title: Outcome of recommendations for radiographic follow-up of pneumonia on outpatient chest radiography.
abstract: OBJECTIVE
  Follow-up chest radiographs are frequently recommended by radiologists to document the clearing of radiographically suspected pneumonia. However, the clinical utility of follow-up radiography is not well understood. The purpose of this study was to examine the incidence of important pulmonary pathology revealed during follow-up imaging of suspected pneumonia on outpatient chest radiography.
  
  
  METHODS
  Reports of 29,138 outpatient chest radiography examinations performed at an academic medical center in 2008 were searched to identify cases in which the radiologist recommended follow-up chest radiography for presumed community-acquired pneumonia (n = 618). Descriptions of index radiographic abnormalities were recorded. Reports of follow-up imaging (radiography and CT) performed during the period from January 2008 to January 2010 were reviewed to assess the outcome of the index abnormality. Clinical history, demographics, microbiology, and pathology reports were reviewed and recorded.
  
  
  RESULTS
  Compliance with follow-up imaging recommendations was 76.7%. In nine of 618 cases (1.5%), a newly diagnosed malignancy corresponded to the abnormality on chest radiography initially suspected to be pneumonia. In 23 of 618 cases (3.7%), an alternative nonmalignant disease corresponded with the abnormality on chest radiography initially suspected to be pneumonia. Therefore, in 32 of 618 patients (5.2%), significant new pulmonary diagnoses were established during follow-up imaging of suspected pneumonia.
  
  
  CONCLUSIONS
  Follow-up imaging of radiographically suspected pneumonia leads to a small number of new diagnoses of malignancy and important nonmalignant diseases, which may alter patient management.
authors.affiliation: 1 Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA.
authors.forename: Brent P
authors.initials: BP
authors.lastname: Little
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Gilman
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Humphrey
authors.forename: Tarik K
authors.initials: TK
authors.lastname: Alkasab
authors.forename: Fiona K
authors.initials: FK
authors.lastname: Gibbons
authors.forename: Jo-Anne O
authors.initials: JA
authors.lastname: Shepard
authors.forename: Carol C
authors.initials: CC
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D017714:Community-Acquired Infections / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000000981:diagnostic imaging* / Q000473:pathology; D013902:Radiography, Thoracic / Q000379:methods*; D011873:Radiology Information Systems; D012189:Retrospective Studies