Diagnostic Chest X-ray Research Articles

Skin dose estimation in adults undergoing diagnostic chest X-ray examinations at Al-Zahra Teaching Hospital in Wasit Governorate, Iraq

This research intended to calculate skin dose (mgy) was determined in 30 adult patients. The average value of the Tube’s potential kVp range from 72 kVp To 100 (kVp) is 9.646±1.76 kVp. The average value of the SSD (cm) range from 100 cm to 180 cm is 22.558±4.118 cm, and the average value of the Tube load (mAs) range from 3 MAs to 16 MAs is 3.727±0.680. Additionally, the SKIN DOSE was from 0.06 mGY to 0.57 mGY, with an average of 0.120 mGY. It was found that the dose results were within the prescribed range of 0.4 mGy; this is recommended by international organizations that protect against radiation. Except for a few instances, the frequency of quality assurance (QA) and quality control (QC) was higher. As a result, the skin dose to patients who have chest exams at Al-Zahra Teaching Hospital in Wasit Province was equivalent to the Global standard.

Radiation Dose Estimation to Adult Patients Undergoing Diagnostic Chest X-Rays Examinations in Kebbi State, North-Western Nigeria

The hyperconsciousness of radiation dose delivered to the patient during chest radiological X-ray procedures are prerequisite to negate menace of exposure. The pinpoint of this research is to inquest radiation doses received by the patient for routine individual radiological chest x-ray procedures in health care system associated to Kebbi State Government, Nigeria. Entrance Surface Dose and effective dose in accordance with the exposure factors collected for the real examinations were estimated by Cal Dose_X 5.0 software. Diagnostic reference levels [75^th percentile] and other statistical parameters were calculated by the use of M. S excels spread sheet. The results obtained for ESD in this research work were 2.95mGy, 2.24mGy & 2.25mGy and 1.71mGy, 1.77mGy & 2.55mGy for Chest anteroposterior [AP], posteroanterior [PA] and lateral [LAT] respectively for Sir Yahaya Memorial Hospital (SYMH) and Federal Medical Centre (FMC), Birnin Kebbi. The effective doses were 0.68 mSv, 0.18 mSv& 0.09 mSv and 0.31 mSv, 0.13 mSv & 0.14 mSv for Chest AP, PA & LAT for SYMH and FMC respectively. Similarly, diagnostic reference level for chest AP, PA, & LAT were 2.34, 3.32 & 2.82, and 2.02, 1.88 & 3.19 respectively for SYMH and FMC. The results were compared with national and international studies. The ESD and DRLs reported in this research work for chest examinations were remarkably higher than that of the European Commission (2010), Australia (2017), NRPB (2000), UNSCEAR (2008), Iran (2008) and other research work reported elsewhere. For effective dose, the results were comparatively high except for few research work published in literatures. Therefore, the obtained results in this work revealed that the variations in the results among the two centres and other studies may likely be due to the improper selection of exposure parameters, patientbody sizes, and technical know-how of the staff. Finally, proper selection of radiological parameters and educational training to the staff can significantly reduce the risk of absorbed dose to patients.

MODERN VIEW FROM UKRAINE ON ETIOLOGY, PATHOGENESIS AND CLINICAL-DIAGNOSTIC ASPECTS OF COMMUNITY-ACQUIRED PNEUMONIA IN CHILDREN

