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Routine Chest Radiography in a Primary Care Setting¹

¹ From the Departments of Radiology (S.T., K.H.V.), Internal Medicine (D.L.R.), and Pulmonary Medicine (D.A.S.), Emory Clinic, Bldg A, 1365 Clifton Rd NE, Atlanta, GA 30322. Received November 11, 2003; revision requested February 3, 2004; final revision received April 18; accepted April 21. Address correspondence to S.T. (e-mail: stefan_tigges@emoryhealthcare.org).

PURPOSE: To determine the frequency, diagnostic yield, outcomes, cost, and rate of false-positive results of routine chest radiography performed in asymptomatic patients in the primary care setting.

MATERIALS AND METHODS: Radiography reports on all patients who underwent routine or screening posteroanterior and lateral chest radiography at a university-affiliated primary care clinic in 2001 were reviewed. Radiographic results were coded as normal or minor findings or as major abnormalities, such as pulmonary nodules, requiring further diagnostic evaluation. Outcomes of patients with major abnormalities were established by using chart reviews or reviewing additional radiographs. Costs were estimated by using 2002 Medicare reimbursement rates. The main measures assessed were frequency, costs, and rate of false-positive results of routine chest radiography.

RESULTS: Of 3812 radiographs obtained at the primary care clinic, 1282 (34%) were ordered for routine or screening purposes by the referring physician. Nine hundred twenty-two radiographs were obtained in male patients and 360 were obtained in female patients; their mean and median age was 49 years (age range, 4–87 years). Fifteen chest radiographs showed major abnormalities. No patient younger than 40 years had a major abnormality. Fourteen of the 15 findings of major abnormalities proved to be false-positive. No disease requiring treatment was diagnosed as a result of radiographic findings. The total cost for follow-up radiography and computed tomography was $46 609.49.

CONCLUSION: Routine chest radiography has low diagnostic yield in asymptomatic primary care patients.

© RSNA, 2004

Index terms: Cancer screening • Cost-effectiveness • Radiology and radiologists, socioeconomic issues • Thorax, radiography, 68.11

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