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Routine chest radiography in a primary care setting.

Stefan Tigges1, David L Roberts, Kay H Vydareny

  • 1Departments of Radiology, Internal Medicine, and Pulmonary Medicine, Emory Clinic, Bldg A, 1365 Clifton Rd NE, Atlanta, GA 30322, USA. stefan_tigges@emoryhealthcare.org.

Radiology
|November 2, 2004
PubMed
Summary

Routine chest X-rays for asymptomatic patients in primary care have a low diagnostic yield. Most major abnormalities found were false positives, indicating limited value for screening this population.

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Area of Science:

  • Radiology
  • Primary Care Medicine
  • Diagnostic Imaging

Background:

  • Routine chest radiography is often performed in primary care settings.
  • The utility of this imaging modality in asymptomatic patients requires evaluation.

Purpose of the Study:

  • To assess the frequency, diagnostic yield, outcomes, and costs of routine chest radiography in asymptomatic primary care patients.
  • To determine the rate of false-positive results associated with this practice.

Main Methods:

  • A retrospective review of radiography reports for patients undergoing routine or screening chest X-rays in 2001.
  • Classification of radiographic results as normal, minor, or major abnormalities.
  • Chart reviews and additional radiographs were used to establish outcomes for major abnormalities.

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  • Costs were estimated using 2002 Medicare reimbursement rates.

    • Main Results:

    • 34% of chest X-rays were for routine/screening purposes in asymptomatic patients.
    • Only 15 major abnormalities were detected among 1282 routine/screening X-rays.
    • 14 of these 15 major abnormalities were false-positive findings.
    • No disease requiring treatment was diagnosed from these routine screenings.
    • The total cost for follow-up imaging was over $46,000.

    Conclusions:

    • Routine chest radiography demonstrates a low diagnostic yield in asymptomatic patients within a primary care setting.
    • The high rate of false-positive results suggests limited clinical benefit for screening this population.
    • The costs associated with follow-up imaging for false positives are substantial.