Critically evaluate the use of mobile chest X-rays in ICU including indications, method, precautions and information obtained.

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College Answer

Mobile  chest  X-rays  are  essential  diagnostic  tools  in  ICU  but  are  subject  to  overuse  and misinterpretation.

Indications include: any ventilated patient with sudden respiratory or cardiovascular deterioration, after intubation, after insertion of NG tube, daily in critically ill ventilated patients and after insertion of CVC or ICC etc

The method: if possible the CXR should be erect with a consistent distance and energy used. Full inspiration should be held during exposure.

Precautions include: avoid in pregnant patients, cover genitalia in young patients particularly if long stay expected. Stay> 3 metres away from X-ray beam.

The useful information includes: position of lines etc., heart, mediastinal, soft tissue, bone and lung pathology (collapse, consolidation, effusion, oedema), trends in fluid status etc

Discussion

This question closely resembles Question 4 from the second paper of 2007, "Critically evaluate the clinical value of daily routine chest radiographs in the ICU."