Bedside Chest Radiography Research Articles

Analysis of Characteristics of Bedside Chest Radiography in Critically Ill COVID-19 Patients

Analysis of Characteristics of Bedside Chest Radiography in Critically Ill COVID-19 Patients

The value of chest ultrasonography applications in the respiratory ICU

BackgroundDiverse imaging systems can be utilized for the evaluation of chest issues in ICU patients; ultrasound (US) is a decent analytic instrument without exposing the patients to radiation and risk of transfer.ObjectivesTo compare the diagnostic performance of transthoracic US and bedside chest radiography (CXR) for the detection of various pathological abnormalities in fundamentally sick patients, using chest computed tomography as a gold standard.Patients and methodsTwo hundred and fifty-six patients who were admitted in the Respiratory Care Unit were included in this study. CXR, computed tomography, and transthoracic US were done to all the patients. Six pathological entities were evaluated: pleural effusion, pneumothorax, consolidation, interstitial lung diseases, pulmonary embolism, and neoplasms.ResultsAll patients were evaluated by the three imaging techniques. The sensitivity and specificity of CXR were 42.1, 84.4% for pneumonia 50.0, 90.0% for pleural effusion, 45.5, 90.6% for interstitial syndrome, 50.0, 94.8% for pneumothorax, 60, 100% for pulmonary embolism, and 66, 94% for neoplasm, while the values for chest US were 89.47, 100% for pneumonia, 60, 100% for pulmonary embolism, 100, 100% for pleural effusion, pneumothorax, interstitial syndrome, and neoplasm.ConclusionUS examination of the chest is a noninvasive and promising bedside tool in the evaluation of patients in the Respiratory Care Unit.

275. Commissioning of a wireless mobile digital radiography system

Purpose Mobile digital radiography (DR) systems with wireless capabilities are becoming very helpful for bedside chest radiography. Specific acceptance tests should analyze both the performance of the radiological equipment as long as the efficacy of the interface between system and the RIS/PACS network. Methods A mobile radiography system equipped with a wireless, flat-panel detector (Motion Mobile with DRX Plus 3543 Mobile Retrofit Kit, Carestream Health) and interfaced via WLAN connection of wireless fidelity to the PACS network (VUE PACS version 12.1.5, Carestream Health) was tested. The criteria for acceptability were assessed using the ImageJ plugin COQ [1] according to Radiation Protection 162 [2] and IPEM Report 32 (VII) [3] . Integration with the RIS/PACS network was assessed according to the AIFM Report 10 [4] . Results All the proposed acceptability criteria have been met. The recommended test parameters allowed to establish the performance characteristics of the flat-panel detector and to compare it with the other Carestrem DRX detectors already used in the radiological rooms. The WLAN-based mobile DR system was successfully integrated into the RIS/PACS network as functional workflow tests among the items were positive. It was also possible to evaluate the management and transmission of images and verify the correct setting of the fundamental DICOM elements. Conclusions Performance and functionality testing enabled the implementation of a WLAN-based mobile DR system.

Impact of donor chest radiography on clinical outcome after lung transplantation.

BackgroundOrgan donation guidelines recommend a “clear” conventional bedside chest radiograph before lung transplantation despite only moderate accuracy for cardiopulmonary abnormalities.PurposeTo evaluate the influence of donor image interpretation on lung transplantation outcome in recipients by following early and late complications, one-year survival, and to correlate imaging findings and blood gas analysis with lung transplantation outcome in recipients.Material and MethodsIn 35 lung donors from a single institution clinical reports and study reviews of imaging findings of the mandatory bedside chest radiographs and blood gas analyses were compared with clinical outcome in 38 recipients. Hospitalization time, peri- and postoperative complications, early complications (primary graft dysfunction, infection), 30-day and one-year survival, and forced expiratory volume in 1 s percentage of predicted normal value (FEV1%) at one-year follow-up were analyzed.ResultsFindings in clinical reports and study reviews differed substantially, e.g. regarding reported decompensation, edema, infection, and atelectasis. No correlation was shown between imaging findings in clinical report or study review and blood gas analyses in the lung donors compared to postoperative outcome in recipients.ConclusionThe interpretation of the mandatory chest radiograph in its present form does not influence one-year outcome in lung transplantation. Larger imaging studies or a change in clinical routine including computed tomography may provide evidence for future guidelines.

