title: Chest radiography practice in critically ill patients: a postal survey in the Netherlands.
abstract: BACKGROUND
  To ascertain current chest radiography practice in intensive care units (ICUs) in the Netherlands.
  
  
  METHODS
  Postal survey: a questionnaire was sent to all ICUs with > 5 beds suitable for mechanical ventilation; pediatric ICUs were excluded. When an ICU performed daily-routine chest radiographs in any group of patients it was considered to be a "daily-routine chest radiography" ICU.
  
  
  RESULTS
  From the number of ICUs responding, 63% practice a daily-routine strategy, in which chest radiographs are obtained on a daily basis without any specific reason. A daily-routine chest radiography strategy is practiced less frequently in university-affiliated ICUs (50%) as compared to other ICUs (68%), as well as in larger ICUs (> 20 beds, 50%) as compared to smaller ICUs (< 20 beds, 65%) (P > 0.05). Remarkably, physicians that practice a daily-routine strategy consider daily-routine radiographs helpful in guiding daily practice in less than 30% of all performed radiographs. Chest radiographs are considered essential for verification of the position of invasive devices (81%) and for diagnosing pneumothorax, pneumonia or acute respiratory distress syndrome (82%, 74% and 69%, respectively). On demand chest radiographs are obtained after introduction of thoracic drains, central venous lines and endotracheal tubes in 98%, 84% and 75% of responding ICUs, respectively. Chest films are also obtained in case of ventilatory deterioration (49% of responding ICUs), and after cardiopulmonary resuscitation (59%), tracheotomy (58%) and mini-tracheotomy (23%).
  
  
  CONCLUSIONS
  There is notable lack of consensus on chest radiography practice in the Netherlands. This survey suggests that a large number of intensivists may doubt the value of daily-routine chest radiography, but still practice a daily-routine strategy.
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.e.graat@amc.uva.nl
authors.forename: Marleen E
authors.initials: ME
authors.lastname: Graat
authors.forename: Karin A
authors.initials: KA
authors.lastname: Hendrikse
authors.forename: Peter E
authors.initials: PE
authors.lastname: Spronk
authors.forename: Johanna C
authors.initials: JC
authors.lastname: Korevaar
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz