Choosing Wisely:

Avoid admission or preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam.

Rationale and Comments: Performing routine admission or preoperative chest x-rays is not recommended for ambulatory patients without specific reasons suggested by the history and/or physical examination findings. Only 2% of such images lead to a change in management. Obtaining a chest radiograph is reasonable if acute cardiopulmonary disease is suspected or there is a history of chronic stable cardiopulmonary diseases in patients older than age 70 who have not had chest radiography within six months.
Sponsoring Organizations:
  • American College of Surgeons
  • Sources:
  • American College of Radiology Appropriateness Criteria
  • Disciplines:
  • Surgical
  • References: • Mohammed TL, Kirsch J, Amorosa JK, Brown K, Chung JH, Dyer DS, Ginsburg ME, Heitkamp DE, Kanne JP, Kazerooni EA, Ketai LH, Ravenel JG, Saleh AG, Shah RD, Expert Panel on Thoracic Imaging. ACR Appropriateness Criteria® routine admission and preoperative chest radiography [Internet]. Reston (VA): American College of Radiology (ACR). 2011. 6 p.
    • Gomez-Gil E, Trilla A, Corbella B, Fernández-Egea E, Luburich P, de Pablo J, Ferrer Raldúa J, Valdés M. Lack of clinical relevance of routine chest radiography in acute psychiatric admissions. Gen Hosp Psychiatry. 2002;24(2):110-3.
    • Archer C, Levy AR, McGregor M. Value of routine preoperative chest x-rays: a meta-analysis. Can J Anaesth. 1993;40(11):1022-7.
    • Munro J, Booth A, Nicholl J. Routine preoperative testing: a systematic review of the evidence. Health Technol Assess. 1997;1(12):i-iv:1-62.
    • Grier DJ, Watson LF, Harnell GG, Wilde P. Are routine chest radiographs prior to angiography of any value? Clin Radiol. 1993;48(2):131-3.
    • Gupta SD, Gibbins FJ, Sen I. Routine chest radiography in the elderly. Age Ageing. 1985;14(1):11-4.
    • Amorosa JK, Bramwit MP, Mohammed TL, Reddy GP, Brown K, Dyer DS, Ginsburg ME, Heitkamp DE, Jeudy J, Kirsch J, MacMahon H, Ravenel JG, Saleh AG, Shah RD, Expert Panel on Thoracic Imaging. ACR Appropriateness Criteria® routine chest radiographs in ICU patients. [Internet]. Reston (VA): American College of Radiology (ACR); 2011. 6 p.

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