Portable chest radiography is a fundamental and frequently utilized examination in the critically ill patient population. The chest radiograph often represents a timely investigation of new or rapidly evolving clinical findings and an evaluation of proper positioning of support tubes and catheters. Thoughtful consideration of the use of this simple yet valuable resource is crucial as medical cost containment becomes even more mandatory. This review addresses the role of chest radiography in the intensive care unit on the basis of the existing literature and as formed by a consensus of an expert panel on thoracic imaging through the American College of Radiology. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
*Ronald Reagan UCLA Medical Center, Los Angeles, CA
†Cleveland Clinic, Weston
§§Mayo Clinic, Jacksonville
†††University of Florida College of Medicine, Gainesville, FL
‡Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
§National Jewish Health, Denver, CO
∥Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
¶Society of Thoracic Surgeons, Columbia University, New York
¶¶The American College of Chest Physicians, New York Methodist Hospital, Brooklyn
##North Shore University Hospital, Manhasset, NY
#Department of Radiology and Imaging Services, Indiana University, Indianapolis, IN
**Emory University Hospital, Atlanta, GA
††University of Michigan Medical Center, Ann Arbor, MI
‡‡Department of Radiology, University of New Mexico, Albuquerque, NM
∥∥Department of Radiology, Medical University of South Carolina, Charleston, SC
***Temple University Hospital, Philadelphia, PA
The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document.
This article is a revised version of the American College of Radiology Appropriateness Criteria Intensive Care Unit Patients. Practitioners are encouraged to refer to the complete version at http://www.acr.org/ac.
Reprinted with permission of the American College of Radiology.
Jeffrey P. Kanne is a consultant at Parexcel Informatics. Robert M. Steiner is a consultant and course director at Education Symposium Inc. and a consultant at John and Johnson. The remaining authors declare no conflicts of interest.
Correspondence to: Robert D. Suh, MD, Department of Radiology, Ronald Reagan UCLA Med Ctr, 757 Westwood Plza Ste 1638, Los Angeles, CA 90095-7437 (e-mail: firstname.lastname@example.org).