Utility of routine pre-operative chest X-rays

Abstract

This retrospective study aimed to determine the applicability in Asia of the 1995 Royal College of Radiologists guidelines on the use of routine pre-operative chest radiographs, and the yield and contribution of pre-operative chest x-rays to operative decision making. A total of 203 consecutive routine pre-operative chest radiographs were examined for abnormalities, which were categorised into significant and non-significant. The significant findings were reviewed to determine whether they were supported by available clinical data, and were also correlated with patients' ages. Radiographic and clinical data were analysed together to determine whether the significant abnormalities contributed to patient management. The majority of the patients were in American Society of Anesthesiologists (ASA) Classes 1 and 2, and underwent minor surgery under general anaesthesia. Chest radiographs were abnormal in 45.8% of patients and showed significant abnormalities in 25.6%. Half of the significant abnormalities were supported by clinical data, and there was a progressive increase in abnormalities with age. Three (1.5%) patients had suspected active tuberculosis, which was the only radiographic lesion considered to alter clinical management. Although the Royal College of Radiologists guidelines are generally applicable in the Asian region, a high index of clinical suspicion for active tuberculosis is recommended during the preoperative evaluation of patients in this area.