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An additional consideration by our radiologists was to use the abdominal film to determine whether air or contrast enema would be optimal for the reduction. I have had radiology request abdominal films after positive ultrasound for this reason.
Mark Lo
Seattle Children's

> On Jan 20, 2015, at 7:39 AM, Christopher Pruitt, M.D <[log in to unmask]> wrote:
>
> I think there are 2 questions here:
>
> 1. I believe the spirit of the initial solicitation (correct me if wrong) was whether or not there is a requirement for plain films prior to US to evaluate for free air. (Our center does not have such a requirement.)
>
> 2. The other issue is that of diagnostic accuracy for plain films (2 or 3 views) when ileocolic intussusception is suspected. Others have mentioned some valuable literature on this topic...my 2 cents would be that, when the diagnosis is likely (speaking to pretest probability), most of us, I think, would order the ultrasound as the gold standard for diagnosis.
>
> It's for the larger proportion of patients, in whom the diagnosis is one of many in the differential, for whom the pre-test probability of ileocolic intussusception is lower, that plain films may prove more helpful in excluding the diagnosis.
> (reference for clinical risk stratification: http://www.ncbi.nlm.nih.gov/pubmed/22270504 )
>
> chris pruitt
> UAB
>
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