Chest Radiographs Of Patients Research Articles

Utility of screening chest radiographs in patients with asymptomatic and mildly symptomatic COVID-19 at a field hospital in Samut Sakhon, Thailand

Background: In a new episode of the COVID -19 pandemic in Thailand during the beginning of 2021, cases in Samut Sakhon Province mainly occurred in foreign workers and were mostly asymptomatic or had mild disease. To prevent overwhelming the local hospital, a field hospital was established which used chest radiography as one of screening tools for triaging patients. Objective: To determine the clinical utility of chest radiographs as a screening tool for COVID-19 patients who were asymptomatic or mildly symptomatic. Materials and Methods: Six hundred nineteen patients with COVID -19 (confirmed by reverse transcriptase-polymerase chain reaction) were registered at the field hospital at Samut Sakhon provincial sport stadium during 5-8 January 2021 and had chest radiographs taken. The image readings were based on the consensus of two radiologists and a final decision was made by a third radiologist if the first two did not agree. Findings on chest radiographs and clinical outcomes were evaluated. Results: The study included 619 radiographs; 328/619 (53%) men and 291/619 (47%) women had a mean age of 33.3+/- 9.7 (range, 5-64) years. There was mild disease in 13/619, and asymptomatic infections in 606/619. Chest radiographs were normal in 568 (91.7%) and abnormal in 51 (8.3%) patients; typical findings of COVID-19 were seen in 3 (0.5%) patients. Other abnormal findings were found in 23 (3.8%) patients such as active tuberculosis in 6 (1.0%). Four patients were transferred to the hospital, one of whom required supplemental oxygen. Conclusion: Combined chest radiographic and clinical information allows better decisions regarding hospital transfers of asymptomatic and mildly symptomatic COVID-19 patients at a field hospital.

Pleural Effusion

Pleural effusions can occur in a wide variety of clinical situations. The most important test for the initial diagnosis and evaluation of a pleural effusion is the chest radiograph. Further investigation, such as imaging, pleural fluid analysis, pleural biopsy, and thoracoscopy, may be required to determine the etiology of the pleural effusion. This review covers the clinical evaluation, investigative studies, and management of pleural effusion, as well as basic facts of the pleura. An algorithm shows the approach to the patient with a pleural effusion. Figures show chest radiographs of patients with pleural effusion; six computed tomographic scans (showing right-side empyema showing a loculated effusion; a free-flowing, sickle-shaped, right-side effusion; parapneumonic effusion [PPE] at diagnosis, after initial chest tube placement, and after fibrinolytics; and left-side chylothorax secondary to lymphoma); an algorithm to manage known malignant pleural effusions; and a photograph of a PleurX catheter after placement and subcutaneous tunneling. Tables list the pathophysiologic mechanisms of pleural effusion, differential diagnosis for pleural effusions, relationship between pleural fluid appearance and causes, pleural fluid tests for causative assessment, practical guidelines for definitive management of malignant pleural effusion, and categorization of PPE by risk of poor outcome. Techniques for bedside thoracentesis and tube thoracostomy as well as for bedside fibrinolytic use are also presented. This review contains 1 management algorithm, 8 figures, 6 tables, and 92 references.

Descriptive analysis of a comparison between lung ultrasound and chest radiography in patients suspected of COVID-19

BackgroundLung ultrasound (LUS) and chest radiography (CXR) are the most used chest imaging tools in the early diagnosis of COVID-19 associated pneumonia. However, the relationship between LUS and CXR is not clearly defined. The aim of our study was to describe the comparison between LUS interpretation and CXR readings in the first approach to patients suspected of COVID-19.MethodsIn the time of the first COVID-19 pandemic surge, we prospectively evaluated adult patients presenting to an emergency department complaining of symptoms raising suspicion of COVID-19. Patients were studied by LUS and only those performing also CXR were analyzed. All the patients performed viral reverse transcriptase-polymerase chain reaction (RT-PCR). LUS studies were classified in 4 categories of probabilities, based on the presence of typical or alternative signs of COVID-19-associated interstitial pneumonia. Accordingly, the CXR readings were retrospectively adapted by 2 experts in 4 categories following the standard language that describes the computed tomography (CT) findings. Patients were divided in two groups, based on the agreement of the LUS and CXR categories. Results were also compared to RT-PCR and, when available, to CT studies.ResultsWe analyzed 139 cases (55 women, mean age 59.1 ± 15.5 years old). The LUS vs CXR results disagreed in 60 (43.2%) cases. RT-PCR was positive in 88 (63.3%) cases. In 45 cases, a CT scan was also performed and only 4 disagreed with LUS interpretation versus 24 in the comparison between CT and CXR. In 18 cases, LUS detected signs of COVID-19 pneumonia (high and intermediate probabilities) while CXR reading was negative; in 14 of these cases, a CT scan or a RT-PCR-positive result confirmed the LUS interpretation. In 6 cases, LUS detected signs of alternative diagnoses to COVID-19 pneumonia while CXR was negative; in 4 of these cases, CT scan confirmed atypical findings.ConclusionOur study demonstrated a strong disagreement between LUS interpretation and CXR reading in the early approach to patients suspected of COVID-19. Comparison with CT studies and RT-PCR results seems to confirm the superiority of LUS over a second retrospective reading of CXR.

