Preoperative chest imaging in elective cardiothoracic surgery in a tertiary cardiothoracic centre

Abstract

Category: Chest Background to the audit: Routine preoperative chest radiographs (CXR) are not indicated for elective non-cardiopulmonary surgery unless there is a history of cardiopulmonary disease. Preoperative CXRs are indicated for patients undergoing elective cardiothoracic surgery. Standard: National Institute for Health and Care Excellence (NICE) guideline (NG 45): Routine preoperative tests for elective surgery. iRefer guidelines (Adult CC18). Indicator:* Percentage of patients undergoing elective cardiothoracic surgery having a preoperative CXR with a valid indication. * Percentage of chest imaging reported preoperatively. * Percentage of chest imaging viewed preoperatively by the clinicians. * Quality. Target: 90% of preoperative CXR requests should have a valid indication. 100% of CXR findings to be documented preoperatively in patients' notes. 100% of computed tomography (CT) chest findings to be documented preoperatively in patients' notes. 100% of all CXRs quality parameter. Methodology: A prospective audit on 50 consecutive elective cardiothoracic surgery patients over a two-week period. Results of first audit round: A total of 50 patients undergoing elective surgery were audited, divided equally between cardiac (n=25) and thoracic (n=25) surgery groups. In the cardiac surgery group, 100% (25/25) of patients had a preoperative CXR, 72% (18/25) had a preoperative CT scan. In the thoracic surgery group, 52% (13/25) had a preoperative CXR, 96% (24/25) had a preoperative CT scan. Both groups had either a preoperative CXR or CT scan with valid indications. In terms of reporting by radiology department, while all 25 patients in the cardiac group had a preoperative CXR, only 28% (7/25) were reported at the time of auditing. Overall CXR reporting for both groups is suboptimal at 34% (17/50), with only 18% (9/50) reported preoperatively. For CT chest scans, all acquired preoperative CT scans in the cardiac group 100% (18/18) were reported preoperatively. In the thoracic group, only 96% (24/25) of patients had preoperative CT scans, with 96% (23/24) reported preoperatively. All preoperative chest radiographs and CT scans were rated by our radiography quality assurance team as having optimal quality measures. First action plan: Dedicated plain film sessions for radiologists and reporting radiographers. Flagging system to highlight preoperative imaging for in-sourcing and outsourcing reports. Consider new technologies for auto-reporting and imaging process:(a) AI solutions in PACs. (b) New photon-counting unenhanced CT scan. Results of second audit round: N/A Second action plan: N/A References: 1. NICE guideline (NG 45): Routine preoperative tests for elective surgery. NICE, 5 April 2016. www.nice.org.uk/guidance/ng45. 2. iRefer guidelines (Adult CC18). Copyright © 2025