Chest X-ray Interpretation Research Articles

Usefulness of radiological signs of pulmonary congestion in predicting failed spontaneous breathing trials.

ABSTRACTObjective:Inspiratory fall in intrathoracic pressure during a spontaneous breathing trial (SBT) may precipitate cardiac dysfunction and acute pulmonary edema. We aimed to determine the relationship between radiological signs of pulmonary congestion prior to an SBT and weaning outcomes. Methods:This was a post hoc analysis of a prospective cohort study involving patients in an adult medical-surgical ICU. All enrolled individuals met the eligibility criteria for liberation from mechanical ventilation. Tracheostomized subjects were excluded. The primary endpoint was SBT failure, defined as the inability to tolerate a T-piece trial for 30-120 min. An attending radiologist applied a radiological score on interpretation of digital chest X-rays performed before the SBT. Results:A total of 170 T-piece trials were carried out; SBT failure occurred in 28 trials (16.4%), and 133 subjects (78.3%) were extubated at first attempt. Radiological scores were similar between SBT-failure and SBT-success groups (median [interquartile range] = 3 [2-4] points vs. 3 [2-4] points; p = 0.15), which, according to the score criteria, represented interstitial lung congestion. The analysis of ROC curves demonstrated poor accuracy (area under the curve = 0.58) of chest x-rays findings of congestion prior to the SBT for discriminating between SBT failure and SBT success. No correlation was found between fluid balance in the 48 h preceding the SBT and radiological score results (ρ = −0.13). Conclusions:Radiological findings of pulmonary congestion should not delay SBT indication, given that they did not predict weaning failure in the medical-surgical critically ill population. (ClinicalTrials.gov identifier: NCT02022839 [http://www.clinicaltrials.gov/])

The Diagnostic Value of Urine Lipoarabinomannan (LAM) Antigen in Childhood Tuberculosis.

Diagnosis of Tuberculosis (TB) in children is difficult because the clinical presentation is not specific, the chest X-ray interpretation has low accuracy and sputum sample is difficult to obtain. Antigen detection test such as rapid urine LAM is a non-invasive alternative for diagnosing TB . Lipoarabinomannan (LAM) is the main component of M.tuberculosis cell wall. To determine the diagnostic value of urinary LAM antigen for diagnosis of childhood TB. In the present cross-sectional study, subjects were included using consecutive sampling method. All the children aged 0-14 years Suspected of pulmonary or extra pulmonary TB suffering from cough more than two weeks, fever without clear aetiology, loss of body weight or poor weight gain, fatigue, malaise, chronic lymph node enlargement, spine angulation, joint swelling and had history of contact with positive sputum smear adult TB patient were enrolled in the study. Pulmonary and extra pulmonary diagnosis was based on clinical presentation, Tuberculin Skin Test (TST), chest X-ray, Acid Fast Bacillus (AFB) staining and or sputum culture. Urinary LAM level was measured by using Enzyme-Linked Immunosorbent Assay (ELISA). Cut off value and Area Under the Curve (AUC) were determined using ROC statistical analysis (SPSS 21.0). Sensitivity and specificity was measured from 2x2 cross table. Out of 61 subjects suspected as TB, 49 (80.3%) were eventually diagnosed with TB. Of those diagnosed with TB, 21 (42.9%) were microbiologically confirmed cases either by sputum microscopy (34.7%) or culture (8.2%), whereas 28 subjects were unconfirmed cases (57.1%). The urinary LAM level was higher in subjects with TB (1.80+1.02) mg/l compared to non-TB group (0.46+0.3) mg/l; p<0.001(independent t-test). Urine LAM had 83% sensitivity and 85% specificity with cut off value 0.98 mg/l using microbiological and clinical confirmation as standard reference and 33% sensitivity and 60% specificity with cut off value 1.69 mg/l using microbiological confirmation only. Urinary LAM has good diagnostic value for childhood TB diagnosis.

A cost utility analysis of the clinical algorithm for nasogastric tube placement confirmation in adult hospital patients.

