Posterior-anterior Chest Radiographs Research Articles

4-month moxifloxacin containing regimens in the treatment of patients with sputum-positive pulmonary tuberculosis in South India - a randomised clinical trial.

Shortening tuberculosis (TB) treatment duration is a research priority. We tested the efficacy and safety of 3- and 4-month regimens containing moxifloxacin in a randomised clinical trial in pulmonary TB (PTB) patients in South India. New, sputum-positive, adult, HIV-negative, non-diabetic PTB patients were randomised to 3- or 4-month moxifloxacin regimens [moxifloxacin (M), isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E)] or to a control regimen (2H3 R3 Z3 E3 /4R3 H3 ) [C]. The 4 test regimens were 3R7 H7 Z7 E7 M7 [M3], 2R7 H7 Z7 E7 M7 /2R7 H7 M7 [M4], 2R7 H7 Z7 E7 M7 /2R3 H3 M3 [M4-I] or 2R7 H7 Z7 E7 M7 /2R3 H3 E3 M3 [M4-IE]. Treatment was directly observed. Clinical and bacteriological assessments were done monthly during treatment and for 24months post-treatment. The primary end point was TB recurrence post-treatment. Of 1371 patients, randomised, modified intention-to-treat (ITT) analysis was done in 1329 and per-protocol (PP) analysis in 1223 patients. Regimen M3 was terminated due to high TB recurrence rates. 'Favourable' response at end of treatment was 96-100% in the moxifloxacin regimensand 93% in the control regimen. Among these, the TB recurrence occurred in 4.1% in the M4 regimen and in 4.5% in the control regimen and demonstrated equivalence within a 5% margin (95% CI -3.68, 4.55). Similar findings were observed in modified ITT analysis. The TB recurrence rates in the M4-I and M4-IE regimens did not show equivalence with the control regimen. Sixteen (1.4%) of 1087 patients in the moxifloxacin regimens required treatment modification. The 4-month daily moxifloxacin regimen [M4] was found to be equivalent and as safe as the 6-month thrice-weekly control regimen.

Spontaneous pneumothorax in a newborn case report: original image, treatment process and follow-up

Pneumothorax is a condition where there is free air between the parietal and visceral pleural leaves within the thoracic cavity. She was born with a cesarean section of 2780grams in 38th gestational week. As the patient had tachypnea and intercostal retractions, he was hospitalized in another hospital and started treatment. On the second day of hospitalization, pneumothorax was seen on the posterior anterior chest radiograph and he was referred to us. When the patient came to our clinic, his general condition was poor, tachypnea, intercostal withdrawal and groan breathing were present. When the patient had low saturation, he was intubated and connected to a mechanical ventilator. The chest tube was placement and free drainage was performed. She was discharged on the 9th day of his hospitalization because of his good general condition, improved laboratory findings and no additional difficulties. Spontaneous pneumothorax should be considered in the presence of sudden respiratory distress in the newborn period. Patients diagnosed with pneumothorax should be immediately chest tube placement, patients with respiratory distress should be evaluated and given supportive treatment.

An investigation of occupational exposure to welding fume, manganese, and manganese compounds in a large container manufacturing enterprise

