Accuracy Of Chest Radiography Research Articles

Chest ultrasound as a differentiating modality between pneumonia and pulmonary edema

Abstract Background Chest ultrasound is still impressing physicians with its capabilities in variable lung disorders. Aim To assess the effectiveness of chest ultrasound as a diagnostic and a differentiating modality in cases of pneumonia and pulmonary edema. It also evaluates chest sonography effectiveness in follow-up of patients with pneumonia and pulmonary edema. Patients and methods Chest ultrasound, chest radiograph, and computed tomography (CT) chest were performed on patients on their arrival, as well as on day 7 and 14 of admission. Patients were divided into group 1, which included 30 patients with clinically consistent signs of pneumonia based on respiratory signs and symptoms in accordance with the American Thoracic Society guidelines 2016, and group 2, which included 15 patients with clinically consistent signs of pulmonary edema. Results The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of ultrasound in the follow-up of pneumonia and pulmonary edema were 100% each. The sensitivity, specificity, PPV, NPV, and accuracy of chest radiograph in the follow-up of pneumonia on day 7 were 100, 90, 81.2, 100, and 93.1%, respectively, but for pulmonary edema were 91.7, 66.7, 91.7, 66.7, and 86.7%, respectively. However, the sensitivity, specificity, PPV, NPV, and accuracy of CT chest in the follow-up of pneumonia on day 7 were 88.9, 100, 100, 95.2, and 96.6%, respectively, whereas the sensitivity, specificity, PPV, NPV, and accuracy of CT chest in the follow-up of pulmonary edema on day 7 were 33.3, 100, 85.7, 100, and 86.7%, respectively. Conclusion Chest ultrasound might be a dependable method in the diagnosis and follow-up of pneumonia cases as well as differentiating pulmonary edema, both cardiogenic and noncardiogenic.

Effect of deep learning-based assistive technology use on chest radiograph interpretation by emergency department physicians: a prospective interventional simulation-based study

BackgroundInterpretation of chest radiographs (CRs) by emergency department (ED) physicians is inferior to that by radiologists. Recent studies have investigated the effect of deep learning-based assistive technology on CR interpretation (DLCR), although its relevance to ED physicians remains unclear. This study aimed to investigate whether DLCR supports CR interpretation and the clinical decision-making of ED physicians.MethodsWe conducted a prospective interventional study using a web-based performance assessment system. Study participants were recruited through the official notice targeting board for certified emergency physicians and residents working at the present ED. Of the eight ED physicians who volunteered to participate in the study, seven ED physicians were included, while one participant declared withdrawal during performance assessment. Seven physicians’ CR interpretations and clinical decision-making were assessed based on the clinical data from 388 patients, including detecting the target lesion with DLCR. Participant performance was evaluated by area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and accuracy analyses; decision-making consistency was measured by kappa statistics. ED physicians with < 24 months of experience were defined as ‘inexperienced’.ResultsAmong the 388 simulated cases, 259 (66.8%) had CR abnormality. Their median value of abnormality score measured by DLCR was 59.3 (31.77, 76.25) compared to a score of 3.35 (1.57, 8.89) for cases of normal CR. There was a difference in performance between ED physicians working with and without DLCR (AUROC: 0.801, P < 0.001). The diagnostic sensitivity and accuracy of CR were higher for all ED physicians working with DLCR than for those working without it. The overall kappa value for decision-making consistency was 0.902 (95% confidence interval [CI] 0.884–0.920); concurrently, the kappa value for the experienced group was 0.956 (95% CI 0.934–0.979), and that for the inexperienced group was 0.862 (95% CI 0.835–0.889).ConclusionsThis study presents preliminary evidence that ED physicians using DLCR in a clinical setting perform better at CR interpretation than their counterparts who do not use this technology. DLCR use influenced the clinical decision-making of inexperienced physicians more strongly than that of experienced physicians. These findings require prospective validation before DLCR can be recommended for use in routine clinical practice.

What is pneumonia?

The diagnosis of pneumonia is both simple and complex. Recent research is challenging our concept of pneumonia and radiological gold standards that have underpinned research for decades. In particular, the accuracy of chest radiographs in diagnosing pneumonia is now highly questionable when compared with computed tomography scans. Depending on the question being asked, pneumonia can be defined in clinical, pathological, radiological, or microbiological contexts, or frequently a combination of all of these. However, while the field is changing, until we have new studies defining pneumonia in new ways, clinicians can be reassured that existing guidelines based on “old” standards remain as valid as they have always been.

The diagnostic performance of chest radiographs for lung malignancy in symptomatic primary-care populations: A systematic review and meta-analysis.

