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Protocol - Chest X-ray

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Description:

The American College of Radiology - Society for Pediatric Radiology (ACR-SPR) "Practice Parameter for the Performance of Chest Radiography" Amended 2014 (Resolution 39) outlines principles for performing high-quality chest X-rays in adult and pediatric participants. Topics covered include indications and contraindications for chest X-ray, qualifications and responsibilities of personnel, specifications of the examination, documentation and reporting, equipment specifications, radiation safety in imaging, quality control and improvement, safety, infection control, and patient education.

Specific Instructions:

The American College of Radiology - Society for Pediatric Radiology (ACR-SPR) "Practice Parameter for the Performance of Chest Radiography" Amended 2014 (Resolution 39) is a clinical practice parameter. Hence the Sickle Cell Disease: Cardiovascular, Pulmonary, and Renal Working Group recommends investigators be aware that when performing chest X-rays in research studies, some uses of this X-ray are to:

  • determine, based on extent of disease, which arm of the study a patient is randomized to, or
  • assess response to a clinical intervention or treatment, or
  • define the natural course of the disease process
Protocol:

Chest Radiograph (i.e. X-ray)

The full American College of Radiology - Society for Pediatric Radiology (ACR-SPR) "Practice Parameter for the Performance of Chest Radiography" Amended 2014 (Resolution 39) is posted here and is also available at the ACR website: www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Chest_Radiography.pdf

Protocol Name from Source:

Availability:

Publicly available

Personnel and Training Required

Physician

Radiologic Technologist

See "Section IV. Qualifications and Responsibilities of Personnel" in the "ACR-SPR Practice Parameter for the Performance of Chest Radiography" Amended 2014 (Resolution 39) at www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Chest_Radiography.pdf

Equipment Needs

See "Section VII. Equipment Specifications" in the "ACR-SPR Practice Parameter for the Performance of Chest Radiography" Amended 2014 (Resolution 39) at www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Chest_Radiography.pdf

Requirements
Requirement CategoryRequired
Major equipment Yes
Specialized training Yes
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Imaging assessment

Life Stage:

Infant, Toddler, Child, Adolescent, Adult, Senior, Pregnancy

Participants:

All ages

Selection Rationale

Chest radiograph (i.e., X-ray) is a valid, reliable, sensitive, and well-established imaging method for a comprehensive evaluation and assessment of the chest, including the respiratory, cardiovascular and upper gastrointestinal systems, and the musculoskeletal system of the thorax.

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) X-Ray Diagnostic Imaging Chest Assessment Status 2603738 CDE Browser
Derived Variables

None

Process and Review

Not applicable

Source

American College of Radiology - Society for Pediatric Radiology (ACR-SPR). (2014). ACR-SPR Practice Parameter for the Performance of Chest Radiography Amended 2014 (Resolution 39). Retrieved from www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Chest_Radiography.pdf

General References

Desai, P. C., & Ataga, K. I. (2013). The acute chest syndrome of sickle cell disease. Expert Opinion on Pharmacotherapy, 14(8), 991-999.

Mekontso Dessap, A., Deux, J. F., Habibi, A., Abidi, N., Godeau, B., Adnot, S., Brun-Buisson, C., Rahmouni, A., Galacteros, F., & Maitre, B. (2014). Lung imaging during acute chest syndrome in sickle cell disease: computed tomography patterns and diagnostic accuracy of bedside chest radiograph. Thorax, 69(2), 144-151.

Protocol ID:

