Conventional Chest X-ray Research Articles

Diagnostic Value of the Thoracic Ultrasonography Compared to Conventional Chest X-Rays in Pneumonia for Children between 0 to 15 Years: Case Study in Two Hospitals in Yaoundé

Introduction: The diagnosis of pneumonia is usually made based on clinical manifestations and chest X-ray. The use of ultrasound in detecting pulmonary diseases in general, and especially consolidation syndrome has been demonstrated. The objective of this study was to determine the accuracy of thoracic ultrasound compared to chest X-ray in the diagnosis of infectious pneumonia in children. Methods: Children between 0 to 15 years were included in our study. The lung ultrasound results obtained were compared with those of the chest X-ray used as the reference. Our data were introduced into the EpiInfo 3.5.4 software and analyzed with the EpiInfo 3.5.4 and IBMSPSS Statistics version 20.0 softwares. Microsoft Office Excel 2016 was used to produce Charts. Continuous quantitative variables were presented. Cohen’s Kappa concordance test was applied with confidence interval of 95%. Results: 52 children were enrolled in the study. In imaging, the dominant sign was consolidation syndrome (75.0%) of cases by chest radiography, and in 78.8% of cases by lung ultrasound (p < 0.05). The chest radiograph was identified pleural effusion in 5 cases whereas lung ultrasound was identified in 6 cases. 3 patients with apparently normal chest X-rays had pulmonary ultrasounds suggestive of pneumonia. The degree of agreement between chest X-ray and lung ultrasound in detecting lesions compatible with pneumonia was satisfactory (kappa: 0.784) and excellent in the detection of pleural effusion (0.898). Conclusion: Our study demonstrated that lung echography is a non-ionizing and reliable tool in the diagnosis of childhood’s pneumonia.

The Role of Thoracic Ultrasound in Diagnosing Pneumothorax

Diagnosis of a pneumothorax in some cases the can be difficult. Traditional gold-standard modalities may not be available or feasible to institute. In this situation, thoracic sonography for pneumothorax can be especially helpful, allowing a method of quickly ruling out this potentially life-threatening complication. Its sensitivity dan specificity of ultrasound is higher than conventional chest x-ray. The four sonograms useful to diagnose pneumothorax and their usefulness in ruling in and ruling out the condition are lung sliding, lung pulse, B-lines and lung point. (J Respir Indo. 2018; 38: 239-43)

Intensive Imaging-based Follow-up of Surgically Treated Localised Renal Cell Carcinoma Does Not Improve Post-recurrence Survival: Results from a European Multicentre Database (RECUR)

The optimal follow-up (FU) strategy for patients treated for localised renal cell carcinoma (RCC) remains unclear. Using the RECUR database, we studied imaging intensity utilised in contemporary FU to evaluate its association with outcome after detection of disease recurrence. Consecutive patients with nonmetastatic RCC (n=1612) treated with curative intent at 12 institutes across eight European countries between 2006 and 2011 were included. Recurrence occurred in 336 patients. Cross-sectional (computed tomography, magnetic resonance imaging) and conventional (chest X-ray, ultrasound) methods were used in 47% and 53%, respectively. More intensive FU imaging (more than twofold) than recommended by the European Association of Urology (EAU) was not associated with improved overall survival (OS) after recurrence. Overall, per patient treated for recurrence remaining alive with no evidence of disease, the number of FU images needed was 542, and 697 for high-risk patients. The study results suggest that use of more imaging during FU than that recommended in the 2017 EAU guidelines is unlikely to improve OS after recurrence. Prospective studies are needed to design optimal FU strategies for the future. Patient summaryAfter curative treatment for localised kidney cancer, follow-up is necessary to detect any recurrence. This study illustrates that increasing the imaging frequency during follow-up, even to double the number of follow-up imaging procedures recommended by the European Association of Urology guidelines, does not translate into improved survival for those with recurrence.