Objectives:To synthesise existing evidence for the diagnostic accuracy of chest radiographs to detect lung malignancy in symptomatic patients presenting to primary care.Methods:A systematic review was performed and reported in accordance with the PRISMA framework, using a protocol prospectively registered with the PROSPERO database (CRD42020212450). Nine databases were searched for relevant studies. Data were extracted and chest radiograph sensitivity and specificity calculated where possible. Risk of bias was assessed using a validated tool. Random effects meta-analysis was performed.Results:Ten studies were included. Sensitivity meta-analysis was performed in five studies which were not the high risk of bias, with summary sensitivity of 81% (95% CI: 74–87%). Specificity could be calculated in five studies, with summary specificity of 68% (95% CI: 49–87%).Conclusions:The sensitivity of chest radiographs for detecting lung malignancy in primary care is relatively low. Physicians and policymakers must consider strategies to attenuate the possibility of false reassurance with a negative chest radiograph for this significant pathology. Options include widening access to cross-sectional imaging in primary care; however, any intervention would need to take into account the medical and financial costs of possible over-investigation. Prospective trials with long-term follow-up are required to further evaluate the risks and benefits of this strategy.Advances in knowledge:The chest radiograph has a sensitivity of 81% and specificity of 68% for lung malignancy in a symptomatic primary-care population. A negative chest radiograph does not exclude lung cancer, and physicians should maintain a low threshold to consider specialist referral or cross-sectional imaging.

Development of a non-linear dual-energy technique in chest radiography

The dual-energy (DE) technique is useful in chest radiography because it can separate anatomical structures, such as bone and soft tissue. The standard log subtraction, simple smoothing of the high-energy image, anti-correlated noise reduction, and general linear noise reduction algorithms have been used as conventional DE techniques to separate bone and soft tissue. However, conventional DE techniques cannot accurately decompose anatomical structures because these techniques are based on the assumption that X-ray imaging proceeds in a linear relationship. This relationship can cause quantum noise, as well as anatomical loss of normal tissue and difficulty in detecting lesions. In this study, we propose a non-linear DE technique that requires the calculation of the coefficient in advance by using a calibration phantom. The calibration phantom is composed of aluminium and PMMA to calculate non-linear coefficients using the quadratic fitting model for soft tissue and bone. The results demonstrated that the non-linear DE technique exhibited a higher contrast-to-noise ratio, signal-to-noise ratio, and figure of merit at 60/70 kVp and 130 kVp. In addition, it demonstrated better performance and image quality than conventional DE techniques in terms of material decomposition capability. In conclusion, diagnostic accuracy in chest radiography is expected to increase through the non-linear DE technique.

Reporting of diagnostic accuracy studies in radiology

No abstract available.

Saber-sheath trachea as a marker of severe airflow obstruction in chronic obstructive pulmonary disease

Saber-sheath trachea is a specific radiographic parameter for chronic obstructive pulmonary disease (COPD), which consists of marked coronal narrowing associated with sagittal widening (tracheal index<2/3-0.67). The aim of this study was to investigate the correlation between saber-sheath trachea and clinical-radiological findings in a group of patients with COPD of varying severity. We evaluated the chest radiographs of 71 patients with COPD distributed as follows: GOLD class I, 8/71 (11.3%); class II, 34/71 (47.9%); class III, 16/71(22.5%); class IV, 13/71 (18.3%). In 52/71 (73.2%) patients we also evaluated chest computed tomography (CT) scans. We analyzed the prevalence of saber-sheath trachea and its correlation with the Tiffenau index, GOLD stage and radiological signs of COPD. Moreover, we evaluated the sensitivity, specificity and accuracy of chest radiography as compared to CT taken as the gold standard, and the correlation between the radiographic and CT tracheal index. Saber-sheath trachea was found in 18/71 (25.4%) patients, with a greater prevalence in patients with lower Tiffenau Index (p=0.02), GOLD stages III-IV and visual severity score 3 (severe) on chest CT. Saber-sheath trachea was not found to be related to other radiological signs of COPD. The sensitivity, specificity and accuracy values of radiography were 72.2, 97.0 and 88.5%, with perfect concordance between the radiographic and CT tracheal index (p<0.00001). Saber-sheath trachea is linked to the functional severity of airway obstruction, but not to other radiological signs of COPD. Thus, evaluation of the trachea at chest radiography is strongly recommended.

The accuracy of chest radiographs in the detection of congenital heart disease and in the diagnosis of specific congenital cardiac lesions

The accuracy of chest radiographs in the detection of congenital heart disease and in the diagnosis of specific congenital cardiac lesions

Pediatric cardiac imaging: the beat goes on!

