Interpretation Of X-ray Films Research Articles

402 A Study to Assess Concordance Rates of Emergency Abdominal X-Ray Film Interpretation and Formal Radiological Reporting.

Abstract Background Abdominal X-rays (AXRs) were a key part of investigating acute abdominal pain prior to the advent of CT imaging. With increasing reliance on CT scanning, the utilisation and therefore reliance on the interpretation of AXRs has reduced. We investigate the concordance rates of interpretations of AXRs with the formal radiological report, along with the time taken for formal reporting. Aim To ascertain the concordance rates of interpretation of emergency AXRs with formal radiological reporting. Method All AXRs performed within the trust in a 15-day period were obtained retrospectively from our electronic imaging database. These were compared with the initial interpretations of the AXR, which was obtained from our electronic record system. Results 248 AXRs were performed, 136 (55%) were not interpreted in the notes. Of the remaining 112, 88 (79%) of AXR interpretations were in concordance with radiological reporting. There was no difference in concordance rates between interpretation by the Emergency Department (ED) or ward-based doctors. The average time for AXRs to be reported was 1.5 days for ED, and 3 for inpatients. Conclusions One fifth of AXRs were incorrectly interpreted and more than half of AXRs were not interpreted at all. This brings into question not only their usefulness in general, but also the utilisation of resources to perform them. As all AXRs are reviewed by a consultant radiologist with little impact on decision making, does this still remain an effective utilisation of resources?

Diagnostic accuracy of chest radiograph interpretation by graduate radiographers in Uganda

Background. Radiographers are increasingly being called on to take on new roles, such as X-ray film interpretation in imaging departments. In Uganda, where this study was conducted, there are just >40 radiologists in a population of ~40 million. In many hospitals, especially in rural areas, clinicians often rely on radiographers to obtain an opinion to assist with proper patient management. Therefore, Ugandan radiographers are being trained in basic radiographic interpretation to address the shortage of radiologists. Objective. To determine the diagnostic accuracy of graduate radiographers in interpreting chest radiographs. Methods. This was a cross-sectional retrospective study involving 57 graduate radiographers who were provided with 53 randomly selected chest radiographs to interpret. The validation of a radiographer’s interpretation of a radiograph was aided by the opinion of two senior radiologists. SPSS version 25 software (IBM Corp, USA) was used to analyse the findings and the radiographer’s performance was assessed using the receiver operating characteristic (ROC). The mean abnormality location sensitivity, overall radiographer sensitivity, specificity and false-positive rates were calculated. Results. The radiographers’ diagnostic accuracy was high. The abnormality location sensitivity was 88.7%, overall sensitivity 76.6%, specificity 79.7% and false-positive rate 20.1%. Conclusion. The study demonstrated that radiographers, if trained, can accurately report on chest radiographs to an acceptable standard.

ANATOMICAL VARIATIONS OF ACCESSORY FORAMINA TRANSVERSARIA IN CERVICAL VERTEBRAE

Introduction: The cervical vertebrae are cranially placed, moveable vertebrae in the human body. The characteristic feature of these vertebrae are the presence of a Foramen Transversarium (FT) in each lateral mass. A plexus of sympathetic nerves surrounding the Vertebral Artery (VA) and Vertebral Veins (VV) passes through the FT. The variable number and size of FT may lead to clinically significant conditions.It may be due to variable course of the VA which implicates an embryological basis.Aims: The objective of the present study is to find out the incidence of accessory FT in the cervical vertebrae and its morphological and clinical significance.Material and Methods:There were 117 dried cervical vertebrae available in the Department of Anatomy of Medical Sciences Stip. They were macroscopically studied to find variations in the number of FT.Results: Out of 117 cervical vertebrae accessory FT were found in 25 vertebrae (21.3%). The accessory FT were unilateral in 15 vertebrae (12.8%) and bilateral in 10 vertebrae (8.7%). The unilateral foramina were more common than the bilateral one. The accessory FT were smaller and posteriorly placed compared to the regular FT. Conclusions: In the present study 21.3% of cervical vertebrae showed accessory FT. Among them the unilateral accessory FT was more common than the bilateral variety. The accessory foramina were mostly observed in the lower cervical vertebrae. These anatomical variations and morphology of the FT is useful in the operations involving spine surgeries. It is also of great value to the radiologists in the interpretation of X-ray films and CT-scans.

