The Utility of Pre-Employment/Pre-School Routine Chest X-Ray in Nigeria

Routine chest X-rays (CXR) are commonly performed in pre-employment and pre-school medical screenings to identify asymptomatic health conditions, particularly tuberculosis (TB). While these screenings have historically been used as preventive measures, their utility has come under scrutiny due to concerns over low diagnostic yield, cost-effectiveness, and the potential health risks associated with radiation exposure. This study evaluates the utility of routine CXR for pre-employment and pre-school candidates at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, by analyzing demographic trends, reasons for screening, and the prevalence of incidental and clinically significant findings. This retrospective study reviewed 300 CXR records of individuals aged 11 to 45 who underwent routine screenings from January 2023 to May 2024. The results showed that 15.3% of subjects had incidental findings being prominent aortic knuckle and cardiomegaly. However, only 10.2% of findings were clinically significant and required further investigation, underscoring the limited diagnostic yield of routine CXR for asymptomatic individuals. The study revealed that routine CXR screenings often identify benign anomalies, leading to additional tests and increased healthcare costs without substantial health benefits. Based on these findings, the study recommends limiting routine CXRs to high-risk groups and prioritizing alternative, lower-risk screening methods. This approach would reduce unnecessary radiation exposure and healthcare expenditures, aligning screening practices with current evidence on the limited utility of CXRs in asymptomatic populations. The study provides valuable insights for healthcare policymakers and institutions considering more targeted, cost-effective screening protocols in pre-employment and pre-school settings.