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Routine daily chest radiographs in pediatric critical care: necessary standard or unwarranted practice?

Duane C Williams1, Conrad Krawiec2, Gregory Vorona3

  • 1Department of Pediatrics, Virginia Commonwealth University College of Medicine. Children's Hospital of Richmond at Virginia Commonwealth University.

Current Opinion in Pediatrics
|April 1, 2026
PubMed

Insights

Daily chest X-rays in pediatric critical care are not necessary. Evidence shows this practice offers no clinical benefit, increases radiation exposure, and should be replaced by clinical assessment for critically ill children.

Area of Science:

  • Pediatric Critical Care Medicine
  • Diagnostic Imaging
  • Radiology

Background:

  • Daily chest radiographs are a common practice in managing critically ill children.
  • The necessity and impact of this routine imaging are increasingly questioned.

Purpose of the Study:

  • To evaluate the necessity and clinical utility of daily chest radiography in pediatric critical care.
  • To assess the impact of routine daily chest X-rays on patient outcomes and radiation exposure.

Main Methods:

  • This is a review of existing evidence regarding daily chest radiography in pediatric critical care.
  • The review synthesizes findings on clinical outcomes, diagnostic value, and risks associated with the practice.

Main Results:

  • Evidence suggests daily chest radiography does not significantly improve clinical outcomes in critically ill children.
  • This practice does not substitute for thorough clinical assessment and exposes children to unnecessary radiation.
  • Routine imaging may stem from defensive medicine rather than patient-centered care.

Conclusions:

  • Imaging decisions in pediatric critical care should be guided by clinical findings and changes in a patient's condition.
  • Routine daily chest radiographs are not supported by evidence and should be discontinued in favor of selective imaging.
  • Prioritizing clinical assessment over routine imaging reduces radiation exposure and promotes evidence-based care.
Abstract

Keywords:
chest radiographclinical outcomesdefensive medicineradiation exposure

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