Detecting drug-resistant tuberculosis in chest radiographs

PurposeTuberculosis is a major global health threat claiming millions of lives each year. While the total number of tuberculosis cases has been decreasing over the last years, the rise of drug-resistant tuberculosis has reduced the chance of controlling the disease. The purpose is to implement a timely diagnosis of drug-resistant tuberculosis, which is essential to administering adequate treatment regimens and stopping the further transmission of drug-resistant tuberculosis.MethodsA main tool for diagnosing tuberculosis is the conventional chest X-ray. We are investigating the possibility of discriminating automatically between drug-resistant and drug-sensitive tuberculosis in chest X-rays by means of image analysis and machine learning methods.ResultsFor discriminating between drug-sensitive and drug-resistant tuberculosis, we achieve an area under the receiver operating characteristic curve (AUC) of up to 66%, using an artificial neural network in combination with a set of shape and texture features. We did not observe any significant difference in the results when including follow-up X-rays for each patient.ConclusionOur results suggest that a chest X-ray contains information about the likelihood of a drug-resistant tuberculosis infection, which can be exploited computationally. We therefore suggest to repeat the experiments of our pilot study on a larger set of chest X-rays.

OPTimal IMAging strategy in patients suspected of non-traumatic pulmonary disease at the emergency department: chest X-ray or ultra-low-dose CT (OPTIMACT)\u2014a randomised controlled trial chest X-ray or ultra-low-dose CT at the ED: design and rationale

BackgroundChest X-ray has been the standard imaging method for patients suspected of non-traumatic pulmonary disease at the emergency department (ED) for years. Recently, ultra-low-dose chest computed tomography (ULD chest CT) has been introduced, which provides substantially more detailed information on pulmonary conditions that may cause pulmonary disease, with a dose in the order of chest X-ray (0.1 vs. 0.05 mSv). The OPTimal IMAging strategy in patients suspected of non-traumatic pulmonary disease at the emergency department: chest X-ray or CT (OPTIMACT) study is a randomized trial designed to evaluate the effectiveness of replacing chest X-ray for ULD chest CT in the diagnostic work-up of patients suspected of non-traumatic pulmonary disease at the ED.MethodsTwo thousand four hundred patients presenting at the ED with pulmonary complaints and suspected of non-traumatic pulmonary disease will be enrolled in this multicenter, pragmatic, randomized trial. During randomly assigned periods of one calendar month, either conventional chest X-ray or ULD chest CT scan will be used as the imaging strategy. Randomization will rely on computer-generated blocks of 2 months to control for seasonal effects. Chest X-ray and ULD chest CT will be performed in a standardized way, after obtaining the clinical history and performing physical examination and initial laboratory tests. The primary outcome measure is functional health at 28 days. Secondary outcome measures are mental health, length of hospital stay, mortality within 28 days, quality-adjusted life years (QALYs) during the first 28 days, correct diagnoses at ED discharge as compared to the final post hoc diagnosis, and number of patients in follow-up because of incidental findings on chest X-ray or ULD chest CT. In an economic evaluation, we will estimate total health care costs during the first 28 days.DiscussionThis pragmatic trial will clarify the effects of replacing chest X-ray by ULD chest CT in daily practice, in terms of patient-related health outcomes and costs, in the diagnostic work-up of patients suspected of non-traumatic pulmonary disease at the ED.Trial registrationThe OPTIMACT trial is registered in the Netherlands National Trial Register under number NTR6163. The date of registration is December 6, 2016.

Boerhaave's syndrome: the role of conventional chest X-ray.

Boerhaave's syndrome: the role of conventional chest X-ray.

CT Findings in Solid Organ Transplant Patients With Sirolimus-Associated Lung Toxicity

