Measurement of lung volumes from supine portable chest radiographs.

PubMed

Ries, A L; Clausen, J L; Friedman, P J

1979-12-01

Lung volumes in supine nonambulatory patients are physiological parameters often difficult to measure with current techniques (plethysmograph, gas dilution). Existing radiographic methods for measuring lung volumes require standard upright chest radiographs. Accordingly, in 31 normal supine adults, we determined helium-dilution functional residual and total lung capacities and measured planimetric lung field areas (LFA) from corresponding portable anteroposterior and lateral radiographs. Low radiation dose methods, which delivered less than 10% of that from standard portable X-ray technique, were utilized. Correlation between lung volume and radiographic LFA was highly significant (r = 0.96, SEE = 10.6%). Multiple-step regressions using height and chest diameter correction factors reduced variance, but weight and radiographic magnification factors did not. In 17 additional subjects studied for validation, the regression equations accurately predicted radiographic lung volume. Thus, this technique can provide accurate and rapid measurement of lung volume in studies involving supine patients.

Community-Acquired Pneumonia Visualized on CT Scans but Not Chest Radiographs: Pathogens, Severity, and Clinical Outcomes.

PubMed

Upchurch, Cameron P; Grijalva, Carlos G; Wunderink, Richard G; Williams, Derek J; Waterer, Grant W; Anderson, Evan J; Zhu, Yuwei; Hart, Eric M; Carroll, Frank; Bramley, Anna M; Jain, Seema; Edwards, Kathryn M; Self, Wesley H

2018-03-01

The clinical significance of pneumonia visualized on CT scan in the setting of a normal chest radiograph is uncertain. In a multicenter prospective surveillance study of adults hospitalized with community-acquired pneumonia (CAP), we compared the presenting clinical features, pathogens present, and outcomes of patients with pneumonia visualized on a CT scan but not on a concurrent chest radiograph (CT-only pneumonia) and those with pneumonia visualized on a chest radiograph. All patients underwent chest radiography; the decision to obtain CT imaging was determined by the treating clinicians. Chest radiographs and CT images were interpreted by study-dedicated thoracic radiologists blinded to the clinical data. The study population included 2,251 adults with CAP; 2,185 patients (97%) had pneumonia visualized on chest radiography, whereas 66 patients (3%) had pneumonia visualized on CT scan but not on concurrent chest radiography. Overall, these patients with CT-only pneumonia had a clinical profile similar to those with pneumonia visualized on chest radiography, including comorbidities, vital signs, hospital length of stay, prevalence of viral (30% vs 26%) and bacterial (12% vs 14%) pathogens, ICU admission (23% vs 21%), use of mechanical ventilation (6% vs 5%), septic shock (5% vs 4%), and inhospital mortality (0 vs 2%). Adults hospitalized with CAP who had radiological evidence of pneumonia on CT scan but not on concurrent chest radiograph had pathogens, disease severity, and outcomes similar to patients who had signs of pneumonia on chest radiography. These findings support using the same management principles for patients with CT-only pneumonia and those with pneumonia seen on chest radiography. Copyright © 2017 American College of Chest Physicians. All rights reserved.

Acute Middle East Respiratory Syndrome Coronavirus: Temporal Lung Changes Observed on the Chest Radiographs of 55 Patients.

PubMed

Das, Karuna M; Lee, Edward Y; Al Jawder, Suhayla E; Enani, Mushira A; Singh, Rajvir; Skakni, Leila; Al-Nakshabandi, Nizar; AlDossari, Khalid; Larsson, Sven G

2015-09-01

The objective of our study was to describe lung changes on serial chest radiographs from patients infected with the acute Middle East respiratory syndrome corona-virus (MERS-CoV) and to compare the chest radiographic findings and final outcomes with those of health care workers (HCWs) infected with the same virus. Chest radiographic scores and comorbidities were also examined as indicators of a fatal outcome to determine their potential prognostic value. Chest radiographs of 33 patients and 22 HCWs infected with MERS-CoV were examined for radiologic features indicative of disease and for evidence of radiographic deterioration and progression. Chest radiographic scores were estimated after dividing each lung into three zones. The scores (1 [mild] to 4 [severe]) for all six zones per chest radiographic examination were summed to provide a cumulative chest radiographic score (range, 0-24). Serial radiographs were also examined to assess for radiographic deterioration and progression from type 1 (mild) to type 4 (severe) disease. Multivariate logistic regression analysis, Kaplan-Meier survival curve analysis, and the Mann-Whitney U test were used to compare data of deceased patients with those of individuals who recovered to identify prognostic radiographic features. Ground-glass opacity was the most common abnormality (66%) followed by consolidation (18%). Overall mortality was 35% (19/55). Mortality was higher in the patient group (55%, 18/33) than in the HCW group (5%, 1/22). The mean chest radiographic score for deceased patients was significantly higher than that for those who recovered (13 ± 2.6 [SD] vs 5.8 ± 5.6, respectively; p = 0.001); in addition, higher rates of pneumothorax (deceased patients vs patients who recovered, 47% vs 0%; p = 0.001), pleural effusion (63% vs 14%; p = 0.001), and type 4 radiographic progression (63% vs 6%; p = 0.001) were seen in the deceased patients compared with those who recovered. Univariate and logistic regression analyses

Semi-automated location identification of catheters in digital chest radiographs

NASA Astrophysics Data System (ADS)

Keller, Brad M.; Reeves, Anthony P.; Cham, Matthew D.; Henschke, Claudia I.; Yankelevitz, David F.

2007-03-01

Localization of catheter tips is the most common task in intensive care unit imaging. In this work, catheters appearing in digital chest radiographs acquired by portable chest x-rays were tracked using a semi-automatic method. Due to the fact that catheters are synthetic objects, its profile does not vary drastically over its length. Therefore, we use forward looking registration with normalized cross-correlation in order to take advantage of a priori information of the catheter profile. The registration is accomplished with a two-dimensional template representative of the catheter to be tracked generated using two seed points given by the user. To validate catheter tracking with this method, we look at two metrics: accuracy and precision. The algorithms results are compared to a ground truth established by catheter midlines marked by expert radiologists. Using 12 objects of interest comprised of naso-gastric, endo-tracheal tubes, and chest tubes, and PICC and central venous catheters, we find that our algorithm can fully track 75% of the objects of interest, with a average tracking accuracy and precision of 85.0%, 93.6% respectively using the above metrics. Such a technique would be useful for physicians wishing to verify the positioning of catheter tips using chest radiographs.

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

PubMed Central

Egbe, N O; Akpan, B E

2015-01-01

Objective: 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. Methods: 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. Results: 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. Conclusion: 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. Advances in knowledge: 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. PMID:25966290

Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients.

PubMed

Omar, Hesham R; Mangar, Devanand; Khetarpal, Suneel; Shapiro, David H; Kolla, Jaya; Rashad, Rania; Helal, Engy; Camporesi, Enrico M

2011-09-27

Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.

Technologist-Directed Repeat Musculoskeletal and Chest Radiographs: How Often Do They Impact Diagnosis?

PubMed

Rosenkrantz, Andrew B; Jacobs, Jill E; Jain, Nidhi; Brusca-Augello, Geraldine; Mechlin, Michael; Parente, Marc; Recht, Michael P

2017-12-01

Radiologic technologists may repeat images within a radiographic examination because of perceived suboptimal image quality, excluding these original images from submission to a PACS. This study assesses the appropriateness of technologists' decisions to repeat musculoskeletal and chest radiographs as well as the utility of repeat radiographs in addressing examinations' clinical indication. We included 95 musculoskeletal and 87 chest radiographic examinations in which the technologist repeated one or more images because of perceived image quality issues, rejecting original images from PACS submission. Rejected images were retrieved from the radiograph unit and uploaded for viewing on a dedicated server. Musculoskeletal and chest radiologists reviewed rejected and repeat images in their timed sequence, in addition to the studies' remaining images. Radiologists answered questions regarding the added value of repeat images. The reviewing radiologist agreed with the reason for rejection for 64.2% of musculoskeletal and 60.9% of chest radiographs. For 77.9% and 93.1% of rejected radiographs, the clinical inquiry could have been satisfied without repeating the image. For 75.8% and 64.4%, the repeated images showed improved image quality. Only 28.4% and 3.4% of repeated images were considered to provide additional information that was helpful in addressing the clinical question. Most repeated radiographs (chest more so than musculoskeletal radiographs) did not add significant clinical information or alter diagnosis, although they did increase radiation exposure. The decision to repeat images should be made after viewing the questionable image in context with all images in a study and might best be made by a radiologist rather than the performing technologist.

Toward the detection of abnormal chest radiographs the way radiologists do it

NASA Astrophysics Data System (ADS)

Alzubaidi, Mohammad; Patel, Ameet; Panchanathan, Sethuraman; Black, John A., Jr.

2011-03-01

Computer Aided Detection (CADe) and Computer Aided Diagnosis (CADx) are relatively recent areas of research that attempt to employ feature extraction, pattern recognition, and machine learning algorithms to aid radiologists in detecting and diagnosing abnormalities in medical images. However, these computational methods are based on the assumption that there are distinct classes of abnormalities, and that each class has some distinguishing features that set it apart from other classes. However, abnormalities in chest radiographs tend to be very heterogeneous. The literature suggests that thoracic (chest) radiologists develop their ability to detect abnormalities by developing a sense of what is normal, so that anything that is abnormal attracts their attention. This paper discusses an approach to CADe that is based on a technique called anomaly detection (which aims to detect outliers in data sets) for the purpose of detecting atypical regions in chest radiographs. However, in order to apply anomaly detection to chest radiographs, it is necessary to develop a basis for extracting features from corresponding anatomical locations in different chest radiographs. This paper proposes a method for doing this, and describes how it can be used to support CADe.

Fully automated calculation of cardiothoracic ratio in digital chest radiographs

NASA Astrophysics Data System (ADS)

Cong, Lin; Jiang, Luan; Chen, Gang; Li, Qiang

2017-03-01

The calculation of Cardiothoracic Ratio (CTR) in digital chest radiographs would be useful for cardiac anomaly assessment and heart enlargement related disease indication. The purpose of this study was to develop and evaluate a fully automated scheme for calculation of CTR in digital chest radiographs. Our automated method consisted of three steps, i.e., lung region localization, lung segmentation, and CTR calculation. We manually annotated the lung boundary with 84 points in 100 digital chest radiographs, and calculated an average lung model for the subsequent work. Firstly, in order to localize the lung region, generalized Hough transform was employed to identify the upper, lower, and outer boundaries of lung by use of Sobel gradient information. The average lung model was aligned to the localized lung region to obtain the initial lung outline. Secondly, we separately applied dynamic programming method to detect the upper, lower, outer and inner boundaries of lungs, and then linked the four boundaries to segment the lungs. Based on the identified outer boundaries of left lung and right lung, we corrected the center and the declination of the original radiography. Finally, CTR was calculated as a ratio of the transverse diameter of the heart to the internal diameter of the chest, based on the segmented lungs. The preliminary results on 106 digital chest radiographs showed that the proposed method could obtain accurate segmentation of lung based on subjective observation, and achieved sensitivity of 88.9% (40 of 45 abnormalities), and specificity of 100% (i.e. 61 of 61 normal) for the identification of heart enlargements.

Routine Chest Radiographs After Central Line Insertion: Mandatory Postprocedural Evaluation or Unnecessary Waste of Resources?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lucey, Brian; Varghese, Jose C.; Haslam, Philip

1999-09-15

Purpose: To study the cost and impact on patient management of the routine performance of chest radiographs in patients undergoing imaged-guided central venous catheter insertion. Methods: Six hundred and twenty-one catheters placed in 489 patients over a 42-month period formed the study group. Catheters were placed in the right internal jugular vein (425), left internal jugular vein (133), and subclavian veins (63). At the end of the procedure fluoroscopy was used to assess catheter position and check for complications. A postprocedural chest radiograph was obtained in all patients. Results: Postprocedural chest fluoroscopy showed no evidence of pneumothorax, hemothorax, or mediastinalmore » hematoma. Inappropriate catheter tip position or catheter kinks were noted with 90 catheters. These problems were all corrected while the patient was on the interventional table. Postprocedural chest radiographs showed no complications but proximal catheter tip migration was noted in six of 621 catheters (1%). These latter six catheters required further manipulation. The total technical and related charges for the postprocedural chest radiographs in this series were estimated at Pounds 15,525. Conclusion: Postprocedural chest radiographs after image-guided central venous catheter insertion are not routinely required. A postprocedural chest radiograph can be performed on a case-by-case basis at the discretion of the interventional radiologist.« less

Segmentation of ribs in digital chest radiographs

NASA Astrophysics Data System (ADS)

Cong, Lin; Guo, Wei; Li, Qiang

2016-03-01

Ribs and clavicles in posterior-anterior (PA) digital chest radiographs often overlap with lung abnormalities such as nodules, and cause missing of these abnormalities, it is therefore necessary to remove or reduce the ribs in chest radiographs. The purpose of this study was to develop a fully automated algorithm to segment ribs within lung area in digital radiography (DR) for removal of the ribs. The rib segmentation algorithm consists of three steps. Firstly, a radiograph was pre-processed for contrast adjustment and noise removal; second, generalized Hough transform was employed to localize the lower boundary of the ribs. In the third step, a novel bilateral dynamic programming algorithm was used to accurately segment the upper and lower boundaries of ribs simultaneously. The width of the ribs and the smoothness of the rib boundaries were incorporated in the cost function of the bilateral dynamic programming for obtaining consistent results for the upper and lower boundaries. Our database consisted of 93 DR images, including, respectively, 23 and 70 images acquired with a DR system from Shanghai United-Imaging Healthcare Co. and from GE Healthcare Co. The rib localization algorithm achieved a sensitivity of 98.2% with 0.1 false positives per image. The accuracy of the detected ribs was further evaluated subjectively in 3 levels: "1", good; "2", acceptable; "3", poor. The percentages of good, acceptable, and poor segmentation results were 91.1%, 7.2%, and 1.7%, respectively. Our algorithm can obtain good segmentation results for ribs in chest radiography and would be useful for rib reduction in our future study.

A computerized method for automated identification of erect posteroanterior and supine anteroposterior chest radiographs

NASA Astrophysics Data System (ADS)

Kao, E.-Fong; Lin, Wei-Chen; Hsu, Jui-Sheng; Chou, Ming-Chung; Jaw, Twei-Shiun; Liu, Gin-Chung

2011-12-01

A computerized scheme was developed for automated identification of erect posteroanterior (PA) and supine anteroposterior (AP) chest radiographs. The method was based on three features, the tilt angle of the scapula superior border, the tilt angle of the clavicle and the extent of radiolucence in lung fields, to identify the view of a chest radiograph. The three indices Ascapula, Aclavicle and Clung were determined from a chest image for the three features. Linear discriminant analysis was used to classify PA and AP chest images based on the three indices. The performance of the method was evaluated by receiver operating characteristic analysis. The proposed method was evaluated using a database of 600 PA and 600 AP chest radiographs. The discriminant performances Az of Ascapula, Aclavicle and Clung were 0.878 ± 0.010, 0.683 ± 0.015 and 0.962 ± 0.006, respectively. The combination of the three indices obtained an Az value of 0.979 ± 0.004. The results indicate that the combination of the three indices could yield high discriminant performance. The proposed method could provide radiologists with information about the view of chest radiographs for interpretation or could be used as a preprocessing step for analyzing chest images.

Usefulness of chest radiographs in first asthma attacks

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gershel, J.C.; Goldman, H.S.; Stein, R.E.K.

1983-08-11

To assess the value of routine chest radiography during acute first attacks of asthma, we studied 371 consecutive children over one year of age who presented with an initial episode of wheezing. Three hundred fifty children (94.3%) had radiographic findings that were compatible with uncomplicated asthma and were considered negative. Twenty-one (5.7%) had positive findings: atelectasis and pneumonia were noted in seven, segmental atelectasis in six, pneumonia in five, multiple areas of subsegmental atelectasis in two, and pneumomediastinum in one. The patients with positive films were more likely to have a respiratory rate above 60 or a pulse rate abovemore » 160 (P < 0.001), localized rales or localized decreased breath sounds before treatment (P < 0.01), and localized rales (P < 0.005) and localized wheezing (P < 0.02) after treatment; also, these patients were admitted to the hospital more often (P < 0.001). Ninety-five percent (20 of 21) of the children with positive films could be identified before treatment on the basis of a combination of tachypnea, tachycardia, fever, and localized rales or localized decreased breath sounds. Most first-time wheezers will not have positive radiographs; careful clinical evaluation should reveal which patients will have abnormal radiographs and will therefore benefit from the procedure. 20 references, 3 tables.« less

Clinical and Laboratory Findings in Patients With Acute Respiratory Symptoms That Suggest the Necessity of Chest X-ray for Community-Acquired Pneumonia.

PubMed

Ebrahimzadeh, Azadeh; Mohammadifard, Mahyar; Naseh, Godratallah; Mirgholami, Alireza

2015-01-01

Pneumonia is a common illness in all parts of the world and is considered as a major cause of death among all age groups. Nevertheless, only about 5% of patients referring to their primary care physicians with acute respiratory symptoms will develop pneumonia. This study was performed to derive practical criteria for performing chest radiographs for the evaluation of community-acquired pneumonia (CAP). A total of 420 patients with acute respiratory symptoms and positive findings on chest radiograph were evaluated from December 2008 to December 2009. The subjects were referred to outpatient clinics or emergency departments of Birjand's medical university hospitals, Iran, and were enrolled as positive cases. A checklist was completed for each patient including their demographic information, clinical signs and symptoms (cough, sputum production, dyspnea, chest pain, fever, tachycardia, and tachypnea), abnormal findings in pulmonary auscultation and laboratory findings (erythrocyte sedimentation rate, C-reactive protein levels, and white blood cell count). An equal number of age-matched individuals with acute respiratory symptoms, but insignificant findings on chest radiography, were included as the control group. Finally, the diagnostic values of different findings were compared. The data showed that vital signs and physical examination findings are useful screening parameters for predicting chest radiograph findings in outpatient settings. Therefore, by implementing a prediction rule, we would be able to determine which patients would benefit from a chest X-Ray (sensitivity, 94% and specificity, 57%). This study's findings suggest that requesting chest radiographs might not be necessary in patients with acute respiratory symptoms unless the vital signs and/or physical examination findings are abnormal. Considering the 94% sensitivity of this rule for predicting CAP, a chest radiograph is required for patients with unreliable follow-ups or moderate to high likelihood

Clinical findings associated with radiographic pneumonia in nursing home residents.

PubMed

Mehr, D R; Binder, E F; Kruse, R L; Zweig, S C; Madsen, R W; D'Agostino, R B

2001-11-01

Subtle presentation and the frequent lack of on-site physicians complicate the diagnosis of pneumonia in nursing home residents. We sought to identify clinical findings (signs, symptoms, and simple laboratory studies) associated with radiographic pneumonia in sick nursing home residents. This was a prospective cohort study. The residents of 36 nursing homes in central Missouri and the St. Louis area with signs or symptoms suggesting a lower respiratory infection were included. We compared evaluation findings by project nurses with findings reported from chest radiographs. Among 2334 episodes of illness in 1474 nursing home residents, 45% of the radiograph reports suggested pneumonia (possible=12%; probable or definite = 33%). In 80% of pneumonia episodes, subjects had 3 or fewer respiratory or general symptoms. Eight variables were significant independent predictors of pneumonia (increased pulse, respiratory rate =30, temperature =38 degrees C, somnolence or decreased alertness, presence of acute confusion, lung crackles on auscultation, absence of wheezes, and increased white blood count). A simple score (range = -1 to 8) on the basis of these variables identified 33% of subjects (score > or =3) with more than 50% probability of pneumonia and an additional 24% (score of 2) with 44% probability of pneumonia. Pneumonia in nursing home residents is usually associated with few symptoms. Nonetheless, a simple clinical prediction rule can identify residents at very high risk of pneumonia. If validated in other studies, physicians could consider treating such residents without obtaining a chest radiograph.

Outcome of recommendations for radiographic follow-up of pneumonia on outpatient chest radiography.

PubMed

Little, Brent P; Gilman, Matthew D; Humphrey, Kathryn L; Alkasab, Tarik K; Gibbons, Fiona K; Shepard, Jo-Anne O; Wu, Carol C

2014-01-01

Follow-up chest radiographs are frequently recommended by radiologists to document the clearing of radiographically suspected pneumonia. However, the clinical utility of follow-up radiography is not well understood. The purpose of this study was to examine the incidence of important pulmonary pathology revealed during follow-up imaging of suspected pneumonia on outpatient chest radiography. Reports of 29,138 outpatient chest radiography examinations performed at an academic medical center in 2008 were searched to identify cases in which the radiologist recommended follow-up chest radiography for presumed community-acquired pneumonia (n = 618). Descriptions of index radiographic abnormalities were recorded. Reports of follow-up imaging (radiography and CT) performed during the period from January 2008 to January 2010 were reviewed to assess the outcome of the index abnormality. Clinical history, demographics, microbiology, and pathology reports were reviewed and recorded. Compliance with follow-up imaging recommendations was 76.7%. In nine of 618 cases (1.5%), a newly diagnosed malignancy corresponded to the abnormality on chest radiography initially suspected to be pneumonia. In 23 of 618 cases (3.7%), an alternative nonmalignant disease corresponded with the abnormality on chest radiography initially suspected to be pneumonia. Therefore, in 32 of 618 patients (5.2%), significant new pulmonary diagnoses were established during follow-up imaging of suspected pneumonia. Follow-up imaging of radiographically suspected pneumonia leads to a small number of new diagnoses of malignancy and important nonmalignant diseases, which may alter patient management.

Pulmonary effects of synthetic marijuana: chest radiography and CT findings.

PubMed

Berkowitz, Eugene A; Henry, Travis S; Veeraraghavan, Srihari; Staton, Gerald W; Gal, Anthony A

2015-04-01

The purpose of this article is to present the first chest radiographic and CT descriptions of organizing pneumonia in response to smoking synthetic marijuana. Chest radiographs showed a diffuse miliary-micronodular pattern. Chest CT images showed diffuse centrilobular nodules and tree-in-bud pattern and a histopathologic pattern of organizing pneumonia with or without patchy acute alveolar damage. This distinct imaging pattern should alert radiologists to include synthetic marijuana abuse in the differential diagnosis.

Multi-scale Morphological Image Enhancement of Chest Radiographs by a Hybrid Scheme.

PubMed

Alavijeh, Fatemeh Shahsavari; Mahdavi-Nasab, Homayoun

2015-01-01

Chest radiography is a common diagnostic imaging test, which contains an enormous amount of information about a patient. However, its interpretation is highly challenging. The accuracy of the diagnostic process is greatly influenced by image processing algorithms; hence enhancement of the images is indispensable in order to improve visibility of the details. This paper aims at improving radiograph parameters such as contrast, sharpness, noise level, and brightness to enhance chest radiographs, making use of a triangulation method. Here, contrast limited adaptive histogram equalization technique and noise suppression are simultaneously performed in wavelet domain in a new scheme, followed by morphological top-hat and bottom-hat filtering. A unique implementation of morphological filters allows for adjustment of the image brightness and significant enhancement of the contrast. The proposed method is tested on chest radiographs from Japanese Society of Radiological Technology database. The results are compared with conventional enhancement techniques such as histogram equalization, contrast limited adaptive histogram equalization, Retinex, and some recently proposed methods to show its strengths. The experimental results reveal that the proposed method can remarkably improve the image contrast while keeping the sensitive chest tissue information so that radiologists might have a more precise interpretation.

Multi-scale Morphological Image Enhancement of Chest Radiographs by a Hybrid Scheme

PubMed Central

Alavijeh, Fatemeh Shahsavari; Mahdavi-Nasab, Homayoun

2015-01-01

Chest radiography is a common diagnostic imaging test, which contains an enormous amount of information about a patient. However, its interpretation is highly challenging. The accuracy of the diagnostic process is greatly influenced by image processing algorithms; hence enhancement of the images is indispensable in order to improve visibility of the details. This paper aims at improving radiograph parameters such as contrast, sharpness, noise level, and brightness to enhance chest radiographs, making use of a triangulation method. Here, contrast limited adaptive histogram equalization technique and noise suppression are simultaneously performed in wavelet domain in a new scheme, followed by morphological top-hat and bottom-hat filtering. A unique implementation of morphological filters allows for adjustment of the image brightness and significant enhancement of the contrast. The proposed method is tested on chest radiographs from Japanese Society of Radiological Technology database. The results are compared with conventional enhancement techniques such as histogram equalization, contrast limited adaptive histogram equalization, Retinex, and some recently proposed methods to show its strengths. The experimental results reveal that the proposed method can remarkably improve the image contrast while keeping the sensitive chest tissue information so that radiologists might have a more precise interpretation. PMID:25709942

Reduction of adult fingers visualized on pediatric intensive care unit (PICU) chest radiographs after radiation technologist and PICU staff radiation safety education.

PubMed

Tynan, Jennifer R; Duncan, Meghan D; Burbridge, Brent E

2009-10-01

A recent publication from our centre revealed a disturbing finding of a significant incidence of adult fingers seen on the pediatric intensive care unit (PICU) chest radiographs. This is inappropriate occupational exposure to diagnostic radiation. We hypothesized that the incidence of adult fingers on PICU chest radiographs would decline after radiation safety educational seminars were given to the medical radiation technologists and PICU staff. The present study's objectives were addressed by using a pretest-posttest design. Two cross-sectional PICU chest radiograph samples, taken before and after the administration of radiation safety education for our medical radiation technologists and PICU staff, were compared by using a chi2 test. There was a 61.2% and 76.9% reduction in extraneous adult fingers, directly exposed to the x-ray beam and those seen in the coned regions of the film, respectively, on PICU chest radiographs (66.7% reduction overall). This reduction was statistically significant (chi2 = 20.613, P < .001). Limiting unnecessary occupational radiation exposure is a critical issue in radiology. There was a statistically and clinically significant association between radiation safety education and the decreased number of adult fingers seen on PICU chest radiographs. This study provides preliminary evidence in favour of the benefit of radiation safety seminars.

Spatial resolution and chest nodule detection: an interesting incidental finding

NASA Astrophysics Data System (ADS)

Toomey, R. J.; McEntee, M. F.; Ryan, J. T.; Evanoff, M. G.; Hayes, A.; Brennan, P. C.

2010-02-01

This study reports an incidental finding from a larger work. It examines the relationship between spatial resolution and nodule detection for chest radiographs. Twelve examining radiologists with the American Board of Radiology read thirty chest radiographs in two conditions - full (1500 × 1500 pixel) resolution, and 300 × 300 pixel resolution linearly interpolated to 1500 × 1500 pixels. All images were surrounded by a 10-pixel sharp grey border to aid in focussing the observer's eye when viewing the comparatively unsharp interpolated images. Fifteen of the images contained a single simulated pulmonary nodule. Observers were asked to rate their confidence that a nodule was present on each radiograph on a scale of 1 (least confidence, certain no lesion is present) to 6 (most confidence, certain a lesion was present). All other abnormalities were to be ignored. No windowing, levelling or magnification of the images was permitted and viewing distance was constrained to approximately 70cm. Images were displayed on a 3 megapixel greyscale monitor. Receiver operating characteristic (ROC) analysis was applied to the results of the readings using the Dorfman-Berbaum-Metz multiplereader, multiple-case method. No statistically significant differences were found with either readers and cases treated as random or with cases treated as fixed. Low spatial frequency information appears to be sufficient for the detection of chest lesion of the type used in this study.

Utility of Chest Computed Tomography after a "Normal" Chest Radiograph in Patients with Thoracic Stab Wounds.

