Use Of Chest Radiography Research Articles

Replacing post–chest tube removal chest radiographs with clinical assessment in adult thoracic surgery patients: A single-center prospective study

ObjectiveThe necessity and utility of chest radiographs in the absence of clinical symptoms have been questioned after chest tube removal. This study aimed to evaluate the impact of replacing routine chest radiographs after chest tube removal with clinical observation on outcomes in patients undergoing elective thoracic surgery. MethodsThis was a single-center prospective study of adult patients undergoing elective lung resection. Standard chest radiographs after chest tube removal were replaced with a clinical observation protocol for 2 hours after removal. Chest radiographs after chest tube removal were meant to be obtained only for symptomatic patients. The primary outcome was the incidence of adverse events related to this change. Secondary outcomes included changes in clinical management, length of stay, and postoperative complications. ResultsA total of 248 patients were included in the study period, and the majority (n = 185, 75%) did not have chest radiographs after chest tube removal. There was no significant difference in the incidence of adverse events or postoperative complications between patients who received chest radiographs and those who did not. Additionally, length of stay was significantly shorter in patients who did not receive chest radiographs (median 2.3 vs 3 days; P < .05). ConclusionsClinical observation can safely replace routine chest radiographs after chest tube removal in asymptomatic patients undergoing elective thoracic surgery. This approach may lead to shorter hospital stays and reduced healthcare costs without compromising patient safety. The findings support a clinically driven use of postoperative imaging in this patient population, highlighting the importance of individualized patient care.

Clinical Outcomes of Rapid Respiratory Virus Testing in Emergency Departments

Rapid tests for respiratory viruses, including multiplex panels, are increasingly available in emergency departments (EDs). Their association with patient outcomes remains unclear. To determine if ED rapid respiratory virus testing in patients with suspected acute respiratory infection (ARI) was associated with decreased antibiotic use, ancillary tests, ED length of stay, and ED return visits and hospitalization and increased influenza antiviral treatment. Ovid MEDLINE, Embase (Ovid), Scopus, and Web of Science from 1985 to November 14, 2022. Randomized clinical trials of patients of any age with ARI in an ED. The primary intervention was rapid viral testing. Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were followed. Two independent reviewers (T.S. and K.W.) extracted data and assessed risk of bias using the Cochrane Risk of Bias, version 2.0. Estimates were pooled using random-effects models. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework. Antibiotic use and secondary outcomes were pooled separately as risk ratios (RRs) and risk difference estimates with 95% CIs. Of 7157 studies identified, 11 (0.2%; n = 6068 patients) were included in pooled analyses. Routine rapid viral testing was not associated with antibiotic use (RR, 0.99; 95% CI, 0.93-1.05; high certainty) but was associated with higher use of influenza antivirals (RR, 1.33; 95% CI, 1.02-1.75; moderate certainty) and lower use of chest radiography (RR, 0.88; 95% CI, 0.79-0.98; moderate certainty) and blood tests (RR, 0.81; 95% CI, 0.69-0.97; moderate certainty). There was no association with urine testing (RR, 0.95; 95% CI, 0.77-1.17; low certainty), ED length of stay (0 hours; 95% CI, -0.17 to 0.16; moderate certainty), return visits (RR, 0.93; 95%, CI 0.79-1.08; moderate certainty) or hospitalization (RR, 1.01; 95% CI, 0.95-1.08; high certainty). Adults represented 963 participants (16%). There was no association of viral testing with antibiotic use in any prespecified subgroup by age, test method, publication date, number of viral targets, risk of bias, or industry funding. The results of this systematic review and meta-analysis suggest that there are limited benefits of routine viral testing in EDs for patients with ARI. Further studies in adults, especially those with high-risk conditions, are warranted.

