Background
The abdominal x-ray (AXR) is commonly ordered in the investigation of the acute abdomen. In most cases it produces limited clinical information and rarely alters management when used alone, but still it is requested sometimes routinely. The unnecessary use of AXRs has a significant financial implication and more importantly unnecessary radiation exposure to the patient (The AXR has 50 times more radiation than a CXR).

Materials and Methods
The case notes, x-ray request cards and abdominal radiographs were retrospectively analysed for all patients admitted to the acute surgical take at a district general hospital over a four week period. The clinical diagnosis in the patient’s notes was compared to that stated on the AXR request card to determine the validity of the request according to the Royal College of Radiologists guidelines. A local guideline was developed following the audit and a re-audit was carried out to assess the degree of adherence to the local guideline.

Result
Before the local guideline introduction 127 AXRs were requested, whereas after the guideline was introduced this number decreased to 114. The number of initial diagnoses that did not meet the AXR guideline criteria decreased from 58% before the local guideline was introduced to 37% after. The proportion of negative AXRs also decreased from 79% to 57%.

Conclusion
Implementing a specifically designed local guideline for the request of AXRs in surgical emergencies reduces the number of requests and the rate of inappropriate requests; leading to reduced costs for the hospital and reduced radiation exposure for the patients.