MRI Chest Without IV Contrast There is no relevant literature to support the use of MRI chest without IV contrast for routine preoperative evaluation of patients with chronic cardiopulmonary disease undergoing noncardiothoracic surgery. Radiography Chest In a retrospective cohort study of patients with known cardiothoracic disease, abnormal chest radiographic findings were a common finding [21]. However, a review of preoperative chest radiographs in a general population (performed before a variety of different types of surgeries) found that only 5% of studies had an impact on anesthetic management [22]. The authors suggested that discontinuing the use of routine preoperative chest radiographs did not result in any adverse effects on patient care. A study of 240 patients with known vascular disease investigated the role of preprocedural chest radiographs before peripheral or coronary angiography. Although nearly half of preprocedural chest radiographs had at least one abnormality, no procedures were postponed or canceled because of the radiographic findings [23]. Given these findings, multiple societal guidelines have been published, largely recommending against the use of routine preoperative chest radiography for patients with known cardiovascular disease. The European Society of Anaesthesia does not recommend routine preoperative chest radiography for elective noncardiac surgery because it rarely changes perioperative course [24]. A practice advisory by the American Society of Anesthesiologists Task Force acknowledged that radiographic abnormalities are higher in older patients and those with stable cardiothoracic disease but did not recommend routine chest radiography in the preanesthesia evaluation of these patients [25]. Evidence generally suggests that most preoperative abnormalities may be predicted by clinical evaluation, although chest radiography may be helpful in patients with known chronic disease or patients >50 years of age [26].
Routine Chest Imaging. MRI Chest Without IV Contrast There is no relevant literature to support the use of MRI chest without IV contrast for routine preoperative evaluation of patients with chronic cardiopulmonary disease undergoing noncardiothoracic surgery. Radiography Chest In a retrospective cohort study of patients with known cardiothoracic disease, abnormal chest radiographic findings were a common finding [21]. However, a review of preoperative chest radiographs in a general population (performed before a variety of different types of surgeries) found that only 5% of studies had an impact on anesthetic management [22]. The authors suggested that discontinuing the use of routine preoperative chest radiographs did not result in any adverse effects on patient care. A study of 240 patients with known vascular disease investigated the role of preprocedural chest radiographs before peripheral or coronary angiography. Although nearly half of preprocedural chest radiographs had at least one abnormality, no procedures were postponed or canceled because of the radiographic findings [23]. Given these findings, multiple societal guidelines have been published, largely recommending against the use of routine preoperative chest radiography for patients with known cardiovascular disease. The European Society of Anaesthesia does not recommend routine preoperative chest radiography for elective noncardiac surgery because it rarely changes perioperative course [24]. A practice advisory by the American Society of Anesthesiologists Task Force acknowledged that radiographic abnormalities are higher in older patients and those with stable cardiothoracic disease but did not recommend routine chest radiography in the preanesthesia evaluation of these patients [25]. Evidence generally suggests that most preoperative abnormalities may be predicted by clinical evaluation, although chest radiography may be helpful in patients with known chronic disease or patients >50 years of age [26].