From the Guidelines
For Medicare patients, a chest x-ray is indicated in the following situations:
- As part of the initial diagnostic workup for symptoms such as cough, chest pain, or shortness of breath that may indicate lung disease or other conditions affecting the chest, as recommended by the American College of Radiology 1.
- For patients with a history of lung disease, such as chronic obstructive pulmonary disease (COPD) or pneumonia, to monitor disease progression or response to treatment, as suggested by the American College of Radiology 1.
- Before and after certain surgical procedures, such as lung surgery or heart surgery, to assess the lungs and chest cavity, as recommended by the American Heart Association 1.
- For patients undergoing chemotherapy or radiation therapy for cancer, to monitor for potential lung complications, as recommended by the American Cancer Society 1.
- When clinically indicated, such as in cases of suspected pulmonary embolism, pneumothorax, or other acute chest conditions, as recommended by the American College of Cardiology 1.
- For patients with occupational exposure to lung diseases, such as asbestos, to screen for lung cancer, as recommended by the American College of Radiology 1. It's essential to note that chest x-ray should not be used for cancer screening in asymptomatic patients, instead, low-dose computed tomography (LDCT) is recommended for patients who meet specific eligibility criteria, such as a history of smoking or exposure to asbestos 1. Additionally, the American College of Radiology recommends that a chest radiograph is usually appropriate for the initial imaging of complicated acute COPD exacerbation in immunocompetent patients 1, and the American Heart Association recommends chest radiographs on presentation for patients with acute chest pain and heart failure 1. The decision to order a chest x-ray should be based on individual patient circumstances and medical history, and should be made in consultation with the patient's healthcare provider.
From the Research
Indications for Chest X-ray in Medicare Patients
- Chest X-rays are indicated in patients with chronic obstructive pulmonary disease (COPD) as part of the initial evaluation, as recommended by the BTS/NICE COPD guideline 2
- The American College of Radiology Appropriateness Criteria suggest that chest radiographs may be taken before surgeries and interventional procedures, but the routine use of chest X-rays in asymptomatic patients is not recommended 3, 4
- In patients with community-acquired pneumonia, chest X-ray may be used as an initial diagnostic tool, but chest computed tomography (CT) may be used to complement chest X-ray in the early diagnosis of pneumonia 5
- In patients with nontraumatic chest pain, a refined decision rule may be used to determine the potential utility of chest X-ray, with a sensitivity of 92.9% and specificity of 30.4% to predict clinically relevant findings on chest X-ray 6
Specific Conditions
- COPD: chest X-ray is recommended as part of the initial evaluation 2
- Community-acquired pneumonia: chest X-ray may be used as an initial diagnostic tool, with chest CT used to complement chest X-ray in the early diagnosis of pneumonia 5
- Nontraumatic chest pain: a refined decision rule may be used to determine the potential utility of chest X-ray 6