Diagnostic Accuracy Of Chest X-ray Research Articles

Diagnostic accuracy of chest x-ray in covid -19, taking high resolution computed tomography as gold standard

ABSTRACT Objective: To determine sensitivity & specificity of chest X-ray in COVID-19, taking High-Resolution Computed Tomography as gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Radiology Deptt, Margalla Hospital, Taxila and Islamabad Diagnostic Centre, Wah. Two years (February 2020 to February 2022). Patients and Methods: The sample comprised 100 COVID-19 patients (Positive Polymerase chain reaction (PCR) test). Their HighResolution Computed Tomography (HRCT) was done which was considered a gold standard for diagnosing COVID-19. Their Chest X-rays (CXR) were performed, and findings of both modalities were compared. Patients having respiratory tract symptoms but PCR negative for COVID-19 were excluded. Results: The research had 49 males & 51 females having a median (IQR) age of 46.50(35-55.75) years. The minimum & maximum ages were 6 years and 83 years respectively. Among 100 PCR-positive patients, 29 were found normal on HRCT and 30 on CXR. For moderate cases, the chest X-rays were 72% sensitive & 90.67% specific, with Positive Predictive Value (PPV), Negative Predictive Value (NPV) & diagnostic efficacy of 72%,90.67% & 86% respectively. Similarly, other severity levels were assessed. Conclusion: CXR has acceptable diagnostic accuracy for COVID-19 patients, especially with good sensitivity for moderate cases and better specificity for severe cases. A portable chest radiograph might be regarded as an initial alternative imaging modality for patients with COVID-19 signs and symptoms in remote areas. Key words: COVID-19, CXR , HRCT

Diagnostic Accuracy of Chest X-Ray for the Diagnosis of Interstitial Lung Disease Keeping High Resolution Computed Tomography (HRCT) as Gold Standard

Objective: To determine diagnostic accuracy of chest x-ray for the diagnosis of interstitial lung disease keeping high resolution computed tomography as gold standard. Study design and setting: Comparative cross sectional study, Department of Radiology PNS Shifa Karachi Methodology: Study done over the period of 1 year and two months. 160 Patients were included by using non-probability consecutive sampling all underwent CXR and HRCT chest. Sample size was calculated using sensitivity and specificity calculator for sample size with expected sensitivity of 80%7, expected specificity of 82.98%7and expected prevalence of 76%7 Results: In this 160 patients were included by using non probability sampling. Among all 116(72.50%) were males while 44 (27.50%) were females. Sensitivity (SE),specificity, positive predictive value (PPV) negative predictive value(NPV) and diagnostic accuracy of CXR vs HRCT in cases of ILD was 88.89%, 87.50%, 88.89%, 87.50% and 88.24% respectively. Conclusion: Chest x-ray has high diagnostic accuracy and simultaneously readily available and cost effective modality, therefore it can be effectively used as alternative to HRCT

Diagnostic Accuracy of Chest X-Ray in Interstitial Lung Diseases, Keeping High Resolution Computed Tomography Scan as Gold Standard

OBJECTIVES To determine the accuracy of the plain chest radiograph in diagnosing interstitial lung diseases (ILDs), keeping a high-resolution CT scan (HRCT) as the gold standard. METHODOLOGY A cross-sectional study was conducted. A total of 75 patients who visited the Department of Radiology department over two years were assessed by prospective analysis of their radiology reports. All the HRCTs and Chest X-ray images were reviewed. Data collected was recorded on a specially designed proforma and entered into Microsoft Excel and SPSS (Version 22.0. IBM Corp., Armonk, NY). Patients with a history of acute exacerbation of symptoms were excluded. RESULTSThe median age of the patients was 59 years, with SD 12.2. Chest radiographs detected interstitial lung disease (ILD) in 42/75 (56%).). The chest radiograph’s sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were 76%, 84%, 86.3% and 76.7%. A plain chest X-ray's positive likelihood ratio (LR+) was 4.75, while the negative likelihood ratio (LR-) was 0.28. The overall accuracy of CXR was calculated as 78.6%. CONCLUSION Our study concluded that chest X-ray is the ideal initial investigation for diagnosing Interstitial lung disease (ILDS) with an accuracy of 78.6% compared to HRCT.