SESSION TITLE: Medical Imaging: New Approaches to Old Technologies SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: mTOR inhibitors play an integral role in induction and long-term maintenance immunosuppressive regimens used in solid organ transplant. However, sirolimus has been associated with a spectrum of lung toxicities, including interstitial pneumonitis, bronchiolitis obliterans organizing pneumonia and diffuse alveolar hemorrhage, with estimated incidence 4.3-10%. Drugs’ direct toxicity and immunological toxicity have been proposed as possible pathophysiology of sirolimus-associated lung toxicity. We aim to characterize chest X-ray and computed tomographic (CT) scan features and add to the scant body of knowledge of role of imaging modalities in diagnosis of sirolimus-associated lung toxicity following solid organ transplant. METHODS: We identified patients on sirolimus as part of immunosuppressive regimen for solid organ transplant at our center between January 1999 and March 2013. Thirteen patients developed lung toxicity. We retrospectively screened patients with suspected sirolimus-associated lung toxicity and reviewed their chest X-rays and CT scans for characteristic diagnostic features. RESULTS: Thirteen patients with solid organ transplant were identified with suspected sirolimus-associated lung injury (10 kidneys, 1 kidney-pancreas, 1 liver and 1 heart). The mean age of patients was 62.4±10.9 years with male predominance (69%). Chest X-rays findings were normal in 31% of patients (n=4/13). 69% of patients (n=9/13) demonstrated interstitial infiltrates (4 bilateral, 4 left sided and 1 right sided) with predilection of lower lobes (Figure 1). Chest CT scans demonstrated interstitial infiltrates accompanied with ground-glass opacities. 53% of patients (n=7/13) had bilateral lower lobes involvement (Figure 2), 31% of patients (n=4/13) had left lower lobe involvement and 8% of patient (n=1/13) had right lower lobe involvement and 8% of patient (n=1/13) had right middle lobe involvement. CONCLUSIONS: Features of interstitial infiltrates and ground-glass opacities favoring lower lung lobes are suggestive of sirolimus-associated lung toxicity in solid organ transplant patients on sirolimus as part of their immunosuppressive regimen. Predilection of lower lung lobes favors direct drug toxicity as the mechanism of pneumonitis associated with mTOR inhibitors. Imaging findings may not be detectable in conventional chest X-rays and chest CT scan is recommended in solid organ transplant patients on sirolimus presenting with respiratory symptoms. CLINICAL IMPLICATIONS: Development of sirolimus associated-lung toxicity in solid organ transplant patients highlights the need for diagnostic criteria that results in early diagnosis and management, in order to avoid compromising patients’ allografts long-term survival at the expense of inducing a devastating lung disease that patients and physicians would end up regretting. Pulmonologists need to be more familiar with characteristics CT scan findings in patients with sirolimus-associated lung toxicity. DISCLOSURE: The following authors have nothing to disclose: Faisal Khateeb, Zaid Ammari, Aahd Kubbara, Yousef Abdel-Aziz, Fadi Safi No Product/Research Disclosure Information

The Diagnosis and Treatment of Hemoptysis.

Hemoptysis, i.e., the expectoration of blood from the lower airways, has an annual incidence of approximately 0.1% in ambulatory patients and 0.2% in inpatients. It is a potentially life-threatening medical emergency and carries a high mortality. This review article is based on pertinent publications retrieved by a selective search in PubMed. Hemoptysis can be a sign of many different diseases. Its cause remains unknown in about half of all cases. Its more common recognized causes include infectious and inflammatory airway diseases (25.8%) and cancer (17.4%). Mild hemoptysis is self-limited in 90% of cases; massive hemoptysis carries a worse prognosis. In patients whose life is threatened by massive hemoptysis, adequate oxygenation must be achieved through the administration of oxygen, positioning of the patient with the bleeding side down (if known), and temporary intubation if necessary. A thorough diagnostic evaluation is needed to identify the underlying pathology, site of bleeding, and vascular anatomy, so that the appropriate treatment can be planned. The evaluation should include conventional chest x-rays in two planes, contrastenhanced multislice computerized tomography, and bronchoscopy. Hemostasis can be achieved at bronchoscopically accessible bleeding sites with interventionalbronchoscopic local treatment. Bronchial artery embolization is the first line of treatment for hemorrhage from the pulmonary periphery; it is performed to treat massive or recurrent hemoptysis or as a presurgical measure and provides successful hemostasis in 75-98% of cases. Surgery is indicated if bronchial artery embolization alone is not successful, or for special indications (traumatic or iatrogenic pulmonary/vascular injury, refractory asper gilloma). The successful treatment of hemoptysis requires thorough diagnostic evaluation and close interdisciplinary collaboration among pulmonologists, radiologists, and thoracic surgeons.

Erratum to: Performance of ultralow-dose CT with iterative reconstruction in lung cancer screening: limiting radiation exposure to the equivalent of conventional chest X-ray imaging.

Erratum to: Performance of ultralow-dose CT with iterative reconstruction in lung cancer screening: limiting radiation exposure to the equivalent of conventional chest X-ray imaging.

Aortic arch calcification on chest X-ray combined with coronary calcium score show additional benefit for diagnosis and outcome in patients with angina.

