Chest X-rays in COPD screening: Are they worthwhile?

• Published in: Respiratory medicine 2009-12, Vol.103 (12), p.1862-1865
• Main Authors: Wallace, G.M.F, Winter, J.H, Winter, J.E, Taylor, A, Taylor, T.W, Cameron, R.C
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Chest X-ray; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Delivery of Health Care - utilization; Dyspnea - diagnostic imaging; Dyspnea - etiology; Family Practice - organization & administration; Female; Humans; Incidental Findings; Lung cancer; Lung Neoplasms - complications; Lung Neoplasms - diagnostic imaging; Male; Mass Screening - methods; Medical sciences; Middle Aged; Pneumology; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - diagnostic imaging; Pulmonary/Respiratory; Radiography; Retrospective Studies; Screening; Tumors of the respiratory system and mediastinum
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2009.07.001

Summary The BTS/NICE COPD guideline recommends a chest X-ray at initial COPD evaluation; this is a grade D recommendation based on expert opinion. We have investigated which pathologies other than COPD are detected by chest X-ray and how they alter management. Dundee smokers aged 40 or over and receiving bronchodilators are assessed for COPD by their practice nurse and offered a chest X-ray if there is no record of a chest X-ray within the previous three years. We retrospectively analysed the chest X-ray reports and case records of these patients. The chest X-ray report was structured with 7 specific questions, most importantly “Are there any features of other disease likely to be causing dyspnoea?” and “Are there any features to suggest lung cancer?” Management of patients with chest X-ray findings suggesting other disease causing dyspnoea or lung cancer was assessed by questionnaire and case record study. Five hundred forty-six consecutive chest X-ray reports were analysed. Fourteen percent of all chest X-rays detected potentially treatable dyspnoea causing disease; where management following receipt of X-ray reports was audited, 84% were thought to help. Eleven lung cancers were detected, 3 had stage 1 disease. Considerable benign and malignant pathology is detected by chest X-ray performed at initial COPD assessment. Clinical management is changed in the majority with a potentially treatable abnormality. This evidence suggests that the NICE guideline to perform chest X-ray at initial COPD evaluation should be elevated from a grade D to grade C recommendation.