PubMed

Nguyen, Brian M; Plurad, David; Abrishami, Sadaf; Neville, Angela; Putnam, Brant; Kim, Dennis Y

2015-10-01

Chest computed tomography (CCT) is used to screen for injuries in hemodynamically stable patients with penetrating injury. We aim to determine the incidence of missed injuries detected on CCT after a negative chest radiograph (CXR) in patients with thoracic stab wounds. A 10-year retrospective review of a Level I trauma center registry was performed on patients with thoracic stab wounds. Patients who were hemodynamically unstable or did not undergo both CXR and CCT were excluded. Patients with a negative CXR were evaluated to determine if additional findings were diagnosed on CCT. Of 386 patients with stab wounds to the chest, 154 (40%) underwent both CXR and CCT. One hundred and fifteen (75%) had a negative screening CXR. CCT identified injuries in 42 patients (37%) that were not seen on CXR. Pneumothorax and/or hemothorax occurred in 40 patients (35%), of which 14 patients underwent tube thoracostomy. Two patients had hemopericardium on CCT and both required operative intervention. Greater than one-third of patients with a normal screening CXR were found to have abnormalities on CCT. Future studies comparing repeat CXR to CCT are required to further define the optimal diagnostic strategy in patients with stab wounds to chest after normal screening CXR.

42 CFR 37.51 - Interpreting and classifying chest radiographs-digital radiography systems.

Code of Federal Regulations, 2014 CFR

2014-10-01

... chest radiographic images provided for use with the Guidelines for the Use of the ILO International... standard digital images may be used for classifying digital chest images for pneumoconiosis. Modification of the appearance of the standard images using software tools is not permitted. (d) Viewing systems...

42 CFR 37.51 - Interpreting and classifying chest radiographs-digital radiography systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... standard digital chest radiographic images provided for use with the Guidelines for the Use of the ILO... NIOSH-approved standard digital images may be used for classifying digital chest images for pneumoconiosis. Modification of the appearance of the standard images using software tools is not permitted. (d...

Loculated pneumothorax due to a rare combination resulting in an interesting chest radiograph.

PubMed

Isaac, Barney Thomas Jesudason; Samuel, Johnson Thamarathu; Mukherjee, Dipak K; Pittman, Marcus

2017-11-01

A 35 years old man presented with acute onset left sided pleuritic chest pain and shortness of breath. On evaluation, he was found to have an interesting chest radiograph which showed a loculated pneumothorax with collapse of the left upper lobe and lingula but fully expanded left lower lobe. He is a known asthmatic who had allergic broncho pulmonary aspergillosis (ABPA) previously with left upper lobe and lingular collapse secondary to mucous plugging. This resolved on treatment with steroids and itraconazole. An interesting combination of events is proposed to explain the current presentation. CT scan chest and blood tests confirmed this sequence of events. He was appropriately treated resulting in complete clinical and radiological recovery. The events leading to the presentation and the likely physiological background for this interesting chest radiograph are discussed. © 2016 John Wiley & Sons Ltd.

Detection of tuberculosis using hybrid features from chest radiographs

NASA Astrophysics Data System (ADS)

Fatima, Ayesha; Akram, M. Usman; Akhtar, Mahmood; Shafique, Irrum

2017-02-01

Tuberculosis is an infectious disease and becomes a major threat all over the world but still diagnosis of tuberculosis is a challenging task. In literature, chest radiographs are considered as most commonly used medical images in under developed countries for the diagnosis of TB. Different methods have been proposed but they are not helpful for radiologists due to cost and accuracy issues. Our paper presents a methodology in which different combinations of features are extracted based on intensities, shape and texture of chest radiograph and given to classifier for the detection of TB. The performance of our methodology is evaluated using publically available standard dataset Montgomery Country (MC) which contains 138 CXRs among which 80 CXRs are normal and 58 CXRs are abnormal including effusion and miliary patterns etc. The accuracy of 81.16% was achieved and the results show that proposed method have outperformed existing state of the art methods on MC dataset.

Impact of clinical history on chest radiograph interpretation.

PubMed

Test, Matthew; Shah, Samir S; Monuteaux, Michael; Ambroggio, Lilliam; Lee, Edward Y; Markowitz, Richard I; Bixby, Sarah; Diperna, Stephanie; Servaes, Sabah; Hellinger, Jeffrey C; Neuman, Mark I

2013-07-01

The inclusion of clinical information may have unrecognized influence in the interpretation of diagnostic testing. The objective of the study was to determine the impact of clinical history on chest radiograph interpretation in the diagnosis of pneumonia. Prospective case-based study. Radiologists interpreted 110 radiographs of children evaluated for suspicion of pneumonia. Clinical information was withheld during the first interpretation. After 6 months the radiographs were reviewed with clinical information. Radiologists reported on pneumonia indicators described by the World Health Organization (ie, any infiltrate, alveolar infiltrate, interstitial infiltrate, air bronchograms, hilar adenopathy, pleural effusion). Children's Hospital of Philadelphia and Boston Children's Hospital. Six board-certified radiologists. Inter- and inter-rater reliability were assessed using the kappa statistic. The addition of clinical history did not have a substantial impact on the inter-rater reliability in the identification of any infiltrate, alveolar infiltrate, interstitial infiltrate, pleural effusion, or hilar adenopathy. Inter-rater reliability in the identification of air bronchograms improved from fair (k = 0.32) to moderate (k = 0.53). Intra-rater reliability for the identification of alveolar infiltrate remained substantial to almost perfect for all 6 raters with and without clinical information. One rater had a decrease in inter-rater reliability from almost perfect (k = 1.0) to fair (k = 0.21) in the identification of interstitial infiltrate with the addition of clinical history. Alveolar infiltrate and pleural effusion are findings with high intra- and inter-rater reliability in the diagnosis of bacterial pneumonia. The addition of clinical information did not have a substantial impact on the reliability of these findings. © 2012 Society of Hospital Medicine.

The value of radiographic findings for the progression of pandemic 2009 influenza A/H1N1 virus infection.

PubMed

Funaki, Takanori; Shoji, Kensuke; Yotani, Nobuyuki; Katsuta, Tomohiro; Miyazaki, Osamu; Nosaka, Shunsuke; Masaki, Hidekazu; Saitoh, Akihiko

2013-11-04

Most illnesses caused by pandemic influenza A (H1N1) pdm09 virus (A/H1N1) infection are acute and self-limiting among children. However, in some children, disease progression is rapid and may require hospitalization and transfer to a pediatric intensive care unit (PICU). We investigated factors associated with rapid disease progression among children admitted to hospital for A/H1N1 infection, particularly findings on initial chest radiographs. In this retrospective study, we investigated the records of children who had received a laboratory or clinical diagnosis of A/H1N1 infection and were admitted to the largest children's hospital in Japan between May 2009 and March 2010. The medical records were reviewed for age, underlying diseases, vital signs on admission, initial chest radiographic findings, and clinical outcomes. According to chest radiographic findings, patients were classified into 4 groups, as follows: [1] normal (n = 46), [2] hilar and/or peribronchial markings alone (n = 64), [3] consolidation (n = 64), and [4] other findings (n = 29). Factors associated with clinical outcomes were analyzed using logistic regression. Two hundreds and three patients (median 6.8 years) were enrolled in this study. Fifteen percent (31/203) of patients were admitted to PICU. Among 31 patients, 39% (12/31) of patients required mechanical ventilation (MV). When the initial chest radiographic findings were compared between patients with consolidation (n = 64) and those without consolidation (n = 139), a higher percentage of patients with consolidation were admitted to PICU (29.7% vs.8.6%, P < 0.001) and required MV (17.2% vs. 0.7%, P < 0.001). These findings remain significant when the data were analyzed with the logistic regression (P < 0.001, P < 0.001, respectively). Consolidation on initial chest radiographs was the most significant factor to predict clinical course of hospitalized children with the 2009 A/H1N1 infection.

[Comparative Study of Patient Identifications for Conventional and Portable Chest Radiographs Utilizing ROC Analysis].

PubMed

Kawashima, Hiroki; Hayashi, Norio; Ohno, Naoki; Matsuura, Yukihiro; Sanada, Shigeru

2015-08-01

To evaluate the patient identification ability of radiographers, previous and current chest radiographs were assessed with observer study utilizing a receiver operating characteristics (ROCs) analysis. This study included portable and conventional chest radiographs from 43 same and 43 different patients. The dataset used in this study was divided into the three following groups: (1) a pair of portable radiographs, (2) a pair of conventional radiographs, and (3) a combination of each type of radiograph. Seven observers participated in this ROC study, which aimed to identify same or different patients, using these datasets. ROC analysis was conducted to calculate the average area under ROC curve obtained by each observer (AUCave), and a statistical test was performed using the multi-reader multi-case method. Comparable results were obtained with pairs of portable (AUCave: 0.949) and conventional radiographs (AUCave: 0.951). In a comparison between the same modality, there were no significant differences. In contrast, the ability to identify patients by comparing a portable and conventional radiograph (AUCave: 0.873) was lower than with the matching datasets (p=0.002 and p=0.004, respectively). In conclusion, the use of different imaging modalities reduces radiographers' ability to identify their patients.

Foreign object detection and removal to improve automated analysis of chest radiographs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hogeweg, Laurens; Sanchez, Clara I.; Melendez, Jaime

2013-07-15

Purpose: Chest radiographs commonly contain projections of foreign objects, such as buttons, brassier clips, jewellery, or pacemakers and wires. The presence of these structures can substantially affect the output of computer analysis of these images. An automated method is presented to detect, segment, and remove foreign objects from chest radiographs.Methods: Detection is performed using supervised pixel classification with a kNN classifier, resulting in a probability estimate per pixel to belong to a projected foreign object. Segmentation is performed by grouping and post-processing pixels with a probability above a certain threshold. Next, the objects are replaced by texture inpainting.Results: The methodmore » is evaluated in experiments on 257 chest radiographs. The detection at pixel level is evaluated with receiver operating characteristic analysis on pixels within the unobscured lung fields and an A{sub z} value of 0.949 is achieved. Free response operator characteristic analysis is performed at the object level, and 95.6% of objects are detected with on average 0.25 false positive detections per image. To investigate the effect of removing the detected objects through inpainting, a texture analysis system for tuberculosis detection is applied to images with and without pathology and with and without foreign object removal. Unprocessed, the texture analysis abnormality score of normal images with foreign objects is comparable to those with pathology. After removing foreign objects, the texture score of normal images with and without foreign objects is similar, while abnormal images, whether they contain foreign objects or not, achieve on average higher scores.Conclusions: The authors conclude that removal of foreign objects from chest radiographs is feasible and beneficial for automated image analysis.« less

Computerized method for detection of vertebral fractures on lateral chest radiographs based on morphometric data

NASA Astrophysics Data System (ADS)

Kasai, Satoshi; Li, Feng; Shiraishi, Junji; Li, Qiang; Straus, Christopher; Vokes, Tamara; MacMahon, Heber; Doi, Kunio

2007-03-01

Vertebral fractures are the most common osteoporosis-related fractures. It is important to detect vertebral fractures, because they are associated with increased risk of subsequent fractures, and because pharmacologic therapy can reduce the risk of subsequent fractures. Although vertebral fractures are often not clinically recognized, they can be visualized on lateral chest radiographs taken for other purposes. However, only 15-60% of vertebral fractures found on lateral chest radiographs are mentioned in radiology reports. The purpose of this study was to develop a computerized method for detection of vertebral fractures on lateral chest radiographs in order to assist radiologists' image interpretation. Our computerized method is based on the automated identification of upper and lower vertebral edges. In order to develop the scheme, radiologists provided morphometric data for each identifiable vertebra, which consisted of six points for each vertebra, for 25 normals and 20 cases with severe fractures. Anatomical information was obtained from morphometric data of normal cases in terms of vertebral heights, heights of vertebral disk spaces, and vertebral centerline. Computerized detection of vertebral fractures was based on the reduction in the heights of fractured vertebrae compared to adjacent vertebrae and normal reference data. Vertebral heights from morphometric data on normal cases were used as reference. On 138 chest radiographs (20 with fractures) the sensitivity of our method for detection of fracture cases was 95% (19/20) with 0.93 (110/118) false-positives per image. In conclusion, the computerized method would be useful for detection of potentially overlooked vertebral fractures on lateral chest radiographs.

Accuracy of the Interpretation of Chest Radiographs for the Diagnosis of Paediatric Pneumonia

PubMed Central

Elemraid, Mohamed A.; Muller, Michelle; Spencer, David A.; Rushton, Stephen P.; Gorton, Russell; Thomas, Matthew F.; Eastham, Katherine M.; Hampton, Fiona; Gennery, Andrew R.; Clark, Julia E.

2014-01-01

Introduction World Health Organization (WHO) radiological classification remains an important entry criterion in epidemiological studies of pneumonia in children. We report inter-observer variability in the interpretation of 169 chest radiographs in children suspected of having pneumonia. Methods An 18-month prospective aetiological study of pneumonia was undertaken in Northern England. Chest radiographs were performed on eligible children aged ≤16 years with clinical features of pneumonia. The initial radiology report was compared with a subsequent assessment by a consultant cardiothoracic radiologist. Chest radiographic changes were categorised according to the WHO classification. Results There was significant disagreement (22%) between the first and second reports (kappa = 0.70, P<0.001), notably in those aged <5 years (26%, kappa = 0.66, P<0.001). The most frequent sources of disagreement were the reporting of patchy and perihilar changes. Conclusion This substantial inter-observer variability highlights the need for experts from different countries to create a consensus to review the radiological definition of pneumonia in children. PMID:25148361

Methods employed for chest radiograph interpretation education for radiographers: A systematic review of the literature.

PubMed

McLaughlin, L; McConnell, J; McFadden, S; Bond, R; Hughes, C

2017-11-01

This systematic review aimed to determine the strength of evidence available in the literature on the effect of training to develop the skills required by radiographers to interpret plain radiography chest images. Thirteen articles feature within the review. Sample size varied from one reporting radiographer to 148 radiography students/experienced radiographers. The quality of the articles achieved a mean score of 7.5/10, indicating the evidence is strong and the quality of studies in this field is high. Investigative approaches included audit of participants' performance in clinical practice post formal training, evaluation of informal training and the impact of short feedback sessions on performance. All studies demonstrated positive attributions on user performance. Using a combination of training techniques can help maximise learning and accommodate those with different preferred learning types. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Training and Validating a Deep Convolutional Neural Network for Computer-Aided Detection and Classification of Abnormalities on Frontal Chest Radiographs.

PubMed

Cicero, Mark; Bilbily, Alexander; Colak, Errol; Dowdell, Tim; Gray, Bruce; Perampaladas, Kuhan; Barfett, Joseph

2017-05-01

Convolutional neural networks (CNNs) are a subtype of artificial neural network that have shown strong performance in computer vision tasks including image classification. To date, there has been limited application of CNNs to chest radiographs, the most frequently performed medical imaging study. We hypothesize CNNs can learn to classify frontal chest radiographs according to common findings from a sufficiently large data set. Our institution's research ethics board approved a single-center retrospective review of 35,038 adult posterior-anterior chest radiographs and final reports performed between 2005 and 2015 (56% men, average age of 56, patient type: 24% inpatient, 39% outpatient, 37% emergency department) with a waiver for informed consent. The GoogLeNet CNN was trained using 3 graphics processing units to automatically classify radiographs as normal (n = 11,702) or into 1 or more of cardiomegaly (n = 9240), consolidation (n = 6788), pleural effusion (n = 7786), pulmonary edema (n = 1286), or pneumothorax (n = 1299). The network's performance was evaluated using receiver operating curve analysis on a test set of 2443 radiographs with the criterion standard being board-certified radiologist interpretation. Using 256 × 256-pixel images as input, the network achieved an overall sensitivity and specificity of 91% with an area under the curve of 0.964 for classifying a study as normal (n = 1203). For the abnormal categories, the sensitivity, specificity, and area under the curve, respectively, were 91%, 91%, and 0.962 for pleural effusion (n = 782), 82%, 82%, and 0.868 for pulmonary edema (n = 356), 74%, 75%, and 0.850 for consolidation (n = 214), 81%, 80%, and 0.875 for cardiomegaly (n = 482), and 78%, 78%, and 0.861 for pneumothorax (n = 167). Current deep CNN architectures can be trained with modest-sized medical data sets to achieve clinically useful performance at detecting and excluding common pathology on chest radiographs.

Potential usefulness of a video printer for producing secondary images from digitized chest radiographs

NASA Astrophysics Data System (ADS)

Nishikawa, Robert M.; MacMahon, Heber; Doi, Kunio; Bosworth, Eric

1991-05-01

Communication between radiologists and clinicians could be improved if a secondary image (copy of the original image) accompanied the radiologic report. In addition, the number of lost original radiographs could be decreased, since clinicians would have less need to borrow films. The secondary image should be simple and inexpensive to produce, while providing sufficient image quality for verification of the diagnosis. We are investigating the potential usefulness of a video printer for producing copies of radiographs, i.e. images printed on thermal paper. The video printer we examined (Seikosha model VP-3500) can provide 64 shades of gray. It is capable of recording images up to 1,280 pixels by 1,240 lines and can accept any raster-type video signal. The video printer was characterized in terms of its linearity, contrast, latitude, resolution, and noise properties. The quality of video-printer images was also evaluated in an observer study using portable chest radiographs. We found that observers could confirm up to 90 of the reported findings in the thorax using video- printer images, when the original radiographs were of high quality. The number of verified findings was diminished when high spatial resolution was required (e.g. detection of a subtle pneumothorax) or when a low-contrast finding was located in the mediastinal area or below the diaphragm (e.g. nasogastric tubes).

Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma.

PubMed

Wilkerson, R Gentry; Stone, Michael B

2010-01-01

Supine anteroposterior (AP) chest radiographs in patients with blunt trauma have poor sensitivity for the identification of pneumothorax. Ultrasound (US) has been proposed as an alternative screening test for pneumothorax in this population. The authors conducted an evidence-based review of the medical literature to compare sensitivity of bedside US and AP chest radiographs in identifying pneumothorax after blunt trauma. MEDLINE and EMBASE databases were searched for trials from 1965 through June 2009 using a search strategy derived from the following PICO formulation of our clinical question: patients included adult (18 + years) emergency department (ED) patients in whom pneumothorax was suspected after blunt trauma. The intervention was thoracic ultrasonography for the detection of pneumothorax. The comparator was the supine AP chest radiograph during the initial evaluation of the patient. The outcome was the diagnostic performance of US in identifying the presence of pneumothorax in the study population. The criterion standard for the presence or absence of pneumothorax was computed tomography (CT) of the chest or a rush of air during thoracostomy tube placement (in unstable patients). Prospective, observational trials of emergency physician (EP)-performed thoracic US were included. Trials in which the exams were performed by radiologists or surgeons, or trials that investigated patients suffering penetrating trauma or with spontaneous or iatrogenic pneumothoraces, were excluded. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. Data analysis consisted of test performance (sensitivity and specificity, with 95% confidence intervals [CIs]) of thoracic US and supine AP chest radiography. Four prospective observational studies were identified, with a total of 606 subjects who met the inclusion and exclusion criteria. The sensitivity and specificity of US for the detection of pneumothorax ranged from

Computerized method to compensate for breathing body motion in dynamic chest radiographs

NASA Astrophysics Data System (ADS)

Matsuda, H.; Tanaka, R.; Sanada, S.

2017-03-01

Dynamic chest radiography combined with computer analysis allows quantitative analyses on pulmonary function and rib motion. The accuracy of kinematic analysis is directly linked to diagnostic accuracy, and thus body motion compensation is a major concern. Our purpose in this study was to develop a computerized method to reduce a breathing body motion in dynamic chest radiographs. Dynamic chest radiographs of 56 patients were obtained using a dynamic flat-panel detector. The images were divided into a 1 cm-square and the squares on body counter were used to detect the body motion. Velocity vector was measured using cross-correlation method on the body counter and the body motion was then determined on the basis of the summation of motion vector. The body motion was then compensated by shifting the images based on the measured vector. By using our method, the body motion was accurately detected by the order of a few pixels in clinical cases, mean 82.5% in right and left directions. In addition, our method detected slight body motion which was not able to be identified by human observations. We confirmed our method effectively worked in kinetic analysis of rib motion. The present method would be useful for the reduction of a breathing body motion in dynamic chest radiography.

Automated localization of costophrenic recesses and costophrenic angle measurement on frontal chest radiographs

NASA Astrophysics Data System (ADS)

Maduskar, Pragnya; Hogeweg, Laurens; Philipsen, Rick; van Ginneken, Bram

2013-03-01

Computer aided detection (CAD) of tuberculosis (TB) on chest radiographs (CXR) is difficult because the disease has varied manifestations, like opacification, hilar elevation, and pleural effusions. We have developed a CAD research prototype for TB (CAD4TB v1.08, Diagnostic Image Analysis Group, Nijmegen, The Netherlands) which is trained to detect textural abnormalities inside unobscured lung fields. If the only abnormality visible on a CXR would be a blunt costophrenic angle, caused by pleural fluid in the costophrenic recess, this is likely to be missed by texture analysis in the lung fields. The goal of this work is therefore to detect the presence of blunt costophrenic (CP) angles caused by pleural effusion on chest radiographs. The CP angle is the angle formed by the hemidiaphragm and the chest wall. We define the intersection point of both as the CP angle point. We first detect the CP angle point automatically from a lung field segmentation by finding the foreground pixel of each lung with maximum y location. Patches are extracted around the CP angle point and boundary tracing is performed to detect 10 consecutive pixels along the hemidiaphragm and the chest wall and derive the CP angle from these. We evaluate the method on a data set of 250 normal CXRs, 200 CXRs with only one or two blunt CP angles and 200 CXRs with one or two blunt CP angles but also other abnormalities. For these three groups, the CP angle location and angle measurements were accurate in 91%, 88%, and 92% of all the cases, respectively. The average CP angles for the three groups are indeed different with 71.6° +/- 22.9, 87.5° +/- 25.7, and 87.7° +/- 25.3, respectively.

Investigation of misfiled cases in the PACS environment and a solution to prevent filing errors for chest radiographs.

PubMed

Morishita, Junji; Watanabe, Hideyuki; Katsuragawa, Shigehiko; Oda, Nobuhiro; Sukenobu, Yoshiharu; Okazaki, Hiroko; Nakata, Hajime; Doi, Kunio

2005-01-01

The aim of the study was to survey misfiled cases in a picture archiving and communication system environment at two hospitals and to demonstrate the potential usefulness of an automated patient recognition method for posteroanterior chest radiographs based on a template-matching technique designed to prevent filing errors. We surveyed misfiled cases obtained from different modalities in one hospital for 25 months, and misfiled cases of chest radiographs in another hospital for 17 months. For investigating the usefulness of an automated patient recognition and identification method for chest radiographs, a prospective study has been completed in clinical settings at the latter hospital. The total numbers of misfiled cases for different modalities in one hospital and for chest radiographs in another hospital were 327 and 22, respectively. The misfiled cases in the two hospitals were mainly the result of human errors (eg, incorrect manual entries of patient information, incorrect usage of identification cards in which an identification card for the previous patient was used for the next patient's image acquisition). The prospective study indicated the usefulness of the computerized method for discovering misfiled cases with a high performance (ie, an 86.4% correct warning rate for different patients and 1.5% incorrect warning rate for the same patients). We confirmed the occurrence of misfiled cases in the two hospitals. The automated patient recognition and identification method for chest radiographs would be useful in preventing wrong images from being stored in the picture archiving and communication system environment.

Pneumothorax detection in chest radiographs using convolutional neural networks

NASA Astrophysics Data System (ADS)

Blumenfeld, Aviel; Konen, Eli; Greenspan, Hayit

2018-02-01

This study presents a computer assisted diagnosis system for the detection of pneumothorax (PTX) in chest radiographs based on a convolutional neural network (CNN) for pixel classification. Using a pixel classification approach allows utilization of the texture information in the local environment of each pixel while training a CNN model on millions of training patches extracted from a relatively small dataset. The proposed system uses a pre-processing step of lung field segmentation to overcome the large variability in the input images coming from a variety of imaging sources and protocols. Using a CNN classification, suspected pixel candidates are extracted within each lung segment. A postprocessing step follows to remove non-physiological suspected regions and noisy connected components. The overall percentage of suspected PTX area was used as a robust global decision for the presence of PTX in each lung. The system was trained on a set of 117 chest x-ray images with ground truth segmentations of the PTX regions. The system was tested on a set of 86 images and reached diagnosis accuracy of AUC=0.95. Overall preliminary results are promising and indicate the growing ability of CAD based systems to detect findings in medical imaging on a clinical level accuracy.

Validation of the plain chest radiograph for epidemiologic studies of airflow obstruction

DOE Office of Scientific and Technical Information (OSTI.GOV)

Musk, A.W.

The chest radiographs of 125 industrial workers from rural New South Wales were examined for overinflated lungs, with and without attenuated midzonal vessels. Although the mean values of a comprehensive range of pulmonary function tests in the whole group were within normal limits, the nine subjects whose radiographs showed overinflated lungs and attenuated vessels had significantly impaired pulmonary function in comparison with 85 subjects with normal radiographs. The mean values for these nine subjects, expressed as a percentage of the mean value for subjects with normal radiographs, were: forced expiratory volume in 1 second, 75%; total lung capacity, 107%; residualmore » volume, 143%; transpulmonary pressure at maximum inspiration, 60%; static deflation compliance, 158%; lung volume at transpulmonary pressure 10 cm H/sub 2/O, 132%; transfer factor, 79%; and transfer factor/alveolar volume, 77%. Similar results were obtained by a second observer. Those subjects with overinflation but no vascular attenuation had significantly larger mean values for vital capacity and alveolar volume but no significant difference in total lung capacity or other tests of the mechanical properties of the lungs. Agreement on the presence of a positive sign between the two observers expressed as a percentage of those considered positive by either was 81% for overinflation and 62% for attenuated midzonal vessels. The results indicate that in groups of subjects with normal-average values of pulmonary function, the plain chest radiograph may provide information concerning pulmonary structure that is reflected in tests of function.« less

A novel semi-transductive learning framework for efficient atypicality detection in chest radiographs

NASA Astrophysics Data System (ADS)

Alzubaidi, Mohammad; Balasubramanian, Vineeth; Patel, Ameet; Panchanathan, Sethuraman; Black, John A., Jr.

2012-03-01

Inductive learning refers to machine learning algorithms that learn a model from a set of training data instances. Any test instance is then classified by comparing it to the learned model. When the set of training instances lend themselves well to modeling, the use of a model substantially reduces the computation cost of classification. However, some training data sets are complex, and do not lend themselves well to modeling. Transductive learning refers to machine learning algorithms that classify test instances by comparing them to all of the training instances, without creating an explicit model. This can produce better classification performance, but at a much higher computational cost. Medical images vary greatly across human populations, constituting a data set that does not lend itself well to modeling. Our previous work showed that the wide variations seen across training sets of "normal" chest radiographs make it difficult to successfully classify test radiographs with an inductive (modeling) approach, and that a transductive approach leads to much better performance in detecting atypical regions. The problem with the transductive approach is its high computational cost. This paper develops and demonstrates a novel semi-transductive framework that can address the unique challenges of atypicality detection in chest radiographs. The proposed framework combines the superior performance of transductive methods with the reduced computational cost of inductive methods. Our results show that the proposed semitransductive approach provides both effective and efficient detection of atypical regions within a set of chest radiographs previously labeled by Mayo Clinic expert thoracic radiologists.

Questionnaire-based study showed that neonatal chest radiographs could be reliably interpreted using the WhatsApp messaging application.

