In my experience, an abdominal radiograph can be used initially to evaluate varying abdominal symptoms. From institution to institution and physician to physician it can vary from requesting a supine only, supine and erect, or a full abdominal series or an abdominal ultrasound as the preliminary method of evaluation. This is similarly stated in the 10th edition, Merrill's Atlas of Radiographic Positions & Radiologic Procedures, volume 2. An abdominal radiograph will provide a two dimensional overview of all abdominal structures from below the diaphragm down to the pubic symphysis, to include the kidneys to the bladder.

Abdominal ultrasound images the texture, borders, anatomic relationships and blood flow patterns of the various organs of the abdomen. When air and gas are present in the abdominal cavity the ultrasound beam can become obstructed, which prevents it from being the ideal tool for obstruction and perforation.

The American College of Radiology, www.acr.org, and the American Institute of Ultrasound in Medicine, www.aium.org, may be able to be assist you with the clinical indications and restrictions of each modality.

Administrators evaluating the various digital mammography systems available have several factors to consider when converting to an all-digital mammography department. The systems ability to meet the current capacity of procedures performed each year should always be at the top of the list.

When looking to calculate capacity and system performance, an evaluation of the mammography centers percentage of screening mammograms versus diagnostic procedures is a necessary step. Additionally, the acceptance of digital within the department across the entire clinical team is a must. There needs to be a level of acknowledgement that converting from screen-film will require patience as the transition occurs. Also, the understanding that initially technologists and radiologists will be going through a learning curve and that their comfort level will improve with time. As the comfort level increases so will productivity.

My experience and that of my team has been that once the comfort level has reached a certain point, the Hologic Selenia digital mammography system can comfortably process six screening exams per hour. This would translate to 12,000 screening exams per year, based on an eight-hour, five days/week over 50 weeks. Diagnostic procedures are not as easily calculated as the examination time can vary depending on the patient, the necessary views, and whether it is an invasive procedure such as needle localization.