Population Covered By The Guidance
This pathway provides guidance on the imaging of adult patients with a suspected soft-tissue foreign body.
Date reviewed: August 2013
Date Published: August 2013
- Plain radiographs should be the initial screening modality for a suspected radio-opaque foreign body. As a general rule further investigation should be in the form of Ultrasonography for superficial and CT scan for deep seated suspected foreign body
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Flom LL, Ellis GL. Radiologic evaluation of foreign bodies. Emerg Med Clin North Am. 1992;10(1):163-77. (Review article)
- Oikarinen KS NT, Makarainen H, Pyhtinen J. Visibility of foreign bodies in soft tissue in plain radiographs, computed tomography, magnetic resonance imaging, and ultrasound. An in vitro study. Int J Oral Maxillofac Surg. (Level III evidence)
- Peterson JJ, Bancroft LW, Kransdorf MJ. Wooden foreign bodies: Imaging appearance. AJR A J Roentgenol. 2002;178(3):557-62. (Level III evidence)
- Hunter TB, Taljanovic MS.Medical devices of the abdomen and pelvis. Radiographics. 2005;25(2):503-523. (Review article)
- O'Connor A,Coakley F, Meng M, Eberhardt S Imaging of retained surgical sponges in the abdomen and pelvis. AJR Am J Roentgenol. 2003;180:481-9. (Review article)
- Manzella A, Filho PB, Albuquerque E, Farias F, Kaercher J. Imaging of gossypibomas: pictorial review. Am J Roentgenol. 2009;193(6 Suppl):94-10. (Review article)
- Hunter TB, Taljanovic MS. Foreign bodies. Radiographics. 2003;23(3):731-57. (Review article)
Pathway User Guide
Yellow Boxes Denotes extra information. Some contain single or multiple white sub-boxes, click a white box to reveal detailed information in a pop-up.
White Boxes: Denotes standard pathway steps. (If inside a yellow box, they open a specific pop-up).
Zoom & Pan Controls: Use + / − or the slider to zoom. Reset returns to default. Tick Panning to drag the diagram when zoomed.
Blue “View Full Screen” Button: Opens the whole diagram in a large, full-screen pop-up window. Use Close to exit.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
|---|---|---|
 |
None | 0 |
 |
Minimal | < 1 millisieverts |
 |
Low | 1-5 mSv |
 |
Medium | 5-10 mSv |
 |
High | >10 mSv |
Disclaimer
Status Of Recommendations Each pathway is designed to assist clinicians in situations when faced with a large array of possible diagnostic tests and examinations. However, it is recognised that diagnostic practice may differ from a particular pathway depending on local availability of equipment and expertise, as well as the experience of individual clinicians. Therefore each pathway is neither a rigid set of rules, nor a substitute for clinical assessment, and individual patient circumstances should always be considered.
Spotted an error or outdated info? Click to tell us.
Investigation of Suspected Foreign Body
Investigation of Suspected Foreign Body: Plain Radiographs
Plain radiographs should be the initial screening modality for a suspected radio-opaque foreign body
- Plain radiographs should be the initial screening modality for a suspected radio-opaque foreign body
- When a suspected foreign body is not delineated on radiographs, ultrasonography should be the next modality of choice for superficial foreign bodies ,
- CT should be reserved for deep seated foreign bodies or those that are not detected on radiographs or ultrasonography but are suspected
- Whereas most metal and glass foreign bodies are detectable on radiographs, many foreign bodies, including wood, are not ,
- In one study, ultrasonography proved most useful for the evaluation of retained wooden foreign bodies
- Surgical instruments such as sponges and gauze are infused with a radiopaque strip to facilitate their detection on radiographs. Radiographs are the most commonly used method to detect retained sponges. If negative, imaging may proceed to Ultrasound and /or CT scan if suspicion is high
Appearance of Foreign Bodies on Radiographs
- Opaque materials: glass of all types; most metallic objects (except aluminum); most animal bones and some fish bones; some foods; some soil fragments, sand, gravel, and mineral fragments; some medications and poisons (CHIPES: chloral hydrate, heavy metals, iodides, phenothiazines, enteric coated pills, solvents)
- Non-opaque materials: most foods and medicines; most fish bones; most wood, splinters, thorns of all types; most plastics; most aluminum objects
Investigation of Suspected Foreign Body
Investigation of Suspected Foreign Body: Ultrasonography
Should be the next modality of choice for suspected superficial foreign bodies
- Plain radiographs should be the initial screening modality for a suspected radio-opaque foreign body
- When a suspected foreign body is not delineated on radiographs, ultrasonography should be the next modality of choice for superficial foreign bodies ,
- CT should be reserved for deep seated foreign bodies or those that are not detected on radiographs or ultrasonography but are suspected
- Whereas most metal and glass foreign bodies are detectable on radiographs, many foreign bodies, including wood, are not ,
- In one study, ultrasonography proved most useful for the evaluation of retained wooden foreign bodies
- Surgical instruments such as sponges and gauze are infused with a radiopaque strip to facilitate their detection on radiographs. Radiographs are the most commonly used method to detect retained sponges. If negative, imaging may proceed to Ultrasound and /or CT scan if suspicion is high
Appearance of Foreign Bodies on Radiographs
- Opaque materials: glass of all types; most metallic objects (except aluminum); most animal bones and some fish bones; some foods; some soil fragments, sand, gravel, and mineral fragments; some medications and poisons (CHIPES: chloral hydrate, heavy metals, iodides, phenothiazines, enteric coated pills, solvents)
- Non-opaque materials: most foods and medicines; most fish bones; most wood, splinters, thorns of all types; most plastics; most aluminum objects
Investigation of Suspected Foreign Body
Investigation of Suspected Foreign Body: Computed Tomography
Should be reserved for deep seated foreign bodies or those not detected on radiographs or ultrasonography but are suspected
- Plain radiographs should be the initial screening modality for a suspected radio-opaque foreign body
- When a suspected foreign body is not delineated on radiographs, ultrasonography should be the next modality of choice for superficial foreign bodies ,
- CT should be reserved for deep seated foreign bodies or those that are not detected on radiographs or ultrasonography but are suspected
- Whereas most metal and glass foreign bodies are detectable on radiographs, many foreign bodies, including wood, are not ,
- In one study, ultrasonography proved most useful for the evaluation of retained wooden foreign bodies
- Surgical instruments such as sponges and gauze are infused with a radiopaque strip to facilitate their detection on radiographs. Radiographs are the most commonly used method to detect retained sponges. If negative, imaging may proceed to Ultrasound and /or CT scan if suspicion is high
Appearance of Foreign Bodies on Radiographs
- Opaque materials: glass of all types; most metallic objects (except aluminum); most animal bones and some fish bones; some foods; some soil fragments, sand, gravel, and mineral fragments; some medications and poisons (CHIPES: chloral hydrate, heavy metals, iodides, phenothiazines, enteric coated pills, solvents)
- Non-opaque materials: most foods and medicines; most fish bones; most wood, splinters, thorns of all types; most plastics; most aluminum objects