Using central venous pressure waveform to confirm the placement of an internal jugular central venous catheter in the intensive care unit

BackgroundA mobile chest X-ray is traditionally performed to confirm the position of an internal jugular central venous catheter (CVC) after placement in the intensive care unit (ICU). Using chest radiography to confirm CVC position often results in delays in authorising the use of the CVC, requires the deployment of additional human resources, and is costly. ObjectiveThis study aimed to determine the feasibility and accuracy of using the central venous pressure (CVP) waveform to confirm the placement of internal jugular CVCs. MethodsThis retrospective study was conducted in a single quaternary ICU over a 6-month period. We included adult patients who had internal jugular CVC inserted and CVP transduced as part of their routine care in the ICU. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CVP waveform analysis in confirming the position of internal jugular CVC relative to chest radiography were calculated. ResultsA total of 241 internal jugular CVCs were inserted (in 219 patients, 35.6% female), and the CVP waveform was assessed. In 231 cases, this suggested adequate placement in a central vein, which corresponded with a correct position on subsequent chest X-ray. On six occasions, the CVP waveforms were interpreted as suboptimal; however, on chest X-rays, the CVCs were noted to be in a suitable position (sensitivity: 97.5%). Four suboptimal CVP waveforms were obtained, and they correctly identified CVC malposition on subsequent chest X-ray (specificity: 100%). The average time from CVC insertion to radiological completion was 118 minutes. ConclusionCVP waveform analysis provides a feasible and reliable method for confirming adequate internal jugular CVC position. The use of chest radiography can be limited to cases where suboptimal CVP waveforms are obtained.

Thoracic ultrasound versus chest X-ray for early detection of mechanical early complications of cardiac device implantation procedures

Abstract Background In the immediate postoperative of cardiac implantable electronic devices (CIED) implantation, the use of chest radiography (CXR) is the gold standard diagnostic tool for early complications, accompanied by electrical parameters testing for diagnostic of early catheter dislodgement. However, the ability to detect thoracic complications using CXR is limited, and it requires radiation exposure. Thoracic ultrasound (TUS) is an easy and highly appropriate technique to detect thoracic pathologies, although its use in cardiac stimulation is not yet widespread. Purpose To compare the diagnostic power of the CXR and TUS alone and in association with electrical parameters testing in detecting early complications after CIED implantation. Methods 397 patients who underwent CIED implantation or upgrade at four large arrhythmia referral centres were prospectively enrolled from November 1, 2021, to September 30, 2022. Following surgery, all patients underwent CXR and TUS at the bedside and the electrical parameters were tested with the device programmer. The primary endpoint was the rate of mechanical complications, defined as a composite or pneumothorax, haemothorax and pericardial effusion. The secondary endpoint was the composite of mechanical complications + electrical complications (lead macro- and micro-dislodgments). Results Total mechanical complications were 21 (5.3%), of which the most common were pneumothorax (3.3%) and pericardial effusion (2%). No cases of hemothorax were observed. The diagnosis of mechanical complication was made by TUS alone in 18 cases (86%), by CXR alone in 2 (9.5%) and in 1 case (4.8%) by both. TUS demonstrated a diagnostic sensitivity for mechanical complications of 90% and for total complications of 87% (associated with electrical control) compared to CXR which had a sensitivity of 20% and 57% respectively. Both methods did not differ in terms of specificity (100%). Conclusions In our experience, TUS has a diagnostic power superior to CXR to detect early mechanical complications. Our results suggest TUS may be used as the primary technique in association with standard electrical control to search for postoperative complications after CIED implantation.

Predicting acute aortic syndrome using aortic dissection detection risk score, D-dimer, and X-ray

