Purpose or Case Report: A button battery lodged in the esophagus is a medical emergency. This study evaluated how accurately button batteries can be distinguished from other ingested foreign bodies on radiographs and how this influences clinical management.
Methods & Materials: 71 cases of ingested foreign bodies were compiled, anonymized, and randomized. 49 were clinical cases and 22 were created using a chest phantom (italics). Fifteen cases were button batteries (6); 2 were hearing aid batteries (1); 20 were a single penny (1), 3 were 2 pennies stacked on each other, 4 were a nickel (1), 1 was a dime (1), 2 were a single quarter (1), and 2 were a quarter with at least one other coin. Remaining cases were identified only as "coin", were foreign coins, or other round objects.

12 clinicians ranging from PGY-2 to 30 years of experience participated in the study: 5 radiology residents, 2 radiology fellows, 2 radiology attendings, 1 ED fellow, 1 ED attending, and 1 pediatric attending. The cases were presented in Synapse PACS. The participants indicated the likelihood the object was a button battery using a Likert scale: 5 (definitely), 4 (probably), 3 (equal likelihood), 2 (probably NOT), 1 (definitely NOT); to decide how urgently the object needed to be removed (4=within 2 hrs regardless of NPO status, 3=within 24 hrs, 2=electively, 1=does not need to be removed); and were asked how comfortable they were identifying button batteries on radiographs before and after viewing the cases and after reviewing the answers.
Results: The average score for cases containing a button battery was 4.62 (Rads 4.67; ED 4.34; Peds 4.06). The average score for a single penny was 2.09 (Rads 1.87; ED 2.63; Peds 2.90). The average level of urgency for removal of button batteries was 3.89 (Rads 3.86; ED 4.00; Peds 4.00). The average level of urgency for removal of a single penny was 2.93 (Rads 2.89; ED 3.50; Peds 3.27). The average degree of confidence before the cases were reviewed was 64%, 70% after viewing, and 85% after reviewing the answers.
Conclusions: Button batteries are readily distinguishable from other foreign bodies on radiographs, which helps to guide appropriate clinical management. Radiologists more accurately distinguish between button batteries and coins and clinicians are more likely to recommend emergent removal. This exercise increased the participants' levels of confidence in identifying button batteries on radiographs and could serve as a valuable teaching tool.