The aim of this study was to evaluate the effectiveness of pH paper testing of aspirate and chest x-ray for determining nasogastric tube (NGT) placement in terms of cost and patient outcome. Nasogastric tubes are frequently used in clinical practice, however during insertion the practitioner is blinded as to the precise final location. Despite robust checking procedures, recognized patient morbidity and mortality associated with this procedure have resulted in national safety alerts prompting the revision of all NGT care clinical guidelines. Cost utility analysis using economic modelling. A decision tree was built and populated with effectiveness data gathered from a systematic search of the extant literature. Specificity, pooled sensitivity and event probabilities were calculated using statistical software. Patient outcome was measured in terms of quality of life. Health state utilities were gathered from a sample (n=23) of adult surgical patients using a recognized instrument. Cost data were gathered using published sources. The study adopted a third party payer perspective in a Scottish context and was completed in June 2013. The results confirm that the current UK algorithm advocated by the National Patient Safety Agency appears to offer the most cost effective approach to NGT confirmation in terms of cost and patient outcome. Sensitivity analyses indicate that these findings may be significantly altered by tube aspiration success and the rates of chest x-ray interpretation errors. The results confirm current UK recommendations and have wider policy implications for those areas, whereby chest x-ray is recommended as the first and only acceptable confirmation approach.

Effect of Massed Versus Interleaved Teaching Method on Performance of Students in Radiology

PurposeRadiology instruction is based on the principle that grouped (or massed) repetition of an intellectual activity leads to expertise. The aim of this study was to test the hypothesis that the spaced (or interleaved) method of teaching chest x-ray interpretation is more effective than the massed method. MethodsAfter institutional review board approval was obtained, 40 first- and second-year medical students were randomized into two groups matched by age, gender, and education experience. Both groups saw six examples of 12 common chest radiographic patterns, one grouped, the other scrambled randomly without repeating strings. After a distraction, participants took a multiple-choice test consisting of two cases in each radiographic pattern, one previously shown, one new. Results were analyzed using two-tailed Student’s t test of proportion. ResultsComparing interleaved and massed groups, the average overall score was 57% versus 43% (P = .03), the recollection score was 61% versus 47% (P = .03), and the induction score was 53% versus 40% (P = 0.10), respectively. Comparing second- and first-year students, average scores were 67% and 39%, respectively (P < .01). First-year students in the interleaved and massed groups scored 55% and 36% (P = .02) in recall and 40% and 28% (P = .10) in induction. Second-year students in the interleaved and massed groups scored 71% and 63% (P = .36) in recall and 74% and 59% (P = .03) in induction. ConclusionsThe interleaved method of instruction leads to better results than the massed method across all levels of education. A higher level of medical education improves performance independent of method of instruction.

Accuracy of remote chest X-ray interpretation using Google Glass technology

ObjectivesWe sought to explore the accuracy of remote chest X-ray reading using hands-free, wearable technology (Google Glass, Google, Mountain View, California). MethodsWe compared interpretation of twelve chest X-rays with 23 major cardiopulmonary findings by faculty and fellows from cardiology, radiology, and pulmonary-critical care via: (1) viewing the chest X-ray image on the Google Glass screen; (2) viewing a photograph of the chest X-ray taken using Google Glass and interpreted on a mobile device; (3) viewing the original chest X-ray on a desktop computer screen. One point was given for identification of each correct finding and a subjective rating of user experience was recorded. ResultsFifteen physicians (5 faculty and 10 fellows) participated. The average chest X-ray reading score (maximum 23 points) as viewed through the Google Glass, Google Glass photograph on a mobile device, and the original X-ray viewed on a desktop computer was 14.1±2.2, 18.5±1.5 and 21.3±1.7, respectively (p<0.0001 between Google Glass and mobile device, p<0.0001 between Google Glass and desktop computer and p=0.0004 between mobile device and desktop computer). Of 15 physicians, 11 (73.3%) felt confident in detecting findings using the photograph taken by Google Glass as viewed on a mobile device. ConclusionRemote chest X-ray interpretation using hands-free, wearable technology (Google Glass) is less accurate than interpretation using a desktop computer or a mobile device, suggesting that further technical improvements are needed before widespread application of this novel technology.

Respiratory hazards: clinical and functional assessment in aluminum industry workers