BackgroundThe coronary artery calcium (CAC) and aortic arch calcification (AoAC) are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined with CAC for cardiovascular diagnosis and outcome in patients with angina.MethodsA total of 2018 stable angina patients who underwent chest X-ray and cardiac multi-detector computed tomography were followed up for four years to assess adverse events, which were categorized as cardiac death, stroke, myocardial infarction, or repeated revascularization. The extent of AoAC on chest X-ray was graded on a scale from 0 to 3.ResultsDuring the four years of follow-up, 620 patients were treated by coronary stenting and 153 (7%) adverse events occurred. A higher grade of AoAC was associated with a higher CAC score. Cox regression showed that the CAC score, but not AoAC, were associated with adverse events. In patients with CAC score < 400, AoAC showed an additive predictive value in detecting significant coronary artery disease (CAD). A gradual increases in the risk of adverse events were noted if AoAC was present in patients with similar CAC score.ConclusionsAs AoAC is strongly correlated with the CAC score regardless of age or gender, careful evaluation of CAD would be required in patients with AoAC on conventional chest X-rays.

Ultra low-dose chest ct with iterative reconstructions as an alternative to conventional chest x-ray prior to heart surgery (CRICKET study): Rationale and design of a multicenter randomized trial

BackgroundStroke after cardiac surgery is a severe complication with a persistently high incidence of 1.4 – 9.7%. Postoperative strokes are mainly embolic and can be provoked by manipulation and clamping of the aorta during cardiac surgery, resulting in the mobilization of atherothrombotic material and calcifications from the aortic wall. Computed tomography (CT) can offer preoperative visualization of aortic calcifications with low radiation exposure. We hypothesize that preoperative knowledge regarding the location and extent of aortic calcifications can be used to optimize surgical strategy and decrease postoperative stroke rate. Methods/designThe CRICKET study (ultra low-dose chest CT with iterative reconstructions as an alternative to conventional chest x-ray prior to heart surgery) is a prospective multicenter randomized clinical trial to evaluate whether non-contrast chest CT before cardiac surgery can decrease postoperative stroke rate by optimizing surgical strategy. Patients scheduled to undergo cardiac surgery aged 18 years and older are eligible for inclusion. Exclusion criteria are pregnancy, a chest/cardiac CT in the past three months, emergency surgery, concomitant or prior participation in a study with ionizing radiation and unwillingness to be informed about incidental findings. Subjects (n = 1.724) are randomized between routine care, including a chest x-ray, or routine care with an additional low dose chest CT. The primary objective is to investigate whether the postoperative in-hospital stroke rate is reduced in the CT arm compared to the routine care arm of the randomized trial. The secondary outcome measures are altered surgical approach based on CT findings and cost-effectiveness.

Performance of ultralow-dose CT with iterative reconstruction in lung cancer screening: limiting radiation exposure to the equivalent of conventional chest X-ray imaging.

To investigate the detection rate of pulmonary nodules in ultralow-dose CT acquisitions. In this lung phantom study, 232 nodules (115 solid, 117 ground-glass) of different sizes were randomly distributed in a lung phantom in 60 different arrangements. Every arrangement was acquired once with standard radiation dose (100 kVp, 100 references mAs) and once with ultralow radiation dose (80 kVp, 6 mAs). Iterative reconstruction was used with optimized kernels: I30 for ultralow-dose, I70 for standard dose and I50 for CAD. Six radiologists examined the axial 1-mm stack for solid and ground-glass nodules. During a second and third step, three radiologists used maximum intensity projection (MIPs), finally checking with computer-assisted detection (CAD), while the others first used CAD, finally checking with the MIPs. The detection rate was 95.5% with standard dose (DLP 126mGy*cm) and 93.3% with ultralow-dose (DLP: 9mGy*cm). The additional use of either MIP reconstructions or CAD software could compensate for this difference. A combination of both MIP reconstructions and CAD software resulted in a maximum detection rate of 97.5% with ultralow-dose. Lung cancer screening with ultralow-dose CT using the same radiation dose as a conventional chest X-ray is feasible. • 93.3% of all lung nodules were detected with ultralow-dose CT. • A sensitivity of 97.5 % is possible with additional image post-processing. • The radiation dose is comparable to a standard radiography in two planes. • Lung cancer screening with ultralow-dose CT is feasible.

