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I was interested in reading the paper by Feyler et al looking at requests for plain film abdominal radiographs in acute medical emergencies.1 Although the results indicate plain film radiography is unnecessarily requested it fails to address several important related issues. Firstly, the discussion of the paper fails to highlight that the existence of many grey areas in clinical diagnosis, particularly the subjectivity of clinical signs and symptoms, may influence the decision to request a plain abdominal radiograph as a first objective means of ruling out intra-abdominal pathology. Fuzzy logic (multivalent logic) is a reality in clinical medicine, because acute clinical signs and symptoms are not as neatly packaged as the Royal College of Radiologists’ guidelines. Secondly, it will be very educational to know the patient profile of the nine patients in whom plain film radiographs influenced clinical management. This is not detailed in the paper.
Editor’s note: The authors have declined an invitation to comment on the above two letters.