Study on the chest radiographic results in patients with pulmonary tuberculosis referred to Zabol tuberculosis center: A descriptive study

Introduction and Purpose: Tuberculosis is the most common cause of death from infectious diseases in the world. This study aimed to evaluate the findings of chest radiography in patients with pulmonary tuberculosis referred to the Zabol tuberculosis center. Materials and Methods: This descriptive-analytical study was performed on 101 patients with positive tuberculosis from January to December 2020. Data were collected using an information form and finally analyzed by SPSS software version 22. Results: In this study, 101 patients were studied, of which 71 were female and 30 were male, and the mean age of patients was 62.68±13.61 years. The frequency of turbidity in patients with smear grades 1, 2, and 3 was 71.4%, 78.5%, and 76.5%, respectively. The frequency of cavitation in patients with grades 1, 2, and 3 was 11.5%, 28.5%, and 52.9%, respectively. The frequency of nodular view in patients with grades 1, 2, and 3 was 18.6, 42.8, and 35.3%, respectively. Conclusion: In general, the results of this study showed that with increasing smear grading, the frequency of cavitation cases increases significantly and the frequency of reticulonodular view cases decreases significantly.

Utility of Screening Chest Radiographs in Patients with Asymptomatic or Minimally Symptomatic COVID-19 in Singapore.

BackgroundSingapore saw an escalation of coronavirus disease 2019 (COVID-19) cases from under 4,000 in April 2020 to over 40,000 in June 2020 largely attributed to spread within shared facilities housing foreign workers. Appropriate triage and escalation of clinical care are critical for this patient group managed in community care facilities (CCFs).PurposeTo evaluate the imaging guideline recommendations for COVID-19 from the Fleischner Society and analyze the clinical utility of chest radiograph screening for asymptomatic or minimally symptomatic patients with COVID-19.Materials and MethodsIn this retrospective study, patients with COVID-19 confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) who were admitted to Singapore Expo, a designated CCF, for continuation of their management during May 3-31, 2020 were identified. Upon admission, patients aged 36 and older without any baseline chest imaging received a chest radiograph. All chest radiographs and clinical outcomes of patients including those who were subsequently transferred to acute hospitals for escalation of care were reviewed. Key proportions of patients with findings of pulmonary infection and those requiring further inpatient treatment were calculated, and 95% binomial proportion confidence intervals obtained using the Clopper-Pearson method.ResultsThe study included 5,621 patients: all men 100% (5,621/5,621), mean age 37 ± 8 years (range 17-60). A total of 1,964 chest radiographs were performed of which normal accounted for 98.0% (1,925/1,964) and findings of pulmonary infection represented 2.0% (39/1,964). Only 0.2% (4/1,964) with chest radiograph findings of pulmonary infection (all of whom were symptomatic) required supplemental oxygenation and inpatient treatment. None of the asymptomatic patients with findings of pulmonary infection required supplemental oxygenation, and they received only symptomatic treatment.ConclusionIn accordance with Fleischner Society recommendations, chest radiograph screening for patients with COVID-19 aged 17-60 with mild or no symptoms is not indicated unless there is risk of clinical deterioration.See also the editorial by Schaefer-Prokop and Prokop.

X-ray patterns of COVID-19 in patients presenting to Lady Reading Hospital, Peshawar, Pakistan.

