Table 2. Role of x-rays in the diagnosis of PDB.

Risk-benefit balance Plain x-rays targeted to the abdomen, skull and facial bones and both tibiae are likely to detect 93% of PDB bone lesions compared with 79% for an abdominal x-ray. The benefit to the patient in making a diagnosis from having additional radiographs is likely to outweigh the risk to the patient in terms of the additional radiation exposure. Quality of evidence Very low Patient values and preferences It’s likely that the majority of patients would be content with having radiographs of three sites as opposed to one to more accurately make a diagnosis of PDB Costs and use of resources Plain x-rays are widely available and relatively inexpensive Recommendation Plain X-rays of the abdomen, tibiae, skull and facial bones are recommended as an initial diagnostic screening test in patients suspected to have PDB on biochemical or clinical grounds.