PubMed

Gross, Itai; Langer, Yshia; Pasternak, Yehonatan; Abu Ahmad, Wiessam; Eventov-Friedman, Smadar; Koplewitz, Benjamin Z

2018-06-11

We surveyed whether clinicians used the WhatsApp messaging application to view neonatal chest radiographs and asked a sub-sample to compare them with computer screen viewings. The study was conducted at three university-affiliated medical centres in Israel from June-December 2016. Questionnaires on using smartphones for professional purposes were completed by 68/71 paediatric residents and 20/28 neonatologists. In addition, 11 neonatologists viewed 20 chest radiographs on a computer screen followed by a smartphone and 10 viewed the same radiographs in the opposite order, separated by a washout period of two months. After another two months, five from each group viewed the same radiographs on a computer screen. Different interpretations between viewing modes were assessed. Most respondents used WhatsApp to send chest radiographs for consultation: 82% of the paediatric residents and 80% of the neonatologists. The mean number of inconsistencies in diagnosis was 3.7/20 between two computer views and 2.9/20 between computer and smartphone views (p=0.88) and the disease severity means were 3.7/20 and 2.85/20, respectively (p=0.94). Neonatologists using WhatsApp only determined umbilical line placement in 80% of cases. WhatsApp was reliable for preliminary interpretation of neonatal chest radiographs, but caution was needed when assessing umbilical lines. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Assessment of Cardiac Device Position on Supine Chest Radiograph in the ICU: Introduction and Applicability of the Aortic Valve Location Ratio.

PubMed

Ouweneel, Dagmar M; Sjauw, Krischan D; Wiegerinck, Esther M A; Hirsch, Alexander; Baan, Jan; de Mol, Bas A J M; Lagrand, Wim K; Planken, R Nils; Henriques, José P S

2016-10-01

The use of intracardiac assist devices is expanding, and correct position of these devices is required for optimal functioning. The aortic valve is an important landmark for positioning of those devices. It would be of great value if the device position could be easily monitored on plain supine chest radiograph in the ICU. We introduce a ratio-based tool for determination of the aortic valve location on plain supine chest radiograph images, which can be used to evaluate intracardiac device position. Retrospective observational study. Large academic medical center. Patients admitted to the ICU and supported by an intracardiac assist device. We developed a ratio to determine the aortic valve location on supine chest radiograph images. This ratio is used to assess the position of a cardiac assist device and is compared with echocardiographic findings. Supine anterior-posterior chest radiographs of patients with an aortic valve prosthesis (n = 473) were analyzed to determine the location of the aortic valve. We calculated several ratios with the potential to determine the position of the aortic valve. The aortic valve location ratio, defined as the distance between the carina and the aortic valve, divided by the thoracic width, was found to be the best performing ratio. The aortic valve location ratio determines the location of the aortic valve caudal to the carina, at a distance of 0.25 ± 0.05 times the thoracic width for male patients and 0.28 ± 0.05 times the thoracic width for female patients. The aortic valve location ratio was validated using CT images of patients with angina pectoris without known valvular disease (n = 95). There was a good correlation between cardiac device position (Impella) assessed with the aortic valve location ratio and with echocardiography (n = 53). The aortic valve location ratio enables accurate and reproducible localization of the aortic valve on supine chest radiograph. This tool is easily applicable and can be used for

The role of chest radiographs and tuberculin skin tests in tuberculosis screening of internationally adopted children.

PubMed

George, Sobenna A; Ko, Catherine A; Kirchner, H Lester; Starke, Jeffrey R; Dragga, Therese A; Mandalakas, Anna M

2011-05-01

Internationally adopted children (IAC) are a growing group of US immigrants who often come from countries with high tuberculosis (TB) burdens. There is limited evidence to support current TB screening guidelines in these high-risk children. Therefore, we have prospectively examined the clinical utility of tuberculin skin testing (TST) and subsequent chest radiograph screening for TB disease in recently immigrated, asymptomatic IAC. Within 6 months of immigration to the United States, we collected demographic information and assessed the nutritional status of 566 IAC who presented for routine postadoptive care. Children completed standardized clinical examination and TSTs. Chest radiographs were recommended for children with TST induration ≥ 5 mm. The association between TST induration and clinical outcome was assessed. The clinical utility of chest radiographs was evaluated. There was no difference in age, birth country, or nutritional status between IAC with TST induration of 0 to < 5 mm and those with 5 to < 10 mm; IAC with TST ≥ 10 mm were older, more chronically malnourished, and more likely to emigrate from Guatemala. Among children with TST ≥ 5 mm (35%), 4 IAC had chest radiographs which were initially interpreted to be abnormal and consistent with TB; ultimately none were diagnosed with TB. The 5-mm TST cut point did not capture IAC with risk factors for latent TB infection or progression to TB disease, suggesting that this is not a useful screening threshold. In contrast, a 10-mm cut point identified IAC at risk for TB infection and therefore should be a more useful screening threshold. We question the clinical utility of radiographic screening for pulmonary TB in asymptomatic children.

Angular relational signature-based chest radiograph image view classification.

PubMed

Santosh, K C; Wendling, Laurent

2018-01-22

In a computer-aided diagnosis (CAD) system, especially for chest radiograph or chest X-ray (CXR) screening, CXR image view information is required. Automatically separating CXR image view, frontal and lateral can ease subsequent CXR screening process, since the techniques may not equally work for both views. We present a novel technique to classify frontal and lateral CXR images, where we introduce angular relational signature through force histogram to extract features and apply three different state-of-the-art classifiers: multi-layer perceptron, random forest, and support vector machine to make a decision. We validated our fully automatic technique on a set of 8100 images hosted by the U.S. National Library of Medicine (NLM), National Institutes of Health (NIH), and achieved an accuracy close to 100%. Our method outperforms the state-of-the-art methods in terms of processing time (less than or close to 2 s for the whole test data) while the accuracies can be compared, and therefore, it justifies its practicality. Graphical Abstract Interpreting chest X-ray (CXR) through the angular relational signature.

Sensitivity and specificity of a CAD solution for lung nodule detection on chest radiograph with CTA correlation.

PubMed

Moore, William; Ripton-Snyder, Jennifer; Wu, George; Hendler, Craig

2011-06-01

The objective of this research was to determine the sensitivity and specificity of a commercially available computer-aided detection (CAD) system for detection of lung nodule on posterior-anterior (PA) chest radiograph in a varied patient population who are referred to computed tomographic angiogram (CTA) of the chest as a reference standard. Patients who had a PA chest radiograph with concomitant CTA of the chest were included in this retrospective study. The PA chest radiograph was analyzed by a CAD device, and results were recorded. A qualitative assessment of the CAD results was performed using a 5-point Likert scale. The CTA was then reviewed to determine if there were correlative nodules. The presence of a correlative nodule between 0.5 cm and 1.5 cm was considered a positive result. The baseline sensitivity of the system was determined to be 0.707 (95% CI = 0.52-0.86), with a specificity of 0.50 (95% CI = 0.38-0.76). Positive predictive value was 0.30 (95% CI = 0.24-0.49), with a negative predictive value of 0.858 (95% CI = 0.82-0.95), and accuracy of 0.555 (95% CI = 0.40-0.66). When excluding nodules that were qualitatively determined by a thoracic radiologist to be false positives, the specificity was 0.781 (95% CI = 0.764-0.839), the positive predictive value was 0.564 (95% CI = 0.491-0.654), the negative predictive value was 0.829 (95% CI = 0.819-0.878), and the accuracy was 0.737 (95% CI = 0.721-0.801). The use of CAD for lung nodule detection on chest radiograph, when used in conjunction with an experienced radiologist, has a very good sensitivity, specificity, and accuracy.

Chest radiography in supporting the diagnosis of asthma in children with persistent cough.

PubMed

Halaby, Claudia; Feuerman, Martin; Barlev, Dan; Pirzada, Melodi

2014-03-01

To establish whether chest radiographic findings suggestive of lower airway obstruction (LAO) disease support the diagnosis of asthma in pediatric patients with persistent cough in an outpatient setting. 180 patient charts were reviewed. The patients were children aged 1 to 18 years referred over a 3-year period to a pediatric pulmonary subspecialty clinic for evaluation of cough lasting ≥ 4 weeks. Chest radiographic images obtained after the initial evaluation of 90 patients diagnosed with cough-variant asthma and 90 patients diagnosed with persistent cough from nonasthma origins were compared with radiologic findings of a control group consisting of patients with a positive tuberculin skin test and no respiratory symptoms. Increased peribronchial markings/peribronchial cuffing and hyperinflation were considered radiographically suggestive findings of LAO disease. Children diagnosed with cough-variant asthma at the initial evaluation had higher rates of chest radiographic findings suggestive of LAO disease (30.00%) than children with persistent cough from other causes (17.80%) or those with a positive tuberculin skin test and no respiratory symptoms (8.16%) (overall P value = 0.0063). They also had higher rates of spirometry abnormalities suggestive of an LAO defect. Children with chest radiographic findings suggestive of LAO disease were found to be younger than those with normal chest radiographic findings (5.0 ± 2.7 years vs 8.6 ± 4.7 years; P < 0.0001). This study suggests that chest radiographic findings indicative of an LAO in correlation with the clinical presentation can support the diagnostic suspicion of asthma, especially in younger children unable to perform spirometry.

Screening for chest disease in college students: policies of student health services regarding the use of routine screening chest radiographs and tuberculin skin tests

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fager, S.S.; Slap, G.B.; Kitz, D.S.

A survey of college health services was conducted to determine their policies regarding the use of screening chest radiographs and tuberculin skin tests. Pre-enrollment chest radiographs are prescribed for all incoming students by 24% of the 531 respondents and for health professions students, foreign students, and intercollegiate athletes only by an additional 20%, 19%, and 6%, respectively. Periodic chest radiography is conducted for all students by 7% of the respondents and for health professions students, foreign students, and intercollegiate athletes only by an additional 22%, 16%, and 8%, respectively. Pre-enrollment tuberculin skin tests are prescribed for all incoming students bymore » 52% of the respondents and for health professions students, foreign students, and intercollegiate athletes only by an additional 48%, 29%, and 9%, respectively. Periodic tuberculin skin testing is conducted for all students by 27% of the respondents and for health professions students, foreign students, and intercollegiate athletes only by an additional 48%, 23%, and 16%, respectively. It is estimated from these data that 723,000 incoming students in the United States received screening chest radiographs in 1979 with estimated charges totaling between $7 million and $27 million. There may be 0.05 to 0.33 induced cases of lung cancer, leukemia, thyroid cancer, and female breast cancer over a 20-year period among this group of students exposed to ionizing radiation.« less

Chest Wall Constriction after the Nuss Procedure Identified from Chest Radiograph and Multislice Computed Tomography Shortly after Removal of the Bar.

PubMed

Chang, Pei-Yeh; Zeng, Qi; Wong, Kin-Sun; Wang, Chao-Jan; Chang, Chee-Jen

2016-01-01

This study radiographically examined the changes in the chest walls of patients with pectus excavatum (PE) after Nuss bar removal, to define the deformation caused by the bar and stabilizer. In the first part of the study, we compared the changes in chest radiographs of patients with PE to a preoperation PE control group. In the second part, we used multislice computed tomography (CT) scans to provide three-dimensional reconstructions with which to evaluate the changes to the thoracic wall. Part 1 From June 2006 to August 2011, 1,125 patients with PE who had posteroanterior chest radiographs taken before undergoing the Nuss procedure at four hospitals were enrolled as a preoperative control group. At the same time, 203 patients who had the bar removed were enrolled as the study group. The maximum dimensions of the outer boundary of the first to ninth rib pairs (R1-R9, rib pair width), chest height, and chest width were measured. Part 2 Thirty-one consecutive patients with PE (20 males and 11 females) who underwent Nuss bar removal were evaluated 7 to 30 days after operation. During this period, a further 34 patients with PE who had undergone CT imaging before bar insertion were evaluated and compared with the postoperative group. Part 1 The width of the lower ribs (R4-R9) after bar removal was significantly less than in the age-matched controls. The ribs adjacent to the bar (R5-R7) showed the greatest restriction. The width of the upper ribs (R1-R3) 2 to 3 years after bar placement did not differ significantly from the controls. Patients who were operated on after 10 years of age had less of a restrictive effect. Three years of bar placement resulted in more restriction than a 2-year period, particularly in patients younger than 10 years old. Part 2: A significant constriction of the chest wall was observed in 13 patients after removal of the Nuss bar. Constriction at ribs 5 to 8 was found to be present adjacent to the site of bar insertion. However

The transverse diameter of the chest on routine radiographs reliably estimates gestational age and weight in premature infants.

PubMed

Dietz, Kelly R; Zhang, Lei; Seidel, Frank G

2015-08-01

Prior to digital radiography it was possible for a radiologist to easily estimate the size of a patient on an analog film. Because variable magnification may be applied at the time of processing an image, it is now more difficult to visually estimate an infant's size on the monitor. Since gestational age and weight significantly impact the differential diagnosis of neonatal diseases and determine the expected size of kidneys or appearance of the brain by MRI or US, this information is useful to a pediatric radiologist. Although this information may be present in the electronic medical record, it is frequently not readily available to the pediatric radiologist at the time of image interpretation. To determine if there was a correlation between gestational age and weight of a premature infant with their transverse chest diameter (rib to rib) on admission chest radiographs. This retrospective study was approved by the institutional review board, which waived informed consent. The maximum transverse chest diameter outer rib to outer rib was measured on admission portable chest radiographs of 464 patients admitted to the neonatal intensive care unit (NICU) during the 2010 calendar year. Regression analysis was used to investigate the association between chest diameter and gestational age/birth weight. Quadratic term of chest diameter was used in the regression model. Chest diameter was statistically significantly associated with both gestational age (P < 0.0001) and birth weight (P < 0.0001). An infant's gestational age and birth weight can be reliably estimated by comparing a simple measurement of the transverse chest diameter on digital chest radiograph with the tables and graphs in our study.

Quantification and visualization of relative local ventilation on dynamic chest radiographs

NASA Astrophysics Data System (ADS)

Tanaka, Rie; Sanada, Shigeru; Okazaki, Nobuo; Kobayashi, Takeshi; Nakayama, Kazuya; Matsui, Takeshi; Hayashi, Norio; Matsui, Osamu

2006-03-01

Recently-developed dynamic flat-panel detector (FPD) with a large field of view is possible to obtain breathing chest radiographs, which provide respiratory kinetics information. This study was performed to investigate the ability of dynamic chest radiography using FPD to quantify relative ventilation according to respiratory physiology. We also reported the results of primary clinical study and described the possibility of clinical use of our method. Dynamic chest radiographs of 12 subjects involving abnormal subjects during respiration were obtained using a modified FPD system (30 frames in 10 seconds). Imaging was performed in three different positions (standing, and right and left decubitus positions) to change the distribution of local ventilation by changing the lung's own gravity in each area. The distance from the lung apex to the diaphragm (abbr. DLD) was measured by the edge detection technique for use as an index of respiratory phase. We measured pixel values in each lung area and calculated correlation coefficients with DLD. Differences in the pixel values between the maximum inspiratory and expiratory frame were calculated, and the trend of distribution was evaluated by two-way analysis of variance. Pixel value in each lung area was strongly associated with respiratory phase and its time variation and distribution were consistent with known properties in respiratory physiology. Dynamic chest radiography using FPD combined with our computerized methods was capable of quantifying relative amount of ventilation during respiration, and of detecting regional differences in ventilation. In the subjects with emphysema, areas with decreased respiratory changes in pixel value are consisted with the areas with air trapping. This method is expected to be a useful novel diagnostic imaging method for supporting diagnosis and follow-up of pulmonary disease, which presents with abnormalities in local ventilation.

Pneumothorax detection in chest radiographs using local and global texture signatures

NASA Astrophysics Data System (ADS)

Geva, Ofer; Zimmerman-Moreno, Gali; Lieberman, Sivan; Konen, Eli; Greenspan, Hayit

2015-03-01

A novel framework for automatic detection of pneumothorax abnormality in chest radiographs is presented. The suggested method is based on a texture analysis approach combined with supervised learning techniques. The proposed framework consists of two main steps: at first, a texture analysis process is performed for detection of local abnormalities. Labeled image patches are extracted in the texture analysis procedure following which local analysis values are incorporated into a novel global image representation. The global representation is used for training and detection of the abnormality at the image level. The presented global representation is designed based on the distinctive shape of the lung, taking into account the characteristics of typical pneumothorax abnormalities. A supervised learning process was performed on both the local and global data, leading to trained detection system. The system was tested on a dataset of 108 upright chest radiographs. Several state of the art texture feature sets were experimented with (Local Binary Patterns, Maximum Response filters). The optimal configuration yielded sensitivity of 81% with specificity of 87%. The results of the evaluation are promising, establishing the current framework as a basis for additional improvements and extensions.

Digital replication of chest radiographs without altering diagnostic observer performance

NASA Astrophysics Data System (ADS)

Flynn, Michael J.; Davies, Eric; Spizarny, David; Beute, Gordon H.; Peterson, Edward; Eyler, William R.; Gross, Barry; Chen, Ji

1991-05-01

A study to test the ability of a high-fidelity system to digitize chest radiographs, store the data in a computer, and reprint the film without altering diagnostic observer performance is reported. Two hundred and fifty-two (252) chest films with subtle image features indicative of interstitial disease, pulmonary nodule, or pneumothorax, along with 36 normal chest films were used in the study. Films were selected from a key word search on a computerized report archive and were graded by two experienced radiologists. Each film was digitized with 86 micron pixels and stored in 4000 X 5000 arrays using a research instrument. Replicates were printed using a commercial laser film printer (Eastman Kodak Company) having 80 micron pixels. Originals and replicates were observed separately by two different experienced radiologists. Each indicated a graded response for the three possible pathologies. The agreement of observers between responses for replicates and originals was described by the kappa statistic and compared to the agreement when rereading the original film. The final result of this study supports a hypothesis that the replicate is indistinguishable from the original.

Psychogenic dyspnea and therapeutic chest radiograph.

PubMed

Kaufman, Kenneth R; Endres, Jennifer K; Kaufman, Nathaniel D

2007-04-01

Conversion disorders, the physical expression of unresolved psychological pain, can be associated with mourning. This case report is third in a series of articles by the authors on childhood mourning reflecting the effects of multiple losses (K. R. Kaufman & N. D. Kaufman, 2005; K. R. Kaufman & N. D. Kaufman, 2006). In this case report, perception of potential death (self or parent) after a motor vehicle accident precipitated psychogenic dyspnea. A "therapeutic" chest radiograph was an effective initial treatment. Rapid intervention with explanation of the functional nature of the conversion symptom, why this symptom developed, and how to address the underlying stresses in the future led to an excellent outcome. Psychosocial intervention should be included in the multidisciplinary approach toward the child with conversion disorder, be it in an ambulatory, ER, or inpatient setting. The clinician must remember that medically unexplained symptoms in childhood may represent a child's expression of mourning.

Radiation safety education reduces the incidence of adult fingers on neonatal chest radiographs.

PubMed

Sahota, N; Burbridge, B E; Duncan, M D

2014-06-01

A previous audit revealed a high frequency of adult fingers visualised on neonatal intensive care unit (NICU) chest radiographs-representing an example of inappropriate occupational radiation exposure. Radiation safety education was provided to staff and we hypothesised that the education would reduce the frequency of adult fingers visualised on NICU chest radiographs. Two cross-sectional samples taken before and after the administration of the education were compared. We examined fingers visualised directly in the beam, fingers in the direct beam but eliminated by technologists editing the image, and fingers under the cones of the portable x-ray machine. There was a 46.2% reduction in fingers directly in the beam, 50.0% reduction in fingers directly in the beam but cropped out, and 68.4% reduction in fingers in the coned area. There was a 57.1% overall reduction in adult fingers visualised, which was statistically significant (Z value - 7.48, P < 0.0001). This study supports radiation safety education in minimising inappropriate occupational radiation exposure.

Chest Radiograph Findings in Childhood Pneumonia Cases From the Multisite PERCH Study

PubMed Central

Deloria Knoll, Maria; Baggett, Henry C.; Brooks, W. Abdullah; Feikin, Daniel R.; Hammitt, Laura L.; Howie, Stephen R. C.; Kotloff, Karen L.; Levine, Orin S.; Madhi, Shabir A.; Murdoch, David R.; Scott, J. Anthony G.; Thea, Donald M.; Awori, Juliet O.; Barger-Kamate, Breanna; Chipeta, James; DeLuca, Andrea N.; Diallo, Mahamadou; Driscoll, Amanda J.; Ebruke, Bernard E.; Higdon, Melissa M.; Jahan, Yasmin; Karron, Ruth A.; Mahomed, Nasreen; Moore, David P.; Nahar, Kamrun; Naorat, Sathapana; Ominde, Micah Silaba; Park, Daniel E.; Prosperi, Christine; wa Somwe, Somwe; Thamthitiwat, Somsak; Zaman, Syed M. A.; Zeger, Scott L.; O’Brien, Katherine L.; O’Brien, Katherine L.; Levine, Orin S.; Knoll, Maria Deloria; Feikin, Daniel R.; DeLuca, Andrea N.; Driscoll, Amanda J.; Fancourt, Nicholas; Fu, Wei; Hammitt, Laura L.; Higdon, Melissa M.; Kagucia, E. Wangeci; Karron, Ruth A.; Li, Mengying; Park, Daniel E.; Prosperi, Christine; Wu, Zhenke; Zeger, Scott L.; Watson, Nora L.; Crawley, Jane; Murdoch, David R.; Brooks, W. Abdullah; Endtz, Hubert P.; Zaman, Khalequ; Goswami, Doli; Hossain, Lokman; Jahan, Yasmin; Ashraf, Hasan; Howie, Stephen R. C.; Ebruke, Bernard E.; Antonio, Martin; McLellan, Jessica; Machuka, Eunice; Shamsul, Arifin; Zaman, Syed M.A.; Mackenzie, Grant; Scott, J. Anthony G.; Awori, Juliet O.; Morpeth, Susan C.; Kamau, Alice; Kazungu, Sidi; Ominde, Micah Silaba; Kotloff, Karen L.; Tapia, Milagritos D.; Sow, Samba O.; Sylla, Mamadou; Tamboura, Boubou; Onwuchekwa, Uma; Kourouma, Nana; Toure, Aliou; Madhi, Shabir A.; Moore, David P.; Adrian, Peter V.; Baillie, Vicky L.; Kuwanda, Locadiah; Mudau, Azwifarwi; Groome, Michelle J.; Mahomed, Nasreen; Baggett, Henry C.; Thamthitiwat, Somsak; Maloney, Susan A.; Bunthi, Charatdao; Rhodes, Julia; Sawatwong, Pongpun; Akarasewi, Pasakorn; Thea, Donald M.; Mwananyanda, Lawrence; Chipeta, James; Seidenberg, Phil; Mwansa, James; wa Somwe, Somwe; Kwenda, Geoffrey

2017-01-01

Abstract Background. Chest radiographs (CXRs) are frequently used to assess pneumonia cases. Variations in CXR appearances between epidemiological settings and their correlation with clinical signs are not well documented. Methods. The Pneumonia Etiology Research for Child Health project enrolled 4232 cases of hospitalized World Health Organization (WHO)–defined severe and very severe pneumonia from 9 sites in 7 countries (Bangladesh, the Gambia, Kenya, Mali, South Africa, Thailand, and Zambia). At admission, each case underwent a standardized assessment of clinical signs and pneumonia risk factors by trained health personnel, and a CXR was taken that was interpreted using the standardized WHO methodology. CXRs were categorized as abnormal (consolidation and/or other infiltrate), normal, or uninterpretable. Results. CXRs were interpretable in 3587 (85%) cases, of which 1935 (54%) were abnormal (site range, 35%–64%). Cases with abnormal CXRs were more likely than those with normal CXRs to have hypoxemia (45% vs 26%), crackles (69% vs 62%), tachypnea (85% vs 80%), or fever (20% vs 16%) and less likely to have wheeze (30% vs 38%; all P < .05). CXR consolidation was associated with a higher case fatality ratio at 30-day follow-up (13.5%) compared to other infiltrate (4.7%) or normal (4.9%) CXRs. Conclusions. Clinically diagnosed pneumonia cases with abnormal CXRs were more likely to have signs typically associated with pneumonia. However, CXR-normal cases were common, and clinical signs considered indicative of pneumonia were present in substantial proportions of these cases. CXR-consolidation cases represent a group with an increased likelihood of death at 30 days post-discharge. PMID:28575361

Chest Radiological Findings of Patients With Severe H1N1 Pneumonia Requiring Intensive Care.

PubMed

Rohani, Payam; Jude, Cecilia M; Chan, Kelvin; Barot, Nikhil; Kamangar, Nader

2016-01-01

A new strain of human influenza A (H1N1) virus originated from Mexico in 2009 and spread to more than 190 countries and territories. The World Health Organization (WHO) declared it a level 6 (highest level) pandemic. In August 2010, WHO announced that the H1N1 2009 influenza virus had moved into the postpandemic period. The WHO also declared that this flu strain is expected to continue to circulate as a seasonal virus "for some years to come." The objective of this study is to describe the chest radiographic and computed tomography (CT) findings of patients with severe H1N1 pneumonia admitted to the intensive care unit (ICU) during the 2009 pandemic. Patients with severe H1N1 pneumonia requiring ICU admission have extensive radiographic and CT abnormalities. Eighteen patients, aged 23 to 62 (mean 41), admitted to the ICU at UCLA-Olive View Medical Center with a primary diagnosis of pandemic H1N1 infection, confirmed either via rapid influenza detection test or by real-time reverse transcriptase polymerase chain reaction assay, formed the study population. All patients had chest x-ray (CXR) within 24 hours of admission and 5 patients had CT examinations. In this retrospective study, images were evaluated for the pattern (ground-glass opacities, consolidation, reticular opacities, and nodular opacities), distribution (unilateral/bilateral, upper/middle/lower lung zone, and central/peripheral/peribronchovascular), and extent (focal/multifocal/diffuse; number of lung zones) of abnormalities. All (100%) patients had abnormal CXR and CT studies. The predominant radiographic findings were ground-glass opacities (16 of 18; 89%), consolidation (16 of 18; 89%), and reticular opacities (6 of 18, 33%). The radiographic abnormalities were bilateral in 17 (94%) patients; involved lower lung distribution in 18 (100%) patients, and mid and lower lung distribution in 16 (89%) patients. Radiographic abnormalities were peribronchovascular in 11 (61%) patients and multifocal in 10 (56

Segmenting lung fields in serial chest radiographs using both population-based and patient-specific shape statistics.

PubMed

Shi, Y; Qi, F; Xue, Z; Chen, L; Ito, K; Matsuo, H; Shen, D

2008-04-01

This paper presents a new deformable model using both population-based and patient-specific shape statistics to segment lung fields from serial chest radiographs. There are two novelties in the proposed deformable model. First, a modified scale invariant feature transform (SIFT) local descriptor, which is more distinctive than the general intensity and gradient features, is used to characterize the image features in the vicinity of each pixel. Second, the deformable contour is constrained by both population-based and patient-specific shape statistics, and it yields more robust and accurate segmentation of lung fields for serial chest radiographs. In particular, for segmenting the initial time-point images, the population-based shape statistics is used to constrain the deformable contour; as more subsequent images of the same patient are acquired, the patient-specific shape statistics online collected from the previous segmentation results gradually takes more roles. Thus, this patient-specific shape statistics is updated each time when a new segmentation result is obtained, and it is further used to refine the segmentation results of all the available time-point images. Experimental results show that the proposed method is more robust and accurate than other active shape models in segmenting the lung fields from serial chest radiographs.

Temporal subtraction of chest radiographs compensating pose differences

NASA Astrophysics Data System (ADS)

von Berg, Jens; Dworzak, Jalda; Klinder, Tobias; Manke, Dirk; Kreth, Adrian; Lamecker, Hans; Zachow, Stefan; Lorenz, Cristian

2011-03-01

Temporal subtraction techniques using 2D image registration improve the detectability of interval changes from chest radiographs. Although such methods are well known for some time they are not widely used in radiologic practice. The reason is the occurrence of strong pose differences between two acquisitions with a time interval of months to years in between. Such strong perspective differences occur in a reasonable number of cases. They cannot be compensated by available image registration methods and thus mask interval changes to be undetectable. In this paper a method is proposed to estimate a 3D pose difference by the adaptation of a 3D rib cage model to both projections. The difference between both is then compensated for, thus producing a subtraction image with virtually no change in pose. The method generally assumes that no 3D image data is available from the patient. The accuracy of pose estimation is validated with chest phantom images acquired under controlled geometric conditions. A subtle interval change simulated by a piece of plastic foam attached to the phantom becomes visible in subtraction images generated with this technique even at strong angular pose differences like an anterior-posterior inclination of 13 degrees.