Enhancing Entry-Level Physiotherapy Student Learning in Interpreting Radiology – An Action Research Project

Purpose: In Australia, the ability to interpret orthopaedic x-rays is an entry-level skill for physiotherapists. Yet there is a paucity of evidence in the literature which details effective learning and teaching methods to optimise confidence and competence in x-ray interpretation. The aims of this study were to describe the content contained in an orthopaedic radiology module within an Australian 2-year graduate entry Master of Physiotherapy degree; approaches to learning and teaching used in this module; student satisfaction associated with this module over a 2-year period. Method: The University’s framework for quality assurance, which is based on the Plan-Implement-Review-Improve underpinned this action research project. The content of the radiology module was reviewed and feedback was gained from a student focus group and standard university course data. Data were analysed using descriptive content analysis and descriptive statistics to identify areas for improvement. Changes to the module were then developed and implemented, and the effect of these changes were evaluated using a custom-designed survey. Results: It was found that didactic methods of teaching were used in this module that encouraged surface level learning. Students reported feeling stressed during the radiology examination due to the learning tasks and assessment being disconnected, and often reported difficulty transferring knowledge into the clinical placement setting. Constructive alignment was undertaken of learning activities and assessment tasks. An additional non-compulsory tutorial was added to the radiology module, where scaffolding and cooperative learning techniques were used to teach students x-ray interpretation. Students reported that the revised curriculum increased their confidence in interpreting x-rays. Students’ competence in x-ray interpretation also increased based on a significant increase in score on their radiology examination. Conclusion: Based on the findings of this study the addition of a tutorial that focused on interpretation of x-ray films to supplement radiology teaching improved entry-level physiotherapy students’ confidence and competence in interpreting x-rays and their perceived preparedness for clinical placement in a small entry-level physiotherapy cohort at a single Australian University.

Postprocedure radiologist's interpretation of ERCP x-ray films: a prospective outcomes study

To prospectively determine if the current practice of radiologists' interpretation of post-ERCP spot images sent by endoscopists resulted in discrepancies in interpretation, affected subsequent management of patients, and resulted in additional costs. A prospective analysis of 145 consecutive patients who underwent ERCP over the course of 4 months was performed. A separate endoscopist, not involved in the patient's care, reviewed the radiologist's report of the ERCP x-ray films to determine whether there was either concordance or discordance with the procedural findings. All patients' clinical courses were prospectively followed for a minimum of 6 months to determine whether clinical decision-making was affected by the radiologists' interpretation of the x-ray films. Secondarily, the cost of the current practice of postprocedure interpretation of ECRP radiographs was measured. This study took place at University Hospitals of Cleveland, which is a tertiary care facility. In total, there were 61 (47%) discordant interpretations of 130 cholangiograms and 27 (38%) discordant interpretations of 72 pancreatograms, with an overall discordance between an endoscopist and a radiologist in 80 (55%) of the 145 cases. Clinical management was subsequently affected in 3 (2.1%) cases, all of which involved a discordant reading. In each of the 3 cases, further testing validated the gastroenterologist's initial findings at the time of the procedure. Radiologists were reimbursed $5395 for interpretation of ERCP x-ray films. Extrapolated over the course of a year, the reimbursement at this single tertiary care hospital would be greater than $16,000. Additional testing based on discordant reports resulted in $2510 of reimbursement for 3 patients. The limitation of this study is that it reflects data from only one academic institution. Radiologists' interpretation of postprocedure ERCP films were inadequate, with a 47% discordance rate among cholangiograms and a 38% discordance rate among pancreatograms. The routine practice of postprocedure ERCP x-ray film interpretation by radiologists altered clinical practice in 2.1% of cases; subsequent care did not confirm radiologists' findings and imparted increased risk to the patients. This practice proved to be a misallocation of resources and should not be continued.

