For the patient with a positive PPD test, which usually indicates prior exposure to tuberculosis, the guidelines recommend a chest x-ray that typically includes a frontal and lateral view. The lateral view, which accounts for 2/3 of the total radiation dose during screening, is not necessary, according to a study performed at the Beth Israel Deaconess Medical Center in Boston, MA.
Chest radiographs, including a lateral view, were taken in 857 patients with positive PPD (tuberculosis) screenings. Abnormalities were detected in 91 of them. “In no case did the lateral view show any abnormality that was not shown on the frontal view, nor did it improve visualization,” said Ronald Eisenberg, MD, lead author of the study. “Eliminating the lateral view would reduce a patient’s overall radiation exposure by about 67 percent,” said Dr. Eisenberg.
“The current guidelines recommend that everyone who has a positive tuberculosis test should have a chest radiograph. We evaluated individuals for pre-employment purposes who were asymptomatic and concluded that there is no need to take a lateral view in this situation,” said Dr. Eisenberg. “However, each individual institution will have to decide for itself whether it is appropriate or not,” he said.
“I believe that all radiologists should always try to limit the radiation dose to our patients as much as possible. Eliminating the lateral view of the chest in this specific situation will decrease radiation exposure and will streamline the work flow for technologists,” said Dr. Eisenberg.