***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: The authors prospect ively studied the radiation doses to radio-sensitive organs secondary to bedside radiographs in intensive care patients and in a control phantom .  Dosimeters were taped on different organs during each bedside X-ray . The mean radiation doses , expressed in 10 - 5 Gy ( m-rad ) , for an “ average patient ” who was hospitalized 9 days and had 6 chest X-rays were respectively : 292 to the sternal bone marrow ; 239 to the thyroid gl and ; 3 to the testes ; 1 to the ovaries ; 605 to the eye for 2 maxillary sinus X-rays . No diffused irradiation was measured during a 2-month period in the intensive care unit nor on dosimeters worn by four nurses Abstract Objective To determine the impact of elimination of daily routine chest radiographs ( CXRs )  in a mixed medical – surgical intensive care unit ( ICU ) on utility of on dem and CXRs , length of stay ( LOS ) in ICU , readmission rate , and mortality rate . Design and setting Prospect i ve , nonr and omized , controlled study in a 28-bed ICU . Analysis included data of all admitted ICU patients during 5 months before and after elimination of daily routine CXRs . Results Before elimination , 2457 daily routine CXRs and 1437 on dem and CXRs were obtained from 754 patients . After elimination , 1267 CXRs were obtained from 622 patients . The ratio of CXRs/patient day decreased from 1.1 ± 0.3 to 0.6 ± 0.4 ( p < 0.05 ) . Elimination did not result in a change in utility and timing of on dem and CXRs . The absolute diagnostic and therapeutic value of on dem and CXRs increased with elimination of daily routine CXRs : before intervention , 147 unexpected predefined abnormalities were found ( 10.2 % of all on dem and CXRs in 15.9 % of all patients ) , of which 57 ( 3.9 % ) in 6.4 % of all patients led to a change in therapy . After intervention , 156 unexpected predefined abnormalities were found ( 11.6 % ; p < 0.05 ) , of which 61 ( 4.8 % ) in 9.5 % of all patients ( p < 0.05 ) led to a change in therapy . The LOS in ICU , readmission rate and ICU , and hospital mortality rate were not influenced by the change in strategy . Conclusions Elimination of daily routine CXRs reduced the number of CXRs in a mixed medical – surgical ICU , while not affecting readmission rate and ICU and hospital mortality rates Introduction The clinical value of daily routine chest radiographs ( CXRs ) in critically ill patients is unknown . We conducted this study to evaluate how frequently unexpected predefined major abnormalities are identified with daily routine CXRs , and how often these findings lead to a change in care for intensive care unit ( ICU ) patients . Method This was a prospect i ve observational study conducted in a 28-bed , mixed medical – surgical ICU of a university hospital . Results Over a 5-month period , 2,457 daily routine CXRs were done in 754 consecutive ICU patients . The majority of these CXRs did not reveal any new predefined major finding . In only 5.8 % of daily routine CXRs ( 14.3 % of patients ) was one or more new and unexpected abnormality encountered , including large atelectases ( 24 times in 20 patients ) , large infiltrates ( 23 in 22 ) , severe pulmonary congestion ( 29 in 25 ) , severe pleural effusion ( 13 in 13 ) , pneumothorax/pneumomediastinum ( 14 in 13 ) , and malposition of the orotracheal tube ( 32 in 26 ) . Fewer than half of the CXRs with a new and unexpected finding were ultimately clinical ly relevant ; in only 2.2 % of all daily routine CXRs ( 6.4 % of patients ) did these radiologic abnormalities result in a change to therapy . Subgroup analysis revealed no differences between medical and surgical patients with regard to the incidence of new and unexpected findings on daily routine CXRs and the effect of new and unexpected CXR findings on daily care . Conclusion In the ICU , daily routine CXRs seldom reveal unexpected , clinical ly relevant abnormalities , and they rarely prompt action . We propose that this diagnostic examination be ab and oned in ICU patients The objectives of this prospect i ve , observational study were to determine the current indications of requesting chest radiograph  in sick infants in a neonatal intensive care unit ( NICU ) and the effect of a user-guided request form for chest radiographs of sick infants . During the three-month study period , a total of 423 chest