Objective: To investigate the current status of the occupational hazards of welding fume, manganese, and manganese compounds in the welding environment of a large container manufacturing enterprise, as well as the status of occupational health examination of workers, and to provide a basis for improving the welding environment of this enterprise. Methods: In August 2016, July 2017, and August 2018, convenience sampling was used to perform an on-site occupational hygiene survey of the welding workshop for three consecutive years, and welding fume, manganese and, manganese compounds (counted as manganese dioxide) were measured for their workplace exposure concentrations and exposure levels in workers. A comprehensive analysis was performed for the results of occupational health examination. Results: Welding fume, manganese, and manganese compounds in the welding environment gradually increased from 2016 to 2018 (χ(2)(trend)=5.14 and 5.54, P<0.05). The maximum over-standard rate of concentration-short term exposure limit was 43.3% (13/30) for welding fume and 40.0% (12/30) for manganese and its compounds, and the maximum over-standard rate of time-weighted average concentration was 26.7% (8/30) for welding fume and 23.3% (7/30) for manganese and its compounds. Abnormalities were observed in the occupational health examination of welding workers in 2016-2018, among which respiratory system abnormalities (cough, expectoration, and wheezing), nervous system abnormalities (dizziness, fatigue, sleep disorders, amnesia, hyperhidrosis, and palpitations), and electrocardiogram abnormalities (bundle conduction block) had an incidence rate of above 10.0%, and the incidence rate of abnormalities on posterior-anterior X-ray high-kV chest radiograph was close to 8.9% (30/336) . Conclusion: There is severe exposure to welding fume, manganese, and manganese compounds among workers in this enterprise, which cause great hazards to the health of workers. It is necessary to strengthen occupational health management, take measures to improve the welding environment, and enhance occupational disease prevention.

Efficiency and reporting confidence analysis of sequential dual-energy subtraction for thoracic x-ray examinations.

Rationale and objectives: We aimed to report and compare accuracy, reproducibility, and reporting confidence between thoracic dual-energy subtraction (DES) and routine posterior–anterior chest radiography (PA-CR) techniques. Materials (patients) and methods: We obtained DES (D1–D4) images from 96 patients using DES and a high-resolution dynamic flat-panel detector in combination. We compared the DES images of these patients with their PA-CR images. The maximum time interval between performing DES and PA-CR was nine weeks. Two radiologists evaluated abnormal findings on DES and PA-CR images using a three-point scale, and reporting confidence was scored using a four-point scale. The intra- and interobserver agreement values of the scores were analyzed. Further, the radiation exposure doses during PA-CR and DES acquisitions were calculated. Results: The intra- and interobserver agreement values of PA-CR and DES images were good. The reporting confidence scores for DES were generally higher than those for PA-CR. Between bone-subtracted (D3) and soft-tissue-subtracted (D4) images, the former was more successful and useful in the evaluation of bone structures, whereas the latter was better in the evaluation of consolidation and/or solitary nodules. Conclusions: DES has the potential to improve the accuracy, reproducibility, and reporting confidence of thoracic radiography. It also has the potential to provide a better diagnosis of chest pathologies using relatively low dose radiation.

Evaluation of the Influence of Exposure Index on Image Quality and Radiation Dose

Introduction: The introduction of digital radiography has led to a significant problem in terms of dose creep. To address this problem, manufacturers have established a set of exposure indicators (EI) as a feedback mechanism to safeguard against overexposure. The EI is the measure of incident exposure to the detector that is directly proportional to the signal-to-noise ratio and can be related to image quality. The aim of this study was to evaluate the influence of EI on image quality and radiation dose for the posterior anterior (PA) chest radiography. Material and Methods: This study was conducted in three phases, namely pre-optimization, experimental, and post-optimization. A total of 60 patients that could fulfill the inclusion and exclusion criteria for the PA chest radiography were recruited. The radiographic technical parameters, dose area product, and EI were recorded. Radiographs were printed and evaluated by two recruited radiologists using the modified evaluation criteria established by the Commission of European Communities in 1996. Results: Statistical analysis using Spearman’s Rho Correlation showed an insignificant relationship between EI and image quality for the PA chest radiography (p >0.05). Conversely, there was a significant relationship between EI and radiation dose (p <0.05). Conclusion: TheEI can be used as an indirect measure of image quality and radiation dose. The EI does not directly determine image quality since the radiographic technique and parameters used can affect image quality. Although EI can be used as a measure of radiation dose, it cannot provide an accurate measurement of the radiation received by the patient.