810201

Variables:
Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX810201_ChestRadiograph_Cardiopulmonary_Symptoms
PX810201090000 Does the patient display cardiopulmonary more
signs and/or symptoms? show less
N/A
PX810201_ChestRadiograph_Date
PX810201010000 What is today's date? Variable Mapping
PX810201_ChestRadiograph_Date_Last_Menstrual_Cycle
PX810201140000 What is the date of the patient's last more
menstrual cycle? show less
Variable Mapping
PX810201_ChestRadiograph_Equipment_Requirement1
PX810201230000 Does the radiograph equipment have a more
beam-limiting device that provides rectangular collimation? show less
N/A
PX810201_ChestRadiograph_Equipment_Requirement2
PX810201240000 For routine upright projections, is there at more
least a 72-inch source-image distance (SID) to minimize magnification? show less
N/A
PX810201_ChestRadiograph_Equipment_Requirement3
PX810201250000 For clinically necessary imaging (e.g. more
supine positioning, infants, young children, immobilized patients, etc), is there at least a 40-inch SID? show less
N/A
PX810201_ChestRadiograph_Equipment_Requirement4
PX810201260000 Does the nominal source (focal spot) exceed 2.0mm? N/A
PX810201_ChestRadiograph_Equipment_Requirement5
PX810201270100 Is this procedure part of an analog study? N/A
PX810201_ChestRadiograph_Equipment_Requirement5a
PX810201270200 If so, is an intensifying screen being used? N/A
PX810201_ChestRadiograph_Equipment_Requirement6
PX810201280100 Is a film-screen image receptor being used? N/A
PX810201_ChestRadiograph_Equipment_Requirement6a
PX810201280200 If so, is the image processing being more
automated through carefully controlled temperature, densitometry and maintenance settings? show less
N/A
PX810201_ChestRadiograph_Examination_Adult_Correct_Exposure
PX810201420100 For adult patients, using the appropriate more
technical settings, does the exposed radiograph display the lung parenchyma at a mid-gray level? show less
N/A
PX810201_ChestRadiograph_Examination_Child_Correct_Exposure
PX810201420200 For newborns, infants, and children, using more
the appropriate technical settings, does the exposed radiograph display the lung parenchyma at a mid-gray level? show less
N/A
PX810201_ChestRadiograph_Examination_Date
PX810201320000 What is the examination date? Variable Mapping
PX810201_ChestRadiograph_Examination_Image_Included
PX810201400000 Where both lung apices and the costophrenic more
sulci included in the radiograph images? show less
N/A
PX810201_ChestRadiograph_Examination_Image_Projection1
PX810201390100 Was an image of the erect PA projection taken? N/A
PX810201_ChestRadiograph_Examination_Image_Projection2
PX810201390200 Was an image of a left lateral projection taken? N/A
PX810201_ChestRadiograph_Examination_Image_Projection3
PX810201390300 If an erect PA or left lateral projection more
was not taken, what was the reason for the need of an alternative? show less
N/A
PX810201_ChestRadiograph_Examination_Image_Projection3a
PX810201390400 What projections were taken as an more
alternative? Check all that apply show less
N/A
PX810201_ChestRadiograph_Examination_Position_Alternative
PX810201410000 Was a cross-table lateral radiograph taken, more
where the patient was in supine position with his/her arms raised above their head? show less
N/A
PX810201_ChestRadiograph_Examination_Protocols_Shielding
PX810201380000 Are there policies and procedures for more
appropriate shielding of patients? show less
N/A
PX810201_ChestRadiograph_Examination_Protocols_Techniques
PX810201370000 Are technique charts and/or protocols in more
generator memory for all anatomic parts, listing exposure factors that will reliably produce diagnostic-quality images of patients of different sizes available? show less
N/A
PX810201_ChestRadiograph_Examination_Protocols_Views
PX810201360000 What protocols for the standard view or more
views of each anatomic area of interest was used? These should be designed to optimize diagnostic information while minimizing radiation exposure show less
N/A
PX810201_ChestRadiograph_Examination_Side
PX810201340000 Which side is the imaged anatomic site? N/A
PX810201_ChestRadiograph_Examination_Side
PX810201350000 What sort of appropriate collimation was more
used to limit exposure to the anatomic area of interest? show less
N/A
PX810201_ChestRadiograph_Examination_Time
PX810201330000 What is the time of examination? Variable Mapping
PX810201_ChestRadiograph_Facility_Id
