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A1486 - Inappropriate Utilization of Portable Chest Radiography in Diagnosis and Treatment of Cardiopulmonary Disease
Author Block: A. Z. Rasheed1, L. Latypov1, M. Shahzadi2, V. P. Vasudevan3, L. N. Gerolemou4, F. Arjomand5; 1Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY, United States, 2Pulmonology, Brooklyn, NY, United States, 3Pulmonary Division, Internal Medicine, The Brooklyn Hospital, Brooklyn, NY, United States, 4The Brooklyn Hospital Center, Brooklyn, NY, United States, 5Brooklyn Hosp Ctr, Brooklyn, NY, United States.
Background: Chest radiography is the most common imaging tests done in hospitalized patients. American College of Radiology guidelines recommend obtaining standard posteroanterior (PA) and lateral radiographs whenever possible as it has a superior diagnostic quality. The portable chest radiograph(CXR) is the examination of choice in patients who are critically ill and unstable for transport to radiology department. Portable CXR is inferior in quality because it is not well standardized and is limited to frontal projection. These technical limitations pose challenges in accurate diagnostic interpretation. Suboptimal interpretation leads to errors in diagnoses and treatment. Objectives: The aim of the study was to define prevalence of inappropriate utilization of portable CXRs, limitations of portable CXR in terms of technical quality, accuracy of interpretation and need for CT thorax. Study Design: Retrospective chart review. Results: 85 patients who had chest radiography done to answer a clinical question were included. These patients had normal vitals signs and had ability to ambulate. ICU and medical unstable were excluded. Mean age was 62 years (range of 29-91). 56 were females and 29 were males. 60/85 (70%) were African Americans. Chief presenting symptoms were; shortness of breath in 55/85 (65%), chest pain 12/85 (14%), cough in 10/85 (11.5%), palpitation in 6/85 (7%) and wheezing in 2/85 (2.5%). Portable CXR was reported negative in 48%, positive in 52% of the patient. In patients with positive portable CXR; 26/44 (59 %) had findings suggestive of congestive heart failure (CHF) as evident by cardiomegaly alone or with combination of congestion, pleural effusion, pulmonary HTN, and basilar atelectasis. Patient in non-CHF category, 12/18 (67%) was reported combination of lower lobe atelectasis and consolidation, 3/20 (15%) chronic interstitial changes, 2/20 (10%) airspace opacification (10%) and 1 emphysema. In patients with positive portable CXR, only 5/44 (11%) were followed up with standard 2 views CXR done and all 5 were negative for any findings. 39 (79%) were followed up with CT chest with contract. In patients who were followed with CT chest, there was no concordance between portable CXR chest and CT findings.Conclusion: Chest x-ray is the most commonly performed diagnostic x-ray examination in hospitalized patients. A high quality standardized PA and lateral projection is helpful in making correct diagnosis and excluding cardiopulmonary disease. Suboptimal quality portable study leads to inaccuracies and uncertainties in diagnosis and treatment.