Routine Chest Radiography in a Primary Care Setting

Tigges, Stefan; Roberts, David L.; Vydareny, Kay H.; Schulman, David

doi:10.1148/radiol.2332031796

Cited by 33 publications

(18 citation statements)

References 29 publications

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“…Our findings were consistent with that obtained by Tigges et al [4] who evaluated the diagnostic yield of used, with the benefits over potential risks carefully considered. If the benefits are outweighed by potential risks then the procedure might as well be given a second thought.…”

Section: Discussionsupporting

confidence: 93%

Assessing the role of routine chest radiography in asymptomatic students during registration at a university in an endemic area of tuberculosis

Moifo

Tambe

Walter

et al. 2012

Ann Trop Med Public Health

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Context: Routine chest radiographs are usually obtained from asymptomatic individuals during routine medical visits probably to detect the presence of occult disease. In sub-Saharan countries tuberculosis is endemic among young individuals; primary tuberculosis might be the most probable occult disease sought for. Aims: The aim was to determine the diagnostic yield and cost-effectiveness of routine chest radiography in an asymptomatic student population in Yaounde during registration at a university. Settings and Design: A cross-sectional descriptive study carried out in a University-affiliated hospital in Yaounde, Cameroon. Materials and Methods: Postero-anterior (PA) chest radiographs were obtained from students during a routine medical visit before university admission. Radiographic results were coded as normal, minor, or major findings. The estimated cost per radiograph was that of the study setting at the time of the study. Statistical Analysis Used: Epi Info software version 3.3.2 of February 9 2005 (CDC Atlanta) was used for statistical analysis. Results: Of 758 students enrolled, there were 280 males and 478 females (sex ratio 1:2). The mean age of the study population was 21 years (age range 15-33 years). All enrolled cases were asymptomatic. There were 739 normal radiographs (97.5%), while 19 radiographs (2.5 %) showed minor abnormalities. No major abnormality was seen. The estimated direct cost of all the radiographs obtained was 3,941,600 F CFA ($ 8,760). Conclusions: Routine chest radiography has a low diagnostic yield in asymptomatic students even in a setting where tuberculosis is endemic, and is therefore not cost-effective.

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Section: Discussionsupporting

confidence: 93%

Assessing the role of routine chest radiography in asymptomatic students during registration at a university in an endemic area of tuberculosis

Moifo

Tambe

Walter

et al. 2012

Ann Trop Med Public Health

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“…The false-positive rates in our study are markedly lower than the false-positive rates found with routine screening chest radiography in asymptomatic patients (93.3%) (13). An interesting subgroup of our study is the fraction of patients (34.6%; 366 of 1057) who did not undergo a follow-up chest CT examination within 1 year.…”

Section: Discussioncontrasting

confidence: 61%

Diagnostic Yield of Recommendations for Chest CT Examination Prompted by Outpatient Chest Radiographic Findings

Harvey

Gilman

et al. 2015

Radiology

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Purpose:To evaluate the diagnostic yield of recommended chest computed tomography (CT) prompted by abnormalities detected on outpatient chest radiographic images. Materials andMethods:This HIPAA-compliant study had institutional review board approval; informed consent was waived. Reports of all outpatient chest radiographic examinations performed at a large academic center during 2008 (n = 29 138) were queried to identify studies that included a recommendation for a chest CT imaging. The radiology information system was queried for these patients to determine if a chest CT examination was obtained within 1 year of the index radiographic examination that contained the recommendation. For chest CT examinations obtained within 1 year of the index chest radiographic examination and that met inclusion criteria, chest CT images were reviewed to determine if there was an abnormality that corresponded to the chest radiographic finding that prompted the recommendation. All corresponding abnormalities were categorized as clinically relevant or not clinically relevant, based on whether further work-up or treatment was warranted. Groups were compared by using t test and Fisher exact test with a Bonferroni correction applied for multiple comparisons. Results:There were 4.5% (1316 of 29138 [95% confidence interval {CI}: 4.3%, 4.8%]) of outpatient chest radiographic examinations that contained a recommendation for chest CT examination, and increasing patient age (P , .001) and positive smoking history (P = .001) were associated with increased likelihood of a recommendation for chest CT examination. Of patients within this subset who met inclusion criteria, 65.4% (691 of 1057 [95% CI: 62.4%, 68.2%) underwent a chest CT examination within the year after the index chest radiographic examination. Conclusion:A radiologist recommendation for chest CT to evaluate an abnormal finding on an outpatient chest radiographic examination has a high yield of clinically relevant findings.q RSNA, 2014

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“…In an African study covering several institutions over a period of 5 years, only 7% of pre-employment radiographs showed abnormalities [8]. Tigges et al [9] reported that a mere 1.17% (n = 15) chest radiographs showed major abnormalities. Fourteen of the 15 findings of major abnormalities (lung nodules, mass, atelectasis, and mediastinal lymphadenopathy) proved to be false-positives.…”

Section: Discussionmentioning

confidence: 99%

An Audit of Routine Chest X-ray Done During Pre-employment Medical Screening in South-Western Nigeria

Chukwuani¹

2017

CAJPH

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Routine pre-employment chest radiography is one of the examinations performed to assess the medical fitness of prospective employees in many establishments around the world. It is also used to ensure that prospective employees can perform their jobs safely without placing co-workers and others at potential health risk by ruling out the existence of chronic infectious pulmonary diseases like tuberculosis. Despite these focused goals, there are concerns over poor positive result yield, associated unnecessary exposure to ionizing radiation and wastage of economic resources linked to pre-employment chest xray. This study aimed to audit the reports of pre-employment chest radiographs, documented associated radiological findings and subsequently examined the clinical relevance or otherwise of this practice in the locality under study. The records of 725 patients, who had underwent pre-employment chest x-rays between January 2014 and December 2016 in three foremost teaching hospitals in South-western Nigeria, were retrospectively reviewed. All findings were documented including abnormalities 'flagged' as clinically-significant by the radiologists' reports irrespective of the severity or the effect of the abnormality on the employment outcome of the individual. The results show that majority of the patients referred for preemployment chest x-ray presented with normal radiological findings (n = 687, 94.8%). The significant abnormal findings (n = 38, 5.2%) were chronic cardiovascular disorder (n = 15, 2.0%), followed by chronic lung disease (n = 18, 2.5%) and finally skeletal abnormality (n = 5, 0.7%). Individuals 25 years and below presented with no abnormal findings while abnormal findings are found in subjects in the age range of 26-30 years and above. This audit has shown that chest radiography has little or no clinical relevance in routine pre-employment medical screening of physically healthy and asymptomatic prospective employees. Therefore, chest radiography should be restricted to individuals with clinical findings suggestive of cardio-thoracic disorders during pre-employment medical screening.

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Routine Chest Radiography in a Primary Care Setting

Abstract: Routine chest radiography has low diagnostic yield in asymptomatic primary care patients.

Cited by 33 publications

References 29 publications

Assessing the role of routine chest radiography in asymptomatic students during registration at a university in an endemic area of tuberculosis

Assessing the role of routine chest radiography in asymptomatic students during registration at a university in an endemic area of tuberculosis

Diagnostic Yield of Recommendations for Chest CT Examination Prompted by Outpatient Chest Radiographic Findings

An Audit of Routine Chest X-ray Done During Pre-employment Medical Screening in South-Western Nigeria

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