Chest x rays―who should report them acutely?

The chest radiograph (CXR) is the most widely performed radiological examination, but is considered to be one of the most complex imaging modalities to interpret.1 Most patients admitted as a medical emergency have one taken, and yet the circumstances under which this is performed—for example, in the acutely ill, poorly positioned patient taking an inadequate breath—reduce the subsequent quality of the image, adding to the difficulties of interpretation. Despite this, initial assessment of the CXR is often left to relatively inexperienced junior doctors, with limited training in radiology, who may misinterpret the images, possibly leading to inappropriate management including the use of antibiotics,2–4 or unnecessary further imaging, increasing cost and risking further morbidity during the admission. Serious lesions may be missed and the diagnosis of malignancy delayed, which may affect a patient’s survival.3 5–7 Several authors have demonstrated that radiologists, not surprisingly, make significantly fewer errors than other clinicians in the reporting of CXRs and other plain radiographs.8–12 It is clearly in a patient’s best interest that their CXR should be reviewed by a trained, competent individual. But not only is this ideal not met, the results of many CXRs go unrecorded and unreported. Grosvenor and colleagues found that about 30% of CXRs on patients admitted to a …