Lung Ultrasound in Coronary Care Unit, an Important Diagnostic Tool for Concomitant Pneumonia.

In the setting of a coronary care unit (CCU), the early detection of pneumonia is of paramount important to prevent severe complications. This study was designed aiming to evaluate the diagnostic accuracy of lung ultrasound (LUS) in the detection of pneumonia and compared with chest X-ray (CXR). We enrolled 110 consecutive patients admitted to the CCU of Federico II University Hospital. Each patient underwent CXR and bedside LUS on admission. The final diagnosis (pneumonia vs. no pneumonia) was established by another clinician reviewing clinical and laboratory data independent of LUS results and possibly prescribing chest contrast-enhanced CT (n = 34). The mean age was 70 ± 11 years old, and 68% were males. Pneumonia was clinically diagnosed in 26 (23%) patients. LUS was positive for pneumonia in 24 patients (sensitivity 92%, specificity 81%). Chest radiography was positive for pneumonia in nine patients (sensitivity 43%, specificity 95%). Using CT scan as a reference, LUS exhibited 92% sensitivity and a specificity of 96%. In ROC curve analysis, the diagnostic accuracy of CXR and LUS for the diagnosis of pneumonia was 0.86 (95% CI 0.77-0.94), which was higher than CXR 0.68 (95% CI 0.55-0.84), p < 0.05. Based on the findings of the present study, the accuracy of LUS in the detection of pneumonia was significantly higher than chest X-ray with comparable sensibility to CT scan.

Diagnostic Accuracy of Chest X-Ray in Detecting Chest Tube Malpositions

Objective: To determine the diagnostic accuracy of chest x-ray in detecting chest tube malpositions. Design of the Study: It was a cross-sectional survey. Place and Duration of Study: This study was carried at the Department of Radiology, Civil Hospital Karachi and Shaheed Mohtarma Benazir Bhutto (SMBB) Trauma Centre Karachi over 6 months from28th January 2021 to 27th July 2021. Patients and Methods: This study comprised a total of 191 patients with blunt or penetrating chest damage needing a tube thoracotomy. An incision in the skin was made directly above the rib. A suitable-sized chest tube was placed inside, fastened with a silk 1-0 suture, and an aseptic dressing was placed. The patient was subsequently transported for a chest CT scan without contrast and a X-ray of chest (frontal and lateral views). Chest tube malposition, or CTM, was identified on a frontal, lateral, or both radiographs. All information was recorded in the Performa. Results: The patients were 35.9611.387 years old on average. 26.1% (52/199) of the patients had malposition, which was verified by CT. The frontal chest x-sensitivity, ray's specificity, positive predictive value, negative predictive value, and accuracy in detecting malposition were 36.5%, 100%, 100%, 81.7%, and 83.4%, respectively, and the lateral chest x-were ray's 15.4%, 100%, 100%, 77%, and 77.9%%. The combined frontal and lateral chest x-sensitivity, ray's specificity, PPV, NPV, and accuracy were 38.5%, 100%, 100%, 82.1%, and 77.4%, respectively, in detecting malposition. 83.4% of chest x-rays with combined frontal and lateral views correctly identified malposition. Practical Implication: A literature search reveals that there is relatively little information available about this topic in our population. As a result, it gives the study a solid justification since its main objective is to compare the diagnostic efficacy of frontal and lateral CXR to that of a CT scan in identifying chest tube malposition. Conclusion: When a chest x-ray is taken from both the front and the side, its accuracy in detecting malposition is 83.4 percent. In high negative and positive findings for the diagnosis of thorax injuries make chest X-ray an essential aspect of the first therapy of a trauma patient. Keywords: Diagnostic Accuracy, Thoracostomy, Chest tube malpositions, Chest X-Ray, CT scan, Radiology

