Chest X-Ray and Basic Imaging Interpretation

A chest radiograph is useful when the result will change management. It is not a harmless routine screen for every symptom, nor is it automatically the best first image. The Canadian Association of Radiologists (CAR) Thoracic Imaging Referral Guideline gives scenario-specific recommendations for suspected pneumonia, pneumothorax, pleural effusion, haemoptysis, chronic cough or dyspnea, suspected interstitial lung disease, incidental nodules, mediastinal lesions, and an elevated hemidiaphragm. Depending on the presentation, the appropriate first study may be a chest radiograph, CT, ultrasound, or no imaging. Do not order a baseline chest radiograph for an asymptomatic adult simply because one has never been obtained. Routine preoperative chest radiography is also not indicated before low-risk surgery in an asymptomatic patient without significant systemic disease. The clinical history and examination determine whether imaging is justified. Ordering authority is provincial rather than uniform across Canada. For example, in Ontario, a general-class Registered Nurse may order diagnostic imaging only under an authorizing directive, whereas a Nurse Practitioner in the extended class may order it within the NP standard of practice. Follow the legislation, employer policy, and local...