Objective:To determine the pattern of COVID-19 on chest radiograph in patients presenting to Lady Reading Hospital, Peshawar, Pakistan.Methods:This prospective observational study was conducted on 178 consecutive swab positive COVID-19 patients presenting to Lady Reading Hospital, Peshawar, Pakistan from 15th March to 15th June 2020. Patients of all ages and both genders were included. Chest X-rays performed by portable radiography unit were viewed for different patterns by two consultant radiologists independently and results were analyzed using IBM SPSS 20.Results:Out of 178 patients 134 were male. Mean age was 55.67 years. Radiographic patterns observed were ground glass haze without or with reticulation and/or consolidation (45.5 % and 33.2% respectively) and predominant consolidation either alone or in combination with ground glass haze or other findings (27.1% collectively). Peripheral distribution pattern was seen in 69.1% of patients with bilateral findings in 84.3%. Further categorization was based on pulmonary zonal demarcation with changes most commonly involving four zones (33.1%) i.e., the lower and mid zones bilaterally.Conclusion:Portable chest radiography is an essential supporting tool for assessing different patterns in COVID-19 infection. The most common pattern observed is alveolar opacities with predominant peripheral distribution either unilateral or more frequently bilateral, starting from the lower and mid zones extending to the upper zones and becoming diffuse with disease progression.

Reducing patient harm following inadvertent endobronchial placecement of nasogastric tubes in patients with SARS-COV-2

IntroductionNasogastric tube (NGT) insertion is essential for enteral feeding but can potentially cause significant injury to the lungs (1). Following a critical incident, we audited our practice of NGT insertion and the consequences of injury in patients with Severe Acute Respiratory Syndrome COVID-19 caused by the (SARS-CoV-2) virus.MethodsNGT insertion followed a local standard safety protocol and were inserted by consultants or senior registrars in anaesthesia and critical care medicine, or advanced critical care practitioners. Individual practitioners were able to choose their technique of insertion. All patients had their post-NGT insertion chest x-ray reviewed and those with misplaced NGTs had their case notes reviewed. Early in the outbreak, blind insertion was recommended in our institution to reduce aerosolisation, this was rapidly changed to direct visualisation with laryngoscopy as our experience managing SARS-CoV-2 patients increased.ResultsDuring the SARS-CoV-2 pandemic, a total of 135 NGTs were inserted into ventilated and/or extracorporeal membrane oxygenation (ECMO) patients. All of NGTs positioned were confirmed by a chest radiograph. Eleven (8.1%) were inadvertently endobronchial, of which four developed pneumothoraces (figure 1). Three patients (including both who had received ECMO) died and a fourth is currently undergoing a prolonged respiratory wean. No patients were fed or received drugs via a misplaced NGT.Chest radiograph of patient with inadvertent NGT placement in right lower lobe. Note the path of the tube suggests breech of the bronchial tree and direct injury to the lung parenchyma (arrowhead). A CT the following day showed a large pneumothorax (arrowhead), some haemothorax (black arrow) and severe ground glass changes consistent with SARS-CoV-2 (white arrow).DiscussionOur inadvertent endobronchial NGT rate is relatively high, compared to our previous clinical experience, which we believe may be related to the challenges of working with cumbersome personal protective equipment and/or changed practice to attempt to reduce transmission of SARS-CoV-2 (2). We suspect the lung parenchyma is particularly fragile in acute respiratory distress syndrome caused by SARS-CoV-2, which contributes to the high rate of pleural breech and subsequent poor outcome (3). We recommend experienced operators place NGTs and do so using direct or videolaryngoscopy to minimise the risk of incorrect placement.We would like to thank the families of our patients for their permission to share the images in this work.

Diagnosis of Coronavirus Disease 2019 Pneumonia by Using Chest Radiography: Value of Artificial Intelligence.

