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Radiology occupies a central position in the evaluation of acutely ill surgical patients. Wepresent what we believe to be the first study evaluating the use of the radiology department for acute general surgical admissions in a busy teaching hospital.A review was undertaken of all imaging performed on acute surgical admissions over an 18month period.There were a total of 1358 acute surgical admissions. 723 (53%) underwent plain chest and/ or abdominal X-rays with 424 (59%) abnormal findings. 124 (9%) patients underwent computed tomography (CT), 185 (14%) ultrasound (US), and 63 (5%) both CT and US, with 259 positive findings (70%). Of these 166 (45%) were performed on the same day as admission, 119 (32%) within 24 hours, and 87 (23%) after 24 hours. Four hundred and ninety-five patients (36%) underwent emergency surgery. Of these 122 (25%) patients had US and/or CT withpreoperative diagnoses made in 111 (91%) based on the positive radiological findings.We believe these results reflect an efficient use of our radiology service for acute surgical admissions, with high diagnostic accuracy deliveredpromptly. We hope thisprovides a standard for comparison, as well as a basis for ongoing audit to ensure continuing improvement in serviceprovision.