Assessment of severe dyspnea in critically ill patients by transthoracic sonography: Fayoum experience of the Bedside Lung Ultrasonography in Emergency protocol

BackgroundManagement of critically ill patients requires imaging tools, which are important for optimizing diagnostic and therapeutic actions. Both bedside chest radiography and thoracic computed tomography have limitations that constrain their utility. The aim of our work is to explore the value of transthoracic ultrasound (TUS) using the Bedside Lung Ultrasonography in Emergency (BLUE) protocol in critical ill patients with severe dyspnea.Patients and methodsThis study included 109 ICU patients with acute dyspnea at Fayoum University Hospital. The judgments of chest ultrasound using the BLUE protocol were compared with the final diagnoses; rare diagnoses and uncertain diagnoses were excluded.ResultsBy application of the BLUE protocol, TUS was absolutely sensitive, specific, and accurate for the diagnosis of pneumothorax. For pneumonia, the sensitivity, specificity, and diagnostic accuracy were 93.8, 95.7, and 95.8%, respectively, whereas these parameters for pulmonary edema were 100, 96.8, and 99%, respectively. TUS was absolutely sensitive in the diagnosis of chronic obstructive pulmonary disease, asthma, or diffuse parenchymal lung disease, whereas the specificity and diagnostic accuracy were 88.9 and 88.9%, respectively, for chronic obstructive pulmonary disease and asthma and 96.8 and 100%, respectively, for diffuse parenchymal lung disease.

Usefulness of Biological Fingerprints and Template Matching Techniques in Bedside Chest Radiography for Patient Identification and Preventing Filing Mistakes

The purpose of this study was to investigate whether patients can be identified by using biological fingerprints extracted from bedside chest radiographs and template matching techniques for preventing filing mistakes in a picture archiving and communication system (PACS) server. A total of 400 bedside chest radiographs from 100 male and 100 female patients with current and previous images were used for evaluating patient identification performance. Five biological fingerprints were extracted from 200 previous images using the averaged bedside chest radiographs, produced for each sex and detector size. The correlation values of 200 same patients and 39,800 different patients were calculated as a similarity index, and used for the receiver operating characteristic (ROC) analysis. The patient identification performance was examined by using the correlation index calculated by the summation of correlation values obtained from five biological fingerprints. The sensitivity at 90.0% specificity was calculated using the correlation index. The correlation index for same patients was higher than that for different patients. The area under the ROC curve was 0.974. The patient identification performance was 76.0% (152/200), and the sensitivity at 90.0% specificity was 93.4% (37168/39800). Our results suggest that the proposed method may potentially be useful for preventing filing mistakes in bedside chest radiographs on a PACS server.

Lung ultrasound in intensive care unit: a prospective comparative study with bedside chest radiography using computed tomography of chest as a gold standard

Background Bedside chest radiography (CXR) is routinely performed on a daily basis to assess lung status for the critically ill patients. However, the technical difficulties during the procedure have led to the incorrect assessment of most common lung pathologies diagnosed in the ICUs, like pneumothorax (PTX), pleural effusion, lung consolidation, and acute interstitial syndrome (AIS). Recently, lung ultrasound (LUS) has become a new reliable, accurate, and attractive tool for diagnosing most of these lung pathologies. Objective Our study was designed to find out if LUS could be a more reliable, accurate, and sensitive bedside tool in diagnosing most of the common chest diseases encountered in the ICUs, in comparison with bedside CXR, using thoracic computed tomography (CT) as a gold standard. Patients and methods Forty critically ill patients scheduled for CT chest were prospectively studied with a standard LUS protocol. Four pathologic entities were evaluated: consolidation, AIS, PTX, and pleural effusion. Each hemithorax was evaluated for the presence or absence of each abnormality. Eighty hemithoracies were evaluated by the three imaging techniques. Results In comparing bedside CXR with CT chest, bedside CXR detected three cases of PTX of 12 by CT (P=0.02), 11 cases of pulmonary consolidation of 21 by CT (P=0.04), 12 cases of pleural effusion of 19 by CT (P=0.03), and 27 cases of AIS of 36 by CT (P=0.11). On the contrary, comparing LUS with CT chest, LUS detected 11 cases of PTX of 12 by CT (P=0.12), 21 cases of pulmonary consolidation of 21 by CT (P=1.0), 17 cases of pleural effusion of 19 by CT (P=0.32), and 32 cases of AIS of 36 by CT (P=0.02). The sensitivity, specificity, and diagnostic accuracy of CXR were found to be 62, 89, and 73%, respectively, for consolidation; 50, 73.6, and 60%, respectively, for AIS; 25, 100, and 78%, respectively, for PTX; and 46, 90, and 78%, respectively, for pleural effusion. The corresponding values for LUS were 100, 81.4, and 93% for consolidation; 100, 58, and 78% for AIS; 100, 86, and 90% for PTX; and 100, 97, and 98% for pleural effusion. Conclusion In our general ICU population, LUS has shown a considerably better diagnostic performance and is more reliable than CXR for the diagnosis of common pathologic conditions and may be used as an alternative to chest CT.