BackgroundAluminum is one of the prevalent alloys on the earth. With the revolution industry, aluminum was very important in all aspects of life from cooking to war weapons. The aim of this work is to study the prevalence of respiratory hazards and changes in pulmonary function among aluminum industry workers. Materials and methodsThis is a case series study which was conducted in an aluminum factory in Nag Hammadi and included 320 workers, who were subdivided into 2 groups according to the duration of daily exposure to aluminum gases and exhausts. Group 1: it included 260 exposed workers, who were randomly selected from potrooms and cast house sectors, and exposed to hazardous effects of primary aluminum industry 8h continuously per day. Group 2: it included 60 interrupted or partially exposed workers, who were randomly selected from the factory maintenance, potroom maintenance, cast house maintenance workers, as well as the general maintenance workers; and exposed to less than 8h interrupted per day on average 2–3h. Data were collected using modified British Medical Research Council (BMRC) questionnaire, and pulmonary function tests, chest X-ray, and laboratory studies were done. ResultsGroup 1 workers had more chronic and acute work related respiratory symptoms. There was a significantly higher occurrence of asthma among exposed workers with p value 0.004 while no significant difference for the occurrence of COPD in both groups, also CRP significantly more frequently occurred in exposed workers with p value 0.001. There was a significant negative correlation between FVC%, FEV1% and PEF25–75% and duration of exposure in years among exposed workers. Interpretation of chest X-ray denoted that reticular, nodular and reticulo-nodular patterns significantly more frequently occurred in exposed group (p value 0.01) also diaphragmatic abnormalities were more in exposed ones (p value 0.04). Solitary pulmonary nodules could be detected in three cases. ConclusionsAluminum industry is hazardous to both the workers and the community. The pulmonary hazards are significantly higher in workers who are continuously exposed to gases and pollutants for more than 8h/day. Moreover the free radicals of silica and polycyclic aromatic hydrocarbons may have a direct relationship with the recorded changes in diaphragmatic and pulmonary functions and may be precancerous.

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.

Computer-Aided Diagnosis for Chest Radiographs in Intensive Care.

The chest radiograph is an essential tool for the diagnosis of several lung diseases in intensive care units (ICU). However, several factors make the interpretation of the chest radiograph difficult including the number of X-rays done daily in ICU, the quality of the chest radiograph, and the lack of a standardized interpretation. To overcome these limitations in the interpretation of chest radiographs, researchers have developed computer-aided diagnosis (CAD) systems. In this review, the authors report the methodology used to develop CAD systems including identification of the region of interest, analysis of these regions, and classification. Currently, only a few CAD systems for chest X-ray interpretation are commercially available. Some promising research is ongoing, but the involvement of the pediatric research community is needed for the development and validation of such CAD systems dedicated to pediatric intensive care.

Interpretation of bedside chest X-rays in the ICU: is the radiologist still needed?

PurposeTo compare diagnostic accuracy of intensivists to radiologists in reading bedside chest X-rays. MethodsIn a retrospective trial, 33 bedside chest X-rays were evaluated by five radiologists and five intensivists with different experience. Images were evaluated for devices and lung pathologies. Interobserver agreement and diagnostic accuracy were calculated. Computed tomography served as reference standard. ResultsSeniors had higher diagnostic accuracy than residents (mean-ExpBSenior=1.456; mean-ExpBResident=1.635). Interobserver agreement for installations was more homogenously distributed between radiologists compared to intensivists (ExpBRad=1.204–1.672; ExpBInt=1.005–2.368). Seniors had comparable diagnostic accuracy. ConclusionNo significant difference in diagnostic performance was seen between seniors of both disciplines, whereas the resident intensivists might still benefit from an interdisciplinary dialogue.

Chest X-ray interpretation in UK intensive care units: A survey 2014.

This survey investigated current practice in intensive care unit radiology reporting using a survey tool. We ascertained physician attitudes regarding best practice. A national survey was sent by email to a sample of intensive care units throughout UK between March and October 2014. The questionnaire determined current practice in reporting chest X-ray in intensive care units. It also identified differences between 'routine' and emergency and out-of-hours service. Further, it investigated how reports were documented and physician preferences for perceived best practice. Of 146 intensive care units contacted, 55% completed the survey. Of the sample, radiologists were solely responsible for chest X-ray reporting in 43.7%, intensive care unit clinicians in 33.7% and joint reporting in 25% of intensive care units. The reporting clinician on intensive care unit was a consultant in 67% of the centres. Written reports by radiologists were provided in 71.7% of cases. This was only 54.5% when intensive care unit clinicians reported chest X-rays. For all routine and emergency films, written reports by radiologists occurred in 63.1% of responders. Out-of-hours, 54.9% of clinicians described different reporting practice to normal hours. Regarding perceived best practice, 64.8% of clinicians preferred joint daily reporting, whilst 27% preferred a radiologist's formal report. For emergencies, 55.2% of the survey recipients preferred a joint report. Based on this cohort of UK intensive care units, at present, there appears to be a lack of a standardised system for image reporting. There are discrepancies in who reports chest X-rays, written documentation and the timing of reports, more so out-of-hours. Clinicians suggest that joint reporting should be the standard.