A Prospective Outcomes Study and Cost Analysis of Post-Procedure Radiologistʼs Interpretation of ERCP X-Ray Films

Purpose: The aims of this study are to prospectively determine if post-ERCP x-ray film reading by radiologists alters clinical decision-making and to determine whether the current standard of care is a cost-efficient practice. Methods: A preliminary, prospective analysis of 145 patients undergoing ERCP over the course of 4 months was performed. A separate endoscopist (E), not involved in the patient's care, reviewed the radiologist's (R) report of the ERCP x-ray films to determine if there was either concordance or discordance with the procedural findings. The patients' clinical courses were prospectively followed to determine if clinical decision-making was affected by the R's interpretation of the x-ray films. Secondarily, a cost analysis was performed. Results: Of the 145 patients, there was an overall discordance between the E and R in 80 of the cases (55%). One patient underwent a laproscopic common bile duct exploration based on R's interpretation that was discordant to the E's, however, the abnormality reported by the R was not confirmed surgically. In two further cases, additionally imaging studies (liver MRI and abdominal CT scan) were ordered based upon R's readings which were discordant from the E's; again, the E's findings were validated by the further imaging. In the other 77 cases, no additional procedures, imaging, or laboratory tests were ordered. In total, 130 cholangiograms with 61 discordances (47%), and 72 pancreatograms with 27 discordances (38%) were evaluated. Radiologists were reimbursed $5,395 for interpretation of ERCP x-ray films, and over the course of a year, their reimbursement would be greater than $17,000. Extra testing based on discordant reports resulted in an additional $2,510 of reimbursement for 3 patients. Conclusions: The R's interpretation of ERCP films was inadequate, with a 47% discordance rate among cholangiograms and a 38% discordance rate among pancreatograms. The routine practice of post-procedure ERCP x-ray film interpretation by R altered clinical practice in only 3 of the 80 discordant cases; subsequent care did not confirm R's findings and imparted increased risk to the patients. This practice proved to be a misallocation of resources and should not be continued. Additional patient enrollment, multi-center involvement, and continued cost analysis are needed to verify these preliminary findings.

A computer aided consultant system for mammogram diagnosis

A computer-aided consultant system for mammogram diagnosis is proposed in this paper based on mammogram segmentation as an image mining technique, to aid radiologistis in X-ray film interpretation. The general architecture of the system is introduced first, followed by a discussion of mammogram segmentation using logic filter, an analysis of the statistical data to the diagnostics with respect to different clinical information, and a brief introduction to a fuzzy decision making subsystem. Finally some experimental results are given.

The ABCs of Chest X-ray Film Interpretation

The ABCs of Chest X-ray Film Interpretation

X-Ray Film Interpretation by Hospital Outpatient Departments and Primary Health Care Center Physicians in Dammam, Saudi Arabia

The objective of this study was to assess the accuracy of x-ray film interpretation by nonradiologist physicians. This was a cross-sectional study based on data collected using a structured check-list from a sample of 863 x-ray films requested and interpreted by physicians working in the outpatient departments of Dammam Central Hospital, and in five primary health care centers in Dammam city, Saudi Arabia. The check-list was used to compare the physicians' interpretations of x-ray films requested with those made by an experienced consultant radiologist. Physicians' interpretations were classified as concordant or discordant with those of the radiologists. Factors affecting those interpretations were assessed. Physicians from both the hospital and primary health care centers were discordant with the radiologist in 20.0% and 22.2% of x-ray films interpreted. There were significant positive correlations of physicians' interpretations with physicians' handwriting and completeness of patient information on the request forms, quality of x-ray films and adequacy of x-ray film views. Also, there were significant negative correlations of interpretations with chest and head and neck x-ray films. The study reveals a significant need for training of hospital and primary health care center physicians in diagnostic radiology.