Screening for pulmonary tuberculosis in a Tanzanian prison and computer-aided interpretation of chest X-rays.

Tanzania is a high-burden country for tuberculosis (TB), and prisoners are a high-risk group that should be screened actively, as recommended by the World Health Organization. Screening algorithms, starting with chest X-rays (CXRs), can detect asymptomatic cases, but depend on experienced readers, who are scarce in the penitentiary setting. Recent studies with patients seeking health care for TB-related symptoms showed good diagnostic performance of the computer software CAD4TB. To assess the potential of computer-assisted screening using CAD4TB in a predominantly asymptomatic prison population. Cross-sectional study. CAD4TB and seven health care professionals reading CXRs in local tuberculosis wards evaluated a set of 511 CXRs from the Ukonga prison in Dar es Salaam. Performance was compared using a radiological reference. Two readers performed significantly better than CAD4TB, three were comparable, and two performed significantly worse (area under the curve 0.75 in receiver operating characteristics analysis). On a superset of 1321 CXRs, CAD4TB successfully interpreted >99%, with a predictably short time to detection, while 160 (12.2%) reports were delayed by over 24 h with conventional CXR reading. CAD4TB reliably evaluates CXRs from a mostly asymptomatic prison population, with a diagnostic performance inferior to that of expert readers but comparable to local readers.

Repeated Monitoring With Transthoracic Echocardiography and Lung Ultrasound After Cardiac Surgery: Feasibility and Impact on Diagnosis.

Cardiorespiratory complications are common after cardiac surgery and current monitors used to diagnose these are invasive and have limitations. Transthoracic echocardiography and lung ultrasound are noninvasive and frequently improve diagnosis in critically ill patients but have not been reported for routine postoperative monitoring after coronary, valve, and aortic surgery. The aim was to determine whether both repeated postoperative transthoracic echocardiography and lung ultrasound revealed or excluded clinically important cardiac and respiratory disorders compared to conventional monitoring and chest x-ray. Prospective observational study. Tertiary university hospital. Ninety-one patients aged older than 18 undergoing cardiac surgery Postoperative clinical patient assessment for significant cardiac and respiratory disorders by the treating physician was recorded at 3 time points (day after surgery, after extubation and removal of chest drains and at discharge) using conventional monitoring and chest x-ray. After each assessment, transthoracic echocardiography and lung ultrasound were performed, and differences in diagnosis from conventional assessment were recorded. Transthoracic echocardiography was interpretable in at least 1 echocardiographic window in 99% of examinations. Transthoracic echocardiography and/or lung ultrasound changed the diagnosis of important cardiac and/or respiratory disorders in 61 patients (67%). New cardiac findings included cardiac dysfunction (38 patients), pericardial effusion (5), mitral regurgitation (2), and hypovolemia (1). New respiratory findings included pleural effusion (30), pneumothorax (4), alveolar interstitial syndrome (3) and consolidation (1). Routine repeated monitoring with cardiac and lung ultrasound after cardiac surgery is feasible and frequently alters diagnosis of clinically important cardiac and respiratory pathology.

Early detection of lung cancer: Low-dose computed tomography screening in China.

Lung cancer is currently the leading cause of cancer-related death in China and western countries for both men and women. Overall, the five-year survival rate of lung cancer is approximately 15%, whereas the five-year survival for patients with surgically resected early-stage disease is 60–80%. Screening is conceptually a good strategy for reducing the mortality rate of lung cancer. Randomized controlled trials in the 1960s and 1970s found that chest radiographic screening did not result in a reduction in mortality for high-risk individuals. Recently published data from the National Lung Screening Trial (NLST) showed a 20% reduction in lung cancer mortality in subjects who underwent low-dose computed tomography (LDCT) screening compared to those randomized to conventional chest X-ray. The encouraging results of the NLST, however, could not be confirmed by the preliminary results of ongoing European trials. More results from European randomized controlled trials are expected in the next few years. Recently, a number of lung cancer screening studies using LDCT have been initiated in China. This article briefly summarizes the results of the current and previous lung cancer screening trials worldwide, and focuses on the current status of LDCT lung cancer screening in China.

