Old habits die hard: chest radiography for screening purposes in primary care

Am J Manag Care. 2006 Nov;12(11):650-6.


Objective: To assess whether the use of chest radiography for screening changes over time.

Design: Systematic review.

Data sources: MEDLINE, ISI, Cochrane Central Register of Controlled Trials, and handsearching of selected journals.

Review methods: We evaluated whether the proportion of primary care physicians using chest radiography to screen for (1) malignancy in the general asymptomatic population, (2) malignancy in a high-risk subgroup, (3) any disease in the general population, and (4) any disease in a high-risk subgroup changed over time, using random-effects meta-regression analysis. Adjustments for the availability of national guidelines were also performed.

Results: Overall, 10% to 90% of primary care physicians reported using chest x-ray for screening. In unadjusted analyses, the proportion of physicians using chest radiography for cancer screening in the general population tended to increase by 0.9% per year (8 studies, n = 4313). The corresponding annual changes were -2.9% for cancer screening in high-risk subgroups (8 studies, n = 2784) and -0.4% regarding screening for any disease in the population (7 studies, n = 2627). No meta-regressions were run for outcome (4) (only 1 study). In the adjusted analyses, there was a decreasing nonsignificant trend for all outcomes.

Conclusions: Despite formal recommendations, many physicians still use chest x-ray for screening, with their number decreasing slowly over time. This practice may be harmful because the positive predictive value of chest radiography is low, and further evaluation of false-positive findings might be associated with increased cost and risk from additional diagnostic or therapeutic interventions.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Humans
  • Mass Screening / statistics & numerical data*
  • Practice Patterns, Physicians' / trends*
  • Predictive Value of Tests
  • Primary Health Care / trends*
  • Radiography, Thoracic / statistics & numerical data*
  • Risk Assessment