Pneumonia is a disease characterized by lung tissue inflammation and the development of respiratory failure. Pneumonia is the most common infectious cause of childhood mortality, occurring every 43 seconds worldwide. Despite advancements in medicine and the use of cutting-edge diagnostic, treatment, and preventive technologies, the incidence of pneumonia remains relatively high, especially in resource-poor countries, adversely affecting the socio-economic life of society. Objective: To summarize contemporary scientific perspectives on the classification, etiology, pathogenesis, and clinical-diagnostic aspects of community-acquired pneumonia in children. Materials and Methods: The literature search was conducted using PubMed, Scopus, Web of Science, WHO, UNICEF databases, international protocols, as well as domestic scientific manuals and professional publications, and medical care standards. Search terms included "community-acquired pneumonia," "pneumonia in childhood," and "pneumonia in children." The analysis utilized methods such as a systemic approach, epidemiological analysis, bibliosemantic analysis, and graphical representation. Results: It was conducted the search and analysis of modern scientific medical literature on community-acquired pneumonia in childhood. Pneumonia is a leading infectious cause of illness and hospitalization in children worldwide. Bacteria, viruses, and mixed infections are identified among the main etiological agents, with cases of non-specific pathogens also observed. The variation in pathogens is presented based on age groups. It is discussed major risk factors for community-acquired pneumonia and pathways of pathogen penetration. Modern insights into the disease's pathogenesis are analyzed, involving a complex process with stages characterized by the development of infectious toxemia, respiratory failure, and disturbances in water-electrolyte balance. The main clinical symptoms are described according to the child's age, along with contemporary methods of laboratory and instrumental diagnostics of community-acquired pneumonia. Conclusions: Information from scientific literature is provided on the contemporary definition, classification, epidemiology, etiology, pathogenesis, clinical presentation, and diagnostics of community-acquired pneumonia in childhood. Currently, severe and non-severe forms of pneumonia are distinguished based on respiratory rate and additional threatening symptoms. The increasing incidence of viral-bacterial pneumonia is noted, with bacteria remaining the primary etiological factor. Pneumococcus and Haemophilus influenzae type B predominate among bacteria. It is also observed an increase in cases of viral pneumonia, attributed to respiratory syncytial and coronavirus infections. The disease's pathogenesis involves multiple phases with the involvement of other organ systems. Clinical features of community-acquired pneumonia include fever, respiratory failure, and cough. Laboratory diagnostic methods include a complete blood count, determination of C-reactive protein levels, and procalcitonin. Among diagnostic methods, chest X-ray, computed tomography, and ultrasound diagnostics of the chest organs are considered the most conclusive.

Covid-19 Analysis and Detection Using Chest X-Ray Images

Abstract: COVID-19 is the most lethal and life-threatening sickness induced by a single corona virus. In December 2019, the Corona virus, which seems originated in Wuhan, China and has been accountable for a significant quantity of fatalities, soon distributed around the world. A correct diagnostic can enable the rapid identification of COVID-19, even if there are no evident manifestations, and this can help people live longer. The most common clinical procedures Diagnostic tests and chest X-rays can both diagnose this illness. This study found that COVID-19 may be spotted using an object recognition method of chest X-ray images and Tomography. Such pictures give vital info on the COVID-19 virus, thus according to ongoing study based on radiology imaging methods... This suggested method, utilizing state-of-the-machine learning capabilities, which has been determined to be profitable in recognizing COVID-19 and when combined with chest radiography, can assist in the correct identification of the condition. The suggested approach for binary classification is designed to offer reliable diagnosis for patients with and without COVID. The results show that VGG-19 is the optimal configuration cantered on the picture, with 98.87% in connection comparisons and 95.91 percentage efficacies in insurance status identification. Each layer has its own filtering, hence convolutional layers were utilized. As a result, the VGG-19 classification system was competent in categorizing COVID-19 instances. . This approach, on the other hand, might be considerably enhanced by changing it or adding a convolution operation on front of it. Our system can help radiology validate their initial screenings and can also be used to quickly test affected role over the web

MS-CheXNet: An Explainable and Lightweight Multi-Scale Dilated Network with Depthwise Separable Convolution for Prediction of Pulmonary Abnormalities in Chest Radiographs

