Choosing Wisely report

Chest X-rays before surgery

When you need them—and when you don’t

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If you’re scheduled for surgery, a pre-operative chest X-ray can sometimes help make it safer by identifying medical problems that might make it a good idea to delay or even cancel the procedure. But if you don’t have signs or symptoms of heart or lung disease, you should think twice about having the X-ray. Here’s why:

The test usually isn’t helpful for low-risk people without symptoms.

Many people automatically receive a chest X-ray to “clear” them before surgery, and some hospitals even require the test for almost all patients who are admitted. But serious abnormalities found through chest X-rays are uncommon in low-risk people, so most of the time all that’s needed is a careful medical history and physical examination. A chest X-ray doesn’t add much useful information for people without risk factors for heart or lung problems and rarely changes their treatment or helps the anesthesiologist and surgeon manage their care. In fact, in those people the test can produce false alarms that require follow-up tests that usually aren’t necessary and can add needless risk and expense.

It can pose risks.

A chest X-ray exposes you to a small amount of radiation. While the risk from any single exposure is uncertain, the harmful effects of radiation might be cumulative, so it’s best to avoid exposure whenever you can. Also, most abnormal test results from the X-ray must be followed up with additional tests to rule out a serious problem. That can cause anxiety, trigger other tests, and prompt referrals to specialists for expensive consultations.

It can be a waste of money.

Chest X-rays aren’t very expensive, usually only about $44 according to But any money spent on tests you don’t need is money wasted. And if it’s ordered solely because you’re having surgery or being hospitalized, your insurance plan might not cover it.

So when is the test necessary?

A pre-operative or hospital admission chest X-ray makes sense if you have lung or heart disease or have signs or symptoms of a heart or lung condition. Those include chest pain, coughing, shortness of breath, ankle swelling, fever, recent heart attack, or an unresolved cold or other respiratory infection. You should also get the test if you’re older than 70 and haven’t had a chest X-ray within the past six months or have a chronic heart or lung disease, even if it’s not causing symptoms. The test is also often a good idea if you’re scheduled for surgery that will involve the heart, lungs, or part of the chest.


Using This Information

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Published by Consumer Reports © 2012 Consumers Union of U.S., Inc., 101 Truman Ave., Yonkers, NY 10703-1057. Developed in cooperation with ACR for Choosing Wisely, a project of the ABIM Foundation. Portions of this report are from ACR’s “Five Things Physicians and Patients Should Question” list. © 2012 ACR.