title: Routine chest radiography following imaging-guided placement of tunneled central lines: a waste of time, money, and radiation.
abstract: BACKGROUND
  This study sought to evaluate routine chest radiography following placement of tunneled central lines using combined ultrasound and fluoroscopic guidance.
  
  
  METHODS
  A prospective study of 150 consecutive patients who underwent placement of tunneled central lines in the vascular radiology suite. Ultrasound-guided vein puncture was performed with an 18-gauge needle in each case, and the access site was noted. Line position was confirmed by fluoroscopy. Following the procedure, 50 patients had both an on-table digital chest radiograph and a conventional chest radiograph. Subsequent patients had a digital radiograph and a fluoroscopic image grab. Final line tip position was scored, and complications were recorded.
  
  
  RESULTS
  Line placement was optimal (95%) or acceptable (5%) in all patients. Line tip position could be satisfactorily evaluated on supine fluoroscopy. Mean fluoroscopic x-ray dose was 0.5 cGy/cm2. Digital chest x-ray dose was 9.0 cGy/cm2, and formal chest radiography dose was 12.0 cGy/cm2. The only complications were 2 carotid artery punctures without clinical sequelae.
  
  
  CONCLUSIONS
  When lines are placed under imaging guidance with ultrasound to direct the venous puncture, complications are rare and are not likely to be clinically important. Conventional and digital chest radiographs do not contribute clinically relevant information but do add to the radiation dose, time, and expense of the procedure.
authors.affiliation: Department of Radiology, St James's University Hospital, The Leeds Teaching Hospitals, Beckett Street, Leeds, LS9 7TF United Kingdom. DKessel@compuserve.com
authors.forename: David O
authors.initials: DO
authors.lastname: Kessel
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Taylor
authors.forename: Iain
authors.initials: I
authors.lastname: Robertson
authors.forename: Jai V
authors.initials: JV
authors.lastname: Patel
authors.forename: Lucy J
authors.initials: LJ
authors.lastname: Denton
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Perren