Pulmonary diseases are life-threatening diseases commonly observed worldwide, and timely diagnosis of these diseases is essential. Meanwhile, increased use of Convolution Neural Networks has promoted the advancement of computer-assisted clinical recommendation systems for diagnosing diseases using chest radiographs. The texture and shape of the tissues in the diagnostic images are essential aspects of prognosis. Therefore, in the latest studies, the vast set of images with a larger resolution is paired with deep learning techniques to enhance the performance of the disease diagnosis in chest radiographs. Moreover, pulmonary diseases have irregular and different sizes; therefore, several studies sought to add new components to existing deep learning techniques for acquiring multi-scale imaging features from diagnostic chest X-rays. However, most of the attempts do not consider the computation overhead and lose the spatial details in an effort to capture the larger receptive field for obtaining the discriminative features from high-resolution chest X-rays. In this paper, we propose an explainable and lightweight Multi-Scale Chest X-ray Network (MS-CheXNet) to predict abnormal diseases from the diagnostic chest X-rays. The MS-CheXNet consists of four following main subnetworks: (1) Multi-Scale Dilation Layer (MSDL), which includes multiple and stacked dilation convolution channels that consider the larger receptive field and captures the variable sizes of pulmonary diseases by obtaining more discriminative spatial features from the input chest X-rays; (2) Depthwise Separable Convolution Neural Network (DS-CNN) is used to learn imaging features by adjusting lesser parameters compared to the conventional CNN, making the overall network lightweight and computationally inexpensive, making it suitable for mobile vision tasks; (3) a fully connected Deep Neural Network module is used for predicting abnormalities from the chest X-rays; and (4) Gradient-weighted Class Activation Mapping (Grad-CAM) technique is employed to check the decision models’ transparency and understand their ability to arrive at a decision by visualizing the discriminative image regions and localizing the chest diseases. The proposed work is compared with existing disease prediction models on chest X-rays and state-of-the-art deep learning strategies to assess the effectiveness of the proposed model. The proposed model is tested with a publicly available Open-I Dataset and data collected from a private hospital. After the comprehensive assessment, it is observed that the performance of the designed approach showcased a 7% to 18% increase in accuracy compared to the existing method.

Survey of Absorbed Dose from Chest X-Ray of Paediatric Patients in Port Harcourt, Nigeria: A Cross-Sectional Study

Background: Radiation protection in paediatric radiology deserves special attention as children are supposed to be more sensitive to radiation than adults. Aim: This study was designed to evaluate the radiation doses for paediatric patients undergoing diagnostic chest X-ray examination. Materials and Methods: This was a cross-sectional survey, which targeted paediatric patients of (0-10) years who were referred by their physicians for chest X-rays examination. The data used for this work were generated using a Thermoluminescence dosimeter (TLD) chip. One TLD chips was placed in the front of the chest to measure the Entrance Surface Dose (ESD) (µGy) and another at the back of the patient directly opposite the one in front to measure the Exit Dose (ED) (µGy). Patient dose, age, ESD, ED and absorbed dose were obtained. The obtained data were analyzed using descriptive statistics. Results: The mean ESD, ED and absorbed dose values were 1.8330± 1.122mGy, 1.0913± 0.7505mGy and 0.7520 ± 3.8160mGy respectively. The ED values in chest X-rays were 0.73± 0.30mGy for age group <1 year, 1.15± 0.91mGy for age group 1-5 years and 6-10 years 1.09± 0.75mGy. The ESD were 3.06 ± 1.76mGy for age group <1, 3.02± 2.04mGy for age group 1-5 years and 6-10 years 1.83± 1.12mGy. The absorbed dose values obtained were 1.88± 1.75mGy for age group <1 year, 1.88± 1.67mGy for age group 1-5 years and 0.75± 3.82mGy for age group 6-10 year. Conclusion: The values for Exit Dose, Entrance Surface Doses, and Absorbed Dose have been determined and it was found to be slightly higher than UNSCEAR values. Keywords: Children, Diagnostic reference level, Radiation.

