 Historically, routine chest radiography served as a method of screening a general population for disease. Early use of routine chest imaging was used to identify tuberculosis in asymptomatic individuals for public health and safety measures [2]. However, as the overall rates of undiagnosed tuberculosis have decreased, its usefulness is now being questioned [2]. More recent studies have shown that routine imaging in an otherwise healthy and asymptomatic population has a low diagnostic yield [3,4]. Preprocedural routine imaging has also been used for detection of subclinical disease, such as malignant neoplasms, emphysema, or cardiovascular disease, that could be associated with perioperative complications [2]. Multiple studies have shown that routine imaging studies in the preoperative setting have no significant impact on the decision to operate [5] and usually do not yield information that is not available by clinical history or physical examination [6]. However, there are no randomized control trials to show whether routine chest imaging improves outcomes. This document reviews the use of routine chest imaging performed on adult patients for evaluation on hospital admission, preoperative preparation, and asymptomatic outpatient follow-up and evaluation. Special Imaging Considerations Chest radiography can be performed as a 2-view or a single-view imaging study. A 2-view (posterior-anterior and lateral views) chest radiograph requires that a patient is able to stand and appropriately position their arms to be out of the field of view. Alternatively, a single-view chest radiograph using anterior-posterior technique (also refered to as portable technique) can be performed in a patient who is not ambulatory or unable to tolerate positioning of a posterior-anterior radiograph. However, anterior-posterior/portable technique is associated with lower image quality, distortion of normal structures (eg, magnification of the cardiac silhouette), and higher rates of artifactual findings [7].
Routine Chest Imaging.  Historically, routine chest radiography served as a method of screening a general population for disease. Early use of routine chest imaging was used to identify tuberculosis in asymptomatic individuals for public health and safety measures [2]. However, as the overall rates of undiagnosed tuberculosis have decreased, its usefulness is now being questioned [2]. More recent studies have shown that routine imaging in an otherwise healthy and asymptomatic population has a low diagnostic yield [3,4]. Preprocedural routine imaging has also been used for detection of subclinical disease, such as malignant neoplasms, emphysema, or cardiovascular disease, that could be associated with perioperative complications [2]. Multiple studies have shown that routine imaging studies in the preoperative setting have no significant impact on the decision to operate [5] and usually do not yield information that is not available by clinical history or physical examination [6]. However, there are no randomized control trials to show whether routine chest imaging improves outcomes. This document reviews the use of routine chest imaging performed on adult patients for evaluation on hospital admission, preoperative preparation, and asymptomatic outpatient follow-up and evaluation. Special Imaging Considerations Chest radiography can be performed as a 2-view or a single-view imaging study. A 2-view (posterior-anterior and lateral views) chest radiograph requires that a patient is able to stand and appropriately position their arms to be out of the field of view. Alternatively, a single-view chest radiograph using anterior-posterior technique (also refered to as portable technique) can be performed in a patient who is not ambulatory or unable to tolerate positioning of a posterior-anterior radiograph. However, anterior-posterior/portable technique is associated with lower image quality, distortion of normal structures (eg, magnification of the cardiac silhouette), and higher rates of artifactual findings [7].