Table 5 Reported low-value thoracic imaging

Routine chest XR

Pre/post-operative

Elective surgery

0–4% change in management

XR is indicated pre-op for cancer, trauma, and cardiac patients

[78,79,80,81]

Post-op soft tissue sarcoma and stage I germ cell cancer

No change in management

Use chest CT instead

[82, 83]

Staging in breast or cervical cancer

2.8% relevant findings

[84, 85]

Medical check-up

0.25% change in management

[86]

At admission to hospital

Up to 4% relevant findings

[87, 88]

Acute abdominal pain

6% change in management

[89]

Trauma patients

Marginal effect on management

[90, 91]

Congenital lung malformations

No change in management

[92]

Repeat chest XR

Trauma patients

19% relevant findings

Use routine repeats only when initial chest XR is abnormal

[93]

Routine follow-up chest XR

After thoracic invasive interventions

 < 1–5.6% change in management

XR patients with symptoms of pneumothorax only

[94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112]

ICU patients

< 8% change in management

Image patients with positive physical examination only

[113]

Chest CT

Pleural effusion

4% relevant findings

[114]

Emergency department patients

About 20% relevant findings

[115]

Pre-op staging of breast cancer

1.5% relevant findings

Useful for stage III patients only

[116]

Repeat chest CT

Covid-19

No change in management when patient is clinically improving

[117]