COVID-19 diagnosis from chest x-rays: developing a simple, fast, and accurate neural network

PurposeChest x-rays are a fast and inexpensive test that may potentially diagnose COVID-19, the disease caused by the novel coronavirus. However, chest imaging is not a first-line test for COVID-19 due to low diagnostic accuracy and confounding with other viral pneumonias. Recent research using deep learning may help overcome this issue as convolutional neural networks (CNNs) have demonstrated high accuracy of COVID-19 diagnosis at an early stage.MethodsWe used the COVID-19 Radiography database [36], which contains x-ray images of COVID-19, other viral pneumonia, and normal lungs. We developed a CNN in which we added a dense layer on top of a pre-trained baseline CNN (EfficientNetB0), and we trained, validated, and tested the model on 15,153 X-ray images. We used data augmentation to avoid overfitting and address class imbalance; we used fine-tuning to improve the model’s performance. From the external test dataset, we calculated the model’s accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F1-score.ResultsOur model differentiated COVID-19 from normal lungs with 95% accuracy, 90% sensitivity, and 97% specificity; it differentiated COVID-19 from other viral pneumonia and normal lungs with 93% accuracy, 94% sensitivity, and 95% specificity.ConclusionsOur parsimonious CNN shows that it is possible to differentiate COVID-19 from other viral pneumonia and normal lungs on x-ray images with high accuracy. Our method may assist clinicians with making more accurate diagnostic decisions and support chest X-rays as a valuable screening tool for the early, rapid diagnosis of COVID-19.

What is the role of chest X-ray imaging in the acute management of children with sickle cell disease?

Children with sickle cell disease (SCD) frequently present to hospital acutely unwell and are often exposed to diagnostic chest X-rays (CXRs). Little evidence exists to determine when CXRs are clinically useful. Using electronic hospital records, we audited CXR use in children aged 0-18 who presented to hospital over the past 10years in both an inpatient and emergency department setting. From a total of 915 first CXRs, only 28·2% of CXRs (n=258) had clinically significant findings that altered management or final diagnosis. Of these abnormalities, consolidation represented 52·3%, effusion 8·9%, cardiomegaly 8·4% and sickle cell-related bone changes 6·3%. Indications for CXR of respiratory distress (OR=3·74, 95% CI 2·28-6·13), hypoxia (OR=1·86, 95% CI 1·50-2·31) and cough (OR=1·64, 95% CI 1·33-2·02), were more likely to have significant CXR findings. Patients who had higher peak fever (38·4°C vs. 37·4°C, P=0·001), higher peak CRP (156·4 vs. 46·1, P<0·001) and higher WCC (20·2 vs. 13·6, P<0·001) were more likely to have clinically significant abnormalities on CXR. We found a decision tool using either hypoxia, cough, respiratory distress, T>38°C, CRP>50 or WCC>15×109 /l as indications for CXR, to have a sensitivity of 88% (with 95% CI 0·78-0·95) and specificity of 46% (95% CI 0·43-0·50) for clinically significant findings.

Diagnostic chest X-rays and breast cancer risk among women with a hereditary predisposition to breast cancer unexplained by a BRCA1 or BRCA2 mutation

BackgroundDiagnostic ionizing radiation is a risk factor for breast cancer (BC). BC risk increases with increased dose to the chest and decreases with increased age at exposure, with possible effect modification related to familial or genetic predisposition. While chest X-rays increase the BC risk of BRCA1/2 mutation carriers compared to non-carriers, little is known for women with a hereditary predisposition to BC but who tested negative for a BRCA1 or BRCA2 (BRCA1/2) mutation.MethodsWe evaluated the effect of chest X-rays from diagnostic medical procedures in a dataset composed of 1552 BC cases identified through French family cancer clinics and 1363 unrelated controls. Participants reported their history of X-ray exposures in a detailed questionnaire and were tested for 113 DNA repair genes. Logistic regression and multinomial logistic regression models were used to assess the association with BC.ResultsChest X-ray exposure doubled BC risk. A 3% increased BC risk per additional exposure was observed. Being 20 years old or younger at first exposure or being exposed before first full-term pregnancy did not seem to modify this risk. Birth after 1960 or carrying a rare likely deleterious coding variant in a DNA repair gene other than BRCA1/2 modified the effect of chest X-ray exposure.ConclusionEver/never chest X-ray exposure increases BC risk 2-fold regardless of age at first exposure and, by up to 5-fold when carrying 3 or more rare variants in a DNA repair gene.Further studies are needed to evaluate other DNA repair genes or variants to identify those which could modify radiation sensitivity. Identification of subpopulations that are more or less susceptible to ionizing radiation is important and potentially clinically relevant.

