Abdominal radiographs are commonly requested indiscriminately for patients with abdominal pain, but the results of many such examinations are negative or non-specific. In today's era of high-technology studies, such as ultrasonography, computed tomography and magnetic resonance imaging, plain abdominal radiography is still appropriate in some situations, and the interpretation of abdominal plain films remains an essential and challenging component of most radiology practices. This article reviews a number of issues regarding the use of plain radiography: the common causes of abdominal pain in patients presenting to a typical emergency department; the appropriate indications for this type of examination so that the number of unnecessary examinations is minimized and the diagnostic yield thereby maximized; and the appropriate views to be obtained, the rationale for their use and a proposed format for standardized viewing of abdominal plain films. The article concludes with a practical review of some commonly misunderstood points regarding the bowel gas pattern and ascites.