Dear X-Ray Insider,
Ever wonder whether your imaging practice should discontinue the interpretation of pre-employment chest x-rays?
It's probably a crazy question, given the steady income and low stress involved in that work. But as we're finding on several fronts, these simple studies can also cost you.
Awhile back we wrote about a radiologist who was sued over his handling of such an exam, because he reported the abnormal findings to the company that ordered the interpretation rather than to the patient, with whom he had no relationship.
This month we focus on a different dilemma created by routine chest x-rays: lost opportunity costs. Instead of doing higher-level work, radiologists can spend a lot of time reading these overwhelmingly normal scans from perfectly healthy people.
A new study demonstrating the extremely low yield of routine and screening chest radiographs is featured this week as our X-Ray Insider Exclusive.
Maybe the solution is to use more chest x-rays to screen for coronary artery disease, as was suggested by researchers in another story we've published recently on AuntMinnie.com. I know that's another potentially crazy suggestion -- perhaps even "irresponsible," according to letters I received from some of our Cardiac Imaging Insiders.
Please feel free to tell me I'm insane, or point me toward other stories we should be covering. Your feedback is always appreciated.
![Axial images from unenhanced calcium score cardiac CT (left) and curved planar reformation images from CT angiography (right) show that higher long-term exposure to air pollution is associated with greater coronary artery calcium and more obstructive coronary artery disease (CAD). Top row: Images in a 68-year-old male patient with higher 10-year mean ambient air pollution exposure (7.9 μg/m3 for particulate matter measuring ≤2.5 μm in diameter [PM2.5] and 17.4 parts per billion [ppb] for NO2) with extensive CAD (coronary artery calcium score [CACS] >1,000 and obstructive CAD [≥70% diameter stenosis]). Bottom row: Images in a 57-year-old female patient with lower 10-year mean ambient air pollution exposure (6.3 μg/m3 for PM2.5 and 4.6 ppb for NO2) with no CAD (CACS = 0 and no obstructive stenosis).](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/06/hanneman.r6SMLzkezo.png?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
