September 2023
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Why Don’t Doctors Routinely Include A Chest X-Ray Anymore During Patients Annual Physical Exam?

Well that’s what I asked my doctor.

During my annual physical exam in late June it occurred to me I hadn’t had a chest X-Ray since 2012 – 5 years ago. I mentioned it to my doctor who informed me they are no longer done routinely. I told him I’d like to get one as I thought it would be interesting to compare to the one done in 2012. He replied they are only done now if there are symptoms to warrant one, such as, experiencing some type of pain, etc.

So I commented to him (with a slight smirk on my face) that I hadn’t mentioned it before because it didn’t seem significant to me, but that I do occasionally get a light to mild pain on the right side of my chest in the upper rib cage. But, it goes away in a few seconds, so never thought much of it.

He immediately said “let me listen” and proceeded to listen to my chest/lungs front and back. Then commented sounds good, but if you’ve had chest pain we better do an X-Ray just to be safe. He wrote up an Image Order and told me where the X-Ray department was located in the building.

About the 2012 chest X-Ray. This was done in the ER. (Why I’m mentioning this will make sense later.) At the time I was in the process of transitioning off high blood pressure medication. One day I had a reaction so phoned the doctors office explaining what I experienced. He instructed to go to ER as he wanted to make sure I hadn’t had a minor stroke. While in ER they did an X-Ray along with 8 1/2 hours of other tests and scans, etc. Finally, telling me everything was good concluding I must have developed a sensitivity to the blood pressure medication and to stop taking it unless my blood pressure went up then to only take 1/2 dose.

After leaving my doctor’s office I went over to the X-Ray department and got the chest X-Rays.

The next day my doctor’s office contacted me saying the X-Rays showed some nodules on my lungs; and, recommending I have a CT Scan to check for cancer.

Two days later I had the CT Scan. The next day my doctors office contacted me with the results and recommendations from the doctor who read the CT Scan, then emailed a copy of the report to me.

It was a lengthy report and of course written in *Doctor-EZE*. That strange foreign language that only doctors understand and comprehend, but leaves us lay people, such as myself, totally clueless as to what the hell they are talking about – LOL.

The essence of the report was there are multiple nodules of varying sizes on both of my lungs. Two of which are of primary concern. A round 8mm one on my left lung and a round 1.8 cm one on my right lung, which according to the doctor who completed the report appear to be okay … BUT … (there is always that damn but, isn’t there – lol) to quote him, “… Cancer can not positively be ruled out. No biopsy should be considered until completion of a PET Scan …”

He recommended doing a PET Scan now. Or, as a minimum do another CT Scan in 3 months. And, that I might want to talk with a lung specialist.

DAMN! What the HELL?! All I know so far is that I have multiple nodules on my lungs and that 2 of them seem to be of concern. (By the way, nodules on the lungs are not uncommon and nearly everyone has them. Less than 2% are cancer. There are over 80 known cause of lung nodules.)

And now I have a long list of additional questions, such as, are the 2 nodules in question cancer or not. Are they stable. Or are they growing. If growing, at what rate. Which brings me back to the 2012 chest X-Ray.

The 2012 X-Ray was done mainly to check my heart. But, the doctor who wrote up the report on the current X-Ray did compare it with the 2012 X-Ray. The report for the 2012 X-Ray mentioned multiple lung nodules that appeared to be stable at that time. This made me curious why I wasn’t made aware of this finding. So I asked my doctor about it who replied because the X-Ray was done in ER he was never made aware of it. It seems that ER only brings to his attention what they consider to be *abnormal* findings. Since the main focus of ER doing the X-Ray pertained to the heart and it didn’t reveal any heart abnormalities the report was not forwarded to my doctor. Had I been aware of the nodules on the 2012 X-Ray I would have insisted on annual X-Rays to monitor them.

Lesson learn: Always, always, always insist and demand that I personally view all images of X-Rays, MRIs, and Scans with a specialist who can translate them and explain the finding in lay terms I understand and comprehend.

After learning I might have lung cancer I did considerable research on the Internet into the scientific medical literature on lung cancers. One of the first things I discovered is that lung cancer rarely, if ever, have any symptoms. They are usually only accidentally discovered when they show up on X-Rays (or other types of scans) done while treating people for other ailments by which time they have usually progressed spreading to other areas in the body.

This reinforces my conviction that annual chest X-Rays should be routinely done as part of annual physical exams, thereby, increasing the chances of finding lung cancers earlier before they’ve spread.

So What I’m I Gonna Do About All This?

I’ve decided to not do the PET Scan at this time (I’m not fond of injecting radio active material into my body, if it can be avoided). Instead I’ll do another CT Scan in 3 months to see if the nodules in question are stable or if they are growing. If growing, at what rate.

Also, I’ve made an appointment with a lung specialist to view the X-Rays and recent CT Scan with me and translate the findings into lay terms that I understand, etc.

After meeting with the lung specialist I’ll get 2nd and 3rd opinions then re-evaluate.

So Does Bob Have Lung Cancer?!


But I’m sure I’ll be finding out in the near future. I’ll update as I learn more while on this little adventure.

Until then …

Rock Onnnnn … Saigon Kids

PS:NO! I’m not turning this site into an old people’s health discussion site. I just thought some of you might find things I’m discovering on this journey of benefit.

PSS: If any of you are knowledgeable in these areas please feel free to share anything you feel might be helpful to me in the Comments below.


  • Dan Harrington

    As you said, millions of people have incidentally-found pulmonary nodules. People in the Pulmonary and Radiology medicine areas have come up with some statistically useful guidelines to deal with this problem (cancer vs not), known as the Fleischner Criteria, most recently modified for 2017. An article on this is at: You can also google Fleischner acriteria for others.

  • Sarah J Rogers

    Hope no real problem Bob.
    I thought Kauai sucked in medical care but apparently it is other places as well….
    Keep healthy and rock on.

  • Cathie Mcintyre

    Wow, Bob! You really had to do a lot of research and requests. You show how we each must be our own advocate when it comes to healthcare. I was surprised to read the ER didn’t send x-ray results to your doctor. Best wishes to you. I’m going to open a beer now to drink to your health. 🙂

    • Thank you for your kind words and well wishes, Cathie. They mean a lot to me.

      Yes, one has to double and triple check everything or things will fall into a crack. I read recently that Preventable Medical Errors, in and out, of the hospitals is the 2nd highest leading cause of preventable deaths in the USA.

      Wishing you all best.


  • Kenneth R. Yeager

    Ity goes without saying, we all wish you well Bob and hope that all will work out well for you. Take care.

    • Thank you very much, Ken. Your kind words and well wishes mean a lot to me. Particularly when facing the uncertainties and unknowns of the journey ahead of me.

      Rock Onnn… 🙂


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