Radiographers' performance in chest X-ray interpretation: the Nigerian experience.

To assess the performance of Nigerian radiographers in interpretation of plain chest radiographs and to assess whether age, years since qualification and sector of practice are associated with performance. A test set of 50 radiographs containing 23 cases with no pathology (normal) and 27 abnormal cases (cardiopulmonary conditions) independently confirmed by 3 radiologists were presented to 51 radiographers in a random order. Readers independently evaluated radiographs for absence or presence of disease and stated the location, radiographic features and diagnosis. Readers self-reported their age, years since qualification and sector of practice. Receiver operating characteristic was used to assess the performance. Mann-Whitney U test was used to assess whether age, years since qualification and sector of practice were associated with performance. Mean location sensitivity was 88.9 [95% confidence interval (CI), 0.787-0.980]. Mean sensitivity and specificity were 76.9 (95% CI, 0.658-0.864) and 79.8 (95% CI, 0.658-0.864), respectively. Age was not associated with performance (p = 0.07). Number of years qualified as radiographer (p = 0.005) and private practice (p = 0.004) were positively associated with performance. Nigerian radiographers can correctly report chest radiographs to a reasonable standard, and performance is associated with number of years since qualification and the sector of practice. There are less than 300 radiologists serving a Nigerian population of about 170 million; therefore, X-ray interpretation by radiographers deserves consideration. Nigerian radiographers have potential to interpret chest X-ray in the clinical setting, and this may significantly improve radiology service delivery in this region.

Comparison of radiological findings of chest x-ray with echocardiography in determination of the heart size.

Background:Heart size is an important and effective parameter in chest X-ray (CXR) interpretation. Studies indicate that, especially in middle-aged men, increased cardiothoracic ratio (CTR) is associated with ischemic heart disease (IHD) and increased rate of morbidity and mortality. The CXR is the most common imaging examination of the heart.Objectives:A good quality posterior-anterior (PA) chest radiograph is an important indicator of the cardiac size. Nowadays, CXR has given its place to more advanced approaches such as two-dimensional echocardiography. However, CXR is still more accessible and feasible for most of the physicians. This study was designed to compare the findings of CXR and echocardiography in determination of the heart size.Patients and Methods:This cross-sectional study was carried out from 2006 to 2007. A total of 197 patients entered the study. The cases had been undergone PA CXR and 2-D echocardiography maximum within two days.Results:Of participants, 24.9% had cardiomegaly according to the findings of CXR and 50.8% based on echocardiography. There was a statistically significant difference between the mean size of Right Ventricular End Diastolic Diameter in the patients with cardiothoracic ratio < 50% and ≥ 50% (P = 0.002) as well as Left Ventricular End Diastolic Diameter (P = 0.023). Also, a statistically significant difference was seen between echocardiography and CXR findings with regard to determination of the heart size (P = 0.003). Nonetheless, it is noteworthy that sensitivity and specificity of CXR findings in the diagnosis of cardiomegaly were 34%, and 84.5%, respectively.Conclusions:CTR is the most common method of describing the heart size. Increased CTR in CXR is associated with poor prognosis, which is suggestive of importance and necessity of early diagnosis. Although CXR may not have the same diagnostic accuracy as echocardiography, its easy accessibility and high specificity in diagnosis of cardiomegaly is very helpful, which can play an important and a cost-benefit role, particularly in screening the enlarged heart size. Moreover, according to the statistics released by Medical Council of Iran, most of Iranian physicians are general practitioners and a few of them are cardiologist.

Comparing the interpretation of traumatic chest x-ray by emergency medicine specialists and radiologists.

Background:Discrepancy between X-ray readings of emergency physicians (EPs) versus radiologists was reported between 0.95% and 16.8% in different studies. The discordance was even higher when specific studies such as chest X-rays (CXR) were probed.Objectives:This prospective study was conducted to assess the discrepancies between emergency and radiology departments with respect to interpretation of the traumatic chest X-rays.Patients and Methods:This prospective study was conducted in Shohadaye Tajrish Hospital, Tehran, Iran, from March to April 2014. Based on Advanced Trauma Life Support (ATLS) guidelines, plain chest radiography (CXR) was ordered for all patients in two standard views of posterior-anterior and lateral. All CXRs were interpreted by a corresponding emergency medicine specialist and a radiologist blind to the clinical findings of the patients. Finally, the results of two interpretations were compared. Accuracy, sensitivity, specificity, and predictive values of traumatic CXR interpretation were calculated by EPs with 95% of confidence interval (CI).Results:The evaluation of EPs was identical to that of the radiologists in 89.5% of the cases. Ninety-eight percent (98%) indicated total agreement and 1.5 percent total disagreement.Conclusions:There is a high agreement between EPs and radiologists in CXR interpretations in Shohadaye Tajrish Hospital. Thus, EPs can substitute radiologists in the emergency department. More improvements are recommended to achieve the standard level of agreement.