PX810201310000 What is the facility identification number? N/A
PX810201_ChestRadiograph_Government_Compliance
PX810201060000 Does the patient need a chest radiograph to more
be in compliance with government regulations? show less
N/A
PX810201_ChestRadiograph_Image_Interpretator
PX810201290000 Is the image being processed and reviewed by more
the qualified professional? Is the image being procesed automated by the proprietary software? show less
N/A
PX810201_ChestRadiograph_Image_Metadata
PX810201450000 Is each film/image permanently marked with more
the facility identification, patient's name, identification number, right or left side indication, patient position, and the date and time of the radiographic exposure? show less
N/A
PX810201_ChestRadiograph_Image_Review
PX810201430000 When the examination is completed, were the more
images reviewed by qualified personnel, either a physician or radiologic show less
N/A
PX810201_ChestRadiograph_Image_Review_Not_Optimal
PX810201440000 Were the images of less than optimal more
diagnostic quality? show less
N/A
PX810201_ChestRadiograph_Medical_Physicist_Certification
PX810201180100 Does the medical physicist have more
certification in therapeutic medical physics, diagnostic medical physics, radiological physics, diagnostic radiological physics, and diagnostic imaging physics? show less
N/A
PX810201_ChestRadiograph_Medical_Physicist_Certification_Subfield
PX810201180200 If no to previous question, is the medical more
physicist certified in any other subfield recommended by the American Board of Radiology (ABR), the Canadian College of Physics in Medicine, or by the American Board of Medical Physics (ABMP)? show less
N/A
PX810201_ChestRadiograph_Patient_Age
PX810201020000 What is the patient's age? Variable Mapping
PX810201_ChestRadiograph_Patient_Critically_Ill
PX810201110000 Is the patient critically ill or medically more
unstable? show less
N/A
PX810201_ChestRadiograph_Patient_Difficulty_Transporting
PX810201120000 Is it difficult to transport the patient for more
standard chest radiography because of his/her age or clinical condition? show less
N/A
PX810201_ChestRadiograph_Patient_Gestational_Age
PX810201130200 If patient knows she is pregnant, what is more
the gestational age of the patient? show less
Variable Mapping
PX810201_ChestRadiograph_Patient_Id
PX810201300000 What is the patient identification number? Variable Mapping
PX810201_ChestRadiograph_Patient_Monitoring_LifeSupport_Devices
PX810201100000 Is the patient connected to monitoring more
and/or life-support devices? show less
N/A
PX810201_ChestRadiograph_Patient_Pregnancy_Test
PX810201130300 If patient is unsure if pregnant, what is more
the result of the pregnancy test? show less
N/A
PX810201_ChestRadiograph_Patient_Pregnant
PX810201130100 Is the patient pregnant or potentially pregnant? Variable Mapping
PX810201_ChestRadiograph_Physician_Radiograph_Certification
PX810201170100 Is the licensed physician certified in more
Radiology or Diagnostic Radiology by the American Board of Radiology, the American Osteopathic Board of Radiology, the Royal College of Physicians and Surgeons of Canada, or the College des Medcins du Quebec? show less
N/A
PX810201_ChestRadiograph_Physician_Radiograph_Certification2
PX810201170200 If no to previous question, has the licensed more
physician completed a diagnostic radiology residency program approved by the Accreditation Council for Graduate Medical Education (ACGME), the Royal College of Physicians and Surgeons of Canada (RCPSC), the College des Medecins du Quebec, or the American Osteopathic Association (AOA) to include radiographic training on all body areas and documentation of a minimum of 6 months of formal dedicated training in the interpretation and formal reporting of general imaging, for patients of all ages? show less
N/A
PX810201_ChestRadiograph_Physician_Radiograph_Qualification2
PX810201170300 Does the licensed physician have documented more
training in and understanding of the physics of diagnostic radiography and have experience with the equipment needed to safely produce the images? show less
N/A
PX810201_ChestRadiograph_Physician_Radiograph_Qualification3
PX810201170400 Is the licensed physician familiar with the more
principles of radiation protection, the hazards of radiation, and radiation monitoring requirements? show less
N/A
PX810201_ChestRadiograph_Physician_Radiograph_Qualification4
