CLINICAL PROBLEM |
INVESTIGATION |
RECOMMENDATION |
COMMENT |
||
| Non-specific chest pain | F01 | CXR | Not indicated initially | [C] | Conditions such as Tietze's disease show no abnormality on CXR. Main purpose is reassurance. |
| Minor Chest trauma | F02 | CXR | Indicated only in specific circumstances | [C] | Showing a rib fracture does not alter management. |
| Pre-employment or screening medicals | F03 | CXR | Indicated only in specific circumstances | [B] | Not justified except in a few high-risk categories (e.g. at risk immigrants with no recent CXR). Some have to be done for occupational (e.g. divers) or emigration purposes (UK category 2). |
| Routine Pre-operative CXR | F04 | CXR | Not indicated | [B] | Routine pre-operative CXR is not indicated in patients ages <60 years undergoing non-cardiothoracic surgery. The yield of abnormalities increases in patients >60 years. However if patients without known cardio-thoracic disease are excluded, the yield is still low. |
| Upper respiratory tract infection | F05 | CXR | Not indicated | [C] | There is no documented evidence of the effect of CXR on the management or outcome of upper respiratory tract infection. |
| Acute exacerbation of asthma | F06 | CXR | Indicated only in specific circumstances | [B] | Patients presenting with asthma but without localising signs in the chest, pyrexia or leukocytosis do not require CXR, except where asthma is life threatening or fails to respond to treatment adequately. |
| Acute Exacerbation of COPD | F07 | CXR | Indicated only in specific circumstances | [B] | Patients presenting with COPD but without localising signs in the chest, pyrexia or leukocytosis do not require CXR, except where asthma is life threatening or fails to respond to treatment adequately. |
| Pneumonia: (For Children see Section M) |
F08 | CXR | Indicated | [C] |
The majority of patients with community-acquired
pneumonia will show radiological resolution at four weeks, but this may be
prolonged in the elderly, smokers, and those with chronic airway disease.
Further CXR after resolution in asymptomatic patients is not indicated.
(for pneumonia in children see M23) |
| Pneumonia: follow-up | F09 | CXR | Indicated only in specific circumstances | [B] |
CXR need not be repeated before hospital
discharge in those who have made a satisfactory clinical recovery from
community-acquired pneumonia. CXR should be arranged after about six weeks
for all patients who have persistent symptoms or physical signs or who are
at higher risk of underlying malignance (especially smokers and patients >50
years) whether or not they are admitted to hospital. (for pneumonia in children see M23) |
| Suspected Pleural effusion | F10 | CXR | Indicated | [C] | CXR may detect small quantities of pleural fluid |
| US | Indicated | [B] | US may be used to confirm the presence of pleural fluid, characterise it, detect pleural mets and guide thoracentesis. | ||
| CT | Indicated only in specific circumstances | [B] | CT with IV contrast may help in the detection and characterisation of pleural fluid | ||
| Haemoptysis | F11 | CXR | Indicated | [B] | All patients presenting with haemoptysis should have a CXR. If this is normal and the haemoptysis was significant and occurred out of the context of an concurrent chest infection, referral for further investigation should be considered. |
| CT | Not Indicated Initially | [B] | CT should be used in conjunction with bronchoscopy to investigate the majority of patients with haemoptysis. CT may detect malignancies not identified on CXR or bronchoscopy, but is insensitive in detecting mucosal or sub mucosal disease. | ||
| ITU/HDU patient | F12 | CXR | Indicated | [B] | A CXR is most helpful when there has been a change in symptoms or insertion or removal of a device. The value of the routine daily CXR is being increasingly questioned. CT is a useful adjunct to CXR for problem-solving in critically ill patients. |
| ?Occult lung disease | F11 | CT (HRCT) | Specialised investigation | [B] | There is evidence to indicate that high resolution CT (HRCT) may be histospecific; valuable information about disease reversibility and prognosis may be gleaned from HRCT |