Preoperative chest radiology. National study by the Royal College of Radiologists.

Over a period of four to five months, eight hospitals in England, Wales, and Scotland took part in an investigation into the use of preoperative chest radiography (POCR) in 10,619 patients undergoing non-acute, non-cardiopulmonary surgery. Wide variations in the use of POCR were recorded both between centres (11.5--54.2%, mean 29.7%) and and between specialties, and this variation could not be explained on clinical grounds. POCR did not seem to influence the decision to operate or the choice of anaesthetic; nor was there any evidence that POCR, at the levels of utilisation observed in this study, would be of much value as a baseline against which subsequent radiographs in patients with postoperative pulmonary complications could be judged. In view of the absence of clinical usefulness of routine POCR in patients scheduled for non-emergency operations, other than those on heart and lung, and on financial grounds, there is a case for setting a temporary norm for POCR in non acute, non-cardiopulmonary surgery at the lowest level of utilisation found in the eight centres (12%). This norm could be used while the policy of abandoning routine POCR in such cases was discussed.