From the Guidelines
Routine follow-up chest X-rays are not necessary after completing treatment for community-acquired pneumonia (CAP).
Key Points
- The 2019 American Thoracic Society/Infectious Diseases Society of America guideline recommends not to obtain routine follow-up chest imaging after treatment for CAP, as stated in 1.
- This recommendation is supported by the fact that patients may be eligible for lung cancer screening, which should be performed as clinically indicated, rather than routine follow-up chest X-rays 1.
- The 2001 guideline from the same societies suggested that a repeat radiograph is recommended during a follow-up office visit, approximately 4 to 6 weeks after hospital discharge, to establish a new radiographic baseline and to exclude the possibility of malignancy associated with CAP, particularly in older smokers 1.
- However, the more recent guideline from 2019 takes precedence, and emphasizes the importance of clinical judgment in determining the need for follow-up imaging, rather than routine chest X-rays 1.
- The British Thoracic Society guidelines from 2001 also support this approach, stating that a chest radiograph need not be repeated prior to hospital discharge in patients who have made a satisfactory clinical recovery, but may be arranged at follow-up for those with persistent symptoms or at higher risk of underlying malignancy 1.
From the Research
Routine Follow-up Chest X-rays after Completing Treatment for Community-Acquired Pneumonia (CAP)
- The necessity of routine follow-up chest X-rays after completing treatment for CAP is a topic of debate among medical professionals 2, 3, 4, 5, 6.
- A study published in 2007 found that routine short-term follow-up chest radiographs of hospitalized patients with severe CAP seem to provide no additional clinical value 2.
- Another study published in 2015 found that the yield from a 6- to 12-week chest X-ray following CAP is low, with only 2.0% of patients being diagnosed with lung cancer based on a chest X-ray within 6-12 weeks after admission 3.
- A 2014 study examined the incidence of important pulmonary pathology revealed during follow-up imaging of suspected pneumonia on outpatient chest radiography and found that follow-up imaging leads to a small number of new diagnoses of malignancy and important nonmalignant diseases 4.
- The diagnosis of pneumonia requires a chest radiograph, but there is debate as to whether clinical features alone are sufficiently reliable to support a diagnosis of CAP 5.
- A 2015 study derived practical criteria for performing chest radiographs for the evaluation of CAP and found that vital signs and physical examination findings are useful screening parameters for predicting chest radiograph findings in outpatient settings 6.
- The studies suggest that routine follow-up chest X-rays may not be necessary for all patients with CAP, but rather should be reserved for patients with abnormal vital signs, physical examination findings, or those with a high likelihood of morbidity if CAP is not initially detected 2, 3, 4, 5, 6.