Impact of clinical history on film interpretation

We performed a study to determine whether clinical history gives a positive or negative influence on X-ray film interpretation. One hundred and nine patient's radiograms, consisting of 55 normal and 54 abnormal cases (136 abnormalities), were interpreted twice by three pairs of residents in radiology and a pair of qualified radiologists, without clinical history first and with clinical history next. The interpreters recorded diagnosis and confidence level of normal or abnormal findings on a six-point scale. Analysis of receiver operating characteristic (ROC) curves showed that knowledge of clinical history improved diagnostic accuracy. Residents, especially beginners, should be advised to obtain clinical history whenever they read radiograms.

Musculoskeletal Disorders: Regional Examination and Differential Diagnosis

This rather inclusive text presents a step-wise approach to the differential diagnosis of musculoskeletal disease. According to the author of chapter 1, the two parts of examination consist of observation of the whole patient and inspection of the musculoskeletal system. In a sense, the book follows this format. The initial five chapters address certain components essential to examining any patient. The remaining sections portray a method of diagnosing regional musculoskeletal diseases and disorders. The various authors adhere to a common format, which takes up in turn anatomy, regional examination, and differential diagnosis. Profuse illustrations and photographic and roentgenographic reproductions provide a valuable counterpart to a well-written, concise text. Chapter 1, on general diagnosis, contains a useful entry on common laboratory values and their alterations in various disorders. Likewise, the chart and discussion on synovial fluid alterations are useful in treating patients with joint diseases. The section on x-ray film interpretation

Cine and TV Methods of Analyzing Search in Roentgen Diagnosis

A 16mm motion-picture camera mounted on a helmet has been used to record simultaneously the scene being viewed by the wearer as well as the point of eye fixation on that scene. The technique has been tested as a means of demonstrating search courses in the survey and interpretation of x-ray films. The analysis of the examiner's eye movements during the viewing of cineradiography may have value in trying to understand and explain the increase in depth awareness brought about by object rotation. A closed-circuit television system was used for the distant transmission of radiographic images, the scanning and search of which were remotely controlled by an observer looking at a display monitor.

ReviewFundamentals of Roentgenology. By SquireLucy Frank, pp. 363, published for The Commonwealth Fund by Harvard University Press, Cambridge, Massachusetts, 1964 (Oxford Univ. Press), £5.

This most unusual book is an instruction manual designed to be read from beginning to end, and not an orthodox text-book or work of reference. The aim throughout is to teach the correct approach to the interpretation of X-ray films, in fact “how to look at a film”. The early parts of the book deal with the formation of the image of the radiograph and the significance of variations in its density.

A DIAGNOSTIC problem: noncyanotic heart disease with heart failure in a seven year-old boy; a clinical pathological conference held at the University of Kansas Medical Center.

The Clinicopathological Conference at this school is somewhat unique. Fourth year students are responsible for the discussion of the case, interpretation of x-ray films, and of electrocardiograms. The comments of the students, in the following presentation, reflect the maturity of the modern-day senior.

The interpretation of x-ray films in the diagnosis of rickets

The interpretation of x-ray films in the diagnosis of rickets

Pre-operative and Post-operative Interpretation of X-ray Films about the Head and Neck

AS a general rule, radiograms are taken mainly with the idea in mind of making a diagnosis for surgical or non-surgical interference, but the study of X-ray films after operation has been neglected or treated lightly and only in gross errors or medico-legal cases have they been called into play. Then, too, the number of monographs in the literature which deal with diagnosis of diseases of the head and neck by the radiogram is relatively small. This is especially true if one takes into consideration only the publications of those authors who have broad experience of the clinical and pathologic entities in this field. There can be no doubt that radiography of the head, when properly undertaken, is distinctly a science—a branch of medicine of the utmost importance—but it can rightfully be said that knowledge of the pathologic conditions and of their clinical values is by no means the common property of all physicians. What is meant by the pre-and post-operative study of radiograms? Since we are discussing wh...