Diagnostic use of lung ultrasound compared to chest radiograph for suspected pneumonia in a resource-limited setting

BackgroundLung ultrasound is an effective tool for diagnosing pneumonia in developed countries. Diagnostic accuracy in resource-limited countries where pneumonia is the leading cause of death is unknown. The objective of this study was to evaluate the sensitivity of bedside lung ultrasound compared to chest X-ray for pneumonia in adults presenting for emergency care in a low-income country.MethodsPatients presenting to the emergency department with suspected pneumonia were evaluated with bedside lung ultrasound, single posterioranterior chest radiograph, and computed tomography (CT). Using CT as the gold standard, the sensitivity of lung ultrasound was compared to chest X-ray for the diagnosis of pneumonia using McNemar’s test for paired samples. Diagnostic characteristics for each test were calculated.ResultsOf 62 patients included in the study, 44 (71%) were diagnosed with pneumonia by CT. Lung ultrasound demonstrated a sensitivity of 91% compared to chest X-ray which had a sensitivity of 73% (p = 0.01). Specificity of lung ultrasound and chest X-ray were 61 and 50% respectively.ConclusionsBedside lung ultrasound demonstrated better sensitivity than chest X-ray for the diagnosis of pneumonia in Nepal.Trial registrationClinicalTrials.gov, registration number NCT02949141. Registered 31 October 2016.

Imaging of the trachea.

Numerous benign and malignant tracheal diseases may affect the trachea primarily and secondarily. While the posterior anterior (PA) and lateral chest radiograph is the conventional study for initial evaluation of the trachea and central airways, findings may not always be apparent on conventional radiographs, and further evaluation with cross sectional imaging is usually necessary. Computed tomography (CT) is the imaging modality of choice for imaging the trachea and bronchi. Familiarity with the imaging appearances of the normal and diseased trachea will enhance diagnostic evaluation.

Benign pleural schwannoma presenting with a large, blood-stained pleural effusion

A previously fit and well 43-year-old man presented with 8 weeks of worsening breathlessness and a dry cough. He was an ex-smoker of 10 pack-years with no history of asbestos...

Training and Validating a Deep Convolutional Neural Network for Computer-Aided Detection and Classification of Abnormalities on Frontal Chest Radiographs.

Convolutional neural networks (CNNs) are a subtype of artificial neural network that have shown strong performance in computer vision tasks including image classification. To date, there has been limited application of CNNs to chest radiographs, the most frequently performed medical imaging study. We hypothesize CNNs can learn to classify frontal chest radiographs according to common findings from a sufficiently large data set. Our institution's research ethics board approved a single-center retrospective review of 35,038 adult posterior-anterior chest radiographs and final reports performed between 2005 and 2015 (56% men, average age of 56, patient type: 24% inpatient, 39% outpatient, 37% emergency department) with a waiver for informed consent. The GoogLeNet CNN was trained using 3 graphics processing units to automatically classify radiographs as normal (n = 11,702) or into 1 or more of cardiomegaly (n = 9240), consolidation (n = 6788), pleural effusion (n = 7786), pulmonary edema (n = 1286), or pneumothorax (n = 1299). The network's performance was evaluated using receiver operating curve analysis on a test set of 2443 radiographs with the criterion standard being board-certified radiologist interpretation. Using 256 × 256-pixel images as input, the network achieved an overall sensitivity and specificity of 91% with an area under the curve of 0.964 for classifying a study as normal (n = 1203). For the abnormal categories, the sensitivity, specificity, and area under the curve, respectively, were 91%, 91%, and 0.962 for pleural effusion (n = 782), 82%, 82%, and 0.868 for pulmonary edema (n = 356), 74%, 75%, and 0.850 for consolidation (n = 214), 81%, 80%, and 0.875 for cardiomegaly (n = 482), and 78%, 78%, and 0.861 for pneumothorax (n = 167). Current deep CNN architectures can be trained with modest-sized medical data sets to achieve clinically useful performance at detecting and excluding common pathology on chest radiographs.

Comparison of methods and formulas used in umbilical venous catheter placement.

