Boston physicians advise peers to abandon routine daily chest X-rays in ICU

by John R. Fischer, Senior Reporter | July 29, 2020

Reducing the use of these daily scans allows doctors to spend more time at patient bedsides and decreases the total amount of radiation exposure to a patient — something that isn’t often considered when deciding on an X-ray in the ICU, since it is ideally necessary as part of lifesaving care. That said, the practice should not completely disappear according to Maley, who says it can be used for certain specific scenarios, such as monitoring certain catheters.

He adds, however, that the chest X-rays from the case highlighted in the study led to several unnecessary imaging tests that stressed both the patient and their family, and nearly resulted in the patient undergoing a harmful, invasive procedure. Such an example illustrates the challenges associated with this practice, which he and Stevens claim should be addressed through ICU policy changes, evidence-based education and clinician engagement.

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“Many ICUs have shifted away from daily chest X-ray use, though practice remains very variable,” he said. “As point of care ultrasound is increasingly used, this will replace the need for chest X-rays in many situations. Overall, I anticipate that routine chest X-ray use will continue to decline as clinicians focus on value-based healthcare and quality improvement at their hospitals.”

The findings were published in JAMA Internal Medicine.

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