BackgroundRadiologists are proficient in differentiating between chest radiographs with and without symptoms of pneumonia but have found it more challenging to differentiate coronavirus disease 2019 (COVID-19) pneumonia from non–COVID-19 pneumonia on chest radiographs.PurposeTo develop an artificial intelligence algorithm to differentiate COVID-19 pneumonia from other causes of abnormalities at chest radiography.Materials and MethodsIn this retrospective study, a deep neural network, CV19-Net, was trained, validated, and tested on chest radiographs in patients with and without COVID-19 pneumonia. For the chest radiographs positive for COVID-19, patients with reverse transcription polymerase chain reaction results positive for severe acute respiratory syndrome coronavirus 2 with findings positive for pneumonia between February 1, 2020, and May 30, 2020, were included. For the non–COVID-19 chest radiographs, patients with pneumonia who underwent chest radiography between October 1, 2019, and December 31, 2019, were included. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated to characterize diagnostic performance. To benchmark the performance of CV19-Net, a randomly sampled test data set composed of 500 chest radiographs in 500 patients was evaluated by the CV19-Net and three experienced thoracic radiologists.ResultsA total of 2060 patients (5806 chest radiographs; mean age, 62 years ± 16 [standard deviation]; 1059 men) with COVID-19 pneumonia and 3148 patients (5300 chest radiographs; mean age, 64 years ± 18; 1578 men) with non–COVID-19 pneumonia were included and split into training and validation and test data sets. For the test set, CV19-Net achieved an AUC of 0.92 (95% CI: 0.91, 0.93). This corresponded to a sensitivity of 88% (95% CI: 87, 89) and a specificity of 79% (95% CI: 77, 80) by using a high-sensitivity operating threshold, or a sensitivity of 78% (95% CI: 77, 79) and a specificity of 89% (95% CI: 88, 90) by using a high-specificity operating threshold. For the 500 sampled chest radiographs, CV19-Net achieved an AUC of 0.94 (95% CI: 0.93, 0.96) compared with an AUC of 0.85 (95% CI: 0.81, 0.88) achieved by radiologists.ConclusionCV19-Net was able to differentiate coronavirus disease 2019–related pneumonia from other types of pneumonia, with performance exceeding that of experienced thoracic radiologists.© RSNA, 2021Online supplemental material is available for this article.

X-Ray and CT Scan Based Prediction of Best Fit Tracheostomy Tube-A Pilot Study.

Tracheostomy is a commonly performed intervention in patients requiring ventilatory support. The insertion of inappropriately sized tracheostomy tubes carries a risk of decannulation, tissue damage, ventilatory difficulties, premature tube change or discomfort. Currently, no clear guidelines exist in determining the most appropriate size tube. Imaging of the airway preoperatively could aid clinical judgement and reduce risk. Patients included adult critical care patients who had appropriate preoperative imaging. The computed tomography scans and chest radiographs of patients were reviewed. Measurements of the airway were taken and scaled to the known internal diameter of an endotracheal tube. A four-point scoring system was developed to identify patients better suited to a non-standard sized tracheostomy tube. Data from 23 patients was analyzed using the Statistical Package for Social Sciences™ (SPSS). Four measured points on imaging corresponded to the patients’ appropriate tracheostomy tube size. Appropriate tracheostomy size correlates with tracheal diameter at endotracheal tube tip (r2 = 0.135), carina (r2 = 0.128), midpoint of larynx to carina (r2 = 0.146), bronchial diameter at the left mainstem (r2 = 0.323), and intrathoracic tracheal length (r2 = 0.23). Among our cohort, a score of 4 predicts the need for a larger tracheostomy tube. Simple imaging provides accurate measurement of patients’ airway dimensions. Our method ensures tube size is selected according to patient airway size, and potentially reduces the risks associated with inappropriate sizing.

Generative Adversarial Networks Improve the Reproducibility and Discriminative Power of Radiomic Features.

To assess the contribution of a generative adversarial network (GAN) to improve intermanufacturer reproducibility of radiomic features (RFs). The authors retrospectively developed a cycle-GAN to translate texture information from chest radiographs acquired using one manufacturer (Siemens) to chest radiographs acquired using another (Philips), producing fake chest radiographs with different textures. The authors prospectively evaluated the ability of this texture-translation cycle-GAN to reduce the intermanufacturer variability of RFs extracted from the lung parenchyma. This study assessed the cycle-GAN's ability to fool several machine learning (ML) classifiers tasked with recognizing the manufacturer on the basis of chest radiography inputs. The authors also evaluated the cycle-GAN's ability to mislead radiologists who were asked to perform the same recognition task. Finally, the authors tested whether the cycle-GAN had an impact on radiomic diagnostic accuracy for chest radiography in patients with congestive heart failure (CHF). RFs, extracted from chest radiographs after the cycle-GAN's texture translation (fake chest radiographs), showed decreased intermanufacturer RF variability. Using cycle-GAN-generated chest radiographs as inputs, ML classifiers categorized the fake chest radiographs as belonging to the target manufacturer rather than to a native one. Moreover, cycle-GAN fooled two experienced radiologists who identified fake chest radiographs as belonging to a target manufacturer class. Finally, reducing intermanufacturer RF variability with cycle-GAN improved the discriminative power of RFs for patients without CHF versus patients with CHF (from 55% to 73.5%, P < .001). Both ML classifiers and radiologists had difficulty recognizing the chest radiographs' manufacturer. The cycle-GAN improved RF intermanufacturer reproducibility and discriminative power for identifying patients with CHF. This deep learning approach may help counteract the sensitivity of RFs to differences in acquisition.Supplemental material is available for this article.© RSNA, 2020See also the commentary by Alderson in this issue.

Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19.

BackgroundCurrent COVID-19 radiological literature is dominated by CT and a detailed description of chest x-ray (CXR) appearances in relation to the disease time course is lacking.PurposeTo describe the time course and severity of the CXR findings of COVID-19 and correlate these with real time reverse transcription polymerase chain reaction (RT-PCR) testing for SARS-Cov-2 nucleic acid.Materials and MethodsRetrospective study of COVID-19 patients with RT-PCR confirmation and CXRs admitted across 4 hospitals evaluated between January and March 2020. Baseline and serial CXRs (total 255 CXRs) were reviewed along with RT-PCRs. Correlation with concurrent CTs (total 28 CTs) was made when available. Two radiologists scored each CXR in consensus for: consolidation, ground glass opacity (GGO), location and pleural fluid. A severity index was determined for each lung. The lung scores were summed to produce the final severity score.ResultsThere were 64 patients (26 men, mean age 56±19 years). Of these, 58, 44 and 38 patients had positive initial RT-PCR (91%, [CI: 81-96%]), abnormal baseline CXR (69%, [CI: 56-80%]) and positive initial RT-PCR with abnormal baseline CXR (59 [CI:46-71%]) respectively. Six patients (9%) showed CXR abnormalities before eventually testing positive on RT-PCR. Sensitivity of initial RT-PCR (91% [95% CI: 83-97%]) was higher than baseline CXR (69% [95% CI: 56-80%]) (p = 0.009). Radiographic (mean 6 ± 5 days) and virologic recovery (mean 8 ± 6 days) were not significantly different (p= 0.33). Consolidation was the most common finding (30/64, 47%), followed by GGO (21/64, 33%). CXR abnormalities had a peripheral (26/64, 41%) and lower zone distribution (32/64, 50%) with bilateral involvement (32/64, 50%). Pleural effusion was uncommon (2/64, 3%). The severity of CXR findings peaked at 10-12 days from the date of symptom onset.ConclusionChest x-ray findings in COVID-19 patients frequently showed bilateral lower zone consolidation which peaked at 10-12 days from symptom onset.

Implementation of a Deep Learning-Based Computer-Aided Detection System for the Interpretation of Chest Radiographs in Patients Suspected for COVID-19.

ObjectiveTo describe the experience of implementing a deep learning-based computer-aided detection (CAD) system for the interpretation of chest X-ray radiographs (CXR) of suspected coronavirus disease (COVID-19) patients and investigate the diagnostic performance of CXR interpretation with CAD assistance.Materials and MethodsIn this single-center retrospective study, initial CXR of patients with suspected or confirmed COVID-19 were investigated. A commercialized deep learning-based CAD system that can identify various abnormalities on CXR was implemented for the interpretation of CXR in daily practice. The diagnostic performance of radiologists with CAD assistance were evaluated based on two different reference standards: 1) real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) results for COVID-19 and 2) pulmonary abnormality suggesting pneumonia on chest CT. The turnaround times (TATs) of radiology reports for CXR and rRT-PCR results were also evaluated.ResultsAmong 332 patients (male:female, 173:159; mean age, 57 years) with available rRT-PCR results, 16 patients (4.8%) were diagnosed with COVID-19. Using CXR, radiologists with CAD assistance identified rRT-PCR positive COVID-19 patients with sensitivity and specificity of 68.8% and 66.7%, respectively. Among 119 patients (male:female, 75:44; mean age, 69 years) with available chest CTs, radiologists assisted by CAD reported pneumonia on CXR with a sensitivity of 81.5% and a specificity of 72.3%. The TATs of CXR reports were significantly shorter than those of rRT-PCR results (median 51 vs. 507 minutes; p < 0.001).ConclusionRadiologists with CAD assistance could identify patients with rRT-PCR-positive COVID-19 or pneumonia on CXR with a reasonably acceptable performance. In patients suspected with COVID-19, CXR had much faster TATs than rRT-PCRs.

