From the Guidelines
To write on an X-ray requesting resolution of pneumonia, clearly state "Clinical history: Follow-up for pneumonia, please assess for resolution" at the beginning of your order, as this provides essential context for the radiologist to evaluate the patient's progress 1. When requesting an X-ray to assess the resolution of pneumonia, it is crucial to include relevant patient information, such as the date of initial diagnosis, location of the pneumonia, any previous imaging, current symptoms, and ongoing treatments. This information helps the radiologist compare current findings with previous images and provide a more accurate assessment of whether the pneumonia has resolved, improved, or worsened.
- Specify if the patient is immunocompromised or has other relevant conditions that might affect recovery.
- Note any specific areas of concern you want the radiologist to evaluate, such as potential complications like pleural effusion or pulmonary abscess 1. The radiologist needs this clinical context to distinguish between residual scarring (which may persist after resolution) and ongoing active infection.
- Remember that complete radiographic resolution may lag behind clinical improvement by several weeks, especially in older patients or those with comorbidities 1. It is also important to consider the patient's clinical parameters, such as white blood cell count, measures of oxygenation, and core temperature, to define the normal pattern of resolution of pneumonia 1.
- Chest radiographs should be repeated to demonstrate either resolution of all pulmonary abnormalities or to document what residual abnormalities persist, with the interval between radiographs depending on the patient's clinical progress 1.
From the Research
Radiographic Resolution of Pneumonia
- The radiographic resolution of pneumonia occurs more rapidly in younger patients and in those with only a single lobe involved 2.
- Factors that can contribute to non-response to treatment include host factors, incorrect antibiotic dosing, atypical or resistant pathogens, and non-infectious conditions 3.
- Appropriate diagnosis and early initiation of adequate antimicrobial treatment for severe pneumonia are crucial in improving survival among critically ill patients 4.
Writing on X-ray for Resolution of Pneumonia
- When writing on an x-ray for resolution of pneumonia, consider the following:
- Note the date and time of the x-ray
- Describe the radiographic findings, including any improvements or worsening of the pneumonia
- Compare the current x-ray to previous ones to assess for resolution or progression of the disease
- Consider including information about the patient's clinical symptoms and response to treatment
Clinical Utility of Follow-up Radiography
- Follow-up chest radiographs are frequently recommended to document the clearing of radiographically suspected pneumonia, but the clinical utility of follow-up radiography is not well understood 5.
- A study found that follow-up imaging of suspected pneumonia leads to a small number of new diagnoses of malignancy and important nonmalignant diseases, which may alter patient management 5.
- The incidence of important pulmonary pathology revealed during follow-up imaging of suspected pneumonia on outpatient chest radiography is relatively low, with 5.2% of patients receiving a new diagnosis 5.
Management of Pneumonia
- Guidelines for the evaluation and treatment of pneumonia recommend knowledge of local bacterial pathogens and their antibiotic susceptibility and resistance profiles for effective pharmacologic selection and treatment 6.
- Adherence to pneumonia guidelines is associated with better outcomes in severe pneumonia 4.