Rethinking Routine: Screening Chest Radiographs Rarely Alter Surgical Plans in Healthy Dogs-But if you are the 3.5% it does matter.....

Preoperative Screening Thoracic Radiographs Yield Few Significant Abnormalities in Dogs with No History or Exam Findings Suggestive of Thoracic Disease

Kristine M. Moss, Christopher M. Gauthier, Elissa K. Randall

Background:
Routine preanesthetic screening thoracic radiographs are sometimes recommended for dogs undergoing elective surgery, especially older patients, to detect occult thoracic abnormalities. However, this practice is not evidence-based and may not provide meaningful information in asymptomatic patients. This prospective study aimed to assess the diagnostic utility of screening thoracic radiographs in dogs with no clinical signs of thoracic or cardiopulmonary disease prior to tibial plateau leveling osteotomy (TPLO).

Methods:
A total of 281 dogs with no history or clinical signs of thoracic disease were enrolled from three surgical centers during 2022. Each dog underwent a 3-view thoracic radiographic study. Images were independently evaluated by the attending surgeon and a board-certified veterinary radiologist, with findings classified as clinically or surgically significant. Statistical analyses assessed associations between patient variables and abnormal findings, and interobserver agreement was measured using Cohen’s kappa.

Results:
Only 10 dogs (3.6%) had surgically significant radiographic abnormalities—findings that could affect the decision to proceed with surgery—including suspected pulmonary neoplasia, cranial abdominal masses, or collapsed lung lobes. Clinically significant abnormalities were present in 30 dogs (10.7%). There was no significant association between age or other patient variables and the likelihood of significant findings. Poor agreement was observed between surgeons and radiologists, with surgeons missing the majority of abnormalities identified by the radiologist. Radiographs rarely led to altered surgical planning.

Limitations:
The study was limited by its sample size, single radiologist review, and subjective classification of radiographic findings. It excluded follow-up imaging to confirm incidental findings and did not assess long-term outcomes. Radiographs were only assessed as a screening tool in clinically normal patients; utility in symptomatic or high-risk dogs was not evaluated.

Conclusions:
Routine thoracic radiographs in clinically normal dogs prior to elective orthopedic surgery have limited diagnostic utility. Significant findings are rare and do not justify widespread use in the absence of clinical indications. However, given the low agreement between surgeons and radiologists, radiographic interpretation by a board-certified radiologist is recommended when imaging is performed. Clinicians should weigh the low diagnostic yield against potential delays, costs, and false positives when deciding whether to include preoperative thoracic radiographs in healthy patients.

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