Diagnostic accuracy of chest X-ray for diagnosis of COVID-19

Diagnostic accuracy of chest X-ray for diagnosis of COVID-19

DIAGNOSTIC ACCURACY OF CHEST X-RAY IN THE DETECTION OF PNEUMOTHORAX IN BLUNT CHEST TRAUMA PATIENTS WITH CT AS THE GOLD STANDARD

Background: To study the diagnostic accuracy of chest X-ray in the detection of pneumothorax in blunt chest trauma patients with CT as the Gold Standard
 Methods: The present study was conducted from 31th July 2018 to 30th July 2019. A total of 36 patients were enrolled in the study.
 Results: On Chest X-Ray Supine AP view, pneumothorax was detected in 11 of 24 patients. The sensitivity of Chest X-Ray Supine AP view was 45.83%, specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 48% and accuracy was 63.89% for the diagnosis of pneumothorax.
 Conclusion: A Chest radiograph is the most preferred and relevant primary investigation in the diagnosis of pneumothorax even with the various advanced techniques that are available. X-ray being relatively cheaper and is easily available even at the peripheral centers at the primary health care level.
 Keywords: X-ray, CT, Pneumothorax

Use of Pulmonary Computed Tomography for Evaluating Suspected Stroke-Associated Pneumonia

ObjectivesAccurate and timely diagnosis of pneumonia complicating stroke remains challenging and the diagnostic accuracy of chest X-ray (CXR) in the setting of stroke-associated pneumonia (SAP) is uncertain. The overall objective of this study was to evaluate the use of pulmonary computed tomography (CT) in diagnosis of suspected SAP. Materials and MethodsPatients with acute ischemic stroke (IS) or intracerebral hemorrhage (ICH) were recruited within 24h of clinically suspected SAP and underwent non-contrast pulmonary CT within 48h of antibiotic initiation. CXR and pulmonary CT were reported by two radiologists. Pulmonary CT was used as the reference standard for final diagnosis of SAP. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and diagnostic odds ratio (OR) for CXR were calculated. Results40 patients (36 IS, 4 ICH) with a median age of 78y (range 44y-90y) and a median National Institute of Health Stroke Scale score of 13 (range 3-31) were included. All patients had at least one CXR and 35/40 patients (88%) underwent pulmonary CT. Changes consistent with pneumonia were present in 15/40 CXRs (38%) and 12/35 pulmonary CTs (34%). 9/35 pulmonary CTs (26%) were reported normal. CXR had a sensitivity of 58.3%, specificity of 73.9%, PPV of 53.8 %, NPV of 77.2 %, diagnostic OR of 3.7 (95% CI 0.7 - 22) and an accuracy of 68.5% (95% CI 50.7% -83.1%). DiscussionCXR has limited diagnostic accuracy in SAP. The majority of patients started on antibiotics had no evidence of pneumonia on pulmonary CT with potential implications for antibiotic stewardship. ConclusionsPulmonary CT could be applied as a reference standard for evaluation of clinical and biomarker diagnostic SAP algorithms in multi-center studies.

Chest X-Ray vs Chest Computed Tomography in Diagnosis of Various Lung Pathologies in Critically ILL Patients

Abstract Background A CT scanner makes many measurements, from different rotational angles, of X-ray attenuation (weakening in force or intensity) through the cross-sectional plane of the thorax. It then uses these data to reconstruct a digital representation of the cross-section with each pixel of the image representing a measurement of the mean attenuation through the thickness of the predetermined segment. This measurement quantifies the fraction of radiation removed in passing through a given amount of material of a certain thickness. Objective To compare the chest CT scan and chest x-ray for early detection of pulmonary complications for adults hospitalized in intensive care unit. Patients and Methods In the present prospective study, we included 40 adults’ patients, who were hospitalized in Intensive Care Unit (ICU), in order to compare the diagnostic accuracy of chest X-ray and CT scan for early detection of pulmonary complications. Patients were recruited from the ICUs of Ain Shams University and Misr University for Science and Technology Hospitals. They were included whether they had primary respiratory manifestations or started to develop respiratory manifestations during ICU stay. Results In the present study, we included 10 patients who were diagnosed with pulmonary embolism. The mean age of the included patients was 59.7 ± 16.3 years old. Five patients were correctly identified by the chest X-ray. Thus, the chest X-ray sensitivity for the detection of pneumonia was 50% and the positive predictive value was 100%. Conclusion In our cohort of patients with a wide variety of chest disorders, routine chest X-ray was not useful to clinicians in the diagnosis of lung disease, compared to chest CT. In addition, chest X-ray had a very low sensitivity in specific conditions like pulmonary embolism and pneumothorax.

Sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms: a systematic review.

Despite increasing use of computed tomography (CT), chest X-ray remains the first-line investigation for suspected lung cancer in primary care in the UK. No systematic review evidence exists as to the sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms. To estimate the sensitivity of chest X-ray for detecting lung cancer in symptomatic people. A systematic review was conducted to determine the sensitivity of chest X-ray for the detection of lung cancer. Databases including MEDLINE, EMBASE, and the Cochrane Library were searched; a grey literature search was also performed. A total of 21 studies met the eligibility criteria. Almost all were of poor quality. Only one study had the diagnostic accuracy of chest X-ray as its primary objective. Most articles were case studies with a high risk of bias. Several were drawn from non-representative groups, for example, specific presentations, histological subtypes, or comorbidities. Only three studies had a low risk of bias. Two primary care studies reported sensitivities of 76.8% (95% confidence interval [CI] = 64.5 to 84.2%) and 79.3% (95% CI = 67.6 to 91.0%). One secondary care study reported a sensitivity of 79.7% (95% CI = 72.7 to 86.8%). Though there is a paucity of evidence, the highest-quality studies suggest that the sensitivity of chest X-ray for symptomatic lung cancer is only 77% to 80%. GPs should consider if further investigation is necessary in high-risk patients who have had a negative chest X-ray.

Yield of chest X-ray tuberculosis screening of immigrants during the European refugee crisis of 2015: a single-centre experience.

Our aim was to determine the prevalence of tuberculosis (TB), the number needed to screen (NNS), and the diagnostic accuracy of chest X-ray (CXR) screening to detect active pulmonary TB during the 2015 European refugee crisis. We evaluated data of all refugees who underwent CXR screeningin a single-centre of one German metropolitan area in 2015. We determined the prevalence of TB, NNS, and accuracy of CXR to detect active pulmonary TB. Reference method for active TB was the database of all definite TB cases registered at the Department of Public Health. A total of 17,487 immigrants underwent single-centre CXR screening in 2015; prevalence of definite pulmonary TB was 0.103%. The NNS for detecting one case of active pulmonary TB was 1749. CXR had a sensitivity of 55.6% [95% confidence interval (CI) 30.8-78.5%) and a specificity 98.3% (CI 98.1-98.5%) to reveal one case of active TB. Our single-centre study indicates that chest X-ray screening for TB during the 2015 European refugee crisis was of low yield due the low prevalence of TB and high number needed to screen, thus implicating the need for improved screening algorithms adapted to the overwhelming number of refugees. • Prevalence of pulmonary tuberculosis (TB) among refugees in 2015 was low (0.103%). • The number needed to screen to detect one case of active pulmonary TB was 1749. • Tuberculosis X-ray screening resulted in a low sensitivity and high specificity. • Tuberculosis X-ray screening during the European refugee crisis is of low yield. • Improved screening algorithms are needed due to the overwhelming the number of refugees.

Clinical impact of pulmonary sampling site in the diagnosis of ventilator-associated pneumonia: A prospective study using bronchoscopic bronchoalveolar lavage