[Imaging of pleural diseases: evaluation of imaging methods based on chest radiography].

PubMed

Poyraz, Necdet; Kalkan, Havva; Ödev, Kemal; Ceran, Sami

2017-03-01

The most commonly employed radiologic method in diagnosis of pleural diseases is conventional chest radiograph. The commonest chest- X-Ray findings are the presence of pleural effusion and thickening. Small pleural effusions are not readily identified on posteroanterior chest radiograph. However, lateral decubitus chest radiograph and chest ultrasonography may show small pleural effusions. These are more efficient methods than posteroanterior chest radiograph in the erect position for demonstrating small amounts of free pleural effusions. Chest ultrasonograph may be able to help in distinguishing the pleural pathologies from parenchymal lesions. On chest radiograph pleural effusions or pleural thickening may obscure the visibility of the underlying disease or parenchymal abnormality. Thus, computed tomography (CT) may provide additional information of determining the extent and severity of pleural disease and may help to differentiate malign pleural lesions from the benign ones. Moreover, CT may provide the differentiation of parenchmal abnormalities from pleural pathologies. CT (coronal and sagittal reformatted images) that also show invasion of chest wall, mediastinum and diaphragm, as well as enlarged hilar or mediastinal lymph nodes. Standart non-invasive imaging techniques may be supplemented with magnetic resonans imaging (MRI).

Chest Radiograph Findings in Childhood Pneumonia Cases From the Multisite PERCH Study.

PubMed

Fancourt, Nicholas; Deloria Knoll, Maria; Baggett, Henry C; Brooks, W Abdullah; Feikin, Daniel R; Hammitt, Laura L; Howie, Stephen R C; Kotloff, Karen L; Levine, Orin S; Madhi, Shabir A; Murdoch, David R; Scott, J Anthony G; Thea, Donald M; Awori, Juliet O; Barger-Kamate, Breanna; Chipeta, James; DeLuca, Andrea N; Diallo, Mahamadou; Driscoll, Amanda J; Ebruke, Bernard E; Higdon, Melissa M; Jahan, Yasmin; Karron, Ruth A; Mahomed, Nasreen; Moore, David P; Nahar, Kamrun; Naorat, Sathapana; Ominde, Micah Silaba; Park, Daniel E; Prosperi, Christine; Wa Somwe, Somwe; Thamthitiwat, Somsak; Zaman, Syed M A; Zeger, Scott L; O'Brien, Katherine L

2017-06-15

Chest radiographs (CXRs) are frequently used to assess pneumonia cases. Variations in CXR appearances between epidemiological settings and their correlation with clinical signs are not well documented. The Pneumonia Etiology Research for Child Health project enrolled 4232 cases of hospitalized World Health Organization (WHO)-defined severe and very severe pneumonia from 9 sites in 7 countries (Bangladesh, the Gambia, Kenya, Mali, South Africa, Thailand, and Zambia). At admission, each case underwent a standardized assessment of clinical signs and pneumonia risk factors by trained health personnel, and a CXR was taken that was interpreted using the standardized WHO methodology. CXRs were categorized as abnormal (consolidation and/or other infiltrate), normal, or uninterpretable. CXRs were interpretable in 3587 (85%) cases, of which 1935 (54%) were abnormal (site range, 35%-64%). Cases with abnormal CXRs were more likely than those with normal CXRs to have hypoxemia (45% vs 26%), crackles (69% vs 62%), tachypnea (85% vs 80%), or fever (20% vs 16%) and less likely to have wheeze (30% vs 38%; all P < .05). CXR consolidation was associated with a higher case fatality ratio at 30-day follow-up (13.5%) compared to other infiltrate (4.7%) or normal (4.9%) CXRs. Clinically diagnosed pneumonia cases with abnormal CXRs were more likely to have signs typically associated with pneumonia. However, CXR-normal cases were common, and clinical signs considered indicative of pneumonia were present in substantial proportions of these cases. CXR-consolidation cases represent a group with an increased likelihood of death at 30 days post-discharge. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

The impact of an early-morning radiologist work shift on the timeliness of communicating urgent imaging findings on portable chest radiography.

PubMed

Kaewlai, Rathachai; Greene, Reginald E; Asrani, Ashwin V; Abujudeh, Hani H

2010-09-01

The aim of this study was to assess the potential impact of staggered radiologist work shifts on the timeliness of communicating urgent imaging findings that are detected on portable overnight chest radiography of hospitalized patients. The authors conducted a retrospective study that compared the interval between the acquisition and communication of urgent findings on portable overnight critical care chest radiography detected by an early-morning shift for radiologists (3 am to 11 am) with historical experience with a standard daytime shift (8 am to 5 pm) in the detection and communication of urgent findings in a similar patient population a year earlier. During a 4-month period, 6,448 portable chest radiographic studies were interpreted on the early-morning radiologist shift. Urgent findings requiring immediate communication were detected in 308 (4.8%) studies. The early-morning shift of radiologists, on average, communicated these findings 2 hours earlier compared with the historical control group (P < .001). Staggered radiologist work shifts that include an early-morning shift can improve the timeliness of reporting urgent findings on overnight portable chest radiography of hospitalized patients. Published by Elsevier Inc.

Prevalence of thoracic scoliosis in adults 25 to 64 years of age detected during routine chest radiographs.

PubMed

Chen, James B; Kim, Abraham D; Allan-Blitz, Lao; Shamie, Arya Nick

2016-10-01

To investigate the prevalence of thoracic scoliosis and determine the effect of both age and gender on coronal curve magnitude among asymptomatic adults aged 25-64 years old, using standing posterior-anterior chest radiographs. This was a retrospective, cross-sectional study evaluating 500 randomly selected digital posterior-anterior chest radiographs taken at a single institution on an outpatient basis between January 2010 and December 2011. Males (n = 184) and females (n = 316) ranged in age from 25 to 64 years. Patients with symptoms of back pain; including a history of back pain, spinal instrumentation, or known pre-existing spinal disease were excluded. Radiographs were evaluated using Centricity PACS Web Diagnostic 2.1 system (General Electric Co. Fairfield, CT). Coronal Cobb angle measurements of the thoracic spine were quantified by the authors, with scoliosis defined as coronal curves greater than 10°. Curvatures were subdivided into groups: a control group with coronal curves less than 10°, curves measuring 10° to 19°, 20° to 29°, and greater than 30°. The effect of age and gender on curve magnitude was examined using Pearson correlation analysis and linear regression analysis. There was a 13.4 % (67 patients) prevalence of thoracic scoliosis. The prevalence among asymptomatic males was 10.9 %, while the prevalence among asymptomatic females was 14.9 %. 11.6 % demonstrated a coronal curvature between 10° and 19° (58 patients), 1.6 % between 20° and 29° (8 patients), and 0.2 % greater than 30° (1 patient). Age and gender were not found to be significant independent predictors of curve severity. We found a 13.4 % prevalence of thoracic scoliosis among asymptomatic adults aged 25-64 years on routine outpatient chest radiographs. 11.6 % of patients demonstrated a coronal curvature between 10° and 19°. Unlike prior studies evaluating asymptomatic thoracic curves in elderly patients, age and gender did not significantly affect curve

Interpretation of digital chest radiographs: comparison of light emitting diode versus cold cathode fluorescent lamp backlit monitors.

PubMed

Lim, Hyun-ju; Chung, Myung Jin; Lee, Geewon; Yie, Miyeon; Shin, Kyung Eun; Moon, Jung Won; Lee, Kyung Soo

2013-01-01

To compare the diagnostic performance of light emitting diode (LED) backlight monitors and cold cathode fluorescent lamp (CCFL) monitors for the interpretation of digital chest radiographs. We selected 130 chest radiographs from health screening patients. The soft copy image data were randomly sorted and displayed on a 3.5 M LED (2560 × 1440 pixels) monitor and a 3 M CCFL (2048 × 1536 pixels) monitor. Eight radiologists rated their confidence in detecting nodules and abnormal interstitial lung markings (ILD). Low dose chest CT images were used as a reference standard. The performance of the monitor systems was assessed by analyzing 2080 observations and comparing them by multi-reader, multi-case receiver operating characteristic analysis. The observers reported visual fatigue and a sense of heat. Radiant heat and brightness of the monitors were measured. Measured brightness was 291 cd/m(2) for the LED and 354 cd/m(2) for the CCFL monitor. Area under curves for nodule detection were 0.721 ± 0.072 and 0.764 ± 0.098 for LED and CCFL (p = 0.173), whereas those for ILD were 0.871 ± 0.073 and 0.844 ± 0.068 (p = 0.145), respectively. There were no significant differences in interpretation time (p = 0.446) or fatigue score (p = 0.102) between the two monitors. Sense of heat was lower for the LED monitor (p = 0.024). The temperature elevation was 6.7℃ for LED and 12.4℃ for the CCFL monitor. Although the LED monitor had lower maximum brightness compared with the CCFL monitor, soft copy reading of the digital chest radiographs on LED and CCFL showed no difference in terms of diagnostic performance. In addition, LED emitted less heat.

Bayesian latent class estimation of the incidence of chest radiograph-confirmed pneumonia in rural Thailand.

PubMed

Lu, Y; Baggett, H C; Rhodes, J; Thamthitiwat, S; Joseph, L; Gregory, C J

2016-10-01

Pneumonia is a leading cause of mortality and morbidity worldwide with radiographically confirmed pneumonia a key disease burden indicator. This is usually determined by a radiology panel which is assumed to be the best available standard; however, this assumption may introduce bias into pneumonia incidence estimates. To improve estimates of radiographic pneumonia incidence, we applied Bayesian latent class modelling (BLCM) to a large database of hospitalized patients with acute lower respiratory tract illness in Sa Kaeo and Nakhon Phanom provinces, Thailand from 2005 to 2010 with chest radiographs read by both a radiology panel and a clinician. We compared these estimates to those from conventional analysis. For children aged <5 years, estimated radiographically confirmed pneumonia incidence by BLCM was 2394/100 000 person-years (95% credible interval 2185-2574) vs. 1736/100 000 person-years (95% confidence interval 1706-1766) from conventional analysis. For persons aged ⩾5 years, estimated radiographically confirmed pneumonia incidence was similar between BLCM and conventional analysis (235 vs. 215/100 000 person-years). BLCM suggests the incidence of radiographically confirmed pneumonia in young children is substantially larger than estimated from the conventional approach using radiology panels as the reference standard.

Radiation risk assessment in neonatal radiographic examinations of the chest and abdomen: a clinical and Monte Carlo dosimetry study

NASA Astrophysics Data System (ADS)

Makri, T.; Yakoumakis, E.; Papadopoulou, D.; Gialousis, G.; Theodoropoulos, V.; Sandilos, P.; Georgiou, E.

2006-10-01

Seeking to assess the radiation risk associated with radiological examinations in neonatal intensive care units, thermo-luminescence dosimetry was used for the measurement of entrance surface dose (ESD) in 44 AP chest and 28 AP combined chest-abdominal exposures of a sample of 60 neonates. The mean values of ESD were found to be equal to 44 ± 16 µGy and 43 ± 19 µGy, respectively. The MCNP-4C2 code with a mathematical phantom simulating a neonate and appropriate x-ray energy spectra were employed for the simulation of the AP chest and AP combined chest-abdominal exposures. Equivalent organ dose per unit ESD and energy imparted per unit ESD calculations are presented in tabular form. Combined with ESD measurements, these calculations yield an effective dose of 10.2 ± 3.7 µSv, regardless of sex, and an imparted energy of 18.5 ± 6.7 µJ for the chest radiograph. The corresponding results for the combined chest-abdominal examination are 14.7 ± 7.6 µSv (males)/17.2 ± 7.6 µSv (females) and 29.7 ± 13.2 µJ. The calculated total risk per radiograph was low, ranging between 1.7 and 2.9 per million neonates, per film, and being slightly higher for females. Results of this study are in good agreement with previous studies, especially in view of the diversity met in the calculation methods.

Cavity contour segmentation in chest radiographs using supervised learning and dynamic programming

DOE Office of Scientific and Technical Information (OSTI.GOV)

Maduskar, Pragnya, E-mail: pragnya.maduskar@radboudumc.nl; Hogeweg, Laurens; Sánchez, Clara I.

Purpose: Efficacy of tuberculosis (TB) treatment is often monitored using chest radiography. Monitoring size of cavities in pulmonary tuberculosis is important as the size predicts severity of the disease and its persistence under therapy predicts relapse. The authors present a method for automatic cavity segmentation in chest radiographs. Methods: A two stage method is proposed to segment the cavity borders, given a user defined seed point close to the center of the cavity. First, a supervised learning approach is employed to train a pixel classifier using texture and radial features to identify the border pixels of the cavity. A likelihoodmore » value of belonging to the cavity border is assigned to each pixel by the classifier. The authors experimented with four different classifiers:k-nearest neighbor (kNN), linear discriminant analysis (LDA), GentleBoost (GB), and random forest (RF). Next, the constructed likelihood map was used as an input cost image in the polar transformed image space for dynamic programming to trace the optimal maximum cost path. This constructed path corresponds to the segmented cavity contour in image space. Results: The method was evaluated on 100 chest radiographs (CXRs) containing 126 cavities. The reference segmentation was manually delineated by an experienced chest radiologist. An independent observer (a chest radiologist) also delineated all cavities to estimate interobserver variability. Jaccard overlap measure Ω was computed between the reference segmentation and the automatic segmentation; and between the reference segmentation and the independent observer's segmentation for all cavities. A median overlap Ω of 0.81 (0.76 ± 0.16), and 0.85 (0.82 ± 0.11) was achieved between the reference segmentation and the automatic segmentation, and between the segmentations by the two radiologists, respectively. The best reported mean contour distance and Hausdorff distance between the reference and the automatic segmentation were

Morphometric Comparison of Clavicle Outlines from 3D Bone Scans and 2D Chest Radiographs: A Short-listing Tool to Assist Radiographic Identification of Human Skeletons

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stephan, Carl N.; Amidan, Brett G.; Trease, Harold E.

This paper describes a computerized clavicle identification system, primarily designed to resolve the identities of unaccounted for US soldiers who fought in the Korean War. Elliptical Fourier analysis is used to quantify the clavicle outline shape from skeletons and postero-anterior antemortem chest radiographs to rank individuals in terms of metric distance. Similar to leading fingerprint identification systems, shortlists of the top matching candidates are extracted for subsequent human visual assessment. Two independent tests of the computerized system using 17 field-recovered skeletons and 409 chest radiographs demonstrate that true positive matches are captured within the top 5% of the sample 75%more » of the time. These results are outstanding given the eroded state of some field-recovered skeletons and the faintness of the 1950’s photoflurographs. These methods enhance the capability to resolve several hundred cold cases for which little circumstantial information exists and current DNA and dental record technologies cannot be applied.« less

Computerized detection of vertebral compression fractures on lateral chest radiographs: Preliminary results with a tool for early detection of osteoporosis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kasai, Satoshi; Li Feng; Shiraishi, Junji

Vertebral fracture (or vertebral deformity) is a very common outcome of osteoporosis, which is one of the major public health concerns in the world. Early detection of vertebral fractures is important because timely pharmacologic intervention can reduce the risk of subsequent additional fractures. Chest radiographs are used routinely for detection of lung and heart diseases, and vertebral fractures can be visible on lateral chest radiographs. However, investigators noted that about 50% of vertebral fractures visible on lateral chest radiographs were underdiagnosed or under-reported, even when the fractures were severe. Therefore, our goal was to develop a computerized method for detectionmore » of vertebral fractures on lateral chest radiographs in order to assist radiologists' image interpretation and thus allow the early diagnosis of osteoporosis. The cases used in this study were 20 patients with severe vertebral fractures and 118 patients without fractures, as confirmed by the consensus of two radiologists. Radiologists identified the locations of fractured vertebrae, and they provided morphometric data on the vertebral shape for evaluation of the accuracy of detecting vertebral end plates by computer. In our computerized method, a curved search area, which included a number of vertebral end plates, was first extracted automatically, and was straightened so that vertebral end plates became oriented horizontally. Edge candidates were enhanced by use of a horizontal line-enhancement filter in the straightened image, and a multiple thresholding technique, followed by feature analysis, was used for identification of the vertebral end plates. The height of each vertebra was determined from locations of identified vertebral end plates, and fractured vertebrae were detected by comparison of the measured vertebral height with the expected height. The sensitivity of our computerized method for detection of fracture cases was 95% (19/20), with 1.03 (139/135) false

Educational Module Intervention for Radiographers to Reduce Repetition Rate of Routine Digital Chest Radiography in Makkah Region of Saudi Arabia Tertiary Hospitals: Protocol of a Quasi-Experimental Study.

PubMed

Almalki, Abdullah A; Abdul Manaf, Rosliza; Hanafiah Juni, Muhamad; Kadir Shahar, Hayati; Noor, Noramaliza Mohd; Gabbad, Abdelsafi

2017-09-26

Repetition of an image is a critical event in any radiology department. When the repetition rate of routine digital chest radiographs is high, radiation exposure of staff and patients is increased. In addition, repetition consumes the equipment's life span, thus affecting the annual budget of the department. The aim of this study is to determine the impact of a printed educational module on reducing the repetition rate of routine digital chest radiography among radiographers in Makkah Region tertiary hospitals. A quasi-experimental time series with a control group will be conducted in Makkah Region tertiary hospitals for 8 months starting in the second quarter of 2017. Four hospitals out of 5 in the region will be selected; 2 of them will be selected as the control group and the other 2 as the intervention group. Stratification and a simple random sampling technique will be used to sample 56 radiographers in each group. Pre- and postintervention assessments will be conducted to determine the radiographer knowledge, motivation, and skills and repetition rate of chest radiographs. Radiographs of the chest performed by sampled radiographers in the selected hospitals will be collected for 2 weeks before and after the intervention. A piloted questionnaire will be distributed and collected by a researcher in both groups. One-way multivariate analysis of variance and 2-way repeated multivariate analysis of variance will be used to analyze the data. It is expected that the repetition rate in the intervention group will decline after implementing the intervention and the change will be statistically significant (P<.05). Furthermore, it is expected that the knowledge, motivation, and skill levels in the intervention group will increase significantly among radiographers after implementation of the intervention (P<.05). Meanwhile, knowledge, motivation, and skills in the control group will not change. A quasi-experimental time series with a control will be conducted to

Cough in Ambulatory Immunocompromised Adults: CHEST Expert Panel Report.

PubMed

Rosen, Mark J; Ireland, Belinda; Narasimhan, Mangala; French, Cynthia; Irwin, Richard S

2017-11-01

Cough is a common symptom prompting patients to seek medical care. Like patients in the general population, patients with compromised immune systems also seek care for cough. However, it is unclear whether the causes of cough in immunocompromised patients who are deemed unlikely to have a life-threating condition and a normal or unchanged chest radiograph are similar to those in persons with cough and normal immune systems. We conducted a systematic review to answer the question: What are the most common causes of cough in ambulatory immunodeficient adults with normal chest radiographs? Studies of patients ≥ 18 years of age with immune deficiency, cough of any duration, and normal or unchanged chest radiographs were included and assessed for relevance and quality. Based on the systematic review, suggestions were developed and voted on using the American College of Chest Physicians (CHEST) methodology framework. The results of the systematic review revealed no high-quality evidence to guide the clinician in determining the likely causes of cough specifically in immunocompromised ambulatory patients with normal chest radiographs. Based on a systematic review, we found no evidence to assess whether or not the proper initial evaluation of cough in immunocompromised patients is different from that in immunocompetent persons. A consensus of the panel suggested that the initial diagnostic algorithm should be similar to that for immunocompetent persons but that the context of the type and severity of the immune defect, geographic location, and social determinants be considered. The major modifications to the 2006 CHEST Cough Guidelines are the suggestions that TB should be part of the initial evaluation of patients with cough and HIV infection who reside in regions with a high prevalence of TB, regardless of the radiographic findings, and that specific causes and immune defects be considered in all patients in whom the initial evaluation is unrevealing. Copyright �

Asbestos-related radiographic findings among household contacts of workers exposed to Libby vermiculite: impact of workers' personal hygiene practices.

PubMed

Hilbert, Timothy J; Franzblau, Alfred; Dunning, Kari K; Borton, Eric K; Rohs, Amy M; Lockey, James E

2013-11-01

To explore the potential impact of worker hygiene by determining the prevalence of radiographic changes consistent with asbestos exposure among household contacts of workers exposed to Libby vermiculite that contained amphibole fibers. Workers and household contacts had chest radiographs and completed questionnaires regarding hygiene and potential exposure pathways. Participants included 191 household contacts of 118 workers. One household contact (0.5%) had localized pleural thickening, and three (1.6%) had irregular opacities at profusion category 1/0 or greater. Worker radiographs demonstrated pleural changes in 45% and irregular opacities at profusion category 1/0 or greater in 8%. Libby vermiculite-exposed workers demonstrated an elevated prevalence of pleural and interstitial chest radiographic changes. There was, however, no increased prevalence of similar changes among household contacts, likely because of personal hygiene measures taken by the majority of workers.

Guidelines for the use of chest radiographs in community-acquired pneumonia in children and adolescents.

PubMed

Andronikou, Savvas; Lambert, Elena; Halton, Jarred; Hilder, Lucy; Crumley, Iona; Lyttle, Mark D; Kosack, Cara

2017-10-01

National guidance from the United Kingdom and the United States on community-acquired pneumonia in children states that chest radiographs are not recommended routinely in uncomplicated cases. The main reason in the ambulatory setting is that there is no evidence of a substantial impact on clinical outcomes. However clinical practice and adherence to guidance is multifactorial and includes the clinical context (developed vs. developing world), the confidence of the attending physician, the changing incidence of complications (according to the success of immunisation programs), the availability of alternative imaging (and its relationship to perceived risks of radiation) and the reliability of the interpretation of imaging. In practice, chest radiographs are performed frequently for suspected pneumonia in children. Time pressures facing clinicians at the front line, difficulties in distinguishing which children require admission, restricted bed numbers for admissions, imaging-resource limitations, perceptions regarding risk from procedures, novel imaging modalities and the probability of other causes for the child's presentation all need to be factored into a guideline. Other drivers that often weigh in, depending on the setting, include cost-effectiveness and the fear of litigation. Not all guidelines designed for the developed world can therefore be applied to the developing world, and practice guidelines require regular review in the context of new information. In addition, radiologists must improve radiographic diagnosis of pneumonia, reach consensus on the interpretive terminology that clarifies their confidence regarding the presence of pneumonia and act to replace one imaging technique with another whenever there is proof of improved accuracy or reliability.

Experiments in concept modeling for radiographic image reports.

PubMed Central

Bell, D S; Pattison-Gordon, E; Greenes, R A

1994-01-01

OBJECTIVE: Development of methods for building concept models to support structured data entry and image retrieval in chest radiography. DESIGN: An organizing model for chest-radiographic reporting was built by analyzing manually a set of natural-language chest-radiograph reports. During model building, clinician-informaticians judged alternative conceptual structures according to four criteria: content of clinically relevant detail, provision for semantic constraints, provision for canonical forms, and simplicity. The organizing model was applied in representing three sample reports in their entirety. To explore the potential for automatic model discovery, the representation of one sample report was compared with the noun phrases derived from the same report by the CLARIT natural-language processing system. RESULTS: The organizing model for chest-radiographic reporting consists of 62 concept types and 17 relations, arranged in an inheritance network. The broadest types in the model include finding, anatomic locus, procedure, attribute, and status. Diagnoses are modeled as a subtype of finding. Representing three sample reports in their entirety added 79 narrower concept types. Some CLARIT noun phrases suggested valid associations among subtypes of finding, status, and anatomic locus. CONCLUSIONS: A manual modeling process utilizing explicitly stated criteria for making modeling decisions produced an organizing model that showed consistency in early testing. A combination of top-down and bottom-up modeling was required. Natural-language processing may inform model building, but algorithms that would replace manual modeling were not discovered. Further progress in modeling will require methods for objective model evaluation and tools for formalizing the model-building process. PMID:7719807

A method to detect occult pneumothorax with chest radiography.

PubMed

Matsumoto, Shokei; Kishikawa, Masanobu; Hayakawa, Koichi; Narumi, Atsushi; Matsunami, Katsutoshi; Kitano, Mitsuhide

2011-04-01

Small pneumothoraces are often not visible on supine screening chest radiographs because they develop anteriorly to the lung. These pneumothoraces are termed occult. Occult pneumothoraces account for an astonishingly high 52% to 63% of all traumatic pneumothoraces. A 19-year-old obese woman was involved in a head-on car accident. The admission anteroposterior chest radiographs were unremarkable. Because of the presence of right chest tenderness and an abrasion, we suspected the presence of a pneumothorax. Thus, we decided to take a supine oblique chest radiograph of the right side of the thorax, which clearly revealed a visceral pleural line, consistent with a diagnosis of traumatic pneumothorax. A pneumothorax may be present when a supine chest radiograph reveals either an apparent deepening of the costophrenic angle (the "deep sulcus sign") or the presence of 2 diaphragm-lung interfaces (the "double diaphragm sign"). However, in practice, supine chest radiographs have poor sensitivity for occult pneumothoraces. Oblique chest radiograph is a useful and fast screening tool that should be considered for cases of blunt chest trauma, especially when transport of critically ill patients to the computed tomographic suite is dangerous or when imminent transfer to another hospital is being arranged and early diagnosis of an occult pneumothorax is essential. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Radiographic findings in late-presenting congenital diaphragmatic hernia: helpful imaging findings.

PubMed

Muzzafar, Sofia; Swischuk, Leonard E; Jadhav, Siddharth P

2012-03-01

Imaging findings in delayed presentation of congenital diaphragmatic hernia can be confusing and misleading, resulting in a delay in diagnosis. To evaluate the often puzzling plain film findings of late-presenting CDH in an effort to determine whether any of the findings could be helpful in arriving at an early diagnosis. We reviewed and documented the plain film findings and clinical data in eight patients seen during the last 20 years with late-presenting CDH. IRB exempt status was obtained in this study. There were five boys and three girls. The age range was 4 months to 12 years with a mean of 2.4 years. Five children presented with acute respiratory problems while three presented with acute abdominal pain. Two children presented with both respiratory and abdominal findings and one also presented with hematemesis. Two children had radiographic findings that were not difficult to analyze while the remaining six had findings that posed initial diagnostic problems. Although not common, late-presenting CDH can result in confusing plain film radiographic findings and a delay in diagnosis. We found that the most important finding in analyzing these radiographs is in evaluating the location and position of the gastric bubble with the more common left-side hernias.

No Value for Routine Chest Radiography in the Work-Up of Early Stage Cervical Cancer Patients

PubMed Central

Hoogendam, Jacob P.; Zweemer, Ronald P.; Verkooijen, Helena M.; de Jong, Pim A.; van den Bosch, Maurice A. A. J.; Verheijen, René H. M.; Veldhuis, Wouter B.

2015-01-01

Aim Evidence supporting the recommendation to include chest radiography in the work-up of all cervical cancer patients is limited. We investigated the diagnostic value of routine chest radiography in cervical cancer staging. Methods All consecutive cervical cancer patients who presented at our tertiary referral center in the Netherlands (January 2006 – September 2013), and for whom ≥6 months follow-up was available, were included. As part of the staging procedure, patients underwent a routine two-directional digital chest radiograph. Findings were compared to a composite reference standard consisting of all imaging studies and histology obtained during the 6 months following radiography. Results Of the 402 women who presented with cervical cancer, 288 (71.6%) underwent chest radiography and had ≥6 months follow-up. Early clinical stage (I/II) cervical cancer was present in 244/288 (84.7%) women, while 44 (15.3%) presented with advanced disease (stage III/IV). The chest radiograph of 1 woman – with advanced pre-radiograph stage (IVA) disease – showed findings consistent with pulmonary metastases. Radiographs of 7 other women – 4 early, 3 advanced stage disease – were suspicious for pulmonary metastases which was confirmed by additional imaging in only 1 woman (with pre-radiograph advanced stage (IIIB) disease) and excluded in 6 cases, including all women with early stage disease. In none of the 288 women were thoracic skeletal metastases identified on imaging or during 6 months follow up. Radiography was unremarkable in 76.4% of the study population, and showed findings unrelated to the cervical carcinoma in 21.2%. Conclusion Routine chest radiography was of no value for any of the early stage cervical cancer patients presenting at our tertiary center over a period of 7.7 years. PMID:26135733

No Value for Routine Chest Radiography in the Work-Up of Early Stage Cervical Cancer Patients.

