Selecting an Imaging Study

If a foreign body is suspected but not found during exploration of a wound, a plain film should be ordered first, since plain radiography will detect as many as 80 to 90 percent of all foreign bodies. It is prudent to order films if a patient believes there is a retained object. If the wound was caused by metal, glass, or gravel and no foreign body was found on plain films or wound exploration, the physician can end the search. For objects not routinely visible on plain radiography, CT scans are the modality of choice. Both plain films and CT scans are useful for identifying the composition, size, shape, and approximate location of an object in tissue. Ultrasound is not as reliable as CT in confirming the presence or absence of nonradiopaque foreign bodies. However, ultrasonography and fluoroscopy are effective methods for guiding an instrument toward a soft tissue foreign body.18,19

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