Re: One-View Chest Radiograph for Initial Management of Most Ambulatory Patients With Rib Pain

To the Editor: We read with interest the article from Nishimura and colleagues, who proposed that the use of posteroanterior (PA) chest radiograph is sufficient to assess patients with a suspected rib fracture, with no need for a rib series. The article also provides the information that ultrasound has been shown to be a sensitive method for detecting rib fractures.¹

While praising her work, I would like to add some information in the discussion surrounding the use of lung ultrasound. Lung ultrasound has become an important tool in the extension of the physical examination, and thus, a great ally for clinicians. The use of radiation must follow the ALARA principle, defined as being “as low as reasonably achievable.” In this context, there is a preference for modalities that do not require radiation, such as ultrasound.²

Another advantage of ultrasound is its cost, being more economically profitable and readily available. An ultrasound allows a faster diagnosis because it can be performed in the physician's office without the need of going to the radiology department.¹ Besides, the use of contrast and sedation is not necessary.³

Many studies have been conducted comparing whether lung ultrasound is superior in accuracy to chest radiography in diagnosing rib fractures following blunt chest wall trauma. These studies have shown that the use of lung ultrasound seems superior compared with a chest radiograph.⁴

However, all studies were small, single-center, and considered at risk of bias on quality assessment, demonstrating the need to reapply more studies in this area since the benefit it would bring to the patient is undeniable.