Indication and use of chest X-ray scans in the ICU

Introduction

Chest X-ray scans are frequently performed in ICUs. It is uncertain how much clinical information all chest X-ray scans provide. There are currently no guidelines or protocols on this subject. We believe some of the chest X-ray scans performed were avoidable, limiting the cost for hospitals and radiation exposure to patients.

Methods

All chest X-ray scans performed in our 23-bed ICU and high dependency unit were monitored by asking the person ordering the X-ray scan to fill in the form confirming the indication for the chest X-ray scan. At the end of 1 month all forms were collected and analysed.

Results

A total of 112 X-ray scans were performed in a 4-week period but only 102 forms were completed. Eighty-four out of 102 chest X-ray scans were taken for only one indication, with 36/84 for diagnosis of chest pathology. Fourteen X-ray scans were taken without completing the indication. Twenty-five per cent of X-ray scans were performed looking for two or more parameters, making them more cost-effective.

Conclusion

Routine chest X-ray scans are debatable. Post-procedure X-ray scans are not required if done by an experienced clinician. The presence of protocols for ordering the chest X-ray scan may reduce the total number of chest X-ray scans performed and so reduce the cost and radiation exposure. A picture archiving and communication system may reduce the overall cost.