Ensemble Learner for Covid-19 from Lung X-Ray Images

Despite Reverse Transcription-Polymerase Chain Reaction (RT-PCR) is the gold standard of Covid-19 detection, some underdeveloped countries are lacking financially and suffer underdeveloped health system to perform fast Covid-19 detection. Both RT-PCR and Computed Tomography (CT) scan are costly diagnosis tool, thus computed diagnostic chest x-ray (CXR) is seen as fast and affordable option to perform Covid-19 diagnosis for underdeveloped countries. Despite of other works suggest to perform Local binary Pattern (LBP) and recent feature extraction methods such as Local Phase Quantization (LPQ), this works employed Gray-Level Co-Occurrence Matrix (GLCM) because it is a powerful method to extract textured features from gray-level images of chest x-ray. The learner to classify Covid-19 detection is tested via non tree-based learner such as k-Nearest Neighbour (kNN). This work also compared the performance especially in the tree-based and voting approach classifier. The experimentation shows that tree-based which uses voting and ensemble approach to detect Covid-19 from CXR images is a possible candidate learner to be improved for the underdeveloped countries.

A Giant Mass in the Liver: Is It Always Bad to be Fat?

Introduction: Hepatic lipomas are rare benign lesions of the liver with characteristic findings on imaging, which differentiate them from other more important tumors of the liver and prevent unessential invasive procedures. Case Presentation: A 62-year-old man with intense acute dyspnea referred to our emergency department in Imam Reza Hospital, Mashhad city, Iran. We performed initial diagnostic tests, Chest X-Ray (CXR), and non-contrast lung CT scan for further evaluation. Laboratory tests were in the normal range, but two well-defined lobulated masses with typical features of lipomas were noted on abdominal sections of plain CT scan in the patient's liver. The aim of this report is to define the characteristic appearance of these benign neoplasms on imaging techniques and to help exclude some more prevalent hepatic tumors with similar appearances without invasive procedures. Conclusions: Although there are numerous fat-containing lesions in the liver and some have heterogeneous and atypical features, it is often possible to make a definitive diagnosis of hepatic lipomas based on their typical imaging features, including pure fat density on CT scan, well-defined margins, chemical shift artifact on MRI, etc.

Diagnostic chest X-ray in atrial septal defects.

Diagnostic chest X-ray in atrial septal defects.

Reducing seed migration to near zero with stranded-seed implants: Comparison of seed migration rates to the chest in 1000 permanent prostate brachytherapy patients undergoing implants with loose or stranded seeds