PurposeIt is unclear whether ventilator-associated pneumonia (VAP) is actually a bilateral and multifocal process. In addition, the diagnostic role of chest x-ray is under debate. Assuming a low microbiologic concordance between the left and right lungs, the reliability of a single pulmonary sampling becomes questionable. The purpose of this study was to determine whether the choice of the pulmonary sampling area is clinically relevant in the management of VAP. MethodsIn 79 patients admitted to a university general intensive care unit with clinically suspected VAP, right- and left-lung bronchoalveolar lavage (BAL) samples were taken with separate bronchoscopes and quantitatively cultured. Primary end-point variable was microbiologic concordance rate between right- and left-lung BAL cultures. Secondary outcomes included predictors of microbiologic concordance, rates of appropriate antibiotic treatment, and diagnostic accuracy of chest x-ray. ResultsBAL cultures were bilaterally negative in 21 (27%) of 79 patients, bilaterally positive in 36 (46%), and unilaterally positive (right in 12, left in 10) in 22 (28%). Intra-patient concordance was observed in 47 (59.5%) of 79 cases and independently associated with purulent secretions and bilateral infiltrates on chest x-ray. In simulated prescribing experiments, treatments chosen based on right or left cultures alone were as appropriate as those based on bilateral data in >90% of cases. The presence of a radiographic infiltrate in the sampling area predicted BAL culture positivity with a positive predictive value of only 61%. ConclusionsIn patients with clinically suspected VAP (especially those without purulent secretions or without radiographically documented bilateral infiltrates), quantitative culture of a single BAL sample may provide an incomplete assessment of lung microbiology, without having a relevant impact on the appropriateness of antimicrobial treatment. These findings suggest that single sampling of respiratory secretions, regardless radiographic opacity, seems to be a reliable diagnostic method in the management of VAP.

Diagnostic Value of Chest Radiography in Pediatric Cardiovascular Diseases: A Retrospective Study in Tabriz, Northwest of Iran

Background and Objective: Chest X-ray is usually the first radiography performed for a newborn. This test is easily accessible and yet a basic screening method. Different results have been reported in various studies regarding the diagnostic value of chest X-ray in cardiovascular disease in children. Materials and Methods: The study was carried out retrospectively using the medical files of 100 patients under 15 years of age who were referred to Tabriz Children’s Hospital during 2013-2014. The data obtained were analyzed with SPSS-17. The mean difference test was used to compare the quantitative variables. P-values less than 0.05 were considered significant. Findings: Fifty-two patients (52%) were male. Their mean age was 4.54  1.22 (0-108) months, and the patients’ mean weight was 4.38  0.34 (1.25-27) kg. Cardiovascular examination and radiology report were negative in 70% and 57% of the patients, respectively, while cardiologic assessments revealed cardiovascular problems in 70% of the cases. The diagnostic accuracy, sensitivity, and specificity, and the positive and negative predictive value of chest X-ray in this study were 61%, 80%, 53%, 86%, and 42%, respectively. In addition, gender, age, weight, the presence or absence of clinical signs, and the type of cardiovascular disease had no effect on the diagnostic accuracy of chest X-ray. Conclusion: According to the results, chest radiography cannot be referred to as a test to confirm or rule-out cardiovascular disease in children. Therefore, when a cardiovascular disease is suspected in physical examination, echocardiography can be recommended without a need for chest X-ray.

Diagnostic Accuracy of Chest x-Ray and Ultrasonography in Detection of Community Acquired Pneumonia; a Brief Report.

Chest x-ray (CXR) is the simplest diagnostic tool of Community Acquired Pneumonia (CAP), but it has some limitation. Therefore, the aim of this study is comparing the diagnostic accuracy of CXR and chest ultrasonography (CUS) in detection of CAP. In the present study, a consecutive sample of suspected patients with CAP was underwent CUS, CXR, and chest computed tomography (CT) scan. Diagnostic accuracy of CUS and CXR was assessed by calculating the sensitivity, specificity, predictive values, and likelihood ratios using SPSS 20 statistical software. 30 patients with CAP were enrolled (93.3% male with mean age of 63.8 ± 18.3 years). Sensitivity of CUS and CXR in detection of CAP were 100.0% (95% Cl: 85.4-100.0) and 93.1% (95% Cl: 75.8-98.8), respectively. Specificity of CXR was 0.0 (95% Cl: 0.0-94.5), while the CUS specificity was not calculable. Findings of the present study demonstrated on the higher diagnostic accuracy of CUS versus CXR in detection of pneumonia.