236 Utility of Chest Radiograph in Patients Admitted to a Pediatric Intensive Care Unit in Status Asthmaticus from a Pediatric Emergency Department

The NHLBI guidelines state that emergency department chest radiographs (CXRs) are not routinely recommended in asthma exacerbations unless a complicating cardiopulmonary process is suspected. Prior studies show a majority of CXRs performed in non-critical asthma reveal no evidence of pneumonia or air leak. There are limited studies that offer specific indications for CXRs in status asthmaticus. The literature suggests that new onset wheezing, fever, hypoxemia and an asymmetric exam are acceptable indications for CXRs. The aim of this study was to determine the utility of CXRs in patients admitted to a pediatric intensive care unit (PICU) in status asthmaticus from a pediatric emergency department (PED). This was a retrospective chart review of children with a diagnosis of asthma aged 2 to 18 between 2012 and 2017 who presented to the PED and were then admitted to the PICU in status asthmaticus, requiring a minimum of continuous albuterol. Patient demographics, physical examination findings and vital signs were collected in addition to imaging results and hospital management information. Patients with underlying disorders including prematurity, cardiac disease, sickle cell disease, cerebral palsy and cystic fibrosis and patients without previous CXRs in the electronic medical record were excluded. Patients were then stratified into two subject groups based on presence of fever, hypoxemia or an asymmetric exam. Routine CXRs were defined as a CXR obtained in the PED in the absence of fever, hypoxemia and asymmetric exam. Descriptive statistical analysis was performed using statistical analysis software. 343 patients were analyzed and 250 (80.6%) of these had CXRs in the PED. Of those 250 patients, 114 (45.6%) had fever, hypoxemia or an asymmetric lung exam. Of the remaining 136 (54.4%) patients, 95 (69.9%) of the routine CXRs were negative. 41 (30.1%) had abnormal CXRs; 5 (3.7%) had infiltrates, 23 (16.9%) had infiltrate vs. atelectasis and 13 (9.6%) showed atelectasis. All 5 (100%) patients with infiltrates and 16 (69.6%) of the patients with infiltrate vs. atelectasis were treated with antibiotics. Eight (8.4%) patients with normal CXRs received antibiotics during hospital admission. 69.9% of the routine CXRs obtained for status asthmaticus in this study were negative. 3.7% of the routine CXRs showed infiltrates, leading to further interventions. All of these patients were admitted to an ICU, where CXR could be obtained if symptoms indicating the need for a CXR were to develop. In this study, routine use of CXR in the evaluation of patients with status asthmaticus led to a high rate of unnecessary imaging.

Diagnostic significance of diaphragmatic height index in traumatic diaphragmatic rupture.

PurposeTraumatic diaphragmatic rupture resulting from blunt trauma is usually severe. However, it is often overlooked during initial evaluation because there are no characteristic signs and symptoms. Thus, this study aimed to determine the clinical characteristics of diaphragmatic rupture caused by blunt trauma and investigate the diagnostic usefulness of diaphragmatic height index (DHI) measured using chest radiographs.MethodsThe cohort comprised patients who were admitted due to diaphragmatic rupture from blunt trauma. Patients were divided into 2 groups; the control group comprised patients with blunt trauma who were matched for age, sex, and Injury Severity Score, while the DHI group comprised patients with diaphragmatic rupture from blunt trauma. Receiver operating characteristic curve was used to determine the cutoff value of DHI for diaphragmatic injury. The sensitivity, specificity, predictability, accuracy, and likelihood ratio of the cutoff were then determined.ResultsA total of 60 patients were confirmed to have diaphragmatic rupture. The mean DHI in patients with diaphragmatic rupture on the right and left side were both significantly different compared to that in the control group. A DHI cutoff value of >1.31 showed 71% sensitivity and 87% specificity for diagnosing right diaphragmatic rupture, while a cutoff value of <0.43 showed 87% sensitivity and 76% specificity for diagnosing left diaphragmatic rupture.ConclusionDHI can be useful in the diagnosis of diaphragmatic rupture. DHI as determined using chest radiographs in patients with blunt abdominal trauma, particularly in those ineligible for diagnostic work-up, may help in the diagnosis of diaphragmatic rupture.

A lung image reconstruction from computed radiography images as a tool to tuberculosis treatment control.

