We welcome the recent very helpful article from Smith et al1 which has broad relevance to all those who are not career surgeons when they embark on their surgical attachments. This article sensibly recognises there is often more than one way to investigate and, for instance when considering renal colic, offers wise advice that will limit unnecessary exposure to radiation.
We cannot, however, agree with the advice, ‘If unsure whether an erect chest X-ray and abdominal X-ray is warranted, get one anyway.’ Exposure to potentially unnecessary radiation should not be ignored and an abdominal X-ray in the context of abdominal pain is one of the most overused plain films,2 with each abdominal X-ray being equivalent to approximately 35 chest X-rays.3
Selection of the most appropriate imaging is often difficult, and guidance, such as Making the Best use of Clinical Radiology Services4 produced by the Royal College of Radiologists, can be extremely useful in this setting. This document is available online throughout the NHS, is evidence based, and provides guidance both as to which investigations may be helpful in each clinical context, and provides a reference if you are asked to justify why you did not feel a particular investigation was appropriate. Radiologists are also generally very happy to offer advice on what is appropriate and may be a useful port of call if you find yourself being asked to request investigations routinely that do not clearly conform to such guidelines.
We suggest adding a point zero: always think for yourself. Seek advice when you need it, but be prepared to justify your own actions.
- © British Journal of General Practice 2011