radiographs were requested on 159 sick newborn infants in the intensive area of this NICU . A majority ( 55.6 % ) of these chest radiographs were performed to verify positions tips of either central catheters ( 27.4 % ) or endotracheal tubes ( 28.1 % ) . The number of chest radiographs done during the period when the user-guided request forms were utilised was significantly lower ( 1.24 per patient ) than before ( 1.37 per patient ) or after ( 1.58 per patients ) the period when these forms were in use ( p=0.01 ) . The rate of radiological abnormalities detected in radiographs requested to verify position of tips of endotracheal tubes were significantly greater during the period when user-guided forms were used than when they were not ( p=0.01 ) . A significantly higher proportion of changes in management were instituted when the user-guided forms were in use than during the period when they were not used ( p=0.03 ) . We conclude that a user-guided radiographic request form helps doctors in NICU to carry out their management more effectively Objective : To determine the usefulness of ultrasound to evaluate central venous catheter misplacements and detection of pneumothorax , thus obviating postprocedural radiograph . After the insertion of a central venous catheter , chest radiograph is usually obtained to ensure correct positioning of the catheter tip and detect postprocedural complications . Design : Prospect i ve observational study . Setting : Adult intensive care unit . Patients : 111 consecutive patients undergoing central venous catheter positioning , using a l and mark technique and contrast-enhanced ultrasonography .  Measurements and Main Results : A postprocedural chest radiograph was obtained for all patients and was considered as a reference technique . At the end of the procedure , a B-mode ultrasonography was first performed to assess catheter position and detect pneumothorax . Right atrium positioning was detected in 19 patients by ultrasonography , and an additional six by contrast enhanced ultrasonography . Combining ultrasonography and contrast enhanced ultrasonography yielded a 96 % sensitivity and 93 % specificity in detecting catheter misplacement . Concordance was 95 % and & kgr ; value was 0.88 ( p < .001 ) . Pneumothorax was detected in four patients by ultrasonography and in two by chest radiograph ( concordance = 98 % ) . The mean time required to perform ultrasonography plus contrast enhanced ultrasonography  was 10 ± 5 mins vs. 83 ± 79 mins for chest radiograph ( p < .05 ) . Conclusions : The close concordance between ultrasonography plus contrast enhanced ultrasonography and chest radiograph justifies the use of sonography as a st and ard technique to ensure the correct positioning of the catheter tip and to detect pneumothorax after central venous catheter cannulation to optimize use of hospital re sources and minimize time consumption and radiation . Chest radiograph will be necessary when sonographic examination is impossible to perform by technical limitations Objective Whether chest radiographs ( CXRs ) in mechanically ventilated patients should be routinely obtained or only when an abnormality is anticipated remains debated . We aim ed to compare the diagnostic , therapeutic and outcome efficacy of a restrictive prescription of CXRs with that of a routine prescription , focusing on delayed diagnoses and treatments potentially related to the restrictive prescription . Design R and omized controlled trial . Setting Intensive care unit of the Avicenne Teaching Hospital , Bobigny , France . Patients and participants All consecutive patients mechanically ventilated for ≥ 48 h between January and June 2006 . Interventions Patients were r and omly assigned to have daily routine CXRs ( routine prescription group ) or clinical ly indicated CXRs ( restrictive prescription group ) . Measurements and results For each CXR , a question naire was completed addressing the reason for the CXR , the new findings , and any subsequent therapeutic intervention . The endpoints were the rates of new findings , the rates of new findings that prompted therapeutic intervention , the rate of delayed diagnoses , and mortality . Eighty-four patients were included in the routine prescription group and 81 in the restrictive prescription group . The rates of new findings and the rates of new findings that prompted therapeutic