PurposePulmonary seed emboli to the chest may occur after permanent prostate brachytherapy (PPB). The purpose of this study is to analyze factors associated with seed migration to the chest in a large series of PPB patients from a single institution undergoing implant with either loose seeds (LS), mixed loose and stranded seeds (MS), or exclusively stranded seeds in an absorbable vicryl suture (VS). Methods and MaterialsBetween May 1998 and July 2015, a total of 1000 consecutive PPB patients with postoperative diagnostic chest x-rays at 4 months after implant were analyzed for seed migration. Patients were grouped based on seed implant technique: LS = 391 (39.1%), MS = 43 (4.3%), or VS = 566 (56.6%). Univariate and multivariate analysis were performed using Cox proportional hazards regression models to determine predictors of seed migration. ResultsOverall, 18.8% of patients experienced seed migration to the chest. The incidence of seed migration per patient was 45.5%, 11.6%, and 0.9% (p < 0.0001), for patients receiving LS, MS, or VS PPB, respectively. The right and left lower lobes were the most frequent sites of pulmonary seed migration. On multivariable analysis, planimetry volume (p = 0.0002; HR = 0.7 per 10 cc [0.6–0.8]), number of seeds implanted (p < 0.0001, HR = 2.4 per 25 seeds [1.7–3.4]), LS implant (p < 0.0001, HR = 15.9 [5.9–42.1]), and MS implant (p = 0.001, HR = 7.9 [2.3–28.1]) were associated with seed migration to the chest. ConclusionsIn this large series, significantly higher rates of seed migration to the chest are observed in implants using any LS with observed hazard ratios of 15.9 and 7.9 for LS and MS respectively, as compared with implants using solely stranded seeds.

Improved total-variation noise-reduction technique with gradient method using iteration counter and its application in medical diagnostic chest and abdominal X-ray imaging

The development of novel noise-reduction algorithms is one of the main research areas in the field of medical diagnostic X-ray imaging. The purpose of this study is to develop an improved total-variation (TV) noise-reduction technique using a gradient method that employs an iteration counter, and confirm its feasibility for applications in chest and abdominal X-ray imaging systems. We evaluated image qualities using contrast–to–noise ratio (CNR) and relative standard deviation (RSD) calculations with the proposed and conventional noise-reduction algorithms for both chest and abdominal X-ray images. The results of the quantitative CNR and RSD evaluations demonstrated the superiority of the proposed TV noise-reduction technique over other algorithms; in particular, the comparison between the conventional and proposed TV techniques revealed that the proposed method has improved noise-reduction characteristics in all cases. In conclusion, the results demonstrated that the improved TV noise-reduction technique with the gradient method using the iteration counter can be used to acquire images with a better quality than those of conventional algorithms. This can lead to lowering of the radiation dose in chest and abdominal X-ray imaging systems.

Protocolo de diagnóstico y tratamiento de la valvulopatía aórtica

Aortic stenosis. Diagnostic evaluationClinical evaluation, baseline ECG, and chest x-ray (Rx) are mandatory in the initial diagnostic evaluation. Transthoracic echocardiography (TTE) is the main tool for diagnosis and follow-up. Other diagnostic techniques are also useful. Therapeutic managementPatients with severe symptomatic aortic stenosis should be involved, especially with aortic valve replacement surgery, and if the surgical risk is high, transcatheter aortic valve implantation (TAVI) may be an adequate alternative. Asymptomatic individuals will only be involved according to several factors predictive of onset of symptoms and adverse events. Aortic insufficiency. Diagnostic assessmentclinical evaluation, baseline ECG, and simple chest x-ray are also mandatory in the initial diagnostic evaluation. The ETT is the main diagnostic and monitoring tool. Therapeutic managementAcute severe aortic insufficiency (AI) should undergo urgent surgery. In chronic severe AI, when symptoms and/or systolic dysfunction of the left ventricle appear, aortic valve surgery must be performed; The asymptomatic patients will be operated according to several factors regarding left ventricular systolic size and function. Sometimes aortic root and ascending aorta surgery must be performed irrespective of the severity of the AI.

Left Atrial Isomerism in Afro-Caribbean Adolescents and Adults with no Intervention: Echocardiographic Findings.

Left atrial isomerism (LAI) is a rare congenital anomaly usually associated with major or minor congenital cardiac lesions. Presentation beyond childhood is unusual as there is usually high morbidity of 63% associated with the co-morbid major congenital cardiac lesions in the first year of life. The four index cases highlight the myriad cardiac lesions facilitating survival into adolescence and adulthood of this rare cardiac condition. Presented are markedly different echocardiographic findings of four cases of LAI in Afro-Caribbeans who had no intervention. Their diagnostic transthoracic echocardiographic findings are the focussed features of this article and the first documentation of isolated patent ductus arteriosus with LAI. Fascinating diagnostic chest X-ray findings of the LAI index cases are presented. They are the first cases of LAI documented in Afro-Caribbeans.

