Practice Review – Abdominal imaging

Accessible version text for the sample report

Read the Practice Review FAQs

The Practice Review that GPs received reported their individualised imaging referral data. The pie charts below show national and aggregate data for different RA classifications. The data show numbers of referrals for selected abdominal and pelvis MBS imaging services written by Australian medical practitioners in the calendar year 2019.

• Taking a clinical history and performing a physical examination is the first step when a patient presents with chronic abdominal pain.¹
• Diagnostic imaging pathways such as WA Diagnostic Imaging Pathways are available and may be helpful to determine whether imaging is indicated and if so, the most appropriate imaging type.
• Balance the benefits and harms of imaging when indicated. (See below for information about benefits and harms).
• When imaging is required, ensure that referrals include information on specific location to image and suspected condition, to focus the investigation and assist in interpreting results.²
• Read more about quality referrals

When referring a patient for imaging, consider the benefits and harms of each type of imaging to determine which is the most appropriate. These include:

• the specific needs of the investigation
• the patient’s ionising radiation dose
• management of any incidental finding
• the consequences of overdiagnosis.

Consider which imaging modality is best for answering the specific clinical question and minimising the risk of harms.

For example, if a CT scan of an organ is being considered, balance the benefits of enhanced image quality of a CT scan against the risk of harms associated with the ionising radiation, compared to an ultrasound, which does not contain any ionising radiation.³

Although X-rays are rarely indicated for investigating chronic abdominal pain,⁴ they are associated with much lower doses of ionising radiation than CT scans and so should be considered where appropriate.⁵

For example, the ionising radiation dose from an abdominal X-ray of the stomach is at least 50 times smaller than the dose from an abdominal CT scan.⁵

Find out more about managing the risk of exposing patients to ionising radiation

Increased use of modalities associated with high imaging quality such as CT scans increases the risk of incidental findings.⁶

The American College of Radiography provides information about incidental findings

This information is available to help radiologists make informed decisions when reporting on imaging tests and also to help medical practitioners manage incidental findings.

Overdiagnosis is a harmful and costly problem with two major causes: overdetection and overdefinition of disease. While the forms of overdiagnosis differ, the consequences are the same: diagnoses that ultimately cause more harm than benefit.⁶

Register for our webinar Chronic abdominal pain: could it be irritable bowel syndrome?, access an online module or learn more about abdominal imaging

• Pichetshote N, Pimentel M. An approach to the patient with chronic undiagnosed abdominal pain. Am J Gastroenterol 2019;2019:726-32.  
• Mendelson R. Imaging for chronic abdominal pain in adults. Austr Prescr 2015;38:49-54.
• Berland LL, Silverman SG, Gore RM, et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 2010;7:754-73.