intervention in the restrictive prescription group and in the routine prescription group were 66 % vs. 7.2 % ( p < 0.0001 ) , and 56.4 % vs. 5.5 % ( p < 0.0001 ) respectively . The rate of delayed diagnoses in the restrictive prescription group was 0.7 % . Mortality was similar . Conclusions Restrictive use of CXRs in mechanically ventilated patients was associated with better diagnostic and therapeutic efficacies without impairing outcome OBJECTIVES To determine whether interventions were performed based on portable routine morning chest x-rays ( CXRs ) in pediatric intensive care unit ( PICU ) patients and to identify patient subgroups for whom the routine CXR is most useful . DESIGN Prospect i ve multiinstitutional study . Setting . PICUs of 15 tertiary care hospitals . Patients . PICU patients who received a routine morning CXR were included in the study . OUTCOME MEASURES Recorded data included : weight , diagnosis , presence of active cardiopulmonary problems , length of stay , and number and type of devices . The number and types of interventions based on the interpretation of the CXR were recorded . RESULTS Five hundred twelve routine CXRs were evaluated . The majority of the routine chest radiographs were obtained on patients who were admitted for cardiovascular disease ( 195/512 ; 38 % ) or respiratory failure ( 186/512 ; 36 % ) , and 465/512 of the routine CXRs ( 91 % ) were performed on patients with one or more devices . Two hundred thirty-one of the 512 routine CXRs ( 45 % ) result ed in 1 or more interventions . One hundred fifty-five of the 284 routine CXRs ( 55 % ) obtained in children < /=10 kg result ed in one or more interventions , compared with 61/152 ( 40 % ) and 15/76 ( 20 % ) of routine CXRs obtained in children 10 to 40 kg and > /=40 kg , respectively . The frequency of interventions increased from 19 % in children with no devices to > 50 % in children with 2 or more devices . One or more interventions were performed in 27 % of routine CXRs when no active cardiopulmonary problems were present , compared with 51 % of routine CXRs when active cardiopulmonary problems were present . Diagnosis and length of intensive care unit stay at the time the routine CXR was obtained did not affect the percentage of CXRs that result ed in interventions . CONCLUSIONS Routine CXRs are more likely to result in interventions in the smaller , critically ill child with one or more devices and if active cardiopulmonary problems are present Objective To determine the utility of routine chest radiographs ( CXRs ) in clinical decision-making in the intensive care unit ( ICU ) . Design A prospect i ve evaluation of CXRs performed in the ICU for a period of 6 months . A question naire was completed for each CXR performed , addressing the indication for the radiograph , whether it changed the patient 's management , and how it did so . Setting A 14-bed medical – surgical ICU in a university-affiliated , tertiary care hospital . Patients A total of 645 CXRs were analyzed in 97 medical patients and 205 CXRs were analyzed in 101 surgical patients . Results Of the 645 CXRs performed in the medical patients , 127 ( 19.7 % ) led to one or more management changes . In the 66 surgical patients with an ICU stay < 48 hours , 15.4 % of routine CXRs  changed management . In 35 surgical patients with an ICU stay ≥ 48 hours , 26 % of the 100 routine films changed management . In both the medical and surgical patients , the majority of changes were related to an adjustment of a medical device . Conclusions Routine CXRs have some value in guiding management decisions in the ICU . Daily CXRs may not , however , be necessary for all patients OBJECTIVE To determine the effects and net costs of routine chest radiographs in a medical intensive care unit ( ICU ) . DESIGN A prospect i ve , cohort study . A survey of experts in critical care and pulmonary diseases was undertaken to assess the effect of routine radiographs on patient management . SETTING Medical ICU of a university hospital . PATIENTS Eighty r and omly selected patients admitted to a medical ICU . Two hundred fourteen experts were surveyed ; 118 (55%)/214 respond 
    Output:
    
Conclusions This meta- analysis did not detect any harm associated with a restrictive chest radiograph strategy .
Therefore , the safety of ab and oning routine CXRs  in patients admitted to the ICU remains uncertain