Chest x-rays (CXRs) are the main imaging tool in intensive care units (ICUs). CXRs also are associated with concerns\r\ninherent to their use, considering both healthcare organization and patient perspectives. In recent years, several\r\nstudies have focussed on the feasibility of lowering the number of bedside CXRs performed in the ICU. Such a\r\ndecrease may result from two independent and complementary processes: a raw reduction of CXRs due to the\r\nelimination of unnecessary investigations, and replacement of the CXR by an alternative technique. The goal of this\r\nreview is to outline emblematic examples corresponding to these two processes. The first part of the review\r\nconcerns the accumulation of evidence-based data for abandoning daily routine CXRs in mechanically ventilated\r\npatients and adopting an on-demand prescription strategy. The second part of the review addresses the use of\r\nalternative techniques to CXRs. This part begins with the presentation of ultrasonography or capnography\r\ncombined with epigastric auscultation for ensuring the correct position of enteral feeding tubes. Ultrasonography\r\nis then also presented as an alternative to CXR for diagnosing and monitoring pneumothoraces, as well as a\r\nvaluable post-procedural technique after central venous catheter insertion. The combination of the emblematic\r\nexamples presented in this review supports an integrated global approach for decreasing the number of CXRs\r\nordered in the ICU.
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