ObjectiveAcute aortic syndrome (AAS) is a fatal disease with high mortality. There were previous studies using aortic dissection detection risk score (ADD-RS) and D-dimer (DD) to screen AAS. There were screening failures in previous studies, suggesting the need for a more accurate tool. This study investigated the effect of combining ADD-RS and age adjusted D-dimer (DDage-adj) with abnormal findings on chest radiographs on the diagnosis of AAS in patients admitted to emergency department (ED). MethodsThis single-center retrospective case-control study included 93 patients with AAS and 465 with chest pain (CP), diagnosis other than AAS. We attempted to compare the initial clinical presentation and laboratory examination findings. ResultsAge-adjusted DD (DDage-adj), defined as age x 0.01 mg/L in patients ≥50 years, showed sensitivity of 92.5% and specificity of 76.3% for patients with AAS (p < 0.001). Positive chest radiography findings were significant with AAS group; sensitivity was 89.2% with a specificity of 80.9% (p < 0.001). Multivariate logistic regression analysis was used; widened mediastinum, widening of aortic contour and aortic kinking indicates the probability of AAS in patients with CP (p < 0.05).ADD-RS was used to evaluate the risk of AAS. For low risk group, ADD-RS ≤1, combined use of chest radiography and DDage-adj showed meaningful result. Sensitivity and specificity were 100% and 67.1% with failure rate of 0% (p < 0.001). Multivariate logistic regression analysis were made; widening of the mediastinum (p = 0.035), widening of the aortic contour (p < 0.001) and aortic kinking (p < 0.001) showed significant p-value. Combining DDage-adj and these three chest radiography findings in ADD-RS≤1 patients resulted 0% failure rate with 67.8% specificity (p < 0.001). ConclusionsThe combination of ADD-RS, DDage-adj and chest radiography could lower the failure rate of AAS exclusion strategy. This combination strategy satisfies low failure rate (<3%) and yields relatively high specificity of 67.8%.

A Deep-Learning Model Using Chest Radiographs for Prediction of 30-Day Mortality in Patients With Community-Acquired Pneumonia: Development and External Validation.

Chest radiography is an essential tool for diagnosing community-acquired pneumonia (CAP), although has an uncertain prognostic role in patients with CAP. To develop a deep-learning (DL) model to predict 30-day mortality in patients with CAP using chest radiographs from the time of diagnosis and to validate the model's performance in patients from different time period or institutions. In this retrospective study, a DL model was developed in 7105 patients from one institution from March 2013 to December 2019 (3:1:1 allocation to training, validation, and internal test sets) to predict risk of all-cause mortality within 30 days after CAP diagnosis using patients' initial chest radiograph. The DL model was evaluated in patients diagnosed with CAP during emergency department visits at the same institution as the development cohort from January 2020 to December 2020 [temporal test cohort (n=947)], and from two additional different institutions [external test cohort A (n=467), January 2020 to December 2020; external test cohort B (n=381), March 2019 to October 2021]. AUCs were compared between DL model and CURB-65 score (an established risk prediction tool). The combination of CURB-65 score and DL model was evaluated by a logistic regression model. AUC for predicting 30-day mortality was higher (P<.001) for DL model than CURB-65 score in temporal test set (0.77 vs 0.67); higher AUC for DL model than CURB-65 score was not significant (P>.05) in external test cohort A (0.80 vs 0.73) or external test cohort B (0.80 vs 0.72). In the three cohorts, DL model, in comparison with CURB-65 score, exhibited higher (P<.001) specificity (range, 61-69% vs 44-58%) at the sensitivity achieved by CURB-65 score. Combination of DL model and CURB-65 score, in comparison with CURB-65 score, yielded increase in AUC in temporal test cohort (0.77, P<.001) and external test cohort B (0.80, P=.04), and nonsignificant increase in AUC in external test cohort A (0.80, P=.16). A DL-based model using initial chest radiographs could predict 30-day mortality in patients with CAP with improved performance compared with CURB-65 score. The DL-based model may guide clinical decision-making in management of patients with CAP.

Diagnosis and Management of Pneumonia in Infants Less Than 90 Days of Age.