Central venous access is frequently provided by way of umbilical venous catheter placement in critically ill newborns. This study compared the methods of Dunn, Shukla-Ferrara, and Revised Shukla-Ferrara in determining the appropriate insertion length of umbilical vein catheters. This prospective observational study was carried out in 121 newborns with umbilical venous catheter, group 1 (n=41) used Dunn method, group 2 (n=40) used the Shukla-Ferrara formula, and group 3 used revised Shukla-Ferrara formula (n=40). Catheter tip position was evaluated with an anterior-posterior chest radiograph after insertion of the umbilical venous catheter. The ideal position for the umbilical venous catheter was defined as the catheter tip being visible between the 9th and 10th thoracic vertebrae on an anterior-posterior chest radiograph. The position of the umbilical venous catheter was considered too high if the tip of the catheter was higher than the 9th thoracic vertebra and too low if the tip was below the 10th thoracic vertebra. The following data were collected: appropriate, inappropriate (low, high) placement, and complications of umbilical venous catheterization. In the Shukla-Ferrara group, 53% (17/32) of umbilical venous catheters were placed directly in the appropriate position, compared with 40% (12/30) in the revised Shukla-Ferrara group and 38% (11/29) in the Dunn method group. Umbilical venous catheter-related complications developed in two patients, thrombus in one, and catheter-related blood stream infection in the other. This study showed that the Shukla-Ferrara formula is more accurate in predicting the insertion length for umbilical venous catheters, though statistical significance was not found. Further studies with larger samples are needed on this topic.

A study of various chest radiological manifestations of pulmonary tuberculosis in both human immunodeficiency virus-positive and human immunodeficiency virus-negative patients in south Indian population

Context: The chest radiography is an essential diagnostic tool in assessing the pattern and progression of pulmonary tuberculosis (PTB), which helps in taking suitable clinical decisions. Aims: The aim of this study is to bring out any specific radiologic pattern in PTB among human immunodeficiency virus (HIV) infected and noninfected and make an attempt to systemize reporting and recording radiographic findings. Settings and Design: Patients of all age groups with sputum positivity were included in the study and divided into groups based on gender, age and HIV-infected and noninfected patients. Chest radiographs were taken and assessed for findings. Materials and Methods: Data for the study were taken from sputum acid-fast bacilli positive patient's referred to the Department of Radiodiagnosis for chest X-ray and were evaluated with standard posterior-anterior chest radiograph. Statistical Analysis Used: Documented observations were compiled using SPSS-16.5 software (IBM). Univariate analysis was carried out for data interpretation. Findings/Results: Chest radiographic pattern change between HIV and noninfected cases. Lymphadenopathy was more common in patients with low CD4 count, predominantly involving the right hilar and mediastinal nodes. Large opacities with mid zone predilection, smaller opacities involving both upper zones, and bilateral lung involvement in patients with HIV coinfection was indicative of low CD4 count. Conclusions: In the present study, it was observed that major chest radiographic pattern change between patients with HIV and noninfected cases were increase in large opacities, decrease in cavity formation, increase in pleural effusion, no apical cap, and no volume loss. Lymphadenopathy was more common in patients with low CD4+ count (<200 cells/dl).

Assessment of Cardiac Device Position on Supine Chest Radiograph in the ICU: Introduction and Applicability of the Aortic Valve Location Ratio.

The use of intracardiac assist devices is expanding, and correct position of these devices is required for optimal functioning. The aortic valve is an important landmark for positioning of those devices. It would be of great value if the device position could be easily monitored on plain supine chest radiograph in the ICU. We introduce a ratio-based tool for determination of the aortic valve location on plain supine chest radiograph images, which can be used to evaluate intracardiac device position. Retrospective observational study. Large academic medical center. Patients admitted to the ICU and supported by an intracardiac assist device. We developed a ratio to determine the aortic valve location on supine chest radiograph images. This ratio is used to assess the position of a cardiac assist device and is compared with echocardiographic findings. Supine anterior-posterior chest radiographs of patients with an aortic valve prosthesis (n = 473) were analyzed to determine the location of the aortic valve. We calculated several ratios with the potential to determine the position of the aortic valve. The aortic valve location ratio, defined as the distance between the carina and the aortic valve, divided by the thoracic width, was found to be the best performing ratio. The aortic valve location ratio determines the location of the aortic valve caudal to the carina, at a distance of 0.25 ± 0.05 times the thoracic width for male patients and 0.28 ± 0.05 times the thoracic width for female patients. The aortic valve location ratio was validated using CT images of patients with angina pectoris without known valvular disease (n = 95). There was a good correlation between cardiac device position (Impella) assessed with the aortic valve location ratio and with echocardiography (n = 53). The aortic valve location ratio enables accurate and reproducible localization of the aortic valve on supine chest radiograph. This tool is easily applicable and can be used for assessment of cardiac device position in patients on the ICU.

