Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
When considering ordering chest X-rays for patients presenting with respiratory symptoms, the following guidelines should be followed:
- Suspected Cancer (NICE NG12):
- Consider an urgent chest X-ray (to be done within 2 weeks) for patients aged 40 and over with a persistent or recurrent chest infection NICE NG12.
- Offer an urgent chest X-ray (to be done within 2 weeks) for patients aged 40 and over with unexplained chest pain who have ever smoked or been exposed to asbestos NICE NG12. This also applies if unexplained chest pain is accompanied by cough, fatigue, shortness of breath, weight loss, or appetite loss NICE NG12.
- Offer an urgent chest X-ray (to be done within 2 weeks) for patients aged 40 and over with an unexplained cough who have ever smoked or been exposed to asbestos NICE NG12. This also applies if an unexplained cough is accompanied by fatigue, shortness of breath, chest pain, weight loss, or appetite loss NICE NG12.
- Offer an urgent chest X-ray (to be done within 2 weeks) for patients aged 40 and over with unexplained shortness of breath who have ever smoked or been exposed to asbestos NICE NG12. This also applies if unexplained shortness of breath is accompanied by cough, fatigue, chest pain, weight loss, or appetite loss NICE NG12.
- Consider an urgent chest X-ray (to be done within 2 weeks) for patients aged 40 and over with chest signs consistent with lung cancer, chest signs compatible with pleural disease, or finger clubbing NICE NG12.
- Suspected Tuberculosis (NICE NG33):
- Take a chest X-ray if chest X-ray appearances suggest tuberculosis (TB) NICE NG33.
- A chest X-ray is a routine diagnostic investigation for suspected pulmonary TB in adults, young people aged 16 to 17 years, and children aged 15 years or younger NICE NG33.
- For patients presenting with extrapulmonary TB, offer a chest X-ray to exclude or confirm coexisting pulmonary TB NICE NG33.
- Suspected Bronchiectasis (CKS Bronchiectasis):
- While chest X-ray is not recommended for diagnosis as findings are non-specific and may be normal, a baseline X-ray should be performed in people with suspected bronchiectasis NICE CKS.
- Palliative Care - Dyspnoea (CKS Palliative care - dyspnoea):
- Chest radiography is a useful investigation to consider in all people with non-acute dyspnoea in a palliative care situation to assess lung disease and heart failure NICE CKS.
- Chronic Obstructive Pulmonary Disease (COPD) (NICE NG115):
- Spirometry is the primary diagnostic tool for COPD NICE NG115. Chest X-ray is not routinely recommended for diagnosis, but symptoms like chest pain or haemoptysis should prompt consideration of alternative diagnoses NICE NG115.
- Chest Pain (CKS Chest pain):
- Do not routinely organize a chest X-ray for stable angina unless other diagnoses, such as lung cancer, are suspected NICE CKS.
- Arrange appropriate investigations if the cause of chest pain cannot be confidently established by clinical features alone NICE CKS.