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 disease in a patient older than 70 years who has not had chest radiography within six months.
Sponsoring Organizations:
  • American College of Physicians
  • American College of Radiology
  • Sources:
  • American College of Radiology Appropriateness Criteria
  • Disciplines:
  • Surgical
  • References: • American College of Radiology. ACR Appropriateness Criteria: routine admission and preoperative chest radiography.
    • Gomez-Gil E, et al. Lack of clinical relevance of routine chest radiography in acute psychiatric admissions. Gen Hosp Psychiatry. 2002; 24(2):110-3.
    • Archer C, et al. Value of routine preoperative chest x-rays: a meta-analysis. Can J Anaesth. 1993; 40(11):1022-17.
    • Munro J, et al. Routine preoperative testing: a systematic review of the evidence. Health Technol Assessment. 1997;1(12):i-iv; 1-62.
    • Grier DJ, et al. Are routine chest radiographs prior to angiography of any value? Clin Radiol. 1993;48(2):131-3.
    • Gupta SD, et al. Routine chest radiography in the elderly. Age Ageing. 1985;14(1):11-4.
    • American College of Radiology. ACR Appropriateness Criteria: routine chest radiographs in ICU patients. SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonThoracicImaging/RoutineChestRadiographDoc7.aspx.

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