Chest X-Ray Resources

This column will introduce several freely available chest x-ray (CXR) websites. Physicians and nurses alike may be required to perform CXR readings;1 however, diagnoses based upon CXR readings are not always accurate,2 implying that the activity requires careful attention and study. The following websites provide images, instruction, and case studies to serve as supplementary educational tools or refresher materials for medical professionals who work with CXRs. Medical students with an interest in CXRs may also find the following websites useful for their own education and future interpretation of CXRs.

ABSTRACT 419

Background and aims: Acute respiratory distress syndrome (ARDS) is the most severe form of acute respiratory failure both in adult and children characterized by increased capillary permeability, inflammation and alveolar repair. Both Consensus Conference performed in 1994 and 2011 require the presence of bilateral pulmonary infiltrates on chest X-ray (CXR). To be consistently useful, interpretation of the CXR must be reliable. Adult studies on radiographic interpretation in ARDS have shown limited inter-observer agreement and concluded that intensivists without formal consensus training can only achieve moderate level of agreements. Aims: A computer-aided diagnosis system (CAD) was developed to automatically detect ARDS. The system is based on texture analysis of many patch of parenchyma lung among the four quadrants. The aim of the present study is to compare clinical assessment to the CAD system. Methods: CXR database was done using 111 CXR selected among 843 children included in a previous study, 60/111 CXR presented an ARDS based on gold standard reading. CXR reading was first performed by two intensivists. In case of disagreement, a consensus was performed with a third intensivist. The 111 CXR were diagnosed automatically by our CAD system. Results: Inter-observer variability was fund between the first two intensivists with a moderate kappa (kappa=0.55). The CAD system was able to significantly improve the kappa (kappa=0.75). Specificity and sensibility of the CAD system was 84.4 and 90% respectively. Conclusions: Our study confirms the inter-observer variability with clinical assessment and the use of a CAD system for CXR interpretation in ARDS is able to reduce it.

Procedural skills in paediatric residency: Re-evaluating the competencies.

The Royal College of Physicians and Surgeons of Canada (RCPSC) sets objectives for residency training, including many skills that may not be commonly performed in practice. To describe attitudes of residents enrolled in Canadian paediatric residency programs toward procedural skills training, including perception of importance and perceived proficiency of the RCPSC-required procedures. An anonymous electronic survey was distributed to all senior residents enrolled in Canadian paediatric residencies, using a five-point Likert scale to address procedural importance and corresponding proficiency. Data were analyzed using descriptive statistics, with Pearson correlation coefficients used to describe relationships among variables. A total of 68 residents responded. Fifteen skills had a mean importance ≥4 (very or extremely important) and five skills had a mean rating <3 (somewhat or not important). Residents believed they were extremely or very proficient (mean rating ≥4) for three skills (bag-mask ventilation, lumbar puncture and chest x-ray interpretation). They reported 23 procedures for which they felt somewhat to not proficient (mean <3). The correlation between importance and proficiency was high (Pearson's correlation coefficient = 0.87). However, proficiency was significantly lower than importance (P<0.05) for the majority of procedures (88%). The largest gaps between importance and proficiency were observed for chest tube insertion, gathering evidence of child maltreatment, defibrillation and intraosseous insertion. Many, but not all, RCPSC-required procedures are believed to be important. Residents do not believe that they are adequately proficient in many of these procedures. Skills with the greatest gap between importance and proficiency may be targets for curricular interventions.

