• Aquino SL, Khan A, Batra PV, Gurney JW, Haramati LB, MacMahon H, Mohammed TL, Rozenshtein A, Vydareny KH, Washington L, Winer-Muram HT, Woodard PK, Kaiser L, Raoof S, Expert Panel on Thoracic Imaging. Routine chest radiograph. [online publication]. Reston (VA): American College of Radiology (ACR); 2006. 6 p. [21 references]

This is the current release of the guideline.

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

ACR Appropriateness Criteria®

Clinical Condition: Routine Chest Radiograph

Variant 1: Monitoring stable patient.

Variant 2: Respiratory failure. Patient receiving mechanical ventilation.

Variant 3: Compromised respiratory function. Patient with endotracheal tubes.

Variant 4: Central venous pressure catheter (CVP) insertion.

Variant 5: Cardiopulmonary compromise. Swan-Ganz catheter insertion.

Variant 6: Potential cardiopulmonary compromise. Nasogastric (NG) tube insertion.

Variant 7: Respiratory compromise. Chest tube insertion.

Summary of Literature Review

Portable Radiographs in the Intensive Care Unit (ICU) Setting

Portable radiographs can be categorized as: 1) daily or routine radiographs for patient monitoring; 2) radiographs obtained after specific procedures; and 3) radiographs documenting the presence or course of disease.

Routine daily portable radiographs are indicated for patients with acute cardiopulmonary problems. In stable patients admitted for cardiac monitoring, or in stable patients admitted for extrathoracic disease only, an initial admission radiograph is recommended, with follow-up radiographs obtained only for specific clinical indications.

Endotracheal Tubes

Very few malpositioned tubes are detected by physical examination. Routine radiographs immediately postintubation are indicated to insure proper positioning.

Central Venous Pressure (CPV) Catheters

A chest radiograph (CXR) after insertion of a CVP catheter is recommended to demonstrate proper placement and detect any complications. Beyond the initial insertion, follow-up radiographs have a low yield for revealing complications. Follow-up radiographs are suggested only when complications are suspected clinically.

Swan-Ganz Catheters

Portable radiography is suggested after catheter insertion. Once pneumothorax has been excluded and proper positioning has been assured, follow-up radiographs are not required except for specific clinical indications.

Nasogastric Tubes

Based on limited evidence, small-bore feeding tubes may, in a small but significant number of patients, be inadvertently placed in the lungs. This error is not always detected clinically and may lead to injection of feeding material into the lung, or tube penetration of the pleura, with subsequent pneumothorax. A CXR is warranted after initial nasogastric tube insertion and before the first feeding. Beyond the initial radiograph, follow-up radiographs are not required for management of stable tubes.

Chest Tubes

After insertion of a chest tube, a CXR is recommended to show the position of the tube, any success in drainage, and possible complications from insertion. Beyond this point, evaluation of tube position and function is warranted based on management of the pleural space and clinical indications.

Algorithms were not developed from criteria guidelines.

The recommendations are based on analysis of the current literature and expert panel consensus.

• Aquino SL, Khan A, Batra PV, Gurney JW, Haramati LB, MacMahon H, Mohammed TL, Rozenshtein A, Vydareny KH, Washington L, Winer-Muram HT, Woodard PK, Kaiser L, Raoof S, Expert Panel on Thoracic Imaging. Routine chest radiograph. [online publication]. Reston (VA): American College of Radiology (ACR); 2006. 6 p. [21 references]

Not applicable: The guideline was not adapted from another source.

2006

American College of Radiology - Medical Specialty Society

The American College of Radiology (ACR) provided the funding and the resources for these ACR Appropriateness Criteria®.

Committee on Appropriateness Criteria, Expert Panel on Thoracic Imaging

Panel Members: Suzanne L. Aquino, MD; Arfa Khan, MD; Poonam V. Batra MD; Jud W. Gurney, MD; Linda B. Haramati, MD; Heber MacMahon, MD; Tan-Lucien H. Mohammed, MD; Anna Rozenshtein, MD; Kay H.Vydareny, MD; Lacey Washington, MD; Helen T. Winer-Muram, MD; Pamela K. Woodard, MD; Larry Kaiser, MD; Suhail Raoof, MBBS

Not stated

This is the current release of the guideline.

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

None available

This NGC summary was completed by ECRI Institute on May 10, 2007.