Plain films and cross-sectional imaging for acute abdominal pain: unresolved issues

The evaluation of acute abdominal pain in its varied presentations has been greatly benefitted by the application of cross-sectional imaging studies. Yet this advance has engendered controversy as well as enthusiasm. One area of contention is the appropriate continued use of basic radiography in the face of the demonstrated capabilities of CT for the diagnosis of both pneumoperitoneum and obstruction. A second concern that must come to the fore is the radiation risk attendant on the universal use of CT for most acute abdominal presentations. A third area needing further discussion is the competition between CT and ultrasonography. Here the debate about decision making should not be one of shrill advocacy, but must be broadened and deepened to consider appropriate imaging resource utilization for individuals of differing habits and habitus.