Background:Background: Tuberculosis (TB) is an infectious lung disease with high worldwide incidence that severely compromises the quality of life in affected individuals. Clinical tests are currently employed to monitor pulmonary status and treatment progression. The present study aimed to apply a three-dimensional (3D) reconstruction method based on chest radiography to quantify lung-involvement volume of TB acute-phase patients before and after treatment. In addition, these results were compared with indices from conventional clinical exams to show the coincidence level.Methods:A 3D lung reconstruction method using patient chest radiography was applied to quantify lung-involvement volume using retrospective examinations of 50 patients who were diagnosed with pulmonary TB and treated with two different drugs schemes. Twenty-five patients were treated with Scheme I (rifampicin, isoniazid, and pyrazinamide), whereas twenty-five patients were treated with Scheme II (rifampicin, isoniazid, pyrazinamide, and ethambutol). Acute-phase reaction: Serum exams included C-reactive protein levels, erythrocyte sedimentation rate, and albumin levels. Pulmonary function was tested posttreatment.Results:We found strong agreement between lung involvement and serum indices pre- and posttreatment. Comparison of the functional severity degree with lung involvement based on 3D image quantification for both treatment schemes found a high correlation.Conclusions: The present 3D reconstruction method produced a satisfactory agreement with the acute-phase reaction, most notably a higher significance level with the C-reactive protein. We also found a quite reasonable coincidence between the 3D reconstruction method and the degree of functional lung impairment posttreatment. The performance of the quantification method was satisfactory when comparing the two treatment schemes. Thus, the 3D reconstruction quantification method may be useful tools for monitoring TB treatment. The association with serum indices are not only inexpensive and sensitive but also may be incorporated into the assessment of patients during TB treatment.

Evaluation of the depiction ability of similar subtraction images using digital chest radiographs of different patients.

The temporal subtraction (TS) technique requires the same patient's chest radiographs (CXRs) acquired on different dates, whereas the similar subtraction (SS) technique can be used in patients who have no previous CXR, using similar CXRs from different patients. This study aimed to examine the depiction ability of SS images with simulated nodules in comparison with that of TS images with 2- and 7-year acquisition intervals. One hundred patients were randomly selected from our image database. The most recently acquired images of the patients were used as target images for subtraction. The simulated nodule was superimposed on each target image to examine the usefulness of the SS technique. The most (Top 1) and ten most (Top 10) similar images for each target image were identified in the 24,254-image database using a template-matching technique, and used for the SS technique. SS and TS images were obtained using a previously developed nonlinear image-warping technique. The depiction ability of SS and TS images was evaluated using the contrast-to-noise ratio (CNR). The proportion of Top 1 SS images showing higher CNR than that of the TS images with 2- and 7-year acquisition intervals was 28% (28/100) and 33% (33/100), respectively. Moreover, the proportion of cases that had any of the Top 10 SS images with higher CNRs than those of TS images with 2- and 7-year acquisition intervals was 56% (56/100) and 72% (72/100), respectively. Our study indicates that the SS technique can potentially be used to detect lung nodules on CXRs.

The conclusions drawn from ventilation/perfusion single-photon emission computed tomography compared with lung perfusion single-photon emission computed tomography and chest radiography in patients with suspected pulmonary thromboembolism.

There are conflicting results from studies on whether ventilation scintigraphy can be safely omitted or replaced by chest radiography. These studies were based on planar ventilation/perfusion (V/Q) scintigraphy. We evaluated the value of the ventilation single-photon emission computed tomography (SPECT) on the final conclusion drawn from a V/Q SPECT and the possible role of the chest radiography as a surrogate for the ventilation SPECT. Raw data of V/Q SPECT images and chest radiography acquired within 48 h over an 18-month period were retrieved, reprocessed and reviewed in batches. The ventilation SPECT, perfusion SPECT and chest radiography were reviewed separately and in combination. Data on the presence and nature of defects and chest radiography abnormalities were recorded. The V/Q SPECT images were interpreted using the criteria in the EANM guideline and the perfusion SPECT and chest radiography images were interpreted using the PISAPED criteria. Agreement between the diagnosis on the V/Q SPECT review and the perfusion SPECT and chest radiography review was analysed. Overall, 21.1% of the patients were classified as 'PE present' on the V/Q SPECT review, whereas 48.9% were classified as 'PE present' on the perfusion SPECT and chest radiography review. Only 5.4% of defects observed on ventilation SPECT had matched chest radiography lung field opacity. Our study showed that the omission of a ventilation SPECT led to a high rate of false-positive diagnoses and that the ventilation scan cannot be replaced by a chest radiography.

Utility of Chest Radiographs in Children Presenting to a Pediatric Emergency Department With Acute Asthma Exacerbation and Chest Pain.

