Are routine chest radiographs prior to angiography of any value?

Chest radiographs are frequently requested prior to diagnostic angiography, though there is no published evidence of their clinical utility. This study was undertaken to evaluate their contribution to patient management. The routine chest radiographs obtained prior to peripheral and coronary angiography in 240 patients were prospectively reviewed for abnormalities likely to affect management. Two hundred and twenty (91.7%) examinations were performed, of which 164 were obtained within 24 h of angiography. Previous radiographs were available in 154 patients (64.2%). One hundred and sixteen radiographs were normal. There were 117 abnormalities on the radiographs of 104 patients, mainly cardiac enlargement and heart failure. No angiogram was postponed or cancelled because of abnormalities detected on a routine radiograph, although radiographic findings led to a change in the volume of contrast medium injected into dilated aortic roots in 10 patients undergoing cardiac catheterization. Pre-angiography radiographs had no effect on the practice of peripheral angiography. In only one patient were further investigations and therapy instigated because of findings, but even in this case these findings were present on previous studies. We conclude that routine pre-angiography chest radiographs are not necessary in the absence of specific clinical indications.