Routine Roentgen Examinations of the Chest of Patients Admitted to the State of Wisconsin General Hospital during a Three Months' Period

Abstract

Introduction ROENTGENOLOGIC examination of the chest is now commonly recognized as the most accurate method for detecting the early changes in most, if not all, intrathoracic diseases. The value of this method is perhaps best exemplified in the diagnosis of early pulmonary tuberculosis. For the past several years it has been the practice at the University of Wisconsin to take single roentgenograms of the chests of all freshmen students who showed a positive Mantoux tuberculin reaction. The results of these studies have shown us that many cases of early tuberculosis will have positive roentgen evidence before they can be detected clinically, and before the patients themselves are aware of any change in their physical status. It was felt that many patients admitted to the Wisconsin General Hospital might have significant intrathoracic disease, which would ordinarily remain undiagnosed because the patients, having no clinical evidence of such disease, would not be subjected to roentgenologic examination. In order to determine what this percentage was and the various diseases that might be discovered, it was decided to take routine roentgenograms of the chests of all patients admitted to the hospital during a three months' period. Our interest in this work was stimulated by a similar study undertaken at the University of Michigan. Patients in whom intrathoracic disease was suspected because of history or physical findings on first examination by the resident physician of the respective service were not included in this study, since these would have chest roentgenograms made during their complete clinical examination. Method of Examination The method of examination consisted of a single roentgenogram taken in the usual manner. This was supplemented in some instances by roentgenoscopic examination and by additional films (stereoscopic, oblique, and lateral, as indicated). Table I indicates the number of admissions during this three months' period; thus it will be seen that 2,856 patients were admitted. Of these, 1,460 had routine chest films and these form the basis for this study. The remainder, or 1,396, either had clinical evidence of disease and their films were not included for study, or else the patients were too ill to be subjected to examination. Undoubtedly a certain number were missed entirely, since it was left to the Resident Staff to make out the necessary requests for examination and to decide whether the patient should be placed in the “routine” or “necessary” group. Also a certain number of patients were placed in the routine group even though showing positive clinical signs either through error or, what was more likely, the examining physician considered that the findings were not significant enough to warrant x-ray examination.