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Plain abdominal radiography is believed to be over utilized as an investigation for acute abdominal complaints. Because of this, the Royal College of Radiologists published guidelines in order to minimise inappropriate requests. The aims of this research were to determine the level of referring clinicians’ adherence to these guidelines while making referrals, to determine whether professional status of the referring clinicians influences their adherence to the guideline, and finally to ascertain if abdominal radiography contribution to patients’ diagnosis is influenced by adherence to the guidelines. In this study, 206 referrals for abdominal radiography with clinical indication that fell within the guidelines were retrospectively collected and analysed. Initial clinical indications were compared with the indications in the guidelines. Also, requests were also analysed according to the professional status of the referring clinicians, and finally, adherence to the guidelines was compared to exams contribution to diagnosis. The results show that out of the 206 referrals used in this study, 133 were made in accordance with the guidelines. From the study, it was a discovered that the professional status of the referring clinicians affects their adherence to the guidelines, most of the non-adherence to the guidelines coming from the Junior Doctors. The study also shows that most of the cases where guidelines were followed contributed positively to patients’ diagnosis, while the reverse is the case where guidelines were not adhered to. Conclusively, from this study, referring clinicians adhere to a large extent to the royal college of radiologist guidelines.




Table 1:  Distribution of appropriate referrals for abdominal 15


Table 2: Distribution of inappropriate referrals for abdominal radiography16

Table 3: Distribution of adherence to the guidelines according to the   17

referring clinicians’ professional status

Table 4: Chi-square test to determine the relationship between the

adherence to theguidelines and referring clinicians’ professional status 18

Table 5: Relationship abdominal radiography guidelines and its 19

contribution to patients’ diagnosis

Table 6: Chi-square result of the relationship between abdominal20

radiography guidelines and its contribution to patients’ diagnosis.


Title page                                                                                                                           i

Approval page                                                                                                                      ii

Certification                                                                                                                        iii

Dedication                                                                                                                           iv

Acknowledge                                                                                                                       v

List of tables                                                                                                                       vi

Abstract                                                                                                                              vii



1.1 Backgrounds                                                                                                                  1

1.2 Statement of problems                                                                                                   3

1.3 Objectives of the study                                                                      3

1.4 Significance of the study                                                                                                4

1.5 Scope of the study                                                                                                          4


Literature review                                                                                                                  5


3.1Research design                                                                                                            13

3.2 Sources of data                                                                                                            13

3.3 Inclusion criteria                                                                                                          13

3.4 Exclusion criteria                                                                                                         13

3.5 Method of data collection                                                                                            14

3.6 Data analysis                                                                                                                14

CHAPTER FOUR: Data presentation                                                                               15


4.1 Discussion                                                                                                                   21

4.2 Summary of findings                                                                                                   23

4.3 Conclusion                                                                                                                  24

4.4 Recommendations                                                                                                       24

4.5 Limitations of the study                                                                                              25

4.6 Areas for further research                                                                                           25






The performance of plain abdominal radiography is often considered to be an essential requirement for assessing acute abdominal complaints. It is commonly requested for acute medical emergences on patients with non-specific abdominal symptoms and signs1.


Often, plain abdominal radiography is requested routinely as part of the initial investigation on the day of admission, mainly by admitting junior doctors who may not be fully aware of the indications or appreciate the limitations of this investigation towards making diagnosis.


There are only few indications in which the plain abdominal radiography is helpful, such as small bowel obstruction2. Majority of the conditions where these exams were performed have been taken over by newer modalities such as ultrasonography. In addition, only few doctors are aware of the relative high radiation dose patient is exposed to while undergoing plain abdominal radiography.

Patient undergoing plain abdominal radiography receives 35 times the dose they receive during normal chest radiography3. The limitations of plain abdominal radiography are consistently demonstrated in several series where the percentage of diagnostic radiography ranges only 10-20%4,5,6, 7. Inorder to minimize inappropriate requests, unnecessary radiation dose to the patient and to enhance the efficiency of this investigation, the Royal College of Radiologists (RCR) issued out clear guidelines for requesting for plain abdominal radiography8.













  • There is doubt whether the referring clinicians in our hospitalsadhere to the guidelines given by the Royal College of Radiologist for abdominal radiography.
  • It is not certain if abdominal radiography contribution towards patients’ diagnosisis associated with adherenceto the guidelines.
  • It is not known whether the referring clinicians’ adherence to the Royal College of Radiologists guidelines is associated with their professional status.



  • To find out if referring clinicians adhere to the Royal College of Radiologists’ guidelines for abdominal radiography.
  • To determine if abdominal radiography contribution to patients’ diagnosisis associatedwith adherence to the guidelines.
  • To find out if professional status of the referring clinicians is associated with their adherence to the guidelines.





The results of the study may assist health policy makers

in developing guidelines for routine plain abdominal radiography utilizations in our locality


This study was carried out on all the patients referred for abdominal radiography at NnammdiAzikiweuniversity teaching hospital (NAUTH), Nnewi, from 2001 to 2011.


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