The Potential Role of Grid-Like Software in Bedside Chest Radiography in Improving Image Quality and Dose Reduction: An Observer Preference Study.

ObjectiveTo compare the observer preference of image quality and radiation dose between non-grid, grid-like, and grid images.Materials and MethodsEach of the 38 patients underwent bedside chest radiography with and without a grid. A grid-like image was generated from a non-grid image using SimGrid software (Samsung Electronics Co. Ltd.) employing deep-learning-based scatter correction technology. Two readers recorded the preference for 10 anatomic landmarks and the overall appearance on a five-point scale for a pair of non-grid and grid-like images, and a pair of grid-like and grid images, respectively, which were randomly presented. The dose area product (DAP) was also recorded. Wilcoxon's rank sum test was used to assess the significance of preference.ResultsBoth readers preferred grid-like images to non-grid images significantly (p < 0.001); with a significant difference in terms of the preference for grid images to grid-like images (p = 0.317, 0.034, respectively). In terms of anatomic landmarks, both readers preferred grid-like images to non-grid images (p < 0.05). No significant differences existed between grid-like and grid images except for the preference for grid images in proximal airways by two readers, and in retrocardiac lung and thoracic spine by one reader. The median DAP were 1.48 (range, 1.37–2.17) dGy*cm2 in grid images and 1.22 (range, 1.11–1.78) dGy*cm2 in grid-like images with a significant difference (p < 0.001).ConclusionThe SimGrid software significantly improved the image quality of non-grid images to a level comparable to that of grid images with a relatively lower level of radiation exposure.

Ultrazvuk pluća - drugi deo (Ultrazvuk pluća deo 2)

Clinical use of lung ultrasound (LUS) in emergency and critical care is studied extensively. LUS is a non-invasive, real-time method, easily available at bedside, economical, free of radiation hazard and free of complications. All these features make LUS useful in reducing need for bedside chest radiography and computed tomography. The First International Conference on Lung Ultrasound (ICC-LUS) recommended approach to six major areas of LUS. The BLUE protocol (Bedside Lung Ultrasound and Emergency Protocol) is the first LUS-based systematic approach in diagnosing pleural and lung pathology. This protocol helps to differentiate features of acute dyspnea (pulmonary edema, pneumonia, acute respiratory distress syndrome, pulmonary embolism, pleural effusion or pneumothorax). LUS for pneumothorax diagnosis has become the standard part of the Extended Focused Assessment by Sonography for Trauma (E-FAST). Interpretation of lung ultrasound findings is based on the identification of the main pathological substrates of pulmonary parenchyma: interstitial syndrome, interstitial-alveolar syndrome, alveolar syndrome / consolidation, pleural effusion and pneumothorax.

Bedside Chest Radiographs in the Intensive care Setting: Wireless Direct Radiography Compared to Computed Radiography

To compare image quality, visibility of anatomic landmarks, tubes and lines, and other clinically significant findings on portable (bedside) chest radiographs acquired with wireless direct radiography (DRw) and computed radiography (CR). In a prospective IRB-approved and HIPAA-compliant study, portable DRw (DRX-1C mobile retrofit portable wireless direct radiography, CareStream Inc., Rochester, NY) and portable CR (AGFA CR (DXG) version; NIM2103, AGFA Healthcare, Ridgefield Park, NJ) images of the chest were acquired within 24-hours in 80 patients in the intensive care unit (ICU). Image pairs of 75 patients (37% female) with a mean age of 60.7±16 years were independently compared side-by-side by 7 experienced thoracic radiologists using a five-point scale. When tubes and lines were present, the radiologist also compared an edge-enhanced copy of the DRw image to the CR image. Most radiologists found significantly fewer artifacts on DRw images compared to CR images and all readers agreed that when present, these artifacts did not significantly preclude the ability to evaluate anatomic landmarks, tubes and lines, or clinically significant findings. None of the radiologists (0/7) reported superior visibility of anatomic structures on CR images compared to DRw images and some radiologists (3/7) found DRw images significantly better for visibility of anatomic landmarks such as the carina (p=0.01-0.001). Most radiologists (6/7) found DRw images to be better or clearly better than CR images for position of tubes and lines, and edge-enhanced DRw images to be especially helpful for evaluation of central venous catheters and esophageal tubes (p=0.027-0.001). None of the radiologists deemed CR images superior for visibility of clinically significant findings. Critical care chest radiography with a portable DRw system can provide similar or superior information compared to a CR system regarding clinically significant findings and position of tubes and lines.

