Should the lateral chest radiograph be a routine projection in the diagnosis of pneumonia in children: a narrative review?

Background: Chest x-rays (CXR) are frequently used in the diagnosis of pneumonia in pediatrics patient. The lateral projection produces more than double the effective patient dose than the frontal (anterior-posterior (AP)/ posterior-anterior (PA)) projection in CXR series, with potentially little assistance in diagnosing disease. Methods: The databases MedLine, PubMed, Cochrane and Scopus were searched for peer-reviewed publications regarding the lateral chest projection in the diagnosis of pneumonia in children. Certain key-words and inclusion/exclusion criteria were included. The results were cross-checked by two appraisers for relevance and duplicates removed. Results: As this study considered only the pediatrics population from recent studies, only 3 studies were included in the review: two retrospective studies and one random control trial. All the studies reviewed agreed that the combined frontal and lateral examinations was able to diagnose more pneumonias than the frontal only examination, however there was disagreement as significance of the amount. The sole study that assessed the impact on the clinical environment found that having the frontal projection only did not significantly change the clinical management of the patients in comparison to both projections. No studies included looked at the efficiency or costs associated with a second projection.