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Significant change in the practice of chest radiography in Dutch ICUs
Critical Care volume 18, Article number: P250 (2014)
>We performed a survey under Dutch intensivists on the current practice of chest radiography in their departments. Chest radiographs (CXRs) are obtained frequently in ICU patients, despite the diagnostic and therapeutic efficacy of routine CXRs being known to be low. The discussion regarding specific indications for CXRs in critically ill patients and the safety of abandoning routine CXRs is still continuing .
A web-based questionnaire was sent to the medical director of all adult ICUs in the Netherlands. This survey contained questions regarding ICU characteristics, ICU patients, daily CXR strategies, indications for routine CXRs and the practice of radiologic evaluation.
Of the 83 ICUs that were contacted, 69 (83%) responded to the survey. Only 7% of ICUs still perform daily routine CXRs for all patients while 65% of ICUs say never to perform CXRs on a routine basis. A daily meeting with a radiologist is established in the majority of ICUs and is judged to be important or even essential. The therapeutic efficacy of routine CXRs was assumed by intensivists to be lower than 10% or to be between 10 and 20%. The efficacy of on-demand CXRs was assumed to be between 10 and 60%. There is consensus between intensivists to perform a routine CXR after endotrachial intubation, chest tube placement or central venous catheterization.
The strategy of daily routine CXRs for critically ill patients has developed from a common practice (63%) in 2006  to a rare practice (7%) nowadays. Intensivists still assume the value of routine CXRs to be higher than the efficacy that is reported in the literature. This might be due to the clinical value of negative findings, which has not been studied before.
Ganapathy A, Adhikari NK, Spiegelman J, Scales DC, et al.: Routine chest X-rays in intensive care units: a systematic review and meta-analysis. Crit Care 2012, 16: R68. doi: 10.1186/cc11321 10.1186/cc11321
Graat ME, Hendrikse KA, Spronk PE, Korevaar JC, Stoker J, Schultz MJ, et al.: Chest radiography practice in critically ill patients: a postal survey in the Netherlands. BMC Med Imaging 2006, 18: 6-8.
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Tolsma, M., Rijpstra, T., Schultz, M. et al. Significant change in the practice of chest radiography in Dutch ICUs. Crit Care 18, P250 (2014). https://doi.org/10.1186/cc13440
- Therapeutic Efficacy
- Central Venous Catheterization
- Chest Radiography
- Endotrachial Intubation
- Chest Tube