The prevalence of cervical ribs in Enugu, Nigeria.

Cervical rib is an important cause of nontraumatic thoracic outlet neurovascular compression. This study was undertaken as there is no known documented report on its prevalence in the study environment. To evaluate the prevalence of cervical ribs and its variation with sex and age among patients presenting at radiological facilities for a chest radiograph. Retrospective evaluation of plain posterior-anterior view chest radiographs done in radiological facilities in Enugu, Southeast, Nigeria. Evaluated in this study were all 6571 chest radiographs consecutively obtained between 2009 and 2012 in three randomly selected radiological facilities in Enugu. SPSS version 17 software was used in data analysis. Chi-square and student t-tests were used to test for the significance of findings at 95% confidence level. This study reports the overall prevalence of cervical ribs as 48 (0.7%) with a significantly higher rate in females 43 (1.1%) when compared to males 5 (0.2%) (P = 0.000). In 27 (0.4%) cases, the cervical ribs were bilateral; whereas in 21 (0.3%) cases, they were unilateral with 8 (0.1%) on the left and 13 (0.2%) on the right. There was no age-related variability with prevalence (P = -0.813). The prevalence of cervical rib in the study population is low and within the known range as seen in other geographical regions of Nigeria.

Investigation of an Optimum Determination Method of Exposure Index for Posterior-Anterior Chest Radiographs Using an Auto Exposure Control

Fifty posterior-anterior chest radiographs taken using an auto exposure control were evaluated in order to find an optimum determination method of the exposure index (EI). Four types of the relevant image regions were tested: (a) full image, (b) central 25% area, (c) full image excluding direct x-ray area, and (d) pulmonary area only, whereas four types of the value of interest (VOI) were adopted to each relevant image region: mean, median, mode, and middle. When the target EI was determined as the average of the 50 images, the deviation index (DI) was within ±1.0 only if pulmonary area was selected as the relevant image region, with the VOI of mean, median, and middle. This result strongly suggests that pulmonary area should be selected as the relevant image region of an EI when an auto exposure control is used.

Evaluation of Chest X-ray and Thoracic Computed Tomography in Patients with Suspected Tuberculosis.

To investigate if there is any correlation between positive findings detected by posterior-anterior (PA) chest radiograph and thoracic computerized tomography (CT) in cases with suspected lung tuberculosis (TB) due to positive tuberculin skin test (TST) results. This is a retrospective evaluation of the medical files of patients who visited the Department of Pediatrics, Istanbul University, Istanbul Faculty of Medicine from 2006, through 2011 as outpatients and had positive TST (>15mm) results. A total of 326 patients were included in the study; 45.7% (n=149) were girls, and the mean age was 9.0±4.1 y (range: 1-17 y). In total, 14.4% (n=47) had TB findings, all of which were in the form of hilar lymphadenopathy. Among the 47 cases with TB findings in PA chest X-ray, 45 (95.7%) also had findings in thoracic CT. Only 2 (4.3%) patients had normal thoracic CT results although their PA chest X-ray results were positive. Evaluation for pulmonary TB in children with positive isolated TSTs should be made primarily with PA chest X-ray. A routine thoracic CT scan is not necessary for asymptomatic patients with only hilar lymphadenopathy findings in PA chest radiographs.