Percutaneous catheterization for extracorporeal membrane oxygenation: a retrospective case series

Objective: To review the experience of percutaneous catheterization for extracorporeal membrane oxygenation (ECMO) by respiratory intensivists at a single institution. Methods: A retrospective review of 87 patients undergoing percutaneous catheterization for ECMO in Department of Respiratory and Critical Care Medicine of Beijing Chaoyang Hospital from November 2009 to January 2017. Subject demographics, type of support, cannulation configuration, types of cannulas, use of imaging modalities, and complications were recorded and summarized. Results: The 87 patients consisted of 61 males and 26 females. The average age was (47±16)years (range 15-82 years ). Fifty-six patients were given ECMO therapy because of acute respiratory distress syndrome(ARDS), and 16 were treated as a bridge for lung transplantation and 15 for other causes. Eighty-one cases were given VV-ECMO support, and 6 cases were given VA-ECMO support. The most commonly used cannulas were 15-17 F arterial cannulas and 21-23 F venous cannulas. Preinsertion ultrasound was performed in 62 patients (71%) . Bedside chest radiography was used to help adjust the position of the end of the cannula in 11 patients (13%). Percutaneous catheterization was successful in 85 cases (97%) , while it failed in 2 female patients due to thick subcutaneous fat layer, and open surgical approach was used. Percutaneous femoral artery collateral circulation was established by ourselves in 5 cases. One patient with femoral artery catheterization without collateral circulation had gangrene of limbs. The complications included 9 cases of catheter site hemorrhage, 4 catheter-related bloodstream infection and 1 pulmonary embolism during ECMO weaning. Conclusion: Percutaneous catheterization for ECMO can be performed with a high rate of success and a low rate of complications.

Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia

Objective In this study we assessed lung reaeration by means of bedside chest radiography, lung computed tomography (CT), and lung ultrasound (LUS) in patients with ventilator-associated pneumonia (VAP) treated by antibiotics. Introduction VAP is a subtype of hospital-acquired pneumonia that occurs in patients under mechanical ventilation for at least 48 h and is characterized by the presence of a new or progressive infiltrate, signs of systemic infection (temperature, blood cell count), changes in sputum characteristics, and detection of the causative agent. Ultrasound examination is increasingly being used as a valuable bedside method for the diagnosis of various thoracic conditions in ICUs, including pleural or pericardial effusion, empyema, pneumothorax, pulmonary embolism, and pneumonia. To date, only a few studies have investigated the use of LUS in the diagnosis of pneumonia in the emergency department or in the ICU. In critically ill patients with acute lung injury, pulmonary aeration may be reliably assessed using bedside LUS. Design This is a randomized prospective comparative trial. Setting The study was conducted in the Critical Care Department of Alexandria Main University Hospital. Patients and methods This study was carried out on 60 patients with a preliminary diagnosis of VAP who matched the inclusion and exclusion criteria in the Critical Care Medicine Department in Alexandria University. In all patients chest ultrasound (US),chest radiography, and chest CT (the gold standard) were performed in sequence at day 0 and day 7 after antibiotic administration. Thereafter, all patients were categorized on the basis of the radiological findings and finally the effectiveness of each method was calculated and statistical comparisons were made. Results In our study, we compared lung reaeration by bedside chest radiography, lung CT, and LUS in patients with VAP treated with antibiotics. We included 60 patients with a preliminary diagnosis of VAP (33.3% were male and 16.7% were female); their ages ranged between 31 and 70 years (mean±SD: 48.3±11.063 years). In our study, we found a highly significant correlation between LUS score and CT reaeration findings (P Conclusion This study can affirm the superiority of chest US over chest radiographs for quantifying lung reaeration in patients with VAP who are successfully treated with antibiotics. LUS is a reliable, dynamic, rapid, noninvasive, bedside technique. Thus, considering the benefits of chest US versus the multiple drawbacks of chest CT, such as the requirement for a special request, the dose of radiation, and the major problem of patient transfer, chest US can be reported to be a reasonable substitute, allowing the early detection of antibiotic-induced lung reaeration or the extension of lung infection in cases of antimicrobial therapy failure. Ultrasound can be considered a reasonable bedside ‘gold standard’ in the critically ill.