PubMed

Hoogendam, Jacob P; Zweemer, Ronald P; Verkooijen, Helena M; de Jong, Pim A; van den Bosch, Maurice A A J; Verheijen, René H M; Veldhuis, Wouter B

2015-01-01

Evidence supporting the recommendation to include chest radiography in the work-up of all cervical cancer patients is limited. We investigated the diagnostic value of routine chest radiography in cervical cancer staging. All consecutive cervical cancer patients who presented at our tertiary referral center in the Netherlands (January 2006 - September 2013), and for whom ≥6 months follow-up was available, were included. As part of the staging procedure, patients underwent a routine two-directional digital chest radiograph. Findings were compared to a composite reference standard consisting of all imaging studies and histology obtained during the 6 months following radiography. Of the 402 women who presented with cervical cancer, 288 (71.6%) underwent chest radiography and had ≥6 months follow-up. Early clinical stage (I/II) cervical cancer was present in 244/288 (84.7%) women, while 44 (15.3%) presented with advanced disease (stage III/IV). The chest radiograph of 1 woman - with advanced pre-radiograph stage (IVA) disease - showed findings consistent with pulmonary metastases. Radiographs of 7 other women - 4 early, 3 advanced stage disease - were suspicious for pulmonary metastases which was confirmed by additional imaging in only 1 woman (with pre-radiograph advanced stage (IIIB) disease) and excluded in 6 cases, including all women with early stage disease. In none of the 288 women were thoracic skeletal metastases identified on imaging or during 6 months follow up. Radiography was unremarkable in 76.4% of the study population, and showed findings unrelated to the cervical carcinoma in 21.2%. Routine chest radiography was of no value for any of the early stage cervical cancer patients presenting at our tertiary center over a period of 7.7 years.

Rate of abnormal osteoarticular radiographic findings in pediatric patients.

PubMed

Petit, P; Sapin, C; Henry, G; Dahan, M; Panuel, M; Bourlière-Najean, B; Chaumoitre, K; Devred, P

2001-04-01

The objective of our study was to assess the rate of abnormal radiographic findings in the most frequent osteoarticular locations of traumatic injury in a pediatric population. During two periods of 12 weeks each, all patients admitted to the pediatric emergency department for osteoarticular trauma who underwent radiography were prospectively included in this study. A connection was drawn between the rate of abnormal radiographic findings for the seven most frequently radiographed locations and the clinical findings. Of 3128 locations of trauma in 2470 children, only 22% of the radiographic examinations were considered to reveal abnormal findings. In decreasing order, the hand and fingers, the ankle, the wrist, the knee, the elbow, the foot and toes, and the forearm were the most frequently examined locations. The rate of abnormal findings was 25.7% for the hand and fingers, 9.0% for the ankle, 42.5% for the wrist, 9.5% for the knee, 33.3% for the elbow, 18.3% for the foot, and 43.2% for the forearm. When only the direct sign of fracture was taken into account, these rates decreased for the ankle and knee to 2.6% and 1.9%, respectively. There was always a significant link between the degree of clinical suspicion and the rate of abnormal radiographic findings. However, fewer than 50% of the cases with high clinical suspicion of fracture were radiographically confirmed. It appears necessary, especially in cases of lower limb trauma, to evaluate clinical tests, including the implementation of the Ottawa ankle rules, to reduce the number of unnecessary radiographic examinations. This reduction will improve some parameters of children's quality of life and will significantly decrease the cost of emergency care.

42 CFR 37.44 - Approval of radiographic facilities that use digital radiography systems.

Code of Federal Regulations, 2014 CFR

2014-10-01

... effective management, safety, and proper performance of chest image acquisition, digitization, processing... digital chest radiographs by submitting to NIOSH digital radiographic image files of a test object (e.g... radiographic image files from six or more sample chest radiographs that are of acceptable quality to one or...

Low Yield of Chest Radiography in a Large Tuberculosis Screening Program1

PubMed Central

Pollock, Nira R.

2010-01-01

Purpose: To assess the frequency and spectrum of abnormalities on routine screening chest radiographs in the pre-employment evaluation of health care workers with positive tuberculin skin test (TST) results. Materials and Methods: The institutional review board approved this HIPAA-compliant retrospective study and waived the need for written informed patient consent. Chest radiographic reports of all 2586 asymptomatic individuals with positive TST results who underwent pre-employment evaluation between January 1, 2003, and December 31, 2007, were evaluated to determine the frequency of detection of evidence of active tuberculosis (TB) or latent TB infection (LTBI) and the spectrum of imaging findings. All chest radiographs interpreted as positive were reviewed by an experienced board-certified radiologist. If there was a discrepancy between the two readings, a second experienced radiologist served as an independent and final arbiter. Any follow-up chest radiographs or computed tomographic images that had been acquired by employee health services or by the employee’s private physician as a result of a suspected abnormality detected at initial screening were also evaluated. Results: Of the 159 (6.1%) chest radiographic examinations that yielded abnormal results, there were no findings that were consistent with active TB. There were 92 cases of calcified granulomas, calcified lymph nodes, or both; 25 cases of apical pleural thickening; 16 cases of fibrous scarring; and 31 cases of noncalcified nodules. All cases of fibrous scarring involved an area smaller than 2 cm2. All noncalcified nodules were 4 mm in diameter or smaller, with the exception of one primary lung malignancy and one necrotizing granuloma (negative for acid-fast bacilli) that grew Mycobacterium kansasii on culture. Conclusion: Universal chest radiography in a large pre-employment TB screening program was of low yield in the detection of active TB or increased LTBI reactivation risk, and it provided

[Lateral chest X-rays. Radiographic anatomy].

PubMed

García Villafañe, C; Pedrosa, C S

2014-01-01

Lateral chest views constitute an essential part of chest X-ray examinations, so it is fundamental to know the anatomy on these images and to be able to detect the variations manifested on these images in different diseases. The aim of this article is to review the normal anatomy and main normal variants seen on lateral chest views. For teaching purposes, we divide the thorax into different spaces and analyze each in an orderly way, especially emphasizing the anatomic details that are most helpful for locating lesions that have already been detected in the posteroanterior view or for detecting lesions that can be missed in the posteroanterior view. Copyright © 2013 SERAM. Published by Elsevier Espana. All rights reserved.

Diagnosing pulmonary edema: lung ultrasound versus chest radiography.

PubMed

Martindale, Jennifer L; Noble, Vicki E; Liteplo, Andrew

2013-10-01

Diagnosing the underlying cause of acute dyspnea can be challenging. Lung ultrasound may help to identify pulmonary edema as a possible cause. To evaluate the ability of residents to recognize pulmonary edema on lung ultrasound using chest radiographs as a comparison standard. This is a prospective, blinded, observational study of a convenience sample of resident physicians in the Departments of Emergency Medicine (EM), Internal Medicine (IM), and Radiology. Residents were given a tutorial on interpreting pulmonary edema on both chest radiograph and lung ultrasound. They were then shown both ultrasounds and chest radiographs from 20 patients who had presented to the emergency department with dyspnea, 10 with a primary diagnosis of pulmonary edema, and 10 with alternative diagnoses. Cohen's κ values were calculated to describe the strength of the correlation between resident and gold standard interpretations. Participants included 20 EM, 20 IM, and 20 Radiology residents. The overall agreement with gold standard interpretation of pulmonary edema on lung ultrasound (74%, κ = 0.51, 95% confidence interval 0.46-0.55) was superior to chest radiographs (58%, κ = 0.25, 95% confidence interval 0.20-0.30) (P < 0.0001). EM residents interpreted lung ultrasounds more accurately than IM residents. Radiology residents interpreted chest radiographs more accurately than did EM and IM residents. Residents were able to more accurately identify pulmonary edema with lung ultrasound than with chest radiograph. Physicians with minimal exposure to lung ultrasound may be able to correctly recognize pulmonary edema on lung ultrasound.

Yield of chest radiography after removal of esophageal foreign bodies.

PubMed

Fisher, Jeremy; Mittal, Rohit; Hill, Sarah; Wulkan, Mark L; Clifton, Matthew S

2013-05-01

The aim of this study was to determine the benefit of routine postoperative chest radiography after removal of esophageal foreign bodies in children. Medical records were reviewed of all patients evaluated with an esophageal foreign body at a single children's hospital over 10 years. Operative records and imaging reports were reviewed for evidence of esophageal injury. Of 803 records identified, 690 were included. All underwent rigid esophagoscopy and foreign body removal. The most common items removed were coins (94%), food boluses (3%), and batteries (2%). The rate of esophageal injury was 1.3% (9 patients). No injuries were identified on chest radiographs done as routine or for concern of injury. Patients with operative findings suggestive of an esophageal injury (n = 105) were significantly more likely to have an injury (8.6% vs 0%, P = .0001). Of the 585 children who did not have physical evidence of injury, 40% (n = 235) received a routine chest radiograph. Regardless of the indication, no injuries were identified on chest films. We conclude that intraoperative findings during rigid esophagoscopy suggestive of an injury are predictive of esophageal perforation. Routine chest radiography is not warranted in children who do not meet this criterion. In patients with a concern for injury, we suggest that chest radiography should be deferred in favor of esophagram.

Super-resolution convolutional neural network for the improvement of the image quality of magnified images in chest radiographs

NASA Astrophysics Data System (ADS)

Umehara, Kensuke; Ota, Junko; Ishimaru, Naoki; Ohno, Shunsuke; Okamoto, Kentaro; Suzuki, Takanori; Shirai, Naoki; Ishida, Takayuki

2017-02-01

Single image super-resolution (SR) method can generate a high-resolution (HR) image from a low-resolution (LR) image by enhancing image resolution. In medical imaging, HR images are expected to have a potential to provide a more accurate diagnosis with the practical application of HR displays. In recent years, the super-resolution convolutional neural network (SRCNN), which is one of the state-of-the-art deep learning based SR methods, has proposed in computer vision. In this study, we applied and evaluated the SRCNN scheme to improve the image quality of magnified images in chest radiographs. For evaluation, a total of 247 chest X-rays were sampled from the JSRT database. The 247 chest X-rays were divided into 93 training cases with non-nodules and 152 test cases with lung nodules. The SRCNN was trained using the training dataset. With the trained SRCNN, the HR image was reconstructed from the LR one. We compared the image quality of the SRCNN and conventional image interpolation methods, nearest neighbor, bilinear and bicubic interpolations. For quantitative evaluation, we measured two image quality metrics, peak signal-to-noise ratio (PSNR) and structural similarity (SSIM). In the SRCNN scheme, PSNR and SSIM were significantly higher than those of three interpolation methods (p<0.001). Visual assessment confirmed that the SRCNN produced much sharper edge than conventional interpolation methods without any obvious artifacts. These preliminary results indicate that the SRCNN scheme significantly outperforms conventional interpolation algorithms for enhancing image resolution and that the use of the SRCNN can yield substantial improvement of the image quality of magnified images in chest radiographs.

Time-series analysis of lung texture on bone-suppressed dynamic chest radiograph for the evaluation of pulmonary function: a preliminary study

NASA Astrophysics Data System (ADS)

Tanaka, Rie; Matsuda, Hiroaki; Sanada, Shigeru

2017-03-01

The density of lung tissue changes as demonstrated on imagery is dependent on the relative increases and decreases in the volume of air and lung vessels per unit volume of lung. Therefore, a time-series analysis of lung texture can be used to evaluate relative pulmonary function. This study was performed to assess a time-series analysis of lung texture on dynamic chest radiographs during respiration, and to demonstrate its usefulness in the diagnosis of pulmonary impairments. Sequential chest radiographs of 30 patients were obtained using a dynamic flat-panel detector (FPD; 100 kV, 0.2 mAs/pulse, 15 frames/s, SID = 2.0 m; Prototype, Konica Minolta). Imaging was performed during respiration, and 210 images were obtained over 14 seconds. Commercial bone suppression image-processing software (Clear Read Bone Suppression; Riverain Technologies, Miamisburg, Ohio, USA) was applied to the sequential chest radiographs to create corresponding bone suppression images. Average pixel values, standard deviation (SD), kurtosis, and skewness were calculated based on a density histogram analysis in lung regions. Regions of interest (ROIs) were manually located in the lungs, and the same ROIs were traced by the template matching technique during respiration. Average pixel value effectively differentiated regions with ventilatory defects and normal lung tissue. The average pixel values in normal areas changed dynamically in synchronization with the respiratory phase, whereas those in regions of ventilatory defects indicated reduced variations in pixel value. There were no significant differences between ventilatory defects and normal lung tissue in the other parameters. We confirmed that time-series analysis of lung texture was useful for the evaluation of pulmonary function in dynamic chest radiography during respiration. Pulmonary impairments were detected as reduced changes in pixel value. This technique is a simple, cost-effective diagnostic tool for the evaluation of regional

Low Yield of Chest Radiography in General Inpatients and Outpatients with "Positive PPD" Results in a Country with Low Prevalence of TB.

PubMed

Eisenberg, Ronald L; Heidinger, Benedikt H

2017-07-01

The purpose of this study was to assess the frequency and spectrum of abnormalities on routine screening chest radiographs among inpatients and outpatients with "positive purified protein derivative (PPD)" in a large tertiary care academic medical center in a country with low prevalence of tuberculosis (TB). The reports of all chest radiographs of general inpatients and outpatients referred for positive PPD (2010-2014) were evaluated for the frequency of evidence of active or latent TB and the spectrum of imaging findings. The results of additional chest radiographs and computed tomography scans were recorded, as were additional relevant clinical histories and symptoms. Of the 2518 patients who underwent chest radiography for positive PPD, the radiographs were normal in 91.3%. The vast majority of the abnormal radiographs demonstrated findings consistent with old tuberculous disease. There were three cases (0.1%) of active TB, all of which were either recent immigrants from an endemic area or had other relevant histories or clinical symptoms suggestive of the disease. Universal chest radiography in general inpatient and outpatient populations referred for positive PPD is of low yield for detecting active disease in a country with low prevalence of TB. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Chest CT findings of toxocariasis: correlation with laboratory results.

PubMed

Hur, J H; Lee, I J; Kim, J-H; Kim, D-G; Hwang, H J; Koh, S H; Lee, K

2014-06-01

To assess the relationship between chest computed tomography (CT) findings of patients with toxocariasis and levels of serological markers. A total of 38 cases of patients diagnosed with toxocariasis by enzyme-linked immunosorbent assay (ELISA), CT, and serological markers were retrospectively reviewed. The presence of nodule with or without ground-glass opacity (GGO) halo, consolidation, focal GGO, pleural effusion, and lymphadenopathy at chest CT were evaluated. Statistical analysis was performed with the Fisher's exact test. The most common chest CT findings were nodule (n = 12, 31.6%) and focal GGO (n = 12, 31.6%). In patients with normal eosinophil levels, focal GGO (n = 9, 37.5%) was the most common finding. In contrast, nodule with a GGO halo (n = 7, 50%) was the most common finding in the eosinophilia group. Nodule with a GGO halo was more common in the eosinophilia group, with a statistically significant difference (p = 0.017). Nodule was more common in the eosinophilia group, and focal GGO was more common in the normal eosinophil group. The most common chest CT findings in toxocariasis were nodule with or without GGO halo, and focal GGO. In the eosinophilia group, nodule with a GGO halo was significantly more frequent. Other CT findings did not show a statistically significant relationship with serological markers. Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

System for pathology categorization and retrieval in chest radiographs

NASA Astrophysics Data System (ADS)

Avni, Uri; Greenspan, Hayit; Konen, Eli; Sharon, Michal; Goldberger, Jacob

2011-03-01

In this paper we present an overview of a system we have been developing for the past several years for efficient image categorization and retrieval in large radiograph archives. The methodology is based on local patch representation of the image content, using a bag of visual words approach and similarity-based categorization with a kernel based SVM classifier. We show an application to pathology-level categorization of chest x-ray data, the most popular examination in radiology. Our study deals with pathology detection and identification of individual pathologies including right and left pleural effusion, enlarged heart and cases of enlarged mediastinum. The input from a radiologist provided a global label for the entire image (healthy/pathology), and the categorization was conducted on the entire image, with no need for segmentation algorithms or any geometrical rules. An automatic diagnostic-level categorization, even on such an elementary level as healthy vs pathological, provides a useful tool for radiologists on this popular and important examination. This is a first step towards similarity-based categorization, which has a major clinical implications for computer-assisted diagnostics.

Automated characterization of perceptual quality of clinical chest radiographs: Validation and calibration to observer preference

DOE Office of Scientific and Technical Information (OSTI.GOV)

Samei, Ehsan, E-mail: samei@duke.edu; Lin, Yuan; Choudhury, Kingshuk R.

Purpose: The authors previously proposed an image-based technique [Y. Lin et al. Med. Phys. 39, 7019–7031 (2012)] to assess the perceptual quality of clinical chest radiographs. In this study, an observer study was designed and conducted to validate the output of the program against rankings by expert radiologists and to establish the ranges of the output values that reflect the acceptable image appearance so the program output can be used for image quality optimization and tracking. Methods: Using an IRB-approved protocol, 2500 clinical chest radiographs (PA/AP) were collected from our clinical operation. The images were processed through our perceptual qualitymore » assessment program to measure their appearance in terms of ten metrics of perceptual image quality: lung gray level, lung detail, lung noise, rib–lung contrast, rib sharpness, mediastinum detail, mediastinum noise, mediastinum alignment, subdiaphragm–lung contrast, and subdiaphragm area. From the results, for each targeted appearance attribute/metric, 18 images were selected such that the images presented a relatively constant appearance with respect to all metrics except the targeted one. The images were then incorporated into a graphical user interface, which displayed them into three panels of six in a random order. Using a DICOM calibrated diagnostic display workstation and under low ambient lighting conditions, each of five participating attending chest radiologists was tasked to spatially order the images based only on the targeted appearance attribute regardless of the other qualities. Once ordered, the observer also indicated the range of image appearances that he/she considered clinically acceptable. The observer data were analyzed in terms of the correlations between the observer and algorithmic rankings and interobserver variability. An observer-averaged acceptable image appearance was also statistically derived for each quality attribute based on the collected individual acceptable

Validation of an image-based technique to assess the perceptual quality of clinical chest radiographs with an observer study

NASA Astrophysics Data System (ADS)

Lin, Yuan; Choudhury, Kingshuk R.; McAdams, H. Page; Foos, David H.; Samei, Ehsan

2014-03-01

We previously proposed a novel image-based quality assessment technique1 to assess the perceptual quality of clinical chest radiographs. In this paper, an observer study was designed and conducted to systematically validate this technique. Ten metrics were involved in the observer study, i.e., lung grey level, lung detail, lung noise, riblung contrast, rib sharpness, mediastinum detail, mediastinum noise, mediastinum alignment, subdiaphragm-lung contrast, and subdiaphragm area. For each metric, three tasks were successively presented to the observers. In each task, six ROI images were randomly presented in a row and observers were asked to rank the images only based on a designated quality and disregard the other qualities. A range slider on the top of the images was used for observers to indicate the acceptable range based on the corresponding perceptual attribute. Five boardcertificated radiologists from Duke participated in this observer study on a DICOM calibrated diagnostic display workstation and under low ambient lighting conditions. The observer data were analyzed in terms of the correlations between the observer ranking orders and the algorithmic ranking orders. Based on the collected acceptable ranges, quality consistency ranges were statistically derived. The observer study showed that, for each metric, the averaged ranking orders of the participated observers were strongly correlated with the algorithmic orders. For the lung grey level, the observer ranking orders completely accorded with the algorithmic ranking orders. The quality consistency ranges derived from this observer study were close to these derived from our previous study. The observer study indicates that the proposed image-based quality assessment technique provides a robust reflection of the perceptual image quality of the clinical chest radiographs. The derived quality consistency ranges can be used to automatically predict the acceptability of a clinical chest radiograph.

WE-G-204-07: Automated Characterization of Perceptual Quality of Clinical Chest Radiographs: Improvements in Lung, Spine, and Hardware Detection

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wells, J; Zhang, L; Samei, E

Purpose: To develop and validate more robust methods for automated lung, spine, and hardware detection in AP/PA chest images. This work is part of a continuing effort to automatically characterize the perceptual image quality of clinical radiographs. [Y. Lin et al. Med. Phys. 39, 7019–7031 (2012)] Methods: Our previous implementation of lung/spine identification was applicable to only one vendor. A more generalized routine was devised based on three primary components: lung boundary detection, fuzzy c-means (FCM) clustering, and a clinically-derived lung pixel probability map. Boundary detection was used to constrain the lung segmentations. FCM clustering produced grayscale- and neighborhood-based pixelmore » classification probabilities which are weighted by the clinically-derived probability maps to generate a final lung segmentation. Lung centerlines were set along the left-right lung midpoints. Spine centerlines were estimated as a weighted average of body contour, lateral lung contour, and intensity-based centerline estimates. Centerline estimation was tested on 900 clinical AP/PA chest radiographs which included inpatient/outpatient, upright/bedside, men/women, and adult/pediatric images from multiple imaging systems. Our previous implementation further did not account for the presence of medical hardware (pacemakers, wires, implants, staples, stents, etc.) potentially biasing image quality analysis. A hardware detection algorithm was developed using a gradient-based thresholding method. The training and testing paradigm used a set of 48 images from which 1920 51×51 pixel{sup 2} ROIs with and 1920 ROIs without hardware were manually selected. Results: Acceptable lung centerlines were generated in 98.7% of radiographs while spine centerlines were acceptable in 99.1% of radiographs. Following threshold optimization, the hardware detection software yielded average true positive and true negative rates of 92.7% and 96.9%, respectively. Conclusion: Updated

The Effect Of Pixel Size On The Detection Rate Of Early Pulmonary Sarcoidosis In Digital Chest Radiographic Systems

NASA Astrophysics Data System (ADS)

MacMahon, Heber; Vyborny, Carl; Powell, Gregory; Doi, Kunio; Metz, Charles E.

1984-08-01

In digital radiography the pixel size used determines the potential spatial resolution of the system. The need for spatial resolution varies depending on the subject matter imaged. In many areas, including the chest, the minimum spatial resolution requirements have not been determined. Sarcoidosis is a disease which frequently causes subtle interstitial infiltrates in the lungs. As the initial step in an investigation designed to determine the minimum pixel size required in digital chest radiographic systems, we have studied 1 mm pixel digitized images on patients with early pulmonary sarcoidosis. The results of this preliminary study suggest that neither mild interstitial pulmonary infiltrates nor other abnormalities such as pneumothoraces may be detected reliably with 1 mm pixel digital images.

Use of chest sonography in acute-care radiology☆

PubMed Central

De Luca, C.; Valentino, M.; Rimondi, M.R.; Branchini, M.; Baleni, M. Casadio; Barozzi, L.

2008-01-01

Diagnosis of acute lung disease is a daily challenge for radiologists working in acute-care areas. It is generally based on the results of chest radiography performed under technically unfavorable conditions. Computed tomography (CT) is undoubtedly more accurate in these cases, but it cannot always be performed on critically ill patients who need continuous care. The use of thoracic ultrasonography (US) has recently been proposed for the study of acute lung disease. It can be carried out rapidly at the bedside and does not require any particularly sophisticated equipment. This report analyzes our experience with chest sonography as a supplement to chest radiography in an Emergency Radiology Unit. We performed chest sonography – as an adjunct to chest radiography – on 168 patients with acute chest pathology. Static and dynamic US signs were analyzed in light of radiographic findings and, when possible, CT. The use of chest US improved the authors' ability to provide confident diagnoses of acute disease of the chest and lungs. PMID:23397048

42 CFR 37.44 - Approval of radiographic facilities that use digital radiography systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... image acquisition, digitization, processing, compression, transmission, display, archiving, and... quality digital chest radiographs by submitting to NIOSH digital radiographic image files of a test object... digital radiographic image files from six or more sample chest radiographs that are of acceptable quality...

42 CFR 37.44 - Approval of radiographic facilities that use digital radiography systems.

Code of Federal Regulations, 2012 CFR

2012-10-01

... image acquisition, digitization, processing, compression, transmission, display, archiving, and... quality digital chest radiographs by submitting to NIOSH digital radiographic image files of a test object... digital radiographic image files from six or more sample chest radiographs that are of acceptable quality...

Repeat rates in digital chest radiography and strategies for improvement.

PubMed

Fintelmann, Florian; Pulli, Benjamin; Abedi-Tari, Faezeh; Trombley, Maureen; Shore, Mary-Theresa; Shepard, Jo-Anne; Rosenthal, Daniel I

2012-05-01

To determine the repeat rate (RR) of chest radiographs acquired with portable computed radiography (CR) and installed direct radiography (DR) and to develop and assess strategies designed to decrease the RR. The RR and reasons for repeated digital chest radiographs were documented over the course of 16 months while a task force of thoracic radiologists, technologist supervisors, technologists, and information technology specialists continued to examine the workflow for underlying causes. Interventions decreasing the RR were designed and implemented. The initial RR of digital chest radiographs was 3.6% (138/3818) for portable CR and 13.3% (476/3575) for installed DR systems. By combining RR measurement with workflow analysis, targets for technical and teaching interventions were identified. The interventions decreased the RR to 1.8% (81/4476) for portable CR and to 8.2% (306/3748) for installed DR. We found the RR of direct digital chest radiography to be significantly higher than that of computed chest radiography. We believe this is due to the ease with which repeat images can be obtained and discarded, and it suggests the need for ongoing surveillance of RR. We were able to demonstrate that strategies to lower the RR, which had been developed in the era of film-based imaging, can be adapted to the digital environment. On the basis of our findings, we encourage radiologists to assess their own departmental RRs for direct digital chest radiography and to consider similar interventions if necessary to achieve acceptable RRs for this modality.

Clinical and Radiologic Predictive Factors of Rib Fractures in Outpatients With Chest Pain.

PubMed

Zhang, Liang; McMahon, Colm J; Shah, Samir; Wu, Jim S; Eisenberg, Ronald L; Kung, Justin W

, rib fractures have a higher association with a history of minor trauma and age ≥40 in the adult population. Radiographic findings associated with rib fractures include pleural effusion. The frontal chest radiograph alone has low sensitivity in detecting rib fractures. The dedicated rib series detected a greater number of rib fractures. Although no patients required hospitalization, those with rib fractures were more likely to receive narcotic analgesia. Copyright © 2018 Elsevier Inc. All rights reserved.

Use of incentive spirometry in portable chest radiography.

PubMed

McEntee, Mark F; Houssein, Nariman; Al-azawi, Dhafir

2014-01-01

The degree of lung inflation seen on a chest radiograph is dependent on the point during the patient's respiratory cycle at which the radiographer exposes the image receptor. Exposing the image receptor at the exact peak of inflation can be difficult because of the limited time available in which to capture the inspiratory pause. An incentive spirometer can indicate the moment of peak inhalation. This study tested whether images taken with and without an incentive spirometer display different levels of image quality. This is a paired, prospective, single-blinded study of 30 patients undergoing portable chest radiography. The radiographs were acquired with and without the use of an incentive spirometer. Visual grading analysis was performed using the 1996 European Guidelines on Quality Criteria for Diagnostic Radiographic Images. The mean patient age was 53 years. Sixty images were acquired, 30 with the use of incentive spirometry and 30 without. The most common indication for portable chest radiography was "postlung lobectomy." Scoring on the radiologist's ability to see the sixth rib, spine, trachea, and cardiac border was not affected significantly by the use of incentive spirometry. Use of an incentive spirometer was associated with significant improvement in ability to see the 10th rib (P ≤ .004), vascular pattern (P ≤ .001), retrocardiac lung (P ≤ .013), and the costophrenic angles (P ≤ .005). This study introduces a technique to improve the quality of portable chest radiographs. The use of incentive spirometry improved inspiratory depth and image quality for portable chest radiographs.