Current guidelines and recent studies on pediatric pneumonia pertain to children older than 3 months of age. Little information exists regarding the diagnostic evaluation, management, and outcomes of infants less than 90 days with pneumonia. We compared infants <90 days of age diagnosed with pneumonia across 38 US children's hospitals from 2016 to 2021 to children 90 days to 5 years of age. We evaluated whether differences exist in patient characteristics, diagnostic testing, antibiotic treatment, and outcomes between young infants and older children. Additionally, we assessed seasonal variability and trends over time in pneumonia diagnoses by age group. Among 109 796 children diagnosed with pneumonia, 3128 (2.8%) were <90 days of age. Compared with older children, infants <90 days had more laboratory testing performed (88.6% vs 48.8%, P < .001; median number of laboratory tests 4 [interquartile range: 2-5] vs 0 [interquartile range: 0-3] respectively), with wide variation in testing across hospitals. Chest radiograph utilization did not differ by age group. Infants <90 days were more likely to be hospitalized and require respiratory support than older children. Seasonal variation was observed for pneumonia encounters in both age groups. Infants <90 days with pneumonia were more likely to undergo laboratory testing, be hospitalized, and require respiratory support than children 90 days to 5 years of age. This may reflect inherent differences in the pathophysiology of pneumonia by age, the manner in which pneumonia is diagnosed, or possible overuse of testing in infants.

Management of Pediatric Pneumonia: A Decade After the Pediatric Infectious Diseases Society and Infectious Diseases Society of America Guideline.

Incomplete uptake of guidelines can lead to nonstandardized care, increased expenditures, and adverse clinical outcomes. The objective of this study was to evaluate the impact of the 2011 Pediatric Infectious Diseases Society and Infectious Diseases Society of America (PIDS/IDSA) pediatric community-acquired pneumonia (CAP) guideline that emphasized aminopenicillin use and de-emphasized the use of chest radiographs (CXRs) in certain populations. This quasi-experimental study queried a national administrative database of children's hospitals to identify children aged 3 months-18 years with CAP who visited 1 of 28 participating hospitals from 2009 to 2021. PIDS/IDSA pediatric CAP guideline recommendations regarding antibiotic therapy, diagnostic testing, and imaging were evaluated. Segmented regression interrupted time series was used to measure guideline-concordant practices with interruptions for guideline publication and the Coronavirus Disease 2019 (COVID-19) pandemic. Of 315 384 children with CAP, 71 804 (22.8%) were hospitalized. Among hospitalized children, there was a decrease in blood culture performance (0.5% per quarter) and increase in aminopenicillin prescribing (1.1% per quarter). Among children discharged from the emergency department (ED), there was an increase in aminopenicillin prescription (0.45% per quarter), whereas the rate of obtaining CXRs declined (0.12% per quarter). However, use of CXRs rebounded during the COVID-19 pandemic (increase of 1.56% per quarter). Hospital length of stay, ED revisit rates, and hospital readmission rates remained stable. Guideline publication was associated with an increase of aminopenicillin prescribing. However, rates of diagnostic testing did not materially change, suggesting the need to consider implementation strategies to meaningfully change clinical practice for children with CAP.

Comparison between thoracic ultrasound and chest x-ray in non-infective early complications detection after cardiac implantable electronic devices implantation procedures

Abstract Funding Acknowledgements Type of funding sources: None. Background In the immediate postoperative of cardiac implantable electronic devices (CIED) implantation procedures, literature and practice suggest the use of chest radiography as a gold standard diagnostic tool for early local complications such as pneumothorax, hemothorax and pericardial effusion. The introduction of bedside thoracic ultrasound into clinical practice guarantees a tool that is easy to use and highly appropriate for the early diagnosis of pleural pathologies. However, its use in the context of cardiac stimulation is not yet validated and is not mentioned in international consensus documents. Purpose The purpose of this study was to evaluate the rate of early mechanical complications in the post-implantation of cardiac stimulation devices and to compare the diagnostic power of the two methods. Methods 397 consecutive patients who underwent intracavitary device implantation or upgrade with the puncture of a central venous vessel were prospectively enrolled in a multicenter study from November 1, 2021, to September 30, 2022. In the two days following surgery, all patients underwent chest radiography, when possible in the supine position, and chest ultrasound at the patient's bed to detect early complications of the implantation. Results Acute mechanical complications following the implantation of CIED accounted for 5.3%, of which 13 were pneumothorax (3.3%), in over 92% of cases of mild degree. The diagnosis was made by chest ultrasound alone in 10 cases (77%), in 2 cases (15.3%) by radiography alone and in 1 case (7.7%) by both methods (p-value 0.006). In 3 patients it was necessary to place a pleural drainage, in 2 cases the diagnosis was made with ultrasound alone and in 1 case with radiography alone (p=ns). Eight pericardial effusions (2%) were also observed, all of a mild degree, diagnosed exclusively with ultrasound methods and did not require drainage. No cases of hemothorax were observed. Conclusion In our experience, thoracic ultrasound performed at the patient's bed following the implantation of a CIED has a diagnostic power superior to standard chest radiography in diagnosing early mechanical complications of the procedure, without subjecting the patient to early mobilization or ionizing radiation.