Computed tomography of the chest: I. Basic principles

### Key points The conventional chest radiograph superimposes a three-dimensional image onto a two-dimensional surface, so limiting its clinical usefulness. Since its introduction in 1971, X-ray computed tomography (CT) has rapidly evolved into an essential diagnostic imaging tool that forms a cross-sectional image, avoiding the super-imposition of structures that occurs in conventional chest imaging, with a >10-fold increase in attenuation sensitivity. Although CT imaging is reported by radiologists, it is important for both anaesthetists and intensivists to be able to interpret the scans, as reporting facilities may not be immediately available. Furthermore, the radiologist may not fully report all facets of a detailed scan and further information may be acquired by a physician with the ability to interpret CT scans. This is the first in a series of two articles written for anaesthetists and intensivists covering both thoracic anatomy and pathology as it relates to CT. A CT scanner makes many measurements, from different rotational angles, of X-ray attenuation ( weakening in force or intensity ) through the cross-sectional plane of the thorax. It then uses these data to reconstruct a digital representation of the cross-section with …

Characteristics of leptospirosis with systemic inflammatory response syndrome: a multicenter study.

BackgroundLeptospirosis is a common zoonotic infection in the world. In patients with leptospirosis, in case of presence of Systemic Inflammatory Response Syndrome (SIRS), clinical and laboratory findings can be mistaken for sepsis due to other causes of infection. The purpose of this study is to assess the clinical and laboratory parameters of patients with leptospirosis in terms of the presence of SIRS and to examine the association of these with mortality.MethodsOne hundred fifty-seven patients were included in the study. The patients were classified according to the presence or absence of SIRS and divided into SIRS (+) and SIRS (−). Patient files were retrospectively evaluated. Clinical features and laboratory data were compared, and risk factors associated with mortality were determined.ResultsSIRS (+) was found in 70 % (n = 110) of patients who had signs on admission. Comparison of the clinical symptoms and findings of organ systems in the SIRS (+) and SIRS (−) showed that abdominal pain and vomiting were significantly more common in the SIRS (+) than in the SIRS (−) (p = 0.025 and p = 0.046, respectively). BUN and serum creatinine levels were significantly higher in the SIRS (+) than in the SIRS (−) (p = 0.002 and p < 0.001, respectively). In follow-up posterior-anterior chest radiography, pathological findings improved in 58.8 % (n = 40) of patients in the SIRS (+) and 27.3 % (n = 9) of patients in the SIRS (−) (p = 0.003). The mortality rate of the SIRS (+) and SIRS (−) was not significantly different (p = 0.868).ConclusionIn patients with positive SIRS findings, while examining the etiology of sepsis, leptospirosis should come to mind especially in endemic areas for differential diagnosis. Early initiation of antibiotic and supportive therapy can be lifesaving in these patients.

Artery calcification, osteoporosis, and plasma adiponectin levels in Chinese elderly

ObjectivesThe purpose of this study is to investigate the plasma adiponectin level and thoracic aortic calcification (TAC) in Chinese elderly. BackgroundThe association of serum adiponectin levels and thoracic aortic calcification has not been reported. MethodsTotal plasma adiponectin level was measured by ELISA. TAC was evaluated by posterior-anterior chest radiographs. Osteoporosis was diagnosed using dual energy X-ray absorptiometry. ResultsThe mean plasma adiponectin level was 6.3 ± 3.7 μg/ml, TAC was detected in 58% of subjects, and comorbidities of TAC and osteoporosis were observed in 33.6% subjects. The percentages of TAC or comorbidities of TAC and osteoporosis were higher in subjects with low adiponectin tertile level than that in patients with intermediate or high adiponectin tertile level. Multivariable logistic regression analysis showed that adiponectin level was negatively associated with TAC prevalence. ConclusionsPlasma adiponectin level is associated with TAC and lower plasma adiponectin level may be a useful indicator of artery calcification in the elderly.

Prevalence of thoracic scoliosis in adults 25 to 64years of age detected during routine chest radiographs.