Navicular subluxation as a radiographic finding in Charcot neuroarthropathy.

PubMed

Estess, Allyson; Marquand, Nicole; Charlton, Timothy P; Thordarson, David B

2013-11-01

Treatment of patients with Charcot midfoot destruction is a difficult and increasingly common clinical problem. The pathoanatomical features of Charcot neuropathy have been evaluated in only a few studies. This study evaluated whether medial navicular subluxation (adduction of the navicular on the talus) is a radiographic finding present in patients with Charcot neuroarthropathy. A retrospective review of 143 consecutive patients diagnosed with Charcot arthropathy of the foot from January 2004 to May 2011 was performed. Patients were identified based on a clinical diagnosis code 713.5 during an outpatient clinic visit with 2 surgeons at a single institution. After exclusion criteria were applied, a series of radiographs of 50 feet in 40 patients were compared with radiographs from an age-matched control group. Radiographic data including talonavicular coverage angle and talonavicular uncoverage percentage were collected. The mean talonavicular coverage angle of the Charcot arthropathy group was 1.5 degrees and of the control group 12.1 degrees (P < .05). The talonavicular uncoverage value for the Charcot arthropathy group was 12.2% and for the control group 22.0% (P < .001). Medial navicular subluxation was a radiographic finding that was more commonly present in patients with Charcot arthropathy than in a matched control group. It is theorized that this finding is attributable to an unopposed pull of the posterior tibial tendon on the destabilized navicular. Level IV, retrospective case series.

Adult sail sign: radiographic and computed tomographic features.

PubMed

Lee, Yu-Jin; Han, Daehee; Koh, Young Hwan; Zo, Joo Hee; Kim, Sang-Hyun; Kim, Deog Kyeom; Lee, Jeong Sang; Moon, Hyeon Jong; Kim, Jong Seung; Chun, Eun Ju; Youn, Byung Jae; Lee, Chang Hyun; Kim, Sam Soo

2008-02-01

The sail sign is a well-known radiographic feature of the pediatric chest. This sign can be observed in an adult population as well, but for a different reason. To investigate the sail sign appearing in adult chest radiography. Based on two anecdotal adult cases in which frontal chest radiographs showed the sail sign, we prospectively screened radiographs of 10,238 patients to determine the incidence of the sail sign found in adults in their 40s or older. The cause of the sail sign was assessed using computed tomography (CT). The sail sign was revealed in 10 (seven males, three females; median age 60.6 years) of 10,238 patients. Of these 10 patients with a sail sign on frontal radiographs, eight underwent CT. The frontal radiographs of these 10 patients showed a concave superior margin toward the lung in nine patients, a concave inferior margin in five, and a double-lined inferior margin in three. Lateral radiographs disclosed a focal opacity over the minor fissure in five of six patients, which was either fuzzy (n = 4) or sharp (n = 1) in its upper margin, and was sometimes double lined in the inferior margin (n = 3). CT revealed the anterior mediastinal fat to be the cause of the radiographic sail sign, which stretched laterally from the mediastinum to insinuate into the minor fissure. The incidence of sail sign on adult chest radiographs is about 0.1%. The sign is specific enough to eliminate the need for more sophisticated imaging.

Accurate segmentation of lung fields on chest radiographs using deep convolutional networks

NASA Astrophysics Data System (ADS)

Arbabshirani, Mohammad R.; Dallal, Ahmed H.; Agarwal, Chirag; Patel, Aalpan; Moore, Gregory

2017-02-01

Accurate segmentation of lung fields on chest radiographs is the primary step for computer-aided detection of various conditions such as lung cancer and tuberculosis. The size, shape and texture of lung fields are key parameters for chest X-ray (CXR) based lung disease diagnosis in which the lung field segmentation is a significant primary step. Although many methods have been proposed for this problem, lung field segmentation remains as a challenge. In recent years, deep learning has shown state of the art performance in many visual tasks such as object detection, image classification and semantic image segmentation. In this study, we propose a deep convolutional neural network (CNN) framework for segmentation of lung fields. The algorithm was developed and tested on 167 clinical posterior-anterior (PA) CXR images collected retrospectively from picture archiving and communication system (PACS) of Geisinger Health System. The proposed multi-scale network is composed of five convolutional and two fully connected layers. The framework achieved IOU (intersection over union) of 0.96 on the testing dataset as compared to manual segmentation. The suggested framework outperforms state of the art registration-based segmentation by a significant margin. To our knowledge, this is the first deep learning based study of lung field segmentation on CXR images developed on a heterogeneous clinical dataset. The results suggest that convolutional neural networks could be employed reliably for lung field segmentation.

Chest radiography practice in critically ill patients: a postal survey in the Netherlands

PubMed Central

Graat, Marleen E; Hendrikse, Karin A; Spronk, Peter E; Korevaar, Johanna C; Stoker, Jaap; Schultz, Marcus J

2006-01-01

Background To ascertain current chest radiography practice in intensive care units (ICUs) in the Netherlands. Methods Postal survey: a questionnaire was sent to all ICUs with > 5 beds suitable for mechanical ventilation; pediatric ICUs were excluded. When an ICU performed daily-routine chest radiographs in any group of patients it was considered to be a "daily-routine chest radiography" ICU. Results From the number of ICUs responding, 63% practice a daily-routine strategy, in which chest radiographs are obtained on a daily basis without any specific reason. A daily-routine chest radiography strategy is practiced less frequently in university-affiliated ICUs (50%) as compared to other ICUs (68%), as well as in larger ICUs (> 20 beds, 50%) as compared to smaller ICUs (< 20 beds, 65%) (P > 0.05). Remarkably, physicians that practice a daily-routine strategy consider daily-routine radiographs helpful in guiding daily practice in less than 30% of all performed radiographs. Chest radiographs are considered essential for verification of the position of invasive devices (81%) and for diagnosing pneumothorax, pneumonia or acute respiratory distress syndrome (82%, 74% and 69%, respectively). On demand chest radiographs are obtained after introduction of thoracic drains, central venous lines and endotracheal tubes in 98%, 84% and 75% of responding ICUs, respectively. Chest films are also obtained in case of ventilatory deterioration (49% of responding ICUs), and after cardiopulmonary resuscitation (59%), tracheotomy (58%) and mini-tracheotomy (23%). Conclusion There is notable lack of consensus on chest radiography practice in the Netherlands. This survey suggests that a large number of intensivists may doubt the value of daily-routine chest radiography, but still practice a daily-routine strategy. PMID:16848892

Preliminary report from the World Health Organisation Chest Radiography in Epidemiological Studies project.

PubMed

Mahomed, Nasreen; Fancourt, Nicholas; de Campo, John; de Campo, Margaret; Akano, Aliu; Cherian, Thomas; Cohen, Olivia G; Greenberg, David; Lacey, Stephen; Kohli, Neera; Lederman, Henrique M; Madhi, Shabir A; Manduku, Veronica; McCollum, Eric D; Park, Kate; Ribo-Aristizabal, Jose Luis; Bar-Zeev, Naor; O'Brien, Katherine L; Mulholland, Kim

2017-10-01

Childhood pneumonia is among the leading infectious causes of mortality in children younger than 5 years of age globally. Streptococcus pneumoniae (pneumococcus) is the leading infectious cause of childhood bacterial pneumonia. The diagnosis of childhood pneumonia remains a critical epidemiological task for monitoring vaccine and treatment program effectiveness. The chest radiograph remains the most readily available and common imaging modality to assess childhood pneumonia. In 1997, the World Health Organization Radiology Working Group was established to provide a consensus method for the standardized definition for the interpretation of pediatric frontal chest radiographs, for use in bacterial vaccine efficacy trials in children. The definition was not designed for use in individual patient clinical management because of its emphasis on specificity at the expense of sensitivity. These definitions and endpoint conclusions were published in 2001 and an analysis of observer variation for these conclusions using a reference library of chest radiographs was published in 2005. In response to the technical needs identified through subsequent meetings, the World Health Organization Chest Radiography in Epidemiological Studies (CRES) project was initiated and is designed to be a continuation of the World Health Organization Radiology Working Group. The aims of the World Health Organization CRES project are to clarify the definitions used in the World Health Organization defined standardized interpretation of pediatric chest radiographs in bacterial vaccine impact and pneumonia epidemiological studies, reinforce the focus on reproducible chest radiograph readings, provide training and support with World Health Organization defined standardized interpretation of chest radiographs and develop guidelines and tools for investigators and site staff to assist in obtaining high-quality chest radiographs.

Mediastinal hemorrhage: An evaluation of radiographic manifestations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Woodring, J.H.; Loh, F.K.; Kryscio, R.J.

1984-04-01

Eleven common radiographic signs of mediastinal hemorrhage were evaluated by two observers for the following three patient groups: normal subjects, patients with mediastinal hemorrhage and no arterial injury, and patients with major thoracic arterial injury. Supine chest radiographs were studied in all cases. Four major conclusions can be made based upon these finding. M/C ratio (mediastinal width to chest width), tracheal deviation, left hemothorax, paraspinal line widening, and aorto-pulmonary window opacification do not reliably separate these three groups of patients. The diagnosis of mediastinal hemorrhage may be made if the aortic contour is abnormal or if one of the followingmore » signs is positive: abnormal mediastinal width, apical cap, widening of the right paratracheal stripe, or deviation of the nasogastric tube. Due to interobserver variation, there is good agreement between observers for the following four signs only: transverse mediastinal width, tracheal deviation, nasogastric tube deviation, nasogastric tube deviation, and right paratracheal stripe widening.« less

Characteristic scapular and rib changes on chest radiographs of children with ADA-deficiency SCIDS in the first year of life.

PubMed

Manson, David; Diamond, Lauren; Oudjhane, Kamaldine; Hussain, Faisal Bin; Roifman, Chaim; Grunebaum, Eyal

2013-03-01

We describe radiographic changes in the ribs and scapulae seen in the first 6 months of life in children with ADA (adenosine deaminase) deficiency severe combined immundeficiency syndrome (SCIDS). We suggest that these changes are reversible with appropriate enzyme replacement therapy. The purpose of this study was to describe characteristic rib and scapular radiographic changes in infants with ADA-deficiency SCIDS. This was a retrospective review of chest radiographs of nine children with ADA-deficiency SCIDS performed in the first year of life by two experienced pediatric radiologists. A control cohort of unaffected children was used for comparison. All children with ADA-deficiency SCIDS manifested unusual scapular spurring and anterior rib cupping. None of the control children manifested these changes. Characteristic and reversible scapular and rib changes in the correct clinical setting should suggest an early diagnosis of ADA deficiency, prompting appropriate diagnostic and therapeutic measures.

A computerized scheme of SARS detection in early stage based on chest image of digital radiograph

NASA Astrophysics Data System (ADS)

Zheng, Zhong; Lan, Rihui; Lv, Guozheng

2004-05-01

A computerized scheme for early severe acute respiratory syndrome(SARS) lesion detection in digital chest radiographs is presented in this paper. The total scheme consists of two main parts: the first part is to determine suspect lesions by the theory of locally orderless images(LOI) and their spatial features; the second part is to select real lesions among these suspect ones by their frequent features. The method we used in the second part is firstly developed by Katsuragawa et al with necessary modification. Preliminary results indicate that these features are good criterions to tell early SARS lesions apart from other normal lung structures.

Chest tube stripping in pediatric oncology patients: an experimental study.

PubMed

Oakes, L L; Hinds, P; Rao, B; Bozeman, P; Taylor, B; Stokes, D; Fairclough, D

1993-07-01

Stripping of chest tubes to promote drainage of the thorax of postthoracotomy patients has been routine practice, based on tradition. Recent published findings indicate that significant negative pressures are generated in the tube during stripping that could cause pain, bleeding and possible damage to the patient's lung tissue. To determine whether pediatric oncology patients whose chest tubes were not stripped would differ in frequency of pain, fever or lung complications from patients who underwent routine tube stripping. Data were collected at multiple points during the first 72-hour postoperative period from 16 patients assigned to the stripped or unstripped groups. Pain was measured by the Faces Pain Scale and the Visual Analogue Scale; temperature, by electronic thermometer; and lung complications, by stethoscope and radiographs. Both groups, which were comparable for age, primary diagnosis and prior history of lung problems, received identical supportive nursing and medical care, with the physicians blind to group assignment. The two groups did not differ significantly in frequency of pain, incidence of fever, breath sounds or radiographic findings across measurement points. A strong correlation was found between the pain scores using the two instruments. Patients whose tubes were not stripped did not have an increased risk of infection or lung complications. Study findings indicated that stripping did not increase the frequency of pain. Stripping of chest tubes as a routine postoperative measure is questioned.

Intramammary Findings on CT of the Chest – a Review of Normal Anatomy and Possible Findings

PubMed Central

Gossner, Johannes

2016-01-01

Summary Computed tomography (CT) is a frequently performed examination in women of all ages. In all thoracic CT examinations of the chest at least parts of the breasts are included. Therefore incidental breast pathology may be observed. It has been suggested that one out of 250 women undergoing chest CT will show a malignant incidental breast lesion. Given the high number of performed chest CT examinations, this contributes to a significant number of malignancies. In this review, after a brief discussion of the value of computed tomography in breast imaging, normal and pathologic findings are discussed to create awareness of this potential “black box” on chest CT. PMID:28058068

Variability and accuracy in interpretation of consolidation on chest radiography for diagnosing pneumonia in children under 5 years of age.

PubMed

Williams, Gabrielle J; Macaskill, Petra; Kerr, Marianne; Fitzgerald, Dominic A; Isaacs, David; Codarini, Miriam; McCaskill, Mary; Prelog, Kristina; Craig, Jonathan C

2013-12-01

Consolidation on chest radiography is widely used as the reference standard for defining pneumonia and variability in interpretation is well known but not well explored or explained. Three pediatric sub-specialists (infectious diseases, radiology and respiratory medicine) viewed 3,033 chest radiographs in children aged under 5 years of age who presented to one Emergency Department (ED) with a febrile illness. Radiographs were viewed blind to clinical information about the child and blind to findings of other readers. Each chest radiograph was identified as positive or negative for consolidation. Percentage agreement and kappa scores were calculated for pairs of readers. Prevalence of consolidation and reader sensitivity/specificity was estimated using latent class analysis. Using the majority rule, 456 (15%) chest radiographs were positive for consolidation while the latent class estimate was 17%. The radiologist was most likely (21.3%) and respiratory physician least likely (13.7%) to diagnose consolidation. Overall percentage agreement for pairs of readers was 85-90%. However, chance corrected agreement between the readers was moderate, with kappa scores 0.4-0.6 and did not vary with patient characteristics (age, gender, and presence of chronic illness). Estimated sensitivity ranged from 0.71 to 0.81 across readers, and specificity 0.91 to 0.98. Overall agreement for identification of consolidation on chest radiographs was good, but agreement adjusted for chance was only moderate and did not vary with patient characteristics. Clinicians need to be aware that chest radiography is an imperfect test for diagnosing pneumonia and has considerable variability in its interpretation. © 2013 Wiley Periodicals, Inc.

Conceptus radiation dose and risk from chest screen-film radiography.

PubMed

Damilakis, John; Perisinakis, Kostas; Prassopoulos, Panos; Dimovasili, Evangelia; Varveris, Haralambos; Gourtsoyiannis, Nicholas

2003-02-01

The objectives of the present study were to (a) estimate the conceptus radiation dose and risks for pregnant women undergoing posteroanterior and anteroposterior (AP) chest radiographs, (b) study the conceptus dose as a function of chest thickness of the patient undergoing chest radiograph, and (c) investigate the possibility of a conceptus to receive a dose of more than 10 mGy, the level above which specific measurements of conceptus doses may be necessary. Thermoluminescent dosimeters were used for dose measurements in anthropomorphic phantoms simulating pregnancy at the three trimesters of gestation. The effect of chest thickness on conceptus dose and risk was studied by adding slabs of lucite on the anterior and posterior surface of the phantom chest. The conceptus risk for radiation-induced childhood fatal cancer and hereditary effects was calculated based on appropriate risk factors. The average AP chest dimension (d(a)) was estimated for 51 women of childbearing age from chest CT examinations. The value of d(a) was estimated to be 22.3 cm (17.4-27.2 cm). The calculated maximum conceptus dose was 107 x 10(-3) mGy for AP chest radiographs performed during the third trimester of pregnancy with maternal chest thickness of 27.2 cm. This calculation was based on dose data obtained from measurements in the phantoms and d(a) estimated from the patient group. The corresponding average excess of childhood cancer was 10.7 per million patients. The risk for hereditary effects was 1.1 per million births. Radiation dose for a conceptus increases exponentially as chest thickness increases. The conceptus dose at the third trimester is higher than that of the second and first trimesters. The results of the current study suggest that chest radiographs carried out in women at any time during gestation will result in a negligible increase in risk of radiation-induced harmful effects to the unborn child. After a properly performed maternal chest X-ray, there is no need for

Chest imaging features of patients afflicted with Influenza A (H1N1) in a Malaysian tertiary referral centre

PubMed Central

Bux, SI; Mohd. Ramli, N; Ahmad Sarji, S; Kamarulzaman, A

2010-01-01

This is a retrospective descriptive study of the chest imaging findings of 118 patients with confirmed A(H1N1) in a tertiary referral centre. About 42% of the patients had positive initial chest radiographic (CXR) findings. The common findings were bi-basal air-space opacities and perihilar reticular and alveolar infiltrates. In select cases, high-resolution computed tomography (CT) imaging showed ground-glass change with some widespread reticular changes and atelectasis. PMID:21611071

Pediatric digital chest imaging.

PubMed

Tarver, R D; Cohen, M; Broderick, N J; Conces, D J

1990-01-01

The Philips Computed Radiography system performs well with pediatric portable chest radiographs, handling the throughout of a busy intensive care service 24 hours a day. Images are excellent and routinely provide a conventional (unenhanced) image and an edge-enhanced image. Radiation dose is decreased by the lowered frequency of repeat examinations and the ability of the plates to respond to a much lower dose and still provide an adequate image. The high quality and uniform density of serial PCR portable radiographs greatly enhances diagnostic content of the films. Decreased resolution has not been a problem clinically. Image manipulation and electronic transfer to remote viewing stations appear to be helpful and are currently being evaluated further. The PCR system provides a marked improvement in pediatric portable chest radiology.

The Development of Expertise in Radiology: In Chest Radiograph Interpretation, "Expert" Search Pattern May Predate "Expert" Levels of Diagnostic Accuracy for Pneumothorax Identification.

PubMed

Kelly, Brendan S; Rainford, Louise A; Darcy, Sarah P; Kavanagh, Eoin C; Toomey, Rachel J

2016-07-01

Purpose To investigate the development of chest radiograph interpretation skill through medical training by measuring both diagnostic accuracy and eye movements during visual search. Materials and Methods An institutional exemption from full ethical review was granted for the study. Five consultant radiologists were deemed the reference expert group, and four radiology registrars, five senior house officers (SHOs), and six interns formed four clinician groups. Participants were shown 30 chest radiographs, 14 of which had a pneumothorax, and were asked to give their level of confidence as to whether a pneumothorax was present. Receiver operating characteristic (ROC) curve analysis was carried out on diagnostic decisions. Eye movements were recorded with a Tobii TX300 (Tobii Technology, Stockholm, Sweden) eye tracker. Four eye-tracking metrics were analyzed. Variables were compared to identify any differences between groups. All data were compared by using the Friedman nonparametric method. Results The average area under the ROC curve for the groups increased with experience (0.947 for consultants, 0.792 for registrars, 0.693 for SHOs, and 0.659 for interns; P = .009). A significant difference in diagnostic accuracy was found between consultants and registrars (P = .046). All four eye-tracking metrics decreased with experience, and there were significant differences between registrars and SHOs. Total reading time decreased with experience; it was significantly lower for registrars compared with SHOs (P = .046) and for SHOs compared with interns (P = .025). Conclusion Chest radiograph interpretation skill increased with experience, both in terms of diagnostic accuracy and visual search. The observed level of experience at which there was a significant difference was higher for diagnostic accuracy than for eye-tracking metrics. (©) RSNA, 2016 Online supplemental material is available for this article.

Left Ventricular Dilatation Assessed on the Lateral Chest Radiograph: The Classic Hoffman and Rigler Sign Falls Short in a Modern-Day Population.

PubMed

Spaziano, Marco; Marquis-Gravel, Guillaume; Ramsay, Isabelle; Romanelli, Giovanni; Marchand, Émilie; Tournoux, François

2016-03-01

The classic Hoffman and Rigler (H&R) sign, originally described in 1965, suggests that left ventricular (LV) dilatation is present if the left ventricle extends more than 18 mm posterior to the inferior vena cava at a level 2 cm above their crossing on a lateral chest radiograph. This sign is still widely used by radiologists but has not been well evaluated against modern methods of noninvasive assessment. This study investigated the sensitivity and specificity of the H&R sign in a modern population. A sample of 145 patients with LV dilatation based on current echocardiographic criteria was matched for age and sex with 145 patients without LV dilatation. Patients were required to have undergone a lateral chest radiograph in the 3 months before or after undergoing echocardiography; the H&R sign and the cardiothoracic index were assessed on the radiograph independently by 2 blinded physicians. Using the threshold value of 18 mm, sensitivity, specificity, and positive and negative likelihood ratios of the H&R sign were 54.9%, 59.2%, 1.34, and 0.76, respectively (area under the curve [AUC], 0.58). In comparison, the cardiothoracic index provided better prediction of LV dilatation (sensitivity, 87.9%; specificity, 47.5%; AUC, 0.72). The H&R sign is a poor marker of LV enlargement when compared with echocardiography and should not be used as a radiologic index of LV enlargement. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Pattern-histogram-based temporal change detection using personal chest radiographs

NASA Astrophysics Data System (ADS)

Ugurlu, Yucel; Obi, Takashi; Hasegawa, Akira; Yamaguchi, Masahiro; Ohyama, Nagaaki

1999-05-01

An accurate and reliable detection of temporal changes from a pair of images has considerable interest in the medical science. Traditional registration and subtraction techniques can be applied to extract temporal differences when,the object is rigid or corresponding points are obvious. However, in radiological imaging, loss of the depth information, the elasticity of object, the absence of clearly defined landmarks and three-dimensional positioning differences constraint the performance of conventional registration techniques. In this paper, we propose a new method in order to detect interval changes accurately without using an image registration technique. The method is based on construction of so-called pattern histogram and comparison procedure. The pattern histogram is a graphic representation of the frequency counts of all allowable patterns in the multi-dimensional pattern vector space. K-means algorithm is employed to partition pattern vector space successively. Any differences in the pattern histograms imply that different patterns are involved in the scenes. In our experiment, a pair of chest radiographs of pneumoconiosis is employed and the changing histogram bins are visualized on both of the images. We found that the method can be used as an alternative way of temporal change detection, particularly when the precise image registration is not available.

The “dirty chest”—correlations between chest radiography, multislice CT and tobacco burden

PubMed Central

Kirchner, J; Goltz, J P; Lorenz, F; Obermann, A; Kirchner, E M; Kickuth, R

2012-01-01

Objectives Cigarette smoking-induced airway disease commonly results in an overall increase of non-specific lung markings on chest radiography. This has been described as “dirty chest”. As the morphological substrate of this condition is similar to the anthracosilicosis of coal workers, we hypothesised that it is possible to quantify the radiological changes using the International Labour Organization (ILO) classification of pneumoconiosis. The aims of this study were to evaluate whether there is a correlation between the extent of cigarette smoking and increased lung markings on chest radiography and to correlate the chest radiographic scores with findings on CT studies. Methods In a prospective analysis a cohort of 85 smokers was examined. The cigarette consumption was evaluated in pack years (defined as 20 cigarettes per day over 1 year). Film reading was performed by two board-certified radiologists. Chest radiographs were evaluated for the presence of thickening of bronchial walls, the presence of linear or nodular opacities, and emphysema. To correlate the smoking habits with the increase of overall lung markings in chest radiography, the ILO profusion score was converted to numbers ranging from zero to nine. Chest radiographs were rated according to the complete set of standard films of the revised ILO classification. Results 63/85 (74%) of the smokers showed an increase in overall lung markings on chest radiography; 32 (37%) had an ILO profusion score of <1/1, 29 (34%) had an ILO profusion score of <2/2 and 2 (2%) had an ILO score of ≥2/2. There was a significant positive linear correlation between the increase of overall lung markings on chest radiography and the cigarette consumption quantified as pack years (r=0.68). The majority of the heavy smokers (>40 pack years) showed emphysema; there was no significant difference between the prevalence of emphysema as diagnosed by CT (62%) or chest radiography (71%) (p<0.05).The most common findings in CT

Fusion of local and global detection systems to detect tuberculosis in chest radiographs.

PubMed

Hogeweg, Laurens; Mol, Christian; de Jong, Pim A; Dawson, Rodney; Ayles, Helen; van Ginneken, Bramin

2010-01-01

Automatic detection of tuberculosis (TB) on chest radiographs is a difficult problem because of the diverse presentation of the disease. A combination of detection systems for abnormalities and normal anatomy is used to improve detection performance. A textural abnormality detection system operating at the pixel level is combined with a clavicle detection system to suppress false positive responses. The output of a shape abnormality detection system operating at the image level is combined in a next step to further improve performance by reducing false negatives. Strategies for combining systems based on serial and parallel configurations were evaluated using the minimum, maximum, product, and mean probability combination rules. The performance of TB detection increased, as measured using the area under the ROC curve, from 0.67 for the textural abnormality detection system alone to 0.86 when the three systems were combined. The best result was achieved using the sum and product rule in a parallel combination of outputs.

Correlation between radiographic findings of osteoarthritis and arthroscopic findings of articular cartilage degeneration within the patellofemoral joint.

PubMed

Kijowski, Richard; Blankenbaker, Donna; Stanton, Paul; Fine, Jason; De Smet, Arthur

2006-12-01

To correlate radiographic findings of osteoarthritis on axial knee radiographs with arthroscopic findings of articular cartilage degeneration within the patellofemoral joint in patients with chronic knee pain. The study group consisted of 104 patients with osteoarthritis of the patellofemoral joint and 30 patients of similar age with no osteoarthritis of the patellofemoral joint. All patients in the study group had an axial radiograph of the knee performed prior to arthroscopic knee surgery. At the time of arthroscopy, each articular surface of the patellofemoral joint was graded using the Noyes classification system. Two radiologists retrospectively reviewed the knee radiographs to determine the presence of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts. The sensitivity and specificity of the various radiographic features of osteoarthritis for the detection of articular cartilage degeneration within the patellofemoral joint were determined. The sensitivity of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts for the detection of articular cartilage degeneration within the patellofemoral joint was 73%, 37%, 4%, and 0% respectively. The specificity of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts for the detection of articular cartilage degeneration within the patellofemoral joint was 67%, 90%, 100%, and 100% respectively. Marginal osteophytes were the most sensitive radiographic feature for the detection of articular cartilage degeneration within the patellofemoral joint. Joint-space narrowing, subchondral sclerosis, and subchondral cysts were insensitive radiographic features of osteoarthritis, and rarely occurred in the absence of associated osteophyte formation.

Preoperative thoracic radiographic findings in dogs presenting for gastric dilatation-volvulus (2000-2010): 101 cases.