Previous studies have not evaluated the utility of obtaining chest radiographs (CXR) in patients with acute asthma exacerbation reporting chest pain. The aims of this study were to evaluate the symptom of chest pain as a predictor for clinicians obtaining a CXR in these patients and to evaluate chest pain as a predictor of a positive CXR finding. This was a retrospective chart review of patients, ages 2 to 18 years, presenting for acute asthma exacerbation to the emergency department from August 1, 2014, to March 31, 2016. Data collected included demographics, clinical data, provider type, and CXR results. Chest radiographs were classified as positive if they showed evidence of pneumonia, pneumothorax, or pneumomediastinum. Multivariate logistic regression models were developed with dependent variables of "obtaining a CXR" and "a positive CXR finding." Seven hundred ninety-three subjects were included in the study. Two hundred thirty-one (29.1%) reported chest pain. Chest radiographs were obtained in 184 patients (23.2%). Of those, 74 patients (40.2%) had chest pain and 21 (11.4%) had a positive CXR. Providers were more likely to obtain CXRs in patients who reported chest pain (odds ratio = 2.2 [95% confidence interval = 1.5-3.2]). Patients reporting chest pain were more likely to have a positive CXR although this difference was not statistically significant (odds ratio = 2.0 [95% confidence interval = 0.7-5.6]). Providers are more likely to obtain CXRs in asthmatic patients complaining of chest pain; however, these CXRs infrequently yield positive findings. This further supports limiting the use of chest radiography in patients with acute asthma exacerbation.

Point-of-care Ultrasonography for Detecting the Etiology of Unexplained Acute Respiratory and Chest Complaints in the Emergency Department: A Prospective Analysis.

Introduction Point-of-care ultrasound (POCUS) is increasingly used as a diagnostic tool in emergency departments. As the number and type of POCUS protocols expand, there is a need to validate their efficacy in comparison with current diagnostic standards. This study compares POCUS to chest radiography in patients with undifferentiated respiratory or chest complaints.MethodsA prospective convenience sample of 59 adult patients were enrolled from those presenting with unexplained acute respiratory or chest complaints (and having orders for chest radiography) to a single emergency department in an academic tertiary-care hospital. After a brief educational session, a medical student, blinded to chest radiograph results, performed and interpreted images from the modified Rapid Assessment of Dyspnea in Ultrasound (RADiUS) protocol. The images were reviewed by a blinded ultrasound fellowship-trained emergency physician and compared to chest radiography upon chart review. The primary “gold standard” endpoint diagnosis was the diagnosis at discharge. A secondary analysis was performed using the chest computed tomography (CT) diagnosis as the endpoint diagnosis in the subset of patients with chest CTs.ResultsWhen using diagnosis at discharge as the endpoint diagnosis, the modified RADiUS protocol had a higher sensitivity (79% vs. 67%) and lower specificity (71% vs. 83%) than chest radiography. When using chest CT diagnosis as the endpoint diagnosis (in the subset of patients with chest CTs), the modified RADiUS protocol had a higher sensitivity (76% vs. 65%) and lower specificity (71% vs. 100%) than chest radiography. The medical student performed and interpreted the 59 POCUS scans with 92% accuracy.ConclusionThe sensitivity and specificity of POCUS using the modified RADiUS protocol was not significantly different than chest radiography. In addition, a medical student was able to perform the protocol and interpret scans with a high level of accuracy. POCUS has potential value for diagnosing the etiology of undifferentiated acute respiratory and chest complaints in adult patients presenting to the emergency department, but larger clinical validation studies are required.

Case Report: Pulmonary and Liver Sarcoidosis Suspected of Metastasis.

Introduction: Sarcoidosis is a granulomatous disease with unknown cause that can vary from an asymptomatic condition. Almost half of the patients with sarcoidosis have no symptoms. In this article, we describe a sarcoidosis patient with lung and liver engagement; it may be confused with metastasis. Case report: A 39-year-old man, with known as hypothyroidism who had come to the emergency ward with dyspnea and coughing after exposure to detergents in a closed environment. The patient smoked for 10 years (3 pack/year). No other findings were found in clinical examinations except for wheezing in the right lung. The patient's chest radiography was shown a mass. For further investigation, spiral CT scan was performed. Large lymph nodes on the right side of the trachea, measuring about 23 mm and a mass of 70 × 77 mm in the vicinity of the right lung hilum and a hypodense nodule in the posterior part of the liver with malignancy suspicious were reported. After several biopsy results was shown chronic granulomatous inflammation, the most important differential diagnosis is tuberculosis (TB) and sarcoidosis. Sputum smear, culture, and PCR were performed for tuberculosis. Also, the level of angiotensin-converting enzyme (ACE) was measured for sarcoidosis. the results ruled out TB and shown a higher level of ACE (ACE = 88 IU/L).After diagnosis treatment started with prednisolone. Now, the patient is in the follow- up. Conclusion: In hilar lymphadenopathy of lung sarcoidosis is the importance differential diagnosis that should be considered.