Cardiopulmonary Physical Therapy Practice in the Paediatric Intensive Care Unit

Physical therapists play an important role in the pediatric intensive care setting. The purpose of this study was to describe current cardiopulmonary physical therapy (CPT) practices in a pediatric cardiac critical care unit (CCCU) and a pediatric intensive care unit (PICU), as well as to determine the feasibility of obtaining clinically relevant outcome measures in this setting. We obtained reasons for admission, CPT treatment patterns, and availability of chest X-rays interpretation via a retrospective chart review of children who received CPT while in the PICU and CCCU (n=111). Congenital cardiac conditions (34.2%) and primary respiratory deterioration (27.9%) were the most common reasons for admission; 50% of the children had associated diagnoses (e.g., developmental delay). Manual hyperinflation with expiratory vibration was the most common CPT treatment. Chest X-ray interpretation was available in 72% of the charts. Manual hyperinflation with expiratory vibration was used across diagnostic groups in the CCCU and PICU; its effectiveness therefore requires further study. Chest X-ray is an important clinical outcome and therefore needs to be recorded in a standardized manner to be useful for future clinical research studies.

The effect of a tuberculosis chest X-ray image reference set on non-expert reader performance

ObjectivesIn low-resource settings, limitations in diagnostic accuracy of chest X-rays (CXR) for pulmonary tuberculosis (PTB) relate partly to non-expert interpretation. We piloted a TB CXR Image Reference Set (TIRS) to improve non-expert performance in an operational setting in Malawi.MethodsNineteen doctors and clinical officers read 60 CXR of patients with suspected PTB, at baseline and using TIRS. Two officers also used the CXR Reading and Recording System (CRRS). Correct treatment decisions were assessed against a “gold standard” of mycobacterial culture and expert performance.ResultsTIRS significantly increased overall non-expert sensitivity from 67.6 (SD 14.9) to 75.5 (SD 11.1, P = 0.013), approaching expert values of 84.2 (SD 5.2). Among doctors, correct decisions increased from 60.7 % (SD 7.9) to 67.1 % (SD 8.0, P = 0.054). Clinical officers increased in sensitivity from 68.0 % (SD 15) to 77.4 % (SD 10.7, P = 0.056), but decreased in specificity from 55.0 % (SD 23.9) to 40.8 % (SD 10.4, P = 0.049). Two officers made correct treatment decisions with TIRS in 62.7 %. CRRS training increased this to 67.8 %.ConclusionUse of a CXR image reference set increased correct decisions by doctors to treat PTB. This tool may provide a low-cost intervention improving non-expert performance, translating into improved clinical care. Further evaluation is warranted.Key Points• Tuberculosis treatment decisions are influenced by CXR findings, despite improved laboratory diagnostics. • In low-resource settings, CXR interpretation is performed largely by non-experts. • We piloted the effect of a simple reference training set of CXRs. • Use of the reference set increased the number of correct treatment decisions. This effect was more marked for doctors than clinical officers. • Further evaluation of this simple training tool is warranted. Electronic supplementary materialThe online version of this article (doi:10.1007/s00330-013-2840-z) contains supplementary material, which is available to authorized users.

A recommended method in order to interpret chest x-rays for diagnosing small size pneumothorax

Background:Pneumothorax can be a both progressive and life threatening disorder. In this survey we evaluated the diagnostic accuracy of a recommended method for the interpretation of chest X-Rays (CXRs) compared to the common method in diagnosis of iatrogenic Pneumothorax in an emergency department.Materials and Methods:We conducted a study on 100 CXRs (31 with the diagnosis of small size pneumothorax and 69 normal) of patients who have undergone the upper central venous catheterization. CXRs were interpreted by 5 Emergency Specialists (ESs) and 5 general practitioners (GPs) separately using the conventional and recommended method. Recommended method included a 90 degree rotation against the side of chateterization in addition to using a yellow shield as the background color. Presence of pneumothorax on the CXR was confirmed by a radiologist.Results:64.5% of the CXRs with pneumothorax were correctly diagnosed by GPs and 87.7% by ESs with reutine method and 83.2% and 97.4% by recommended method, respectively (P.value<0.001). 96.8% out of all CXRs were correctly diagnosed by GPs and 99.4% by ESs by conventional method and 97.9% by GP and 99.7% by ES was correctly diagnosed using recommended method(P.value<0.001). None of the underlying variables including sex, age, underlying diseases, the side of intervention did not affect on the diagnostic accuracy in either groups (P.value>0.05).Conclusion:A significant raise was obtained in the diagnostic accuracy of CXR using the recommended method. This study can be a preliminary study to conduct further investigations in order to enhance the diagnostic accuracy of CXRs.

P13 Mismatch Between Clinical and Radiological Diagnosis of Pneumonia

IntroductionNational guidelines on management of pneumonia stipulate the need for radiological evidence of consolidation to confirm the diagnosis. An incorrect diagnosis may lead to sub-optimal management, inappropriate antibiotic use and...