Imaging Utilization Patterns in the Follow-Up of Extremity Soft Tissue Sarcomas in the United States

This study aimed to describe patterns of imaging utilization after resection of extremity soft tissue sarcoma in the United States, assess for potential disparities, and evaluate temporal trends. A retrospective cohort study using a national database of private payer claims data was performed to determine the utilization rate of extremity and chest imaging in a 5-year postoperative follow-up period for patients with extremity soft tissue sarcoma treated between 2007 and 2019. Imaging utilization was assessed according to patient demographics (age, sex, race and ethnicity, and region of residency), calendar year of surgery, and postoperative year. Associations of demographic variables with imaging use were assessed using chi-square tests, trends in imaging use were analyzed using the Cochran-Armitage trend test or linear regression, and associations of postoperative year with imaging use were evaluated with the Pearson Correlation coefficient. A total of 3707 patients were included. Most patients received at least 1 chest (74%) and extremity (53%) imaging examination during their follow-up period. The presence of surveillance imaging was significantly associated with age (P < 0.0001) and region (P=0.0029). Over the study period, there was an increase in use of extremity MRI (P < 0.05) and ultrasound (P < 0.01) and chest CT (P < 0.0001) and a decrease in use of chest radiographs (P < 0.0001). Imaging use declined over postoperative years (decrease by 85%-92% from year 1-5). In conclusion, the use of surveillance imaging varied according to patient demographics and has increased for extremity MRI and ultrasound and chest CT over the study period.

The Diagnostic Performance and Utility of Chest XR in Relation to Chest CT in Nontraumatic Respiratory Emergency Patients

ABSTRACT Background and Aim: This study aimed to determine the diagnostic performance and utility of chest radiography in relation to chest computed tomography (CT) in nontraumatic respiratory emergency patients. Patients and Methods: Patients presenting to the emergency department with respiratory complaints due to nontraumatic pathologies and who had consecutive chest XR and chest CT assessments with an interval of fewer than 6 hours were enrolled in the study (n = 561). Results: The two methods were determined to be consistent with moderate agreement in detecting pleural effusion (k = 0.576, P &lt; 0.001), pneumothorax (k = 0.567, P &lt; 0.001), increased cardiothoracic ratio (k =0.472, P &lt; 0.001), and pneumonic consolidation (k = 0.465, P &lt; 0.001). The consistency rate was significantly higher in patients aged &lt;40 years (95.5% in ≤30 years and 90.9% in 31–40 years) as compared to older patients (81.8%, 68.2%, and 72.7% in 41–60 years, 61–80 years, and &gt;80 years, respectively; P &lt; 0.001 for each). The consistency rate was also higher for posteroanterior (PA) chest XR views than for anteroposterior (AP) chest XR views (72.7% vs. 68.2%, P = 0.005) and for high- and moderate-quality chest XR views than for poor-quality views (72.7% and 77.3% vs. 70.5%, P = 0.001). Conclusion: The consistency between the chest XR and CT was more likely in patients aged &lt;40 years and for PA and moderate-to-high quality chest XR views, as compared to older patients and AP and poor-quality views, respectively. We suggest that an upright position PA chest X-ray with high imaging quality may be the first choice, especially in patients aged &lt;40 years admitted to the emergency department with respiratory symptoms.