PubMed

Green, Jaime L; Cimino Brown, Dorothy; Agnello, Kimberly A

2012-10-01

To identify the incidence of clinically significant findings on preoperative thoracic radiographs in dogs with gastric dilatation-volvulus (GDV) and to determine if those findings are associated with survival. Retrospective study from 2000 to 2010. Urban university small animal teaching hospital. One hundred and one dogs diagnosed with GDV that had thoracic radiographs obtained preoperatively, and medical records available with the following information available: signalment, time of presentation, respiratory status, plasma lactate, presence of cardiac arrhythmias, reason for thoracic radiographs, radiographic findings, and outcome. None. Findings on preoperative thoracic radiographs included small vena cava (40%), esophageal dilation (39%), microcardia (34%), aspiration pneumonia (14%), cardiomegaly (5%), pulmonary nodule (4%), pulmonary edema (2%), sternal lymphadenopathy (1%), and pulmonary bullae (1%). Eighty-four percent of dogs (85 out of 101) survived to discharge. Dogs without cardiomegaly on presenting thoracic radiographs had a 10.2 greater odds of surviving to discharge. The most common findings on preoperative thoracic radiographs include esophageal dilation, microcardia, and a small vena cava while the incidence of pulmonary nodules was low. A negative association between survival and presence of cardiomegaly on preoperative thoracic radiographs in dogs with GDV supports the need to obtain these images for prognostic information in spite of the emergency surgical nature of the GDV. The main limitations of this study include the possibilities of type I and type II errors, the retrospective nature of the study, and the lack of well-defined criteria for obtaining thoracic radiographs. © Veterinary Emergency and Critical Care Society 2012.

Unsupervised segmentation of lung fields in chest radiographs using multiresolution fractal feature vector and deformable models.

PubMed

Lee, Wen-Li; Chang, Koyin; Hsieh, Kai-Sheng

2016-09-01

Segmenting lung fields in a chest radiograph is essential for automatically analyzing an image. We present an unsupervised method based on multiresolution fractal feature vector. The feature vector characterizes the lung field region effectively. A fuzzy c-means clustering algorithm is then applied to obtain a satisfactory initial contour. The final contour is obtained by deformable models. The results show the feasibility and high performance of the proposed method. Furthermore, based on the segmentation of lung fields, the cardiothoracic ratio (CTR) can be measured. The CTR is a simple index for evaluating cardiac hypertrophy. After identifying a suspicious symptom based on the estimated CTR, a physician can suggest that the patient undergoes additional extensive tests before a treatment plan is finalized.

Chest X-ray and chest CT findings in patients diagnosed with pulmonary tuberculosis following solid organ transplantation: a systematic review.

PubMed

Giacomelli, Irai Luis; Schuhmacher Neto, Roberto; Marchiori, Edson; Pereira, Marisa; Hochhegger, Bruno

2018-04-01

The objective of this systematic review was to select articles including chest X-ray or chest CT findings in patients who developed pulmonary tuberculosis following solid organ transplantation (lung, kidney, or liver). The following search terms were used: "tuberculosis"; "transplants"; "transplantation"; "mycobacterium"; and "lung". The databases used in this review were PubMed and the Brazilian Biblioteca Virtual em Saúde (Virtual Health Library). We selected articles in English, Portuguese, or Spanish, regardless of the year of publication, that met the selection criteria in their title, abstract, or body of text. Articles with no data on chest CT or chest X-ray findings were excluded, as were those not related to solid organ transplantation or pulmonary tuberculosis. We selected 29 articles involving a collective total of 219 patients. The largest samples were in studies conducted in Brazil and South Korea (78 and 35 patients, respectively). The imaging findings were subdivided into five common patterns. The imaging findings varied depending on the transplanted organ in these patients. In liver and lung transplant recipients, the most common pattern was the classic one for pulmonary tuberculosis (cavitation and "tree-in-bud" nodules), which is similar to the findings for pulmonary tuberculosis in the general population. The proportion of cases showing a miliary pattern and lymph node enlargement, which is most similar to the pattern seen in patients coinfected with tuberculosis and HIV, was highest among the kidney transplant recipients. Further studies evaluating clinical data, such as immunosuppression regimens, are needed in order to improve understanding of the distribution of these imaging patterns in this population.

The clinical value of daily routine chest radiographs in a mixed medical-surgical intensive care unit is low.

PubMed

Graat, Marleen E; Choi, Goda; Wolthuis, Esther K; Korevaar, Johanna C; Spronk, Peter E; Stoker, Jaap; Vroom, Margreeth B; Schultz, Marcus J

2006-02-01

The clinical value of daily routine chest radiographs (CXRs) in critically ill patients is unknown. We conducted this study to evaluate how frequently unexpected predefined major abnormalities are identified with daily routine CXRs, and how often these findings lead to a change in care for intensive care unit (ICU) patients. This was a prospective observational study conducted in a 28-bed, mixed medical-surgical ICU of a university hospital. Over a 5-month period, 2,457 daily routine CXRs were done in 754 consecutive ICU patients. The majority of these CXRs did not reveal any new predefined major finding. In only 5.8% of daily routine CXRs (14.3% of patients) was one or more new and unexpected abnormality encountered, including large atelectases (24 times in 20 patients), large infiltrates (23 in 22), severe pulmonary congestion (29 in 25), severe pleural effusion (13 in 13), pneumothorax/pneumomediastinum (14 in 13), and malposition of the orotracheal tube (32 in 26). Fewer than half of the CXRs with a new and unexpected finding were ultimately clinically relevant; in only 2.2% of all daily routine CXRs (6.4% of patients) did these radiologic abnormalities result in a change to therapy. Subgroup analysis revealed no differences between medical and surgical patients with regard to the incidence of new and unexpected findings on daily routine CXRs and the effect of new and unexpected CXR findings on daily care. In the ICU, daily routine CXRs seldom reveal unexpected, clinically relevant abnormalities, and they rarely prompt action. We propose that this diagnostic examination be abandoned in ICU patients.

Radiographic Findings in Revision Anterior Cruciate Ligament Reconstructions from the MARS Cohort

PubMed Central

2013-01-01

The Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) group was developed to investigate revision ACL reconstruction outcomes. An important part of this is obtaining and reviewing radiographic studies. The goal for this radiographic analysis is to establish radiographic findings for a large revision ACL cohort to allow comparison with future studies. The study was designed as a cohort study. Various established radiographic parameters were measured by three readers. These included sagittal and coronal femoral and tibial tunnel position, joint space narrowing, and leg alignment. Inter- and intraobserver comparisons were performed. Femoral sagittal position demonstrated 42% were more than 40% anterior to the posterior cortex. On the sagittal tibia tunnel position, 49% demonstrated some impingement on full-extension lateral radiographs. Limb alignment averaged 43% medial to the medial edge of the tibial plateau. On the Rosenberg view (45-degree flexion view), the minimum joint space in the medial compartment averaged 106% of the opposite knee, but it ranged down to a minimum of 4.6%. Lateral compartment narrowing at its minimum on the Rosenberg view averaged 91.2% of the opposite knee, but it ranged down to a minimum of 0.0%. On the coronal view, verticality as measured by the angle from the center of the tibial tunnel aperture to the center of the femoral tunnel aperture measured 15.8 degree ± 6.9% from vertical. This study represents the radiographic findings in the largest revision ACL reconstruction series ever assembled. Findings were generally consistent with those previously demonstrated in the literature. PMID:23404491

A parameterized logarithmic image processing method with Laplacian of Gaussian filtering for lung nodule enhancement in chest radiographs.

PubMed

Chen, Sheng; Yao, Liping; Chen, Bao

2016-11-01

The enhancement of lung nodules in chest radiographs (CXRs) plays an important role in the manual as well as computer-aided detection (CADe) lung cancer. In this paper, we proposed a parameterized logarithmic image processing (PLIP) method combined with the Laplacian of a Gaussian (LoG) filter to enhance lung nodules in CXRs. We first applied several LoG filters with varying parameters to an original CXR to enhance the nodule-like structures as well as the edges in the image. We then applied the PLIP model, which can enhance lung nodule images with high contrast and was beneficial in extracting effective features for nodule detection in the CADe scheme. Our method combined the advantages of both the PLIP algorithm and the LoG algorithm, which can enhance lung nodules in chest radiographs with high contrast. To test our nodule enhancement method, we tested a CADe scheme, with a relatively high performance in nodule detection, using a publically available database containing 140 nodules in 140 CXRs enhanced through our nodule enhancement method. The CADe scheme attained a sensitivity of 81 and 70 % with an average of 5.0 frame rate (FP) and 2.0 FP, respectively, in a leave-one-out cross-validation test. By contrast, the CADe scheme based on the original image recorded a sensitivity of 77 and 63 % at 5.0 FP and 2.0 FP, respectively. We introduced the measurement of enhancement by entropy evaluation to objectively assess our method. Experimental results show that the proposed method obtains an effective enhancement of lung nodules in CXRs for both radiologists and CADe schemes.

Radiographic findings of femoroacetabular impingement in National Football League Combine athletes undergoing radiographs for previous hip or groin pain.

PubMed

Nepple, Jeffrey J; Brophy, Robert H; Matava, Matthew J; Wright, Rick W; Clohisy, John C

2012-10-01

The purpose of this study was to investigate the prevalence of radiographic findings of femoroacetabular impingement (FAI) in elite football players with a history of hip pain or groin injury who underwent radiographs. We performed a retrospective review of athletes undergoing hip radiography at the National Football League Combine from 2007 to 2009. Radiographs were obtained in athletes with a history of hip pain or injury. Anteroposterior pelvis and frog-lateral radiographs were obtained in 123 hips (107 players) that met our inclusion criteria. Radiographic indicators of cam-type FAI (alpha angle, head-neck offset ratio) and pincer-type FAI (acetabular retroversion, center-edge angle, acetabular inclination) were recorded. Findings were correlated with clinical factors (previous groin/hip pain, position, race, and body mass index). The most common previous injuries included groin strain (n = 57) and sports hernia/abdominal strain (n = 21). Markers of cam- and/or pincer-type FAI were present in 94.3% of hips (116 of 123). Radiographic evidence of combined cam- and pincer-type FAI was the most common (61.8%, 76 hips), whereas isolated cam-type FAI (9.8%, 12 hips) and pincer-type FAI (22.8%, 28 hips) were less common. The most common deformities included acetabular retroversion (71.5%) and an abnormal alpha angle (61.8%). A body mass index greater than 35 was associated with the presence of global overcoverage (46.2% v 17.3%, P = .025). Radiographic indicators of FAI are very common among athletes evaluated at the National Football League Scouting Combine subjected to radiographic examination for the clinical suspicion of hip disease. Elite football athletes with significant or recurrent pain about the hip should be evaluated clinically and radiographically for FAI, because pain from FAI may be falsely attributed to or may be present in addition to other disorders. Level IV, therapeutic case series. Copyright © 2012 Arthroscopy Association of North America

[The value of the x-ray findings in the follow-up of the adult respiratory distress syndrome. A retrospective analysis].

PubMed

Konrad, H; Schild, H; Weilemann, L S; Lorenz, J

1992-09-01

Serial chest x-rays of 23 ARDS patients, taken in an 24 hour interval, were retrospectively analysed. Radiographic patterns of ARDS were divided into five stages and were related to corresponding parameters of respiratory status. Characteristic findings on chest x-ray films occurred after a short latency period following the clinical onset of ARDS. There was a close relationship between the time of maximum radiographic changes and maximum loss of lung function. The progression through successive radiologic stages was in many cases accompanied by a significant deterioration of functional parameters. Distinction between survivors and non-survivors was achieved while considering maximum radiographic abnormalities. The results suggest significance of serial chest x-rays in diagnosis and course estimation of ARDS.

Reader characteristics linked to detection of pulmonary nodules on radiographs: ROC vs. JAFROC analyses of performance

NASA Astrophysics Data System (ADS)

Kohli, Akshay; Robinson, John W.; Ryan, John; McEntee, Mark F.; Brennan, Patrick C.

2011-03-01

The purpose of this study is to explore whether reader characteristics are linked to heightened levels of diagnostic performance in chest radiology using receiver operating characteristic (ROC) and jackknife free response ROC (JAFROC) methodologies. A set of 40 postero-anterior chest radiographs was developed, of which 20 were abnormal containing one or more simulated nodules, of varying subtlety. Images were independently reviewed by 12 boardcertified radiologists including six chest specialists. The observer performance was measured in terms of ROC and JAFROC scores. For the ROC analysis, readers were asked to rate their degree of suspicion for the presence of nodules by using a confidence rating scale (1-6). JAFROC analysis required the readers to locate and rate as many suspicious areas as they wished using the same scale and resultant data were used to generate Az and FOM scores for ROC and JAFROC analyses respectively. Using Pearson methods, scores of performance were correlated with 7 reader characteristics recorded using a questionnaire. JAFROC analysis showed that improved reader performance was significantly (p<=0.05) linked with chest specialty (p<0.03), hours per week reading chest radiographs (p<0.03) and chest readings per year (p<0.04). ROC analyses demonstrated only one significant relationship, hours per week reading chest radiographs (p<0.02).The results of this study have shown that radiologist's performance in the detection of pulmonary nodules on radiographs is significantly linked to chest specialty, hours reading per week and number of radiographs read per year. Also, JAFROC is a more powerful predictor of performance as compared to ROC.

Recurrent Pneumocystis Pneumonia with Uncommon Radiographic Presentation.

PubMed

Dixit, Ayushi; Shariff, Rayhan; Gandham, Sherleen; Bhavsar, Ravi; Mantis, Jazila; Vapnyar, Victoria

2018-01-29

Pneumocystis carinii pneumonia (PCP) is a common opportunistic infection of the pulmonary parenchyma seen in the immunocompromised host. The clinical presentation and radiographic findings are varied, with the latter ranging from normal to bilateral ground-glass opacities with cyst formation. We present a case of a 46-year-old woman with a history of human immunodeficiency virus (HIV) with multiple treated prior episodes of PCP, who was found to have an impressive presentation on high-resolution chest computed tomography (HRCT).

Validation of the international labour office digitized standard images for recognition and classification of radiographs of pneumoconiosis.

PubMed

Halldin, Cara N; Petsonk, Edward L; Laney, A Scott

2014-03-01

Chest radiographs are recommended for prevention and detection of pneumoconiosis. In 2011, the International Labour Office (ILO) released a revision of the International Classification of Radiographs of Pneumoconioses that included a digitized standard images set. The present study compared results of classifications of digital chest images performed using the new ILO 2011 digitized standard images to classification approaches used in the past. Underground coal miners (N = 172) were examined using both digital and film-screen radiography (FSR) on the same day. Seven National Institute for Occupational Safety and Health-certified B Readers independently classified all 172 digital radiographs, once using the ILO 2011 digitized standard images (DRILO2011-D) and once using digitized standard images used in the previous research (DRRES). The same seven B Readers classified all the miners' chest films using the ILO film-based standards. Agreement between classifications of FSR and digital radiography was identical, using a standard image set (either DRILO2011-D or DRRES). The overall weighted κ value was 0.58. Some specific differences in the results were seen and noted. However, intrareader variability in this study was similar to the published values and did not appear to be affected by the use of the new ILO 2011 digitized standard images. These findings validate the use of the ILO digitized standard images for classification of small pneumoconiotic opacities. When digital chest radiographs are obtained and displayed appropriately, results of pneumoconiosis classifications using the 2011 ILO digitized standards are comparable to film-based ILO classifications and to classifications using earlier research standards. Published by Elsevier Inc.

Routine use of chest radiographs in the post-operative management of pectus bar removal: necessity or futility.

PubMed

Poola, Ashwini Suresh; Rentea, Rebecca M; Weaver, Katrina L; St Peter, Shawn David

2017-05-01

While there is literature on techniques for pectus bar removal, there are limited reports on post-operative management. This can include obtaining a postoperative chest radiograph (CXR) despite the minimal risk of associated intra-thoracic complications. This is a review of our experience with bar removal and lack of routine post-operative CXR. A single institution retrospective chart review was performed from 2000 to 2015. Patients who underwent a pectus bar removal procedure were included. We assessed operative timing of bar placement and removal, procedure length, intra-operative and post-operative complications and post-operative CXR findings, specifically the rate of pneumothoraces. 450 patients were identified in this study. Median duration of bar placement prior to removal was 35 months (interquartile range 30 and 36 months). Sixtey-four patients obtained a post-operative CXR. Of these, only one (58%) film revealed a pneumothorax; this was not drained. A CXR was not obtained in 386 (86%) patients with no immediate or delayed complications from this practice. Median follow-up time for all patients was 11 months (interquartile range 7.5-17 months). The risk for a clinically relevant pneumothorax is minimal following bar removal. This suggests that not obtaining routine imaging following bar removal may be a safe practice.

The diagnostic accuracy of the mediastinal width on supine anteroposterior chest radiographs with nontraumatic Stanford type A acute aortic dissection.

PubMed

Funakoshi, Hiraku; Mizobe, Michiko; Homma, Yosuke; Nakashima, Yoshiyuki; Takahashi, Jin; Shiga, Takashi

2018-03-01

Nontraumatic Stanford type A acute aortic dissection is a life-threatening condition; thus, the ability to make a precise diagnosis of nontraumatic Stanford type A acute aortic dissection is essential for the emergency physician. Several reports have shown that the mediastinal widening on a chest radiograph is useful for the diagnosis of nontraumatic Stanford type A acute aortic dissection; however, the exact cutoff value of the mediastinal width on plain radiographs is rarely defined. A single-center retrospective case-control study was conducted between October 1, 2013, and March 31, 2015. We evaluated the maximal mediastinal width of the anteroposterior chest X-ray at the level of the aortic knob in the supine position between patient groups with and without nontraumatic Stanford type A acute aortic dissection. We enrolled 72 patients (36 patients with nontraumatic Stanford type A acute aortic dissection and 36 patients without nontraumatic Stanford type A acute aortic dissection). The median mediastinal width of patients with nontraumatic Stanford type A acute aortic dissection was significantly larger than that of patients without nontraumatic Stanford type A acute aortic dissection (100.7 mm vs 77.7 mm, P  < .01). The optimal cutoff level was 87 mm (sensitivity, 81%; specificity, 89%). Using multivariable logistic regression, the odds ratio of a mediastinal width of >87 mm for a diagnosis nontraumatic Stanford type A acute aortic dissection was 57.1 (95% confidence interval, 11.2-290.2). A mediastinal width of >87 mm showed high sensitivity in the diagnosis of probable nontraumatic Stanford type A acute aortic dissection.

Comparing posteroanterior with lateral and anteroposterior chest radiography in the initial detection of parapneumonic effusions.

PubMed

Moffett, Bryan K; Panchabhai, Tanmay S; Nakamatsu, Raul; Arnold, Forest W; Peyrani, Paula; Wiemken, Timothy; Guardiola, Juan; Ramirez, Julio A

2016-12-01

It is unclear whether anteroposterior (AP) or posteroanterior with lateral (PA/Lat) chest radiographs are superior in the early detection of clinically relevant parapneumonic effusions (CR-PPEs). The objective of this study was to identify which technique is preferred for detection of PPEs using chest computed tomography (CCT) as a reference standard. A secondary analysis of a pneumonia database was conducted to identify patients who received a CCT within 24 hours of presentation and also received AP or PA/Lat chest radiographs within 24 hours of CCT. Sensitivity and specificity were then calculated by comparing the radiographic diagnosis of PPEs of both types of radiographs compared with CCT by using the existing attending radiologist interpretation. Clinical relevance of effusions was determined by CCT effusion measurement of >2.5 cm or presence of loculation. There was a statistically significant difference between the sensitivity of AP (67.3%) and PA/Lat (83.9%) chest radiography for the initial detection of CR-PPE. Of 16 CR-PPEs initially missed by AP radiography, 7 either required drainage initially or developed empyema within 30 days, whereas no complicated PPE or empyema was found in those missed by PA/Lat radiography. PA/Lat chest radiography should be the initial imaging of choice in pneumonia patients for detection of PPEs because it appears to be statistically superior to AP chest radiography. Published by Elsevier Inc.

Esophageal Lichen Planus: Clinical and Radiographic Findings in Eight Patients.

PubMed

Rauschecker, Andreas M; Levine, Marc S; Whitson, Matthew J; Tondon, Rashmi; Rubesin, Stephen E; Furth, Emma E; Metz, David C

2017-01-01

The purpose of this study is to present the clinical and radiographic findings of esophageal lichen planus. A search of computerized medical records identified 15 patients with pathologic findings of esophageal lichen planus on endoscopic biopsy specimens. Three other patients had presumed esophageal lichen planus, although no biopsy specimens were obtained. Twelve of these 18 patients (67%) had double-contrast esophagography performed at our institution; for eight of the 12 patients (67%), the studies revealed abnormalities in the esophagus. These eight patients constituted our study group. The barium esophagrams and medical records of these eight patients were reviewed to determine the clinical, radiographic, and endoscopic findings of esophageal lichen planus as well as the treatment and patient outcome. All eight patients were women (median age, 66.5 years), and all eight presented with dysphagia (mean duration, 3.2 years). Four patients had previous lichen planus that involved the skin (n = 1), the oral cavity (n = 2), or both (n = 1), and one patient later had lichen planus that involved the vagina. Five patients had a small-caliber esophagus with diffuse esophageal narrowing. The remaining three patients had segmental strictures in the cervical (n = 1), upper thoracic (n = 1), and distal thoracic (n = 1) esophagus. Esophageal lichen planus typically occurs in older women with longstanding dysphagia and often develops in the absence of extraesophageal disease. Barium esophagrams may reveal a small-caliber esophagus or, less commonly, segmental esophageal strictures. Greater awareness of the radiographic findings of esophageal lichen planus hopefully will lead to earlier diagnosis and better management of this condition.

Optical compensation device for chest film radiography

NASA Astrophysics Data System (ADS)

Gould, Robert G.; Hasegawa, Bruce H.; DeForest, Sherman E.; Schmidt, Gregory W.; Hier, Richard G.

1990-07-01

Although chest radiography is the most commonly performed radiographic examination and one of the most valuable and cost-effective studies in medicine it suffers from relatively high error rates in both missing pathology and false positive interpretations. Detectability of lung nodules and other structures in underpenetrated regions of the chest film can be improved by both exposure and optical compensation but current compensation systems require major capital cost or a significant change in normal clinical practice. A new optical compensation system called the " Intelligent X-Ray Illuminator" (IXI) automatically and virtually instantaneously generates a patient-specific optical unsharp mask that is projected directly on a radiograph. When a radiograph is placed on the IXI which looks much like a conventional viewbox it acquires a low-resolution electronic image of this film from which the film transmission is derived. The transmission information is inverted and blurred in an image processor to form an unsharp mask which is fed into a spatial light modulator (SLM) placed between a light source and the radiograph. The SLM tailors the viewbox luminance by decreasing illumination to underexposed (i. e. transmissive) areas of the radiograph presenting the observer with an optically unsharp-masked image. The IXI uses the original radiograph and will allow it to be viewed on demand with conventional (uniform illumination. Potentially the IXI could introduce the known beneficial aspects of optical unsharp masking into radiology at low capital

Effect of data compression on diagnostic accuracy in digital hand and chest radiography

NASA Astrophysics Data System (ADS)

Sayre, James W.; Aberle, Denise R.; Boechat, Maria I.; Hall, Theodore R.; Huang, H. K.; Ho, Bruce K. T.; Kashfian, Payam; Rahbar, Guita

1992-05-01

Image compression is essential to handle a large volume of digital images including CT, MR, CR, and digitized films in a digital radiology operation. The full-frame bit allocation using the cosine transform technique developed during the last few years has been proven to be an excellent irreversible image compression method. This paper describes the effect of using the hardware compression module on diagnostic accuracy in hand radiographs with subperiosteal resorption and chest radiographs with interstitial disease. Receiver operating characteristic analysis using 71 hand radiographs and 52 chest radiographs with five observers each demonstrates that there is no statistical significant difference in diagnostic accuracy between the original films and the compressed images with a compression ratio as high as 20:1.

Clavicle Chest Cage Angle Difference: Is It a Radiographic and Clinical Predictor of Postoperative Shoulder Imbalance in Lenke I Adolescent Idiopathic Scoliosis?

PubMed

Han, Xiao; Liu, Zhen; Qiu, Yong; Sha, Shifu; Yan, Huang; Jin, Mengran; Zhu, Zezhang

2016-09-01

A retrospective study. To evaluate the effect of preoperative clavicle chest cage angle difference (CCAD) on postoperative radiographic shoulder imbalance, cosmetic shoulder balance, patient's satisfaction, and surgeon's fulfillment in Lenke I adolescent idiopathic scoliosis (AIS). CCAD is a novel predictor of postoperative radiographic shoulder imbalance in AIS. However, radiographic shoulder balance does not always correspond to cosmetic shoulder balance. Forty-four Lenke I AIS patients treated with posterior spinal fusion with a minimum 2-year follow-up were analyzed. Shoulder height difference (SHD) and CCAD were measured on anteroposterior standing radiographs. The inner shoulder height (SHi) and the outer shoulder height (SHo) were measured using the patients' photographs. The patients' satisfaction and the surgeons' fulfillment were evaluated using a questionnaire. A receiver operative characteristic curve analysis was performed to explore the threshold values of preoperative CCAD in the prediction of the final follow-up radiographic shoulder imbalance, patients' satisfaction, and surgeons' fulfillment. At the final follow-up, the preoperative CCAD was significantly greater in patients with unbalanced shoulders (SHD ≥1 cm). For cosmetic shoulder balance at the final follow-up, there was no significant difference in preoperative CCAD between Group 1i (SHi ≥1 cm, n = 14) and Group 2i (SHi <1 cm, n = 30), and the preoperative CCAD was also similar between Group 1o (SHo ≥1 cm, n = 17) and Group 2o (SHo <1 cm, n = 27). For patients' satisfaction and surgeons' fulfillment, the preoperative CCAD was significantly greater in patients with unsatisfied outcomes. The threshold value of preoperative CCAD to predict the final follow-up radiographic shoulder imbalance, patients' satisfaction, and surgeons' fulfillment was 5.5°. CCAD is a good radiographic predictor for postoperative radiographic shoulder imbalance in Lenke I AIS

Detection of incidental cardiac findings in noncardiac chest computed tomography

PubMed Central

Secchi, Francesco; Di Leo, Giovanni; Zanardo, Moreno; Alì, Marco; Cannaò, Paola Maria; Sardanelli, Francesco

2017-01-01

Abstract The aim of the study was to estimate the rate of incidental cardiac findings (ICF) in patients undergoing noncardiac chest CT. An experienced radiologist retrospectively reviewed 237 consecutive patients (147 males and 90 females with median age of 69 years) undergoing a noncardiac chest CT. ICF at targeted review were compared to those mentioned in original reports (χ2 test). At review, ≥1 ICF was detected in 124/237 patients (52%), for a total of 229 ICF, 158 of them (69%) not originally mentioned. Valvular calcifications were unmentioned in 23/23 (100%) patients, main pulmonary artery dilation in 21/22 (96%), coronary calcifications in 69/86 (80%), right or left atrial dilation in 7/11 (64%), aortic atherosclerosis in 29/62 (47%), and ascending aorta dilatation in 8/18 (44%). All 6 pericardial effusions were originally mentioned. No association with sex (P ≥ .189); positive correlation with age (P < .001). Half of patients undergoing noncardiac chest CT presented ≥1 ICF, independently from sex but increasing with age. Moreover, 69% of detectable ICFs were not originally mentioned. PMID:28723768

Detection of incidental cardiac findings in noncardiac chest computed tomography.

