Is it possible to reduce the number of Chest-X-ray in the ICU?

Abstract

Chest-X-rays (CXR) are the most frequent imagebased explorations performed in intensive care units (ICUs). Indications and prescription modalities (whether routine or on demand prescription strategies) may substantially differ from an ICU to another. The observed heterogeneity reflects a substantial distance between clinical practice and official recommendations. Current guidelines recommend CXRs on a daily basis especially for patients receiving mechanical ventilation and/or suffering from acute cardio-pulmonary failure, whereas practice-based studies report that CXR prescriptions are mainly based on the clinical context. The recently published RARE study shows, with a reliable methodology, that prescribing CXR on demand rather than as a daily routine allows to reduce CXR prescription by 32% in patients receiving mechanical ventilation, with a better diagnostic and therapeutic efficiency and without any impairment of prognosis. Therefore, precise targeted prescription together with the use of reliable diagnostic alternatives (such as ultrasound) should result in a decrease in the number of CXRs performed in the ICU, in patients’ global irradiation, in diagnostic delays, and in costs. Considering current available data, guidelines for CXR prescriptions in the ICU should be updated.