Retracted: The Use of Chest Radiographs and Machine Learning Model for the Rapid Detection of Pneumonitis in Pediatric.

[This retracts the article DOI: 10.1155/2022/5260231.].

Radiographic assessment of the cardiothoracic ratio in the pediatric age group at a tertiary institution in North-Central Nigeria

Objectives: The most common method for detecting cardiomegaly and calculating the cardiothoracic ratio (CTR) is through the use of chest radiography. Since 1919, when the CTR was first described, there has been an interest in its utility as a predicator of heart size, leading to a lot of research, notably in the adult Caucasian population. However, in the African pediatric age group, there is paucity of data on this subject. We aim to establish normative data on CTR and its determinants in Nigerian children aged 1–15 years, using chest radiographs. Material and Methods: This was a 7-month observational analytical study assessing chest radiographs of healthy children aged 1–15 years at the Radiology Department of Benue State University Teaching Hospital, Makurdi, from May to November 2021. The respondents’ biometrics and chest radiographs were obtained after the protocol was authorized by the institutional Health Research Ethics Committee. The CTR was calculated using measurements of the maximum transverse cardiac diameter (MTCD) and the maximum internal thoracic width (MITW). The data obtained were analyzed using Statistical Package for the Social Sciences version 26, and Microsoft Excel 2017. The statistical significance level was selected at P ≤ 0.05. Results: A total of 150 pediatric chest radiographs were evaluated, with a male: female ratio of 1.4:1. The study population’s mean age was 6.9 ± 4.8 years. There was a steady decrease in CTR with increasing age across the sexes. The mean CTR of the general population was 49.3%. Weight, height, age, and MITW correlated negatively but statistically significantly with CTR (P = 0.000), while the correlation of CTR with race, MTCD, and sex was not statistically significant (P = 0.657, 0.688, and 0.692, consecutively). Conclusion: The result of the study has established 49.3% as the mean CTR value of the pediatric age group in our environment. We also found out that CTR was significantly influenced by weight, height, age, and thoracic size (MITW).

Evaluation of chest radiography and low-dose computed tomography as valuable screening tools for thoracic diseases.

Background:Recent studies have shown that low-dose computed tomography (LDCT) is effective for the early detection of lung cancer. However, the utility of chest radiography (CR) and LDCT for other thoracic diseases has not been as well investigated as it has been for lung cancer. This study aimed to clarify the usefulness of the veridical method in the screening of various thoracic diseases.Methods:Among individuals who had received general health checkups over a 10-year period, those who had undergone both CR and LDCT were selected for analysis. The present study included 4317 individuals (3146 men and 1171 women). We investigated cases in which abnormal opacity was detected on CR and/or LDCT.Results:A total of 47 and 124 cases had abnormal opacity on CR and LDCT, respectively. Among these, 41 cases in which the abnormal opacity was identified by both methods contained 20 treated cases. Six cases had abnormalities only on CR, and none of the cases required further treatment. Eighty-three cases were identified using LDCT alone. Of these, many cases, especially those over the age of 50 years, were diagnosed with thoracic tumors and chronic obstructive pulmonary disease, which required early treatment. In contrast, many cases of pulmonary infections have improved spontaneously, without any treatment.Conclusion:These results revealed that LDCT allowed early detection of thoracic tumors and chronic obstructive pulmonary disease, especially in individuals over the age of 50 years. CR is still a useful imaging modality for other thoracic diseases, especially in individuals under the age of 49 years.

The Use of Chest Radiographs and Machine Learning Model for the Rapid Detection of Pneumonitis in Pediatric.