The relative efficacy of chest ultrasonography in comparison to other diagnostic modalities in the evaluation of dyspneic patient

BackgroundDyspnea is defined by the American Thoracic Society (ATS) as the subjective experience of breathing discomfort. Traditionally lung imaging in critically ill patients is performed either by bedside chest radiography (CXR) or thoracic computed tomography (CT). Nowadays bedside lung ultrasound is increasingly used for the evaluation of critically ill patients with different lung pathologies. ObjectiveOur study was designed to determine the relative efficacy of chest ultrasonography in comparison to CXR for the detection of four common lung pathologies (pneumothorax, pleural effusions, alveolar consolidation, and alveolar interstitial syndrome) that have important implications in dyspneic patient management and decision making using thoracic CT as a gold standard. MethodsThe study was conducted on 90 adult critically ill patients of both genders who were admitted to the Department of Critical Care Medicine in The Alexandria Main University Hospital. Exclusion criteria included those who were below 18years or above 70years, trauma patients, any patient with moderate to severe susceptibility to have pulmonary embolism according to Wells’ Criteria and pregnant females. All patients were subjected to complete history taking, complete physical examination, complete 12-lead electrocardiogram and arterial blood gases was sampled and analyzed. Lung ultrasound, a bedside CXR and CT scan were performed in sequence in the first six hours of admission. ResultsSimple bedside lung ultrasound provided immediate diagnosis of acute dyspnea in 91.1% of cases. The sensitivity, specificity, and diagnostic accuracy of CXR were 46.4, 96.8, and 81.1% for consolidation, 46.7, 98.3, and 81.1% for interstitial syndrome, 60, 100, and 97.8% for pneumothorax, and 63, 96.8, and 86.7% for pleural effusion, respectively. The corresponding values for lung ultrasound were 89.3, 100, and 96.7% for consolidation, 93.3, 100, and 97.8% for interstitial syndrome, 80, 100, and 98.9% for pneumothorax, and 92.6, 100, and 97.8% for pleural effusion, respectively. ConclusionLung ultrasound has a considerably better diagnostic performance than CXR for the diagnosis of common pathologic conditions and may be used as an alternative to thoracic CT.

Imaging of the Lungs in Organ Donors and its Clinical Relevance: A Retrospective Analysis.

The aim of the study was to retrospectively evaluate the diagnostic imaging that potential lung donors undergo, the reader variability of image interpretation and its relevance for donation, and the potential information gained from imaging studies not primarily intended for lung evaluation but partially including them. Bedside chest radiography and computed tomography (CT), completely or incompletely including the lungs, of 110 brain-dead potential organ donors in a single institution during 2007 to 2014 were reviewed from a donation perspective. Two chest radiologists in consensus analyzed catheters and cardiovascular, parenchymal, and pleural findings. Clinical reports and study review were compared for substantial differences in findings that could have led to a treatment change, triggered additional examinations such as bronchoscopy, or were considered important for donation. Among 136 bedside chest radiographs, no differences between clinical reports and study reviews were found in 37 (27%), minor differences were found in 28 (21%), and substantial differences were found in 71 (52%) examinations (P<0.0001). In 31 of 42 (74%) complete or incomplete CT examinations, 50 of 74 findings with relevance for lung donation were not primarily reported (P<0.0001). The majority of donor patients undergo only chest radiography. A targeted imaging review of abnormalities affecting the decision to use donor lungs may be useful in the preoperative stage. With a targeted list, substantial changes were made from initial clinical interpretations. CT can provide valuable information on donor lung pathology, even if the lungs are only partially imaged.