PX810201170500 Does the licensed physician have documented more
training and understanding of other medical imaging modalities (fluoroscopy, computed tomography, ultrasound, magnetic resonance imaging, nuclear medicine, etc) and their value relative to general radiography in order to determine the best imaging examination to evaluate the patient's clinical symptoms? show less
N/A
PX810201_ChestRadiograph_Physician_Radiograph_Qualification5
PX810201170600 Has the licensed physician performing these more
general radiography examinations demonstrated evidence of continued competence in the interpretation and reporting of these examinations? show less
N/A
PX810201_ChestRadiograph_Physician_Radiograph_Qualified
PX810201170700 Does the physician meet the last 5 more
requirements? If no, then physician is not qualified to perform general radiography examinations. show less
N/A
PX810201_ChestRadiograph_Preoperative_Evaluation
PX810201070000 Does the patient require a preoperative more
radiographic evaluation due to cardiac or respiratory symptoms or because there is a significant potential for thoracic pathology that may influence anesthesia or the surgical result or lead to increased perioperative morbidity or mortality? show less
N/A
PX810201_ChestRadiograph_Radiograph_Interpreter
PX810201160000 Which of the following best describes the more
individual responsible for interpeting and supervising the generation of these radiographic images? show less
N/A
PX810201_ChestRadiograph_Radiological_Assistant_Certification
PX810201190000 Is the radiological assistant certified and more
registered as a radiological assistant by the American Registry of Radiologic Technologists (ARRT) after successfully completing an advanced academic program encompassing an ACR/ASRT (American Society of Radiologic Technologists) radiologist assistant curriculum and a radiologist-directed clinical preceptorship? show less
N/A
PX810201_ChestRadiograph_Radiological_Assistant_Certification2
PX810201200000 Is the radiologic technologic certified by more
the American Registry of Radiologic Technologist (ARRT) or an unrestricted state licese? show less
N/A
PX810201_ChestRadiograph_Recent_Medical_Events
PX810201080000 Has the patient recently had cardiac or more
thoacic surgery or suffered from trauma? show less
N/A
PX810201_ChestRadiograph_Request
PX810201210000 Is there a written or electronic request for more
chest radiography? show less
N/A
PX810201_ChestRadiograph_Requestor
PX810201220000 Who was responsible for the request for more
radiological examination? show less
N/A
PX810201_ChestRadiograph_SexuallyActive_Contraception
PX810201150200 If sexually active, were any contraceptive more
methods used? show less
N/A
PX810201_ChestRadiograph_SexuallyActive_Last_Menstrual_Cycle
PX810201150100 Was the patient sexually active after her more
last menstrual cycle? show less
N/A
PX810201_ChestRadiograph_SignsSymptoms_Disease
PX810201030000 Does the patient need to be evaluated for more
his/her signs and symptoms related to respiratory, cardiovascular, and upper gastrointestinal systems, and the musculoskeletal system of the thorax? show less
N/A
PX810201_ChestRadiograph_SignsSymptoms_Disease
PX810201040000 Does the patient need to be evaluated for more
thoracic disease processes, including systemic and extrathoracic diseases that secondarily involve the chest? show less
N/A
PX810201_ChestRadiograph_SignsSymptoms_Disease_FollowUp
PX810201050000 Does the patient need a follow-up of known more
thoracic disease processes to assess improvement, resolution, or progression? show less
N/A
Sickle Cell Disease
Measure Name:

Chest X-ray

Release Date:

July 30, 2015

Definition

Chest radiograph (i.e., X-ray) is a medical imaging assessment of the chest wall, airways, lungs, pulmonary vessels, heart, mediastinum, and pleura.

Purpose

This measure is used to show the size, shape, and structures of the chest. Information from this measure is used to determine the presence and etiology of disorders that involve the chest, evaluate the signs and symptoms potentially related to the respiratory, cardiovascular and upper gastrointestinal systems and the musculoskeletal system of the thorax, and to follow the course of disease.

Keywords

Chest X-ray, pulmonary, radiology, radiograph, sickle cell disease, SCD, lung, respiratory, airway, pulmonary vessels, mediastinum, heart, pleura, chest wall, gastrointestinal, musculoskeletal, thorax, chest, smoking