The publication of the paper “The accuracy of chest radiographs in the detection of congenital heart disease and in the diagnosis of specific congenital cardiac lesions” [1] provides an opportunity for me to reflect on my career as a pediatric cardiac imager, on past teaching strategies in cardiac imaging, and to comment on the current and future opportunities. I welcome this re-evaluation of cardiac imaging, and the new horizons. Nearly 40 years ago, prior to echocardiography, the gold standard for recognizing children with congenital heart disease consisted of findings on physical examination and a chest radiograph. Traditionally, the radiologist tried to decide based on the chest radiograph whether the infant or child had congenital or acquired heart disease and to suggest a differential diagnosis. Each new generation of residents would learn the list of congenital heart lesions associated with increased, decreased and normal flow, and after asking whether the patient was cyanotic or acyanotic, they would proceed with a list of lesions associated with the flow pattern. Despite the advancement of non-invasive modalities such as echocardiography, CT, and MRI, the approach to teaching and educational programs was based on the assessment of pulmonary flow. Retrospectively, this may have been a flawed approach to cardiac imaging and has resulted in many radiologists not understanding basic physiology and anatomy of the heart.

The accuracy of chest radiographs in the detection of congenital heart disease and in the diagnosis of specific congenital cardiac lesions

Congenital heart disease (CHD) is a significant cause of morbidity and mortality in pediatric patients. Traditional teaching holds that specific types of CHD can be diagnosed on the chest radiograph (CXR) through pattern recognition. To determine the accuracy of radiologists in detecting CHD on the CXR. This study was a blinded retrospective review of chest radiographs from 281 patients (<12 years) by five pediatric radiologists from three institutions. Thirteen groups were evaluated that included 12 categories of CHD and a control group of patients without heart disease. Radiographs were assessed for heart size, heart and mediastinal shape and vascularity. Clinical information, angiography, echocardiograms and surgery were used as the gold standard for definitive diagnosis. The average accuracy of the five readers in distinguishing normal from CHD patients was 78% (range of 72% to 82%). The overall measure of accuracy in distinguishing specific congenital cardiac lesions among 13 groups of patients was 71% (range of 63% to 79%). CXR alone is not diagnostic of specific cardiac lesions, with a low accuracy of only 71%. We believe that less emphasis should be placed on the use of radiographs alone in diagnosing specific congenital cardiac lesions.

Postoperative Chest Imaging (Part II): Complications After Major Lung Resection

Abstract This article reviews the postoperative complications following pulmonary resections, which vary according to the type of procedure and the time elapsed since surgery was performed. Early complications include atelectasis, pulmonary edema, pneumonia, bronchopleural fistula, empyema, and less frequent conditions such as cardiac herniation and lung torsion and herniation. Among late complications are postpneumonectomy syndrome, recurrent tumor, and late empyema. The relative low diagnostic accuracy of chest radiography in detecting these complications can be improved with CT, as well as a knowledge of the clinical settings in which specific complications are likely to occur.

Specific diagnosis by CT and HRCT in six chronic lung diseases

CT and high-resolution CT (HRCT) are both important modalities for imaging lung chronic disease, and certain features (distribution of disease in the axial plane, unilateral or bilateral disease, bronchovascular bundle thickening, septal thickening, central dot thickening, polygons, distortion of parenchyma, air-space disease, nodules) are well known to suggest specific diagnoses. In a series of 54 consecutive patients with six specific diseases (scleroderma or UIP, sarcoidosis, lymphangitic carcinomatosis, drug toxicity, lymphomas, eosinophilic granuloma), these diagnostic CT features were always present. In 50 54 cases, a histologic proof was obtained. In 36 patients with histologic confirmation of four different diseases and in six normal controls, we compared sensibility, specificity, and accuracy of chest radiography, chest CT, and HRCT and found the highest diagnostic accuracy by HRCT together with standard CT.

How accurate is chest radiography in the diagnosis of tracheobronchial foreign bodies in children?

The radiographic and endoscopic findings of 83 consecutive patients with suspected foreign body (FB) inhalation into the tracheobronchial tree were compared and the accuracy of chest radiography was estimated. Typical radiologic signs of FB aspiration, such as localized air trapping, atelectasis and infection occurred on radiographs of patients with and without FB. Twenty-four percent of patients with endoscopically verified FB had no abnormalities on chest radiography. In an analysis of radiographs of 83 consecutive patients, in which the prevalence of FB aspiration was 41%, the diagnostic accuracy was 67%, sensitivity 68% and specificity 67%. Plain film radiology alone is not a sufficiently sensitive nor specific method for the diagnosis of FB aspiration.

Detection Accuracy in Chest Radiography

Detection Accuracy in Chest Radiography

Detection accuracy in chest radiography.

The detection accuracy of the diagnostic radiologist is important in everyday medical decision making. However, little work has been done relating the detection accuracy of the radiologist to the quality of the image. This study, using a thorax and lung phantom, simulated tissue-equivalent 6.4 mm lesions, and a 183 cm source-to-image distance, shows that the detection accuracy is not dependent on the focal spot size (over a range of 0.3-2.0 mm). However, the false positive rate increases when using small focal spots. In addition, the detection accuracy decreases with increasing root-mean-square (RMS) noise (a measure of the amount of quantum mottle in the image), while the false positive rate and intraobserver disagreement increase with increasing RMS noise. It is also shown that the nonradiologist responds to changes in noise in exactly the same way as the radiologist.