In general, do hospitals still require all admitted patients to have a chest x-ray? I remember when I had my tonsils removed back in my early years (late 1960s) that I had an x-ray. If not required, when did the practice go out of vogue?
No definitely not (having spent a lot of time in-paitent in a Children’s hospital recently).
It was a TB related thing I believe and now its only required (e.g. when applying for Green Card) if you show an immune response to TB. I also had to have one back in the UK when my sister was diagnosed with TB (she’s a pathologist and its a little known occupational hazard)
I remember the admission CXR being standard when I started med school back in 1979 but by the time I graduated in 1983 it was being used for higher risk folk rather than for every patient admitted.
The standard is ordering one for those with some reason for requiring it. It would be expected for admissions for heart or lung disorders or those that might spread to or involve the chest or abdomen, some anticipated operations, trauma, some unclear differential diagnoses and some infections. They are quite safe in pregnancy but one might need a stronger indication in this population.
I think that X-rays are only done when needed. Even though the radiological dose is low, there is no point in taking risks for no reason. I get the impression that nearly all medical practice is about balancing risk.
Ultrasound is used a lot more too these days. Less risk, and quality has come on by leaps and bounds.
As well as other imaging options like MRI. Though I gather that the equipment for that is more expensive, and so not as widely available.
Not anymore. Now we know the cumulative results of exposure to x rays, and they aren’t good. If they did that routinely, it would put people at risk if they developed cancer or some other serious disease later on because treatment options would be severely limited.
For a long time, the chest x-ray was the gold standard for diagnosing tuberculosis, whether it was in an era where it was treatable or not. Nowadays, most people can use the PPD test, which does take a few days to elicit a response.
Before I did rotations in 1994, all of us had to be examined for TB, at the school’s expense, and most of us were able to use a PPD. Two of my friends, one from Hong Kong and the other from Uganda, had to get the BCG vaccine before entering the U.S. when they emigrated, and this will always produce a positive response with the PPD, so they got chest x-rays. AFAIK, nobody had a positive test.
Although radiation exposure is a concern, the amount for a chest X-ray is similar to flying on an airplane - not so much. Some surgeons insist on one being done before most operations. It gives a lot of information for little risk, but still no point doing it without some reason.
CTs are bunches of X-rays interpreted by computer to make better images. These have significantly higher doses of radiation. MRIs are almost never done at admission routinely, without a specific reason. They have no significant radiation exposure.
Ultrasound is better or similar for a few specific diagnoses, conditions or locations. It almost never replaces a chest X-ray. It has no significant radiation exposure. Quality depends on several things, including frequency and depth, but is limited for many lung studies without some expertise. It is useful for pneumothoraces and of some use in supporting diagnoses of congestion and pneumonia which are mainly clinical, .
Hasn’t been a blanket requirement for as long as I’ve been a nurse, in my experience.