Role of thoracic ultrasound in diagnosis of pulmonary and pleural diseases in critically ill patients

ObjectiveTo evaluate the diagnostic performance of thoracic ultrasound and compare it with the bedside chest radiography (CXR) and thoracic computed tomography (CT) for the detection of various pathologic abnormalities in unselected critically ill patients. IntroductionLung imaging in critically ill patients is usually performed either by bedside CXR or thoracic CT, but both techniques have limitations which constrain their usefulness. Ultrasound has quite similar performances to CT. Nowadays, bedside thoracic ultrasound is increasingly used in critically ill patients. Patients and methodsThis study was conducted upon 130 mechanically ventilated and non-mechanically ventilated patients; 84 males and 46 females with a mean age of 43.23±12.62years in the medical and surgical ICUs – Menoufia University Hospitals from October 2014 to October 2015. The patients were evaluated for any possible lung pathology according to the modified lung ultrasound protocol and the lung ultrasound results were compared to those of plain CXR and CT chest. ResultsRegarding pneumonia diagnosis, US showed a sensitivity of 93%, specificity of 95%, PPV of 98% and NPV of 87% and when combined with clinical findings, these values became 94%, 93%, 97%, 89% respectively. In diagnosing pleural effusion, US showed a sensitivity of 94%, specificity of 96%, PPV of 97% and NPV of 90% and also when combined with clinical findings, these values became 94%, 96%, 97%, 90% respectively. In diagnosing pulmonary edema, US showed a sensitivity of 93%, specificity of 93%, PPV of 62% and NPV of 99% and when combined with clinical findings these values became 93%, 91%, 54%, 99% respectively. In diagnosing pneumothorax, the US sensitivity was 96%, specificity was 98%, PPV was 93% and NPV was 99% and also when combined with clinical findings these values became 100%, 98%, 93%, 100% respectively. ConclusionThe results and advantages of thoracic US make it a suitable diagnostic modality for evaluating lung and pleural pathologies in the ICU that will have the upper hand over CXR and chest CT in the following decades.

Dental prosthesis aspiration: An uncommon cause of respiratory distress

We present a case of a 66-year-old Caucasian man with acute respiratory distress. The patient had a history of multiple cerebrovascular accidents which resulted in left hemiplegia, swallowing problems, and aphasia. He was tentatively diagnosed with aspiration pneumonia. However, because of clinical deterioration further investigations concluded to the aspiration of a dental prosthesis. After intubation and stabilization, the prosthesis could be manually extracted. However, the patient developed a Staphylococcus epidermidis sepsis and despite adequate antibiotic therapy, he eventually died. Dental prosthesis aspiration is a medical situation associated with a higher morbidity and mortality rate compared to ingested foreign bodies. It requires a high level of suspicion to ensure a timely diagnosis and life-saving treatment. Thorough history taking is of great importance in case of tracheobronchial aspiration, which is in the adult population mostly secondary to an underlying disorder. In impaired adults with missing dental prostheses there should be extra awareness for this problem. This case report illustrates the importance of a detailed history in case of tracheobronchial aspiration and shows the limitations in the diagnostic usefulness of bedside chest radiography.

Lung ultrasound versus chest radiography for the diagnosis of pneumothorax in critically ill patients: A prospective, single-blind study

Background:Radiologic data remains the gold standard for the diagnosis of pneumothorax (PTX). The use of ultrasonography (US) has recently emerged as the method of choice with physicians who can perform bedside US.Purpose:To compare the diagnostic accuracy of lung US against bedside chest radiography (CR) for the detection of PTX using thoracic computed tomography (CT) as the gold standard.Materials and Methods:We conducted a prospective, single-blind study on 192 critically ill patients; each patient received lung US examination, bedside CR, followed by thoracic CT scan searching for PTX.Results:Of the studied patients, CT of the chest confirmed the diagnosis of PTX in 36 (18.75%) patients of which 31 were diagnosed by thoracic US while CR detected only 19 cases. Overall lung US showed a considerable higher sensitivity than bedside CR (86.1% vs. 52.7%), lung US also showed higher, negative predictive values, and diagnostic accuracy against CR (96.8% vs. 90.1%), and (95.3% vs. 90.6%), respectively. CR had a slightly higher specificity than lung US (99.4% vs. 97.4%), and higher positive predictive values (95.0% vs. 88.6%).Conclusion:Lung US is an accurate modality more than anteroposterior bedside CR in comparison with CT scanning when evaluating critically ill mechanically ventilated patients, patients underwent thoracocentesis, central venous catheter insertion, or patients with polytrauma.