Pneumonia is a common lung disease that is the leading cause of death worldwide. It primarily affects children, accounting for 18% of all deaths in children under the age of five, the elderly, and patients with other diseases. There is a variety of imaging diagnosis techniques available today. While many of them are becoming more accurate, chest radiographs are still the most common method for detecting pulmonary infections due to cost and speed. A convolutional neural network (CNN) model has been developed to classify chest X-rays in JPEG format into normal, bacterial pneumonia, and viral pneumonia. The model was trained using data from an open Kaggle database. The data augmentation technique was used to improve the model's performance. A web application built with NextJS and hosted on AWS has also been designed. The model that was optimized using the data augmentation technique had slightly better precision than the original model. This model was used to create a web application that can process an image and provide a prediction to the user. A classification model was developed that generates a prediction with 78 percent accuracy. The precision of this calculation could be improved by increasing the epoch, among other subjects. With the help of artificial intelligence, this research study was aimed at demonstrating to the general public that deep-learning models can be created to assist health professionals in the early detection of pneumonia.

Correlation of Physiological and Radiological Characteristics in Chronic Obstructive Pulmonary Disease

Background. Diagnosis of chronic obstructive pulmonary disease (COPD) is confirmed on spirometry but the diagnosis of emphysema remains problematic. The objective of this study was to evaluate the utility of chest radiograph (CXR) and computed tomography (CT) for the diagnosis of emphysema and to correlate these findings with pulmonary function tests (PFTs). Methods. Thirty-five patients with COPD were studied. In all of them, CXR, CT and PFTs were done; three patients had bronchiectasis on CT and were excluded from the study. Chest radiographs (CXRs) were scored for signs of hyperinflation. Lung densities were measured on CT. Results. Functional indices of hyperinflation, i.e. functional residual capacity (FRC), residual volume (RV) and RV/total lung capacity (TLC) had significant correlation with CXR scores. The mean retrosternal space (RSP) measurement was 2.63±0.6 cm (range 1.2 to 3.6cm). Mean lung density (MLD) was -867.91 Hounsfield units (HU) which significantly correlated with functional indices of hyperinflation (FRC, RV, TLC, RV/TLC). Conclusions. In Indian population hyperinflation was found to occur even with lesser values of RSP than the western criteria. CT lung density gives good radiological evidence of emphysema and correlates with lung function abnormalities. [Indian J Chest Dis Allied Sci 2012;54:235-242]

Impact of the COVID-19 Pandemic on Trends in Cardiothoracic Imaging.

Introduction Here, we evaluate the effect of the COVID-19 pandemic on utilization of cardiothoracic imaging studies. Methods We queried our radiology record system to retrospectively identify numbers of specific key cardiothoracic imaging studies for five years prior and during the COVID-19 pandemic. Statistical analysis was performed to evaluate changes in the number of exams in 2020 and 2021 compared to 2019. Results Five-year retrospective analysis demonstrated progressive increases in nearly all cross-sectional studies. In 2020, daily chest radiograph utilization decreased with an overall number of daily radiographs of 406 (SD = 73.1) compared to 480 per day in 2019 (SD = 82.6) (p < 0.0001). Portable radiograph utilization was increased in 2020 averaging 320 (SD = 68.2) films daily in 2020 compared to 266 (SD = 29.1) in 2019 (p < 0.0001). Utilization of thoracic CT was decreased during the pandemic, with 21.8 (SD = 12.9) studies daily compared to 52.0 (SD = 21.4) (p < 0.0001) studies daily in 2019. Cardiac imaging utilization was also substantially decreased in 2020 compared to 2019, averaging a total of 3.8 (SD = 3.2) versus 10.8 (SD = 6.6) studies daily and 0.88 (SD = 1.7) versus 2.5 (SD = 2.3) studies daily for CT and MRI, respectively. Evaluation of cardiothoracic imaging for the subsequent 18 months after New York's entry to phase I recovery in June 2020 demonstrated that by one year after the emergence of COVID-19 imaging utilization had recovered to prepandemic levels. Cardiac imaging continued to increase throughout the chronic phase of the COVID-19 pandemic, reaching almost twice the prepandemic levels by the end of 2021. Conclusion COVID-19 has had far-reaching effects on medicine and public health. Here, we demonstrate decreases in all cross-sectional cardiothoracic imaging studies, closely mirroring findings in other fields during the height of the pandemic, which have since rebounded.

