Routine Fluororoentgen Chest Examinations of Hospital Admissions

From the Viewpoint of the Radiologist

¹ The Department of Radiology, Evangelical Deaconess Hospital, Milwaukee, Wisconsin.

The routine chest screening of hospital admissions by the fluororoentgen method is practicable in most general hospitals where the x-ray department is directed by a certified roentgenologist. Such procedures yield results of at least equal, if not greater, magnitude than other routine hospital laboratory procedures.

Abnormal and pathologic conditions of the chest of clinical importance are discovered in approximately 10 per cent of chests examined in hospital screening programs. About 10 per cent of these pathologic findings are probably due to pulmonary tuberculosis. Although pulmonary tuberculosis represents a relatively small percentage of the clinically important findings such case detection in hospitals is extremely important for several reasons: (1) It minimizes exposure of other hospital patients to tuberculosis by providing reason for segregation or transfer. (2) It permits of early diagnosis and institution of proper therapy. (3) It minimizes exposure of hospital personnel to tuberculosis. (4) It provides valuable data in compensation matters and disputes.

Nontuberculous diseases of the chest in hospital surveys are of much greater frequency and probably of equal importance. Cardiac abnormalities, mediastinal tumors or widening, enlarged hilar nodes, metastatic lesions, etc., account for approximately 90 per cent of the pathologic conditions uncovered by this method.

Admission chest fluororoentgenograms provide at least one more advantage. The availability of so-called "control" films of the chest is of great value in those instances where chest complications develop during the hospital stay or even at a later date after discharge from the hospital. Comparison of the "control" films with subsequent roentgen studies affords criteria which often permit of unequivocal diagnostic statements. With such comparative roentgen studies of the chest diagnostic uncertainty is often reduced to a minimum.

The viewpoint of the roentgenologists as regards chest surveys or screening is no different from the viewpoint of the medical profession in general; that is, to provide feasible, well planned and supervised programs. Such planning is mandatory if the procedure is not to be discredited and the reputation of the medical profession is to be sustained. It is imperative that the medical profession undertake and supervise such programs if leadership in public health matters is to be regained and retained.