From authors in Australia, and published in Australasian Psychiatry, is this
contribution:
When should we image our patients? Appropriate use of imaging in inpatient psychiatry.
contribution:
When should we image our patients? Appropriate use of imaging in inpatient psychiatry.
Australas Psychiatry. 2020 Jun 25:1039856220934313. doi: 10.1177/1039856220934313. Online ahead of print.PMID: 32586111
The abstract is at the above link and below is the relevant text related to ECT:
Chest X-ray for patients undergoing electroconvulsive therapy
When I first read the title of this report, I was sure it would be about brain imaging (CT or MRI) as part of the pre-ECT workup. No, just this reminder that a CXR is not necessarily a routine part of the pre-ECT workup.
The two other situations covered in this short paper are neuroimaging for first-episode psychosis, and abdominal radiography for antipsychotic-induced constipation.
The abstract is at the above link and below is the relevant text related to ECT:
Chest X-ray for patients undergoing electroconvulsive therapy
Background
In some inpatient units in Australian and New Zealand, a chest X-ray (CXR) is required for all patients prior to undergoing electroconvulsive therapy (ECT). The RANZCP guidelines recommend that a CXR only be ordered if medically indicated.6 However, the interpretation of ‘medically indicated’ varies, and some psychiatrists consider a CXR to be part of the pre-ECT evaluation for all patients.7,8 This can result in routine ordering of a CXR before ECT.
Evidence
It was first highlighted in 1979 that CXR has limited utility in the medical work-up for ECT.9 ECT is a low-risk procedure and routine evaluation should include history and examination to screen patients for conditions that increase the risk associated with ECT including cardiopulmonary disease, intracranial lesions and recent stroke.10 A review of pre-anaesthesia medical evaluation guidelines for ECT recommended the following investigations: baseline electrocardiogram; urea, creatinine and electrolytes; and full blood count. It did not recommend CXR.11
Recommendation
As a routine screening assessment for ECT, there is little benefit in ordering a CXR in the absence of a history of exacerbation of cardiopulmonary disease and/or an abnormal respiratory examination.
When I first read the title of this report, I was sure it would be about brain imaging (CT or MRI) as part of the pre-ECT workup. No, just this reminder that a CXR is not necessarily a routine part of the pre-ECT workup.
The two other situations covered in this short paper are neuroimaging for first-episode psychosis, and abdominal radiography for antipsychotic-induced constipation.
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