American College of Surgeons

View all recommendations from this society

Released September 4, 2013

Avoid admission or preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam.

Performing routine admission or preoperative chest X-rays is not recommended for ambulatory patients without specific reasons suggested by the history and/or physical examination findings. Only 2 percent of such images lead to a change in management. Obtaining a chest radiograph is reasonable if acute cardiopulmonary disease is suspected or there is a history of chronic stable cardiopulmonary diseases in patients older than age 70 who has not had chest radiography within six months.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American College of Surgeons (ACS) solicited recommendations for the ABIM Foundation’s Choosing Wisely® campaign from the Commission on Cancer, Committee on Trauma, and the Advisory Councils for Colon and Rectal Surgery, General Surgery, and Pediatric Surgery. The committees were provided with a description of the campaign’s initiative, a link to the Choosing Wiselywebsite, and published recommendations from organizations already participating in the campaign were referenced and reviewed during discussions. All of the recommendations collected from the ACS committees were reviewed, and five items were identified. The ACS’ disclosure and conflict of interest policy can be found at www.facs.org.

Participating ACS Committees:

Advisory Council for Colon and Rectal Surgery

  • Chair: Thomas E. Read, MD, FACS, Burlington, MA

Advisory Council for General Surgery

  • Chair: E. Christopher Ellison, MD, FACS, Columbus, OH

Advisory Council for Pediatric Surgery

  • Chair: Mary E. Fallat, MD, FACS, Louisville, KY
  • Immediate Past Chair: Thomas F. Tracy Jr., MD, FACS, Providence, RI

Commission on Cancer

  • Chair: Daniel P. McKellar, MD, FACS, Greenville, OH

Committee on Trauma

  • Chair: Michael F. Rotondo, MD, FACS, Greenville, NC

Sources

Mohammed TL, Kirsch J, Amorosa JK, Brown K, Chung JH, Dyer DS, Ginsburg ME, Heitkamp DE, Kanne JP, Kazerooni EA, Ketai LH, Ravenel JG, Saleh AG, Shah RD, Expert Panel on Thoracic Imaging. ACR Appropriateness Criteria® routine admission and preoperative chest radiography [Internet]. Reston (VA): American College of Radiology (ACR). 2011. 6 p.

Gomez-Gil E, Trilla A, Corbella B, Fernández-Egea E, Luburich P, de Pablo J, Ferrer Raldúa J, Valdés M. Lack of clinical relevance of routine chest radiography in acute psychiatric admissions. Gen Hosp Psychiatry. 2002;24(2):110-3.

Archer C, Levy AR, McGregor M. Value of routine preoperative chest x-rays: a meta-analysis. Can J Anaesth. 1993;40(11):1022-7.

Munro J, Booth A, Nicholl J. Routine preoperative testing: a systematic review of the evidence. Health Technol Assess. 1997;1(12):i-iv:1-62.

Grier DJ, Watson LF, Harnell GG, Wilde P. Are routine chest radiographs prior to angiography of any value? Clin Radiol. 1993;48(2):131-3.

Gupta SD, Gibbins FJ, Sen I. Routine chest radiography in the elderly. Age Ageing. 1985;14(1):11-4.

Amorosa JK, Bramwit MP, Mohammed TL, Reddy GP, Brown K, Dyer DS, Ginsburg ME, Heitkamp DE, Jeudy J, Kirsch J, MacMahon H, Ravenel JG, Saleh AG, Shah RD, Expert Panel on Thoracic Imaging. ACR Appropriateness Criteria® routine chest radiographs in ICU patients. [Internet]. Reston (VA): American College of Radiology (ACR); 2011. 6 p.