Don’t perform preoperative chest x-rays in the absence of clinical signs or symptoms which indicate diseases that could affect the clinical outcomes.

Oct 17, 2018

Don’t perform preoperative chest x-rays in the absence of clinical signs or symptoms which indicate diseases that could affect the clinical outcomes.

Type of practice

Imaging

Age

Adult, Geriatric, Pediatric

Topic Area

Medical Radiology

Routine preoperative chest X-rays are not recommended, regardless of the clinical evidence and the type of procedure, as well as the degree of complexity, unless specifically justified by the clinical patient’s history and/or physical examination.
In the absence of cardiopulmonary signs or symptoms, routine preoperative chest radiographs uncommonly result in significant changes in clinical management or improvement in patient outcomes, while exposing patients to ionizing radiation, incidental findings and high costs for society and environmental harm.
The decision to perform a chest radiograph should principally derive from the needing to investigate a clinical suspicion for acute or stable chronic cardiopulmonary disease in advanced patient age (especially >70 years). The indication for examination should also correlate with preoperative anesthesiologic assessment and with the complexity of the surgical procedure.

Sources

1. Bouillot JL, Paquet JC, Hay JM, et al. Is preoperative systematic chest x-ray useful in general surgery? A multicenter prospective study of 3959 patients. ACAPEM. Association des Chirurgiens de l'Assistance Publique pour les Evaluations Médicales. Ann Fr Anesth Reanim 1992;11:88-95. doi:10.1016/s0750-7658(05)80324-7.
2. NICE Guideline 2016. Routine preoperative tests for elective surgery. 2016. https://www.nice.org.uk/guidance/ng45 (ultimo accesso: gennaio 2026)
3. Vicente-Guijarro, J, Valencia-Martín JL, Moreno-Nunez P, et al. SOBRINA Working Group. Estimation of the Overuse of Preoperative Chest X-rays According to “Choosing Wisely”, “No Hacer”, and “Essencial” Initiatives: Are They Equally Applicable and Comparable? Int J Environ Res Public Health 2020; 17: 8783. doi:10.3390/ijerph17238783.
4. ACR–SPR–STR Practice Parameter for the Performance of Chest Radiography. 2022. https://www.gravitas.acr.org/PPTS/GetDocumentView?docId=129 (ultimo accesso: gennaio 2026).
5. Wu TJ, Chen KH, Kang YN, et al. Should We Routinely Take Chest X-Rays Before Surgery? A Systematic Scoping Review of Clinical Recommendations Using the Appraisal of Guidelines for Research and Evaluation-Recommendations Excellence (AGREE-REX) Instrument. J Eval Clin Pract. 2025; 31: e70265. doi:10.1111/jep.70265.

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Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.