A national survey of the diagnosis and management of suspected ventilator-associated pneumonia

BackgroundVentilator-associated pneumonia (VAP) affects up to 20% of patients admitted to intensive care units (ICU). It is associated with increased morbidity, mortality and healthcare costs. Despite published guidelines, variability in...

Assessment of Entrance Skin Dose and Image Quality of Chest X-Rays in Two University Teaching Hospitals, North East Nigeria

The need for radiation dose assessment of patients during diagnostic chest x-ray examination is considered in this study. Radiation exposure received by patients during routine x-rays is known to increase the risk of malignancy these was the major problem that necessitated this study. This study was carried out in two university teaching hospitals in Northeastern Nigeria. The aim and objective of this work was to assess the Entrance Skin Dose delivered to patients during routine chest x-ray examination and to evaluate the Image quality of the radiographs produced. Sixty thermoluminiscent dosimeters were placed on the patients during chest x-ray exposure to estimate the entrance skin dose received by each patient during exposure.The thermoluminescent dosimeters were analyzed at the Center for Energy Research and Training Zaria. Committee for European Guidelines 1999 criteria was used to analyze the image quality. Findings show that the dose obtained in the two hospitals were 0.50 mGy and 0.54 mGy respectively.The results obtained were high compared to other established work. The image quality criteria score was good with a score of 60% and above. Conclusion showed that there is need to optimize service in the two teaching hospitals and most hospitals in Nigeria.

Diagnostic Chest X-Rays and Breast Cancer Risk before Age 50 Years for BRCA1 and BRCA2 Mutation Carriers

The effects of low-dose medical radiation on breast cancer risk are uncertain, and few studies have included genetically susceptible women, such as those who carry germline BRCA1 and BRCA2 mutations. We studied 454 BRCA1 and 273 BRCA2 mutation carriers ages younger than 50 years from three breast cancer family registries in the United States, Canada, and Australia/New Zealand. We estimated breast cancer risk associated with diagnostic chest X-rays by comparing mutation carriers with breast cancer (cases) with those without breast cancer (controls). Exposure to chest X-rays was self-reported. Mammograms were not considered in the analysis. After adjusting for known risk factors for breast cancer, the ORs for a history of diagnostic chest X-rays, excluding those for tuberculosis or pneumonia, were 1.16 [95% confidence interval (CI), 0.64-2.11] for BRCA1 mutations carriers and 1.22 (95% CI, 0.62-2.42) for BRCA2 mutations carriers. The OR was statistically elevated for BRCA2 mutation carriers with three to five diagnostic chest X-rays (P = 0.01) but not for those with six or more chest X-rays. Few women reported chest fluoroscopy for tuberculosis or chest X-rays for pneumonia; the OR estimates were elevated, but not statistically significant, for BRCA1 mutation carriers. Our findings do not support a positive association between diagnostic chest X-rays and breast cancer risk before the ages of 50 years for BRCA1 or BRCA2 mutation carriers. Given the increasing use of diagnostic imaging involving higher ionizing radiation doses, further studies of genetically predisposed women are warranted.

Pediatric cervicomediastinal hibernoma: A case report

Hibernoma is a rare lipomatous tumor of brown fat origin. Though uniformly benign in nature these tumors may cause symptoms secondary to extrinsic compression of neighboring structures. Hibernomas may be found anywhere that normal fetal brown fat may be located but are most commonly located in the thigh. We present a case of a hibernoma presenting as an unusual cervicomediastinal mass in a 6-year-old male. This mass was discovered during a diagnostic chest x-ray for pneumonia and treated by resection. Complete surgical resection is considered curative. Hibernoma should be considered in the differential diagnosis of any lipomatous tumor.