TH-AB-201-12: A Consumer Report for Mobile Digital Radiography: A Holistic Comparative Evaluation Across Four Systems

Purpose: To provide a template for the comprehensive clinical evaluation of new imaging technologies with initial application to mobile digital radiography (DR). Methods: Four mobile DR devices (GE Optima XR220amx+Flashpad; Carestream DRX Revolution+DRX-1C; Philips Mobile Diagnost wDR; Philips Mobile Diagnost wDR+Skyplate) were evaluated under four categories: 1)Technical specifications: Vendor data were collected and complied into a unified nomenclature. 2)Physical performance: Each unit underwent imaging physics evaluation including MTF, NPS, DQE, and grid artifact analysis. 3)Clinical performance: Fifteen bedside chest radiographs were acquired using each unit. Metadata were stripped and images cropped to 14:17 aspect ratio to ensure vendor anonymity. Six cardiothoracic radiologists scored the randomized images on PACS workstations using five criteria: overall quality, mediastinum noise, rib-lung contrast, lung density, and lung detail. Results were processed using multiple linear regression analysis. 4)Operability performance: A survey was designed and administered to technologists asking questions which captured use, preference, and experiential data for each unit. To avoid impropriety, units were randomly assigned numbers 1–4. Results: Vendor specifications were compiled into a single-page table enabling ready comparative review. All systems had MTF within 20% and NNPS within 27% of the average response at frequencies below 2.5 mm−1. Units [1,2,4] had DQE within 19% of average while unit 3 was 49% below average at high-frequencies. According to grid artifact analysis, the best and worst results were from units [2,3,4,1], respectively. The radiologist study revealed high inter-radiologist variability which limited the number of significant overall results. Survey results uncovered clear technologist biases. In general, technologists value practical over optional features. Conclusion: The compilation of vendor, physicist, radiologist, and technologist data provides an easy means for healthcare professionals to compare different medical equipment options using a data-driven approach. This type of comprehensive assessment now serves as a model for new technology review at our institution. This work was supported by Duke University Health Systems.

Is Thoracic Ultrasound a Viable Alternative to Conventional Imaging in the Critical Care Setting?

Thoracic imaging is regularly performed on the majority of critical care patients. Conventionally, this uses a combination of plain radiography and computed tomography. There is growing enthusiasm for the use of ultrasound to replace much of this radiology and provide more immediate, point-of-care imaging with reduction in patient transfers, ionizing radiation exposure and cost. This article explores the diagnostic performance of thoracic ultrasound in the imaging of pleural effusion, consolidation, extra-vascular lung water (EVLW), and pneumothorax. Current evidence suggests that, in expert hands, thoracic ultrasonography has similar diagnostic accuracy to computed tomography in pleural effusion, consolidation and pneumothorax. The technique also has potential to identify the cause of increased EVLW and accurately quantify pleural effusions. More large-scale studies are required in these areas however. Ultrasonography outperforms bedside chest radiography in all cases.

A comparative study of collimation in bedside chest radiography for preterm infants in two teaching hospitals

ObjectiveUnnecessary exposure of the abdomen, arms or head may lead to a substantial increase of the radiation dose in portable chest X-rays on the neonatal intensive care unit. The objective was to identify potential factors influencing inappropriate exposure of non-thoracic structures in two teaching hospitals. MethodsThe study analysed 200 consecutive digital chest radiographs in 20 preterm neonates (mean gestation 25±1 weeks). Demographical data, tube settings and exposure parameters were recorded. To grade the collimation, we used a scoring system with a maximum of 12 exposed non-thoracic structures. Length of gestation, age, the radiographer, years of experience in performing X-rays and the number of in situ catheters or lines, were correlated with collimation quality. ResultsThere was no significant difference between the rates of optimal images obtained in the two hospitals (0.32 vs 0.39, n.s.). Scores showed that most suboptimal images had only mildly reduced image quality (1.40±1.38 vs 1.20±1.43, n.s.). Length of gestation or presence of surgical drains, catheters and tubes had no obvious effects on the exposure of non-thoracic structures. Large intra-individual variation in optimal collimation (14–86%) was noted for the radiographers in both hospitals; this was unrelated to their respective years of experience. ConclusionIn our study, the only identifiable factor influencing the collimation of portable chest radiographs in preterm infants was the radiographer’s dedication and awareness. There were no apparent differences between the hospitals investigated. Exposure of non-thoracic structures was relatively frequent and mainly involved the proximal humeri.