Purpose: To construct a simple model to assess the role and impact of diagnostic imaging in abdominal pain. Scenarios employing a combination of modalities are analyzed with respect to length of stay, cost, and radiation dose. Methods and Materials: A Markov model was constructed for abdominal pain in the emergency department (ED). Diagnostic decisions are directed through an observation pathway or MDCT, abd plain film (ABX) or ultrasound. Models were constructed for two paradigms, one with ABX and one without. Model data were from 2724 adult patients presenting to our ED with abdominal pain between 1/1 and 31/12/2007. Expected values were calculated for time (hrs), cost (dollars) and radiation exposure (mGy) in each paradigm. Cost‑effectiveness and sensitivity analyses were performed for change in the preferred scenario. Monte Carlo simulation estimated scenario specific cost. Results: Values favored no‑ABX pathway for cost and time analysis, but favored ABX pathway in the radiation exposure analysis. Sensitivity analyses revealed an ABX preferred pathway in time and cost only when diagnostic efficiency of ABX was elevated and MDCT severely reduced. Radiation dose model consistently favored ABX scenario in all analyses. Values in cost‑effectiveness models favored ABX scenario, but were essentially collinear using dollar cost and time. Conclusion: MDCT is favored over ABX in the initial ED evaluation of abdominal pain in simple models using dollar cost and ED time metrics. ABX scenario is favored only when the sole consideration was radiation exposure. All cost‑effectiveness models favor ABX scenario, but are nearly collinear in dollar cost and length‑ofstay (time) models.