To investigate the prevalence of thoracic scoliosis and determine the effect of both age and gender on coronal curve magnitude among asymptomatic adults aged 25-64years old, using standing posterior-anterior chest radiographs. This was a retrospective, cross-sectional study evaluating 500 randomly selected digital posterior-anterior chest radiographs taken at a single institution on an outpatient basis between January 2010 and December 2011. Males (n=184) and females (n=316) ranged in age from 25 to 64years. Patients with symptoms of back pain; including a history of back pain, spinal instrumentation, or known pre-existing spinal disease were excluded. Radiographs were evaluated using Centricity PACS Web Diagnostic 2.1 system (General Electric Co. Fairfield, CT). Coronal Cobb angle measurements of the thoracic spine were quantified by the authors, with scoliosis defined as coronal curves greater than 10°. Curvatures were subdivided into groups: a control group with coronal curves less than 10°, curves measuring 10° to 19°, 20° to 29°, and greater than 30°. The effect of age and gender on curve magnitude was examined using Pearson correlation analysis and linear regression analysis. There was a 13.4% (67 patients) prevalence of thoracic scoliosis. The prevalence among asymptomatic males was 10.9%, while the prevalence among asymptomatic females was 14.9%. 11.6% demonstrated a coronal curvature between 10° and 19° (58 patients), 1.6% between 20° and 29° (8 patients), and 0.2% greater than 30° (1 patient). Age and gender were not found to be significant independent predictors of curve severity. We found a 13.4% prevalence of thoracic scoliosis among asymptomatic adults aged 25-64years on routine outpatient chest radiographs. 11.6% of patients demonstrated a coronal curvature between 10° and 19°. Unlike prior studies evaluating asymptomatic thoracic curves in elderly patients, age and gender did not significantly affect curve magnitude in our younger cohort. These data may provide a reference point to help clinicians counsel asymptomatic patients diagnosed with thoracic scoliosis on routine chest radiographs.

Comparison of radiological findings of chest x-ray with echocardiography in determination of the heart size.

Background:Heart size is an important and effective parameter in chest X-ray (CXR) interpretation. Studies indicate that, especially in middle-aged men, increased cardiothoracic ratio (CTR) is associated with ischemic heart disease (IHD) and increased rate of morbidity and mortality. The CXR is the most common imaging examination of the heart.Objectives:A good quality posterior-anterior (PA) chest radiograph is an important indicator of the cardiac size. Nowadays, CXR has given its place to more advanced approaches such as two-dimensional echocardiography. However, CXR is still more accessible and feasible for most of the physicians. This study was designed to compare the findings of CXR and echocardiography in determination of the heart size.Patients and Methods:This cross-sectional study was carried out from 2006 to 2007. A total of 197 patients entered the study. The cases had been undergone PA CXR and 2-D echocardiography maximum within two days.Results:Of participants, 24.9% had cardiomegaly according to the findings of CXR and 50.8% based on echocardiography. There was a statistically significant difference between the mean size of Right Ventricular End Diastolic Diameter in the patients with cardiothoracic ratio < 50% and ≥ 50% (P = 0.002) as well as Left Ventricular End Diastolic Diameter (P = 0.023). Also, a statistically significant difference was seen between echocardiography and CXR findings with regard to determination of the heart size (P = 0.003). Nonetheless, it is noteworthy that sensitivity and specificity of CXR findings in the diagnosis of cardiomegaly were 34%, and 84.5%, respectively.Conclusions:CTR is the most common method of describing the heart size. Increased CTR in CXR is associated with poor prognosis, which is suggestive of importance and necessity of early diagnosis. Although CXR may not have the same diagnostic accuracy as echocardiography, its easy accessibility and high specificity in diagnosis of cardiomegaly is very helpful, which can play an important and a cost-benefit role, particularly in screening the enlarged heart size. Moreover, according to the statistics released by Medical Council of Iran, most of Iranian physicians are general practitioners and a few of them are cardiologist.