eComment. Chest sonography could reduce routine chest radiographs after pulmonary surgery.

We read with interest the well-written best evidence topic by Reeb and colleagues, about the use of daily routine chest radiographs as compared to on-demand strategy after pulmonary surgery [1]. The authors concluded that daily radiographs could be foregone, because the on-demand strategy has a better impact on management and has not proven to negatively affect outcomes, even if prospective and randomized trials are necessary to improve the current level of evidence. We would like to add some comment on this important topic. In their overview, the authors listed the important prospective study by Cerfolio and Bryant [2]. In his related commentary [3], Michael Lanuti wrote: "The authors observed that chest roentgenograms changed clinical management in 72% (49 of 62) of patients exhibiting hypoxia during their hospitalization, thus justifying the need for chest radiography. In contrast, only 27% (268 of 975) of patients required an alteration in clinical management in the absence of hypoxia. […] One could argue that because a chest roentgenogram changed clinical management in nonhypoxic patients nearly one third (27%) of the time, daily chest radiography remains beneficial." According to these data, Lanuti suggested to start a simple prospective randomized controlled trial to improve the level of evidence. Recently, Goudie and colleagues evaluated chest sonography in postoperative care, and found it to be a possibility to reduce the number of chest radiographs [4]. The conclusion of this prospective trial was that chest sonography is an effective, convenient, inexpensive and easy to learn tool in the postoperative management of thoracic surgery patients. In our opinion, the use of chest sonography could be an alternative way to promote a reduction of postoperative chest radiographs, without the risk of delaying a change in management. Today, cost saving is an important goal, but it would be better to save money without sacrificing quality or reducing safety: according to the IDEAL recommendations [5], we believe that any change in postoperative management of surgical patients should be evaluated with the best possible evidence. Conflict of interest: none declared.