positive side effect when it aligns with patients’ best interests.
Prof. Dr. med. Omar Kherad, MPH, Chief of Internal Medicine, Quality Manager