Radiation dose levels for conventional chest and abdominal X-ray procedures in elected hospitals in Sudan.

This study aimed to assess patient entrance surface air kerma (ESAK) during chest and abdominal X-ray procedures in screen film radiography (SFR) and computed radiography (CR) to establish dose reference levels. Patients' doses were measured in five hospitals for a total of 196 patients. ESAK was calculated from exposure parameters using DosCal software. The X-ray tube output (mGy mAs(-1)), accuracy of exposure factors, linearity and reproducibility were measured using an Unfors Xi dosimeter. The overall mean and range of ESAK during chest X-ray were 0.6 ± 0.3 (0.1-1.3) mGy, while for abdominal X-rays they were 4.0 ± 3.2 (1.3-9.2) mGy. Hospital with a CR system was found to use relatively higher doses. Dose values for abdominal X-ray procedures were comparable with previous studies. The dose for chest X-ray procedure was higher by a factor of 2-3 compared with the current international reference levels.

Immunoglobulin replacement therapy in antibody deficiency syndromes: are we really doing enough?

Immunoglobulin replacement therapy in antibody deficiency syndromes: are we really doing enough?

Radiologic management of haemoptysis: diagnostic and interventional bronchial arterial embolisation.

Hemoptysis can be a life-threatening pulmonary emergency with high mortality, is symptomatic of an underlying severe pulmonary disease and requires immediate diagnosis and treatment. Diagnostically, bronchoscopy, conventional chest x-ray and contrast-enhanced multislice computed tomography (MSCT) with CT angiography (CTA) provide information regarding the underlying pulmonary disease, bleeding site, the vascular anatomy of the bronchial arteries (BA) and extrabronchial branches, as well a basis for planning of endovascular intervention. Therapeutically, bronchial artery embolization (BAE) is a safe and effective technique in the hands of an experienced interventionist with profound knowledge of the BA anatomy and possible pitfalls as well as experience with first-line therapy of recurrent and massive hemoptysis or as an intervention prior to elective surgery. Recurrent episodes of hemoptysis are not uncommon and require a prompt repeat BAE after exclusion of extrabronchial systemic and pulmonary artery bleeding sources. This review article should give an overview of the history, anatomical and pathophysiological basics and the clinical context of hemoptysis and diagnosis, as well as a survey of management, treatment and results of BAE. Hemoptyses are life threatening and require urgent diagnostic and therapy. Chest x-ray, bronchoscopy, and contrast-enhanced MSCT with CTA should be carried out before therapeutic bronchial artery embolization (BAE). BAE for the treatment of massive and recurrent hemoptysis is safe and effective. False embolization in spinal branches of BA are the most serious complication of a BAE. Repeatedly BAE refractory cases should undergo elective surgery.

Topographic Analysis and Evaluation of Anatomical Landmarks for Placement of Central Venous Catheters Based on Conventional Chest X-Ray and Computed Tomography

Dulce, M.; Steffen, I. G.; Preuss, A.; Renz, D. M.; Hamm, B.; Elgeti, T. Author Information

Multi-detector computed tomography imaging of blunt chest trauma

Background and purposeChest trauma is a significant cause of mortality and morbidity, especially in the younger population. The purpose of this study was to evaluate the role of multi-detector computed tomography (MDCT) in the assessment of patients with blunt chest trauma. Patients and methodsA prospective study was conducted on thirty (30) patients with blunt chest trauma (21 males and 9 females, aged from 6 to 62years) and 29 control patients presented with any trauma other than blunt chest trauma (23 males and 6 females, aged from 10 to 68years) at the Emergency Department, Tanta University Hospital, from January 2013 to February 2014. Cases were subjected to clinical evaluation and radiological assessment of the chest using conventional chest X-ray (CXR) and multi-detector computed tomography. ResultsThe most common mode of injury was motor vehicle accidents (56.7%). On MDCT scan, the frequency of chest injuries were; chest wall injuries (86.7%), pleural injuries (80%), parenchymal injuries (56.7%), mediastinal injuries (30%) and finally the dorsal spine injuries (16.7%). MDCT is more sensitive, specific, and accurate than CXR in the assessment of blunt chest trauma and management of patients. ConclusionMDCT is the modality of choice for rapid assessment of emergency chest trauma patients, when chest X-ray was inconclusive.