The Contribution of Chest Radiography to the Clinical Management of Children Exposed to Tuberculosis.

Rationale: Although World Health Organization guidelines emphasize contact investigation for tuberculosis (TB)-exposed children, data that support chest radiography as a useful tool are lacking. Objectives: We evaluated the diagnostic and prognostic information of chest radiography in children exposed to TB and measured the efficacy of isoniazid preventive therapy (IPT) in those with relevant radiographic abnormalities. Methods: Between September 2009 and August 2012, we enrolled 4,468 TB-exposed children who were screened by tuberculin skin testing, symptom assessment, and chest radiography. Those negative for TB disease were followed for 1 year for the occurrence of new TB diagnoses. We assessed the protective efficacy of IPT in children with and without abnormal chest radiographs. Measurements and Main Results: Compared with asymptomatic children with normal chest films, asymptomatic children with abnormal radiographs were 25.1-fold more likely to have coprevalent TB (95% confidence interval [CI], 1.02-613.76) and 26.7-fold more likely to be diagnosed with incident TB disease during follow-up (95% CI, 10.44-68.30). Among the 29 symptom-negative and CXR-abnormal child contacts, 20% (3/15) of the isoniazid recipients developed incident TB, compared with 57% (8/14) of those who did not receive IPT (82% IPT efficacy). Conclusions: Our results strongly support the use of chest radiography as a routine screening tool for the evaluation of child TB contacts, which is readily available. Radiographic abnormalities not usually considered suggestive of TB may indicate incipient or subclinical disease, although TB preventive treatment is adequate in most cases.

COVID-19 Detection from Radiographs: Is Deep Learning Able to Handle the Crisis?

Deep learning in the last decade has been very successful in computer vision and machine learning applications. Deep learning networks provide state-of-the-art performance in almost all of the applications where they have been employed. In this review, we aim to summarize the essential deep learning techniques and then apply them to COVID-19, a highly contagious viral infection that wreaks havoc on everyone’s lives in various ways. According to the World Health Organization and scientists, more testing potentially helps contain the virus’s spread. The use of chest radiographs is one of the early screening tests for determining disease, as the infection affects the lungs severely. To detect the COVID-19 infection, this experimental survey investigates and automates the process of testing by employing state-of-the-art deep learning classifiers. Moreover, the viruses are of many types, such as influenza, hepatitis, and COVID. Here, our focus is on COVID-19. Therefore, we employ binary classification, where one class is COVID-19 while the other viral infection types are treated as non-COVID-19 in the radiographs. The classification task is challenging due to the limited number of scans available for COVID-19 and the minute variations in the viral infections. We aim to employ current state-of-the-art CNN architectures, compare their results, and determine whether deep learning algorithms can handle the crisis appropriately and accurately. We train and evaluate 34 models. We also provide the limitations and future direction.

Diagnostic accuracy of lung ultrasound in acute heart failure

Background and objective Although acute heart failure (AHF) is a common cause of dyspnea, its diagnosis still represents a challenge. Lung ultrasound is an emerging point-of-care diagnostic tool, but its diagnostic performance for AHF is still under evaluation. We evaluated the accuracy and clinical usefulness of combining lung ultrasound with clinical assessment compared with the use of chest radiography, echocardiography, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in conjunction with clinical evaluation for diagnosing AHF in the emergency department. Patients and methods A total of 47 patients presenting with dyspnea and symptoms suggestive of AHF were evaluated by NT-proBNP, echocardiography, and chest radiography. Lung ultrasound was done to look for the presence of diffuse B-lines. Results Lung ultrasound showed a sensitivity of 91.9% and a specificity of 100% in diagnosing AHF comparable to plasma NT-proBNP, which had a sensitivity of 100% and a specificity of 60%. It was also superior to other methods of diagnosing AHF namely chest radiograph. Lung ultrasound showed a significant correlation with the echocardiography findings (P=0.001). Conclusion The implementation of lung ultrasound with the clinical evaluation improves accuracy of diagnosis of AHF in the emergency department.