PubMed

Secchi, Francesco; Di Leo, Giovanni; Zanardo, Moreno; Alì, Marco; Cannaò, Paola Maria; Sardanelli, Francesco

2017-07-01

The aim of the study was to estimate the rate of incidental cardiac findings (ICF) in patients undergoing noncardiac chest CT.An experienced radiologist retrospectively reviewed 237 consecutive patients (147 males and 90 females with median age of 69 years) undergoing a noncardiac chest CT. ICF at targeted review were compared to those mentioned in original reports (χ test).At review, ≥1 ICF was detected in 124/237 patients (52%), for a total of 229 ICF, 158 of them (69%) not originally mentioned. Valvular calcifications were unmentioned in 23/23 (100%) patients, main pulmonary artery dilation in 21/22 (96%), coronary calcifications in 69/86 (80%), right or left atrial dilation in 7/11 (64%), aortic atherosclerosis in 29/62 (47%), and ascending aorta dilatation in 8/18 (44%). All 6 pericardial effusions were originally mentioned. No association with sex (P ≥ .189); positive correlation with age (P < .001).Half of patients undergoing noncardiac chest CT presented ≥1 ICF, independently from sex but increasing with age. Moreover, 69% of detectable ICFs were not originally mentioned.

Radiographic findings and clinical factors in dogs with surgically confirmed or presumed colonic torsion.

PubMed

Gremillion, Christine L; Savage, Mason; Cohen, Eli B

2018-05-01

Colonic torsion is a life-threatening condition in dogs and radiographic findings for this condition have not been well described. The purpose of this retrospective case series was to describe radiographic findings and clinical signs in a group of dogs with colonic torsion. Inclusion criteria were dogs presenting during the period of 2006 and 2016, and that had abdominal radiography and a surgically confirmed or presumed diagnosis of colonic torsion. For each dog, clinical data were recorded from medical records and imaging findings were recorded from retrieved plain radiographs and positive contrast radiographs in which barium enema was performed. Fourteen dogs met inclusion criteria. Of these, nine dogs had colonic torsion confirmed at surgery, with five dogs having surgical confirmation of colonic congestion or mesenteric torsion. Radiographic findings included segmental distention of the colon (14/14), focal narrowing of the colon (11/14), displacement of cecum (11/14), displacement of descending colon (14/14), and mild to no small intestinal distention (14/14). In cases where barium enema was performed, focal narrowing of the colon and longitudinal striations that course in a helical pattern were identified, termed the "torsion sign." Vomiting was the most common clinical sign observed (12/14), followed by abdominal pain in a small majority of cases (8/14). Severe abdominal pain and hypovolemic shock were uncommon in the patients reported (3/14). Colonic torsion should be considered as a differential diagnosis for dogs with radiographic segmental colonic distention with displacement of the descending colon and cecum. Barium enema is recommended for more definitive diagnosis. © 2018 American College of Veterinary Radiology.

Evaluation of the usefulness of color digital summation radiography in temporally sequential digital radiographs: a phantom study.

PubMed

Ogata, Yuji; Naito, Hiroaki; Tomiyama, Noriyuki; Hamada, Seiki; Kozuka, Takenori; Koyama, Mitsuhiro; Tsubamoto, Mitusko; Murai, Sachiko; Ueguchi, Takashi; Matsumoto, Mitsuhiro; Tamura, Shinichi; Nakamura, Hironobu; Johkoh, Takeshi

2006-04-01

The purpose of this study was to assess the usefulness of color digital summation radiography (CDSR) for detection of nodules on chest radiographs by observers with different levels of experience. A total of 30 radiographs of chest phantoms with abnormalities and 30 normal ones were arranged at random. Set A was conventional radiographs only. Set B consisted of both conventional radiographs and CDSR images, which were colored with magenta. Five chest radiologists and five residents evaluated both image sets on a TFT monitor. The observers were asked to rate each image set using a continuous rating scale. The reading time for each set was also recorded. In set A, the performance of chest radiologists was significantly superior to that of the residents (P < 0.05). However, in set B, there was no significant difference in the performance of the chest radiologists and the residents. In both observer groups, the mean reading time per case in set B was significantly shorter than that in set A (P < 0.01). By using CDSR, the detection capability of observers with little experience improves and is comparable to that of experienced observers. Moreover, the reading time becomes much shorter using CDSR.

Regionally adaptive histogram equalization of the chest.

PubMed

Sherrier, R H; Johnson, G A

1987-01-01

Advances in the area of digital chest radiography have resulted in the acquisition of high-quality images of the human chest. With these advances, there arises a genuine need for image processing algorithms specific to the chest, in order to fully exploit this digital technology. We have implemented the well-known technique of histogram equalization, noting the problems encountered when it is adapted to chest images. These problems have been successfully solved with our regionally adaptive histogram equalization method. With this technique histograms are calculated locally and then modified according to both the mean pixel value of that region as well as certain characteristics of the cumulative distribution function. This process, which has allowed certain regions of the chest radiograph to be enhanced differentially, may also have broader implications for other image processing tasks.

Increasing radiology capacity within the lung cancer pathway: centralised work-based support for trainee chest X-ray reporting radiographers.

PubMed

Woznitza, Nick; Steele, Rebecca; Piper, Keith; Burke, Stephen; Rowe, Susan; Bhowmik, Angshu; Maughn, Sue; Springett, Kate

2018-05-27

Diagnostic capacity and time to diagnosis are frequently identified as a barrier to improving cancer patient outcomes. Maximising the contribution of the medical imaging workforce, including reporting radiographers, is one way to improve service delivery. An efficient and effective centralised model of workplace training support was designed for a cohort of trainee chest X-ray (CXR) reporting radiographers. A comprehensive schedule of tutorials was planned and aligned with the curriculum of a post-graduate certificate in CXR reporting. Trainees were supported via a hub and spoke model (centralised training model), with the majority of education provided by a core group of experienced CXR reporting radiographers. Trainee and departmental feedback on the model was obtained using an online survey. Fourteen trainees were recruited from eight National Health Service Trusts across London. Significant efficiencies of scale were possible with centralised support (48 h) compared to traditional workplace support (348 h). Trainee and manager feedback overall was positive. Trainees and managers both reported good trainee support, translation of learning to practice and increased confidence. Logistics, including trainee travel and release, were identified as areas for improvement. Centralised workplace training support is an effective and efficient method to create sustainable diagnostic capacity and support improvements in the lung cancer pathway. © 2018 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.

42 CFR 37.43 - Approval of radiographic facilities that use film.

Code of Federal Regulations, 2013 CFR

2013-10-01

... roentgenography of the chest. Amer J Roentgenol 117(4):771-776. (b) Each radiographic facility submitting chest... facility addressing radiation exposures, equipment maintenance, and image quality, and must conform to the... individual data, interpretations, and images) consistent with applicable statutes and regulations governing...

42 CFR 37.43 - Approval of radiographic facilities that use film.

Code of Federal Regulations, 2014 CFR

2014-10-01

... roentgenography of the chest. Amer J Roentgenol 117(4):771-776. (b) Each radiographic facility submitting chest... facility addressing radiation exposures, equipment maintenance, and image quality, and must conform to the... individual data, interpretations, and images) consistent with applicable statutes and regulations governing...

Pulmonary Aspergillus chest wall involvement in chronic granulomatous disease: CT and MRI findings.

PubMed

Kawashima, A; Kuhlman, J E; Fishman, E K; Tempany, C M; Magid, D; Lederman, H M; Winkelstein, J A; Zerhouni, E A

1991-01-01

Pulmonary Aspergillus infection in patients with chronic granulomatous disease tends to involve the chest wall and consequently carries a high mortality rate. We report the findings of computed tomography (CT) and magnetic resonance imaging (MRI) in three such cases. One patient underwent both CT and MRI, one, CT only, and one, MRI only. In all three, both CT and MRI demonstrated pulmonary consolidations with direct extension to the adjacent chest wall. In both patients who were examined by CT, scans revealed permeative osteolytic changes of adjacent rib or spine compatible with osteomyelitis. In both patients who were examined by MRI, adjacent chest wall involvement was depicted on T1-weighted images and showed increased signal intensity on T2-weighted images. In one of these patients, the chest wall lesion was well defined on T2-weighted images, an appearance compatible with abscess. Epidural extension was demonstrated on MRI in the other patient, who later developed paraparesis. We suggest that CT and MRI have a complementary role in evaluating chest wall invasion by pulmonary Aspergillus infection in chronic granulomatous disease.

Assessment of low-contrast detectability for compressed digital chest images

NASA Astrophysics Data System (ADS)

Cook, Larry T.; Insana, Michael F.; McFadden, Michael A.; Hall, Timothy J.; Cox, Glendon G.

1994-04-01

The ability of human observers to detect low-contrast targets in screen-film (SF) images, computed radiographic (CR) images, and compressed CR images was measured using contrast detail (CD) analysis. The results of these studies were used to design a two- alternative forced-choice (2AFC) experiment to investigate the detectability of nodules in adult chest radiographs. CD curves for a common screen-film system were compared with CR images compressed up to 125:1. Data from clinical chest exams were used to define a CD region of clinical interest that sufficiently challenged the observer. From that data, simulated lesions were introduced into 100 normal CR chest films, and forced-choice observer performance studies were performed. CR images were compressed using a full-frame discrete cosine transform (FDCT) technique, where the 2D Fourier space was divided into four areas of different quantization depending on the cumulative power spectrum (energy) of each image. The characteristic curve of the CR images was adjusted so that optical densities matched those of the SF system. The CD curves for SF and uncompressed CR systems were statistically equivalent. The slope of the CD curve for each was - 1.0 as predicted by the Rose model. There was a significant degradation in detection found for CR images compressed to 125:1. Furthermore, contrast-detail analysis demonstrated that many pulmonary nodules encountered in clinical practice are significantly above the average observer threshold for detection. We designed a 2AFC observer study using simulated 1-cm lesions introduced into normal CR chest radiographs. Detectability was reduced for all compressed CR radiographs.

Area beam equalization: optimization and performance of an automated prototype system for chest radiography.

PubMed

Xu, Tong; Shikhaliev, Polad M; Berenji, Gholam R; Tehranzadeh, Jamshid; Saremi, Farhood; Molloi, Sabee

2004-04-01

To evaluate the feasibility and performance of an x-ray beam equalization system for chest radiography using anthropomorphic phantoms. Area beam equalization involves the process of the initial unequalized image acquisition, attenuator thickness calculation, mask generation using a 16 x 16 piston array, and final equalized image acquisition. Chest radiographs of three different anthropomorphic phantoms were acquired with no beam equalization and equalization levels of 4.8, 11.3, and 21. Six radiologists evaluated the images by scoring them from 1-5 using 13 different criteria. The dose was calculated using the known attenuator material thickness and the mAs of the x-ray tube. The visibility of anatomic structures in the under-penetrated regions of the chest radiographs was shown to be significantly (P < .01) improved after beam equalization. An equalization level of 4.8 provided most of the improvements with moderate increases in patient dose and tube loading. Higher levels of beam equalization did not show much improvement in the visibility of anatomic structures in the under-penetrated regions. A moderate level of x-ray beam equalization in chest radiography is superior to both conventional radiographs and radiographs with high levels of beam equalization. X-ray beam equalization can significantly improve the visibility of anatomic structures in the under-penetrated regions while maintaining good image quality in the lung region.

[Radiation exposure of children in pediatric radiology. Part 5: organ doses in chest radiography].

PubMed

Seidenbusch, M C; Schneider, K

2009-05-01

Reconstruction of organ doses of selected organs and tissues from radiographic settings and exposure data collected during chest X-ray examinations of children of various age groups performed in Dr. von Hauner's Kinderspital (children's hospital of the University of Munich, DvHK) between 1976 and 2007. The dosimetric data of all X-ray examinations performed since 1976 at DvHK were stored electronically in a database. After 30 years of data collection, the database now includes 305 107 radiological examinations (radiographs and fluoroscopies), especially 119 150 chest radiographs of all age groups. Reconstruction of organ doses in 40 organs and tissues in X-ray examinations of the chest was performed based on the conversion factor concept. The radiation exposure of organs in projection radiography is determined by the exact site of the organs relative to the edges of the X-ray field and the beam direction of X-rays. Optimal collimation in chest radiography can reduce the exposure of organs located at the periphery of the X-ray field, e. g. thyroid gland, stomach and partially the liver, by a factor of 2 to 3, while organs located in the center of the X-ray-field, e. g. thymus, breasts, lungs, esophagus and red bone marrow, are not affected by exact collimation. The high frequency of the roentgen examination of the chest in early age groups increases the collective radiation burden to radiosensitive organs. Therefore, radiation protection of the patient during chest radiographies remains of great importance.

A Retrospective Analysis of Radiographic Jaw Findings in Young Women; Prevalence and Predictors

PubMed Central

El Khateeb, Sara M.; Abu-Hammad, Osama; Fadel, Hani; Dar-Odeh, Najla

2017-01-01

Aims and Objectives: To determine the prevalence and types of jaw pathologic findings as detected in panoramic radiographs of a sample of young women attending a teaching hospital in Al Madinah Al Munawarah, Saudi Arabia, and to determine the most important factors that predict the occurrence of jaw pathologic findings. Materials and Methods: The electronic clinical files of a representative sample of female patients who attended the outpatient dental clinics were retrieved. Patients were aged 18 to 25 years. Types of pathologic radiographic jaw findings and their prevalence were determined through screening of panoramic radiographs. Data were analyzed using the statistical analysis software [SPSS version 21 (IBM Corp.)]. Multiple linear regression was used to explore the significance of some types of dental lesions as predictor variables for the occurrence of jaw pathologic findings. Results: A total of 190 patients (mean age, 22.4 ± 2.46 years) were included in the study. Periapical lesions, retained roots, and alveolar bone loss were detected in 53.6%, 24.8%, and 17.4% of the participants, respectively. Other odontogenic abnormalities such as supernumerary and impacted teeth (6.4% and 33.7%, respectively) were also detected. Patients' age was found to be a good predictor for alveolar bone loss and number of periapical lesions (P ≤ 0.05). Conclusions: A high prevalence of periapical lesions, retained roots, and alveolar bone loss was found among a sample of young female dental attendees, as shown by their panoramic radiographs. Further studies are needed to explore potential risk factors for such a noticeable trend of poor oral health, and the needed strategies to counteract this trend. PMID:28316945

Using Standardized Interpretation of Chest Radiographs to Identify Adults with Bacterial Pneumonia--Guatemala, 2007-2012.

PubMed

Wortham, Jonathan M; Gray, Jennifer; Verani, Jennifer; Contreras, Carmen Lucia; Bernart, Chris; Moscoso, Fabiola; Moir, Juan Carlos; Reyes Marroquin, Emma Lissette; Castellan, Rigoberto; Arvelo, Wences; Lindblade, Kim; McCracken, John P

2015-01-01

Bacterial pneumonia is a leading cause of illness and death worldwide, but quantifying its burden is difficult due to insensitive diagnostics. Although World Health Organization (WHO) protocol standardizes pediatric chest radiograph (CXR) interpretation for epidemiologic studies of bacterial pneumonia, its validity in adults is unknown. Patients (age ≥ 15 years) admitted with respiratory infections to two Guatemalan hospitals between November 2007 and March 2012 had urine and nasopharyngeal/oropharyngeal (NP/OP) swabs collected; blood cultures and CXR were also performed at physician clinical discretion. 'Any bacterial infection' was defined as a positive urine pneumococcal antigen test, isolation of a bacterial pneumonia pathogen from blood culture, or detection of an atypical bacterial pathogen by polymerase chain reaction (PCR) of nasopharyngeal/oropharyngeal (NP/OP) specimens. 'Viral infection' was defined as detection of viral pathogens by PCR of NP/OP specimens. CXRs were interpreted according to the WHO protocol as having 'endpoint consolidation', 'other infiltrate', or 'normal' findings. We examined associations between bacterial and viral infections and endpoint consolidation. Urine antigen and/or blood culture results were available for 721 patients with CXR interpretations; of these, 385 (53%) had endpoint consolidation and 253 (35%) had other infiltrate. Any bacterial infection was detected in 119 (17%) patients, including 106 (89%) pneumococcal infections. Any bacterial infection (Diagnostic Odds Ratio [DOR] = 2.9; 95% confidence Interval (CI): 1.3-7.9) and pneumococcal infection (DOR = 3.4; 95% CI: 1.5-10.0) were associated with 'endpoint consolidation', but not 'other infiltrate' (DOR = 1.7; 95% CI: 0.7-4.9, and 1.7; 95% CI: 0.7-4.9 respectively). Viral infection was not significantly associated with 'endpoint consolidation', 'other infiltrate,' or 'normal' findings. 'Endpoint consolidation' was associated with 'any bacterial infection

Digital tomosynthesis of the chest for lung nodule detection: interim sensitivity results from an ongoing NIH-sponsored trial.

PubMed

James, T Dobbins; McAdams, H Page; Song, Jae-Woo; Li, Christina M; Godfrey, Devon J; DeLong, David M; Paik, Sang-Hyun; Martinez-Jimenez, Santiago

2008-06-01

The authors report interim clinical results from an ongoing NIH-sponsored trial to evaluate digital chest tomosynthesis for improving detectability of small lung nodules. Twenty-one patients undergoing computed tomography (CT) to follow up lung nodules were consented and enrolled to receive an additional digital PA chest radiograph and digital tomosynthesis exam. Tomosynthesis was performed with a commercial CsI/a-Si flat-panel detector and a custom-built tube mover. Seventy-one images were acquired in 11 s, reconstructed with the matrix inversion tomosynthesis algorithm at 5-mm plane spacing, and then averaged (seven planes) to reduce noise and low-contrast artifacts. Total exposure for tomosynthesis imaging was equivalent to that of 11 digital PA radiographs (comparable to a typical screen-film lateral radiograph or two digital lateral radiographs). CT scans (1.25-mm section thickness) were reviewed to confirm presence and location of nodules. Three chest radiologists independently reviewed tomosynthesis images and PA chest radiographs to confirm visualization of nodules identified by CT. Nodules were scored as: definitely visible, uncertain, or not visible. 175 nodules (diameter range 3.5-25.5 mm) were seen by CT and grouped according to size: < 5, 5-10, and > 10 mm. When considering as true positives only nodules that were scored definitely visible, sensitivities for all nodules by tomosynthesis and PA radiography were 70% (+/- 5%) and 22% (+/- 4%), respectively, (p < 0.0001). Digital tomosynthesis showed significantly improved sensitivity of detection of known small lung nodules in all three size groups, when compared to PA chest radiography.

Eye-tracking AFROC study of the influence of experience and training on chest x-ray interpretation

NASA Astrophysics Data System (ADS)

Manning, David; Ethell, Susan C.; Crawford, Trevor

2003-05-01

Four observer groups with different levels of expertise were tested in an investigation into the comparative nature of expert performance. The radiological task was the detection and localization of significant pulmonary nodules in postero-anterior vies of the chest in adults. Three test banks of 40 images were used. The observer groups were 6 experienced radiographers prior to a six month training program in chest image interpretation, the same radiographers after their tr4aining program, and 6 fresher undergraduate radiography students. Eye tracking was carried out on all observers to demonstrate differences in visual activity and nodule detection performance was measured with an AFROC technique. Detection performances of the four groups showed the radiologists and radiographers after training were measurably superior at the task. The eye-tracking parameters saccadic length, number of fixations visual coverage and scrutiny timer per film were measured for all subjects and compared. The missed nodules fixated and not fixated were also determined for the radiologist group. Results have shown distinct stylistic differences in the visual scanning strategies between the experienced and inexperienced observers that we believe can be generalized into a description of characteristics of expert versus non-expert performance. The findings will be used in the educational program of image interpretation for non-radiology practitioners.

European Guidelines for AP/PA chest X-rays: routinely satisfiable in a paediatric radiology division?

PubMed

Tschauner, Sebastian; Marterer, Robert; Gübitz, Michael; Kalmar, Peter I; Talakic, Emina; Weissensteiner, Sabine; Sorantin, Erich

2016-02-01

Accurate collimation helps to reduce unnecessary irradiation and improves radiographic image quality, which is especially important in the radiosensitive paediatric population. For AP/PA chest radiographs in children, a minimal field size (MinFS) from "just above the lung apices" to "T12/L1" with age-dependent tolerance is suggested by the 1996 European Commission (EC) guidelines, which were examined qualitatively and quantitatively at a paediatric radiology division. Five hundred ninety-eight unprocessed chest X-rays (45% boys, 55% girls; mean age 3.9 years, range 0-18 years) were analysed with a self-developed tool. Qualitative standards were assessed based on the EC guidelines, as well as the overexposed field size and needlessly irradiated tissue compared to the MinFS. While qualitative guideline recommendations were satisfied, mean overexposure of +45.1 ± 18.9% (range +10.2% to +107.9%) and tissue overexposure of +33.3 ± 13.3% were found. Only 4% (26/598) of the examined X-rays completely fulfilled the EC guidelines. This study presents a new chest radiography quality control tool which allows assessment of field sizes, distances, overexposures and quality parameters based on the EC guidelines. Utilising this tool, we detected inadequate field sizes, inspiration depths, and patient positioning. Furthermore, some debatable EC guideline aspects were revealed. • European Guidelines on X-ray quality recommend exposed field sizes for common examinations. • The major failing in paediatric radiographic imaging techniques is inappropriate field size. • Optimal handling of radiographic units can reduce radiation exposure to paediatric patients. • Constant quality control helps ensure optimal chest radiographic image acquisition in children.

Clinical utility of wavelet compression for resolution-enhanced chest radiography

NASA Astrophysics Data System (ADS)

Andriole, Katherine P.; Hovanes, Michael E.; Rowberg, Alan H.

2000-05-01

This study evaluates the usefulness of wavelet compression for resolution-enhanced storage phosphor chest radiographs in the detection of subtle interstitial disease, pneumothorax and other abnormalities. A wavelet compression technique, MrSIDTM (LizardTech, Inc., Seattle, WA), is implemented which compresses the images from their original 2,000 by 2,000 (2K) matrix size, and then decompresses the image data for display at optimal resolution by matching the spatial frequency characteristics of image objects using a 4,000- square matrix. The 2K-matrix computed radiography (CR) chest images are magnified to a 4K-matrix using wavelet series expansion. The magnified images are compared with the original uncompressed 2K radiographs and with two-times magnification of the original images. Preliminary results show radiologist preference for MrSIDTM wavelet-based magnification over magnification of original data, and suggest that the compressed/decompressed images may provide an enhancement to the original. Data collection for clinical trials of 100 chest radiographs including subtle interstitial abnormalities and/or subtle pneumothoraces and normal cases, are in progress. Three experienced thoracic radiologists will view images side-by- side on calibrated softcopy workstations under controlled viewing conditions, and rank order preference tests will be performed. This technique combines image compression with image enhancement, and suggests that compressed/decompressed images can actually improve the originals.

Chest CT findings in patients with dysphagia and aspiration: a systematic review

PubMed Central

Scheeren, Betina; Gomes, Erissandra; Alves, Giordano; Marchiori, Edson; Hochhegger, Bruno

2017-01-01

ABSTRACT The objective of this systematic review was to characterize chest CT findings in patients with dysphagia and pulmonary aspiration, identifying the characteristics and the methods used. The studies were selected from among those indexed in the Brazilian Virtual Library of Health, LILACS, Indice Bibliográfico Español de Ciencias de la Salud, Medline, Cochrane Library, SciELO, and PubMed databases. The search was carried out between June and July of 2016. Five articles were included and reviewed, all of them carried out in the last five years, published in English, and coming from different countries. The sample size in the selected studies ranged from 43 to 56 patients, with a predominance of adult and elderly subjects. The tomographic findings in patients with dysphagia-related aspiration were varied, including bronchiectasis, bronchial wall thickening, pulmonary nodules, consolidations, pleural effusion, ground-glass attenuation, atelectasis, septal thickening, fibrosis, and air trapping. Evidence suggests that chest CT findings in patients with aspiration are diverse. In this review, it was not possible to establish a consensus that could characterize a pattern of pulmonary aspiration in patients with dysphagia, further studies of the topic being needed. PMID:28767772

Chest CT findings in patients with dysphagia and aspiration: a systematic review.

PubMed

Scheeren, Betina; Gomes, Erissandra; Alves, Giordano; Marchiori, Edson; Hochhegger, Bruno

2017-01-01

The objective of this systematic review was to characterize chest CT findings in patients with dysphagia and pulmonary aspiration, identifying the characteristics and the methods used. The studies were selected from among those indexed in the Brazilian Virtual Library of Health, LILACS, Indice Bibliográfico Español de Ciencias de la Salud, Medline, Cochrane Library, SciELO, and PubMed databases. The search was carried out between June and July of 2016. Five articles were included and reviewed, all of them carried out in the last five years, published in English, and coming from different countries. The sample size in the selected studies ranged from 43 to 56 patients, with a predominance of adult and elderly subjects. The tomographic findings in patients with dysphagia-related aspiration were varied, including bronchiectasis, bronchial wall thickening, pulmonary nodules, consolidations, pleural effusion, ground-glass attenuation, atelectasis, septal thickening, fibrosis, and air trapping. Evidence suggests that chest CT findings in patients with aspiration are diverse. In this review, it was not possible to establish a consensus that could characterize a pattern of pulmonary aspiration in patients with dysphagia, further studies of the topic being needed.

Radiographic findings after treatment with balloon brachytherapy accelerated partial breast irradiation.

PubMed

Ibrahim, Nafisa B; Anandan, Srividya; Hartman, Audrey L; McSweeney, Michelle; Chun, Jeanette; McKee, Andrea; Yang, Rebecca; Kim, Cathleen

2015-01-01

The use of accelerated partial breast irradiation (APBI) following breast-conserving surgery is rapidly gaining popularity as an alternative to whole-breast irradiation (WBI) in selected patients with early-stage breast cancer. Although data on the long-term effectiveness and safety of APBI accelerated partial breast irradiation are still being gathered, the shorter treatment course and narrowed radiation target of APBI accelerated partial breast irradiation provide an attractive alternative for carefully selected patients. These patients include those with relatively small tumors (≤3 cm), negative or close margins, and negative sentinel lymph nodes. Possible long-term complications include telangiectasia and the development of a palpable mass at the lumpectomy site. Mammographic findings in patients who have undergone APBI accelerated partial breast irradiation are distinct from those in patients who have undergone conventional WBI whole-breast irradiation . The most common post-APBI accelerated partial breast irradiation radiographic findings include formation of seromas at the lumpectomy site, focal parenchymal changes such as increased trabeculation and parenchymal distortion, fat necrosis, and skin changes such as thickening or retraction. Given the continued evolution of breast cancer treatment, it is important that radiologists have a comprehensive understanding of APBI accelerated partial breast irradiation in terms of rationale, patient selection criteria, common postprocedural radiographic findings (and how they differ from post-WBI whole-breast irradiation findings), and advantages and potential complications. RSNA, 2015

Outcomes and radiographic findings of anatomic press-fit radial head arthroplasty.

PubMed

Levy, Jonathan C; Formaini, Nathan T; Kurowicki, Jennifer

2016-05-01

Radial head arthroplasty (RHA) is a popular method of treatment for complex fractures of the radial head. The purpose of this study was to investigate patient outcomes and radiographic findings associated with a single anatomic monopolar press-fit radial head system commonly used for the treatment of radial head fractures. A retrospective review of prospectively collected data was performed for a consecutive series of patients treated with a press-fit anatomically designed RHA between November 2007 and April 2014. The most recent radiographs were evaluated for loosening, stress shielding, and instability. Postoperative motion and outcomes were reported at most recent follow-up. At an average follow-up of 30 months, 6 of the 15 patients (40%) demonstrated radiographic loosening. Six of the 9 patients (67%) without loosening demonstrated stress shielding (average, 6 mm). Functional outcome scores included a mean American Shoulder and Elbow Surgeons score of 70, Mayo Elbow Performance Score of 85, visual analog scale score for pain of 2, visual analog scale score for function of 7, and Single Assessment Numeric Evaluation score of 75. Average flexion-extension arc was 14° to 138°, and average pronation-supination was 75° to 74°. All 6 of the patients with radiographic loosening had undergone RHA with an associated ligamentous injury repair. Satisfaction among patients was high as no patient reported an unsatisfactory outcome. The use of an anatomic, press-fit monopolar RHA in the management of acute complex radial head fractures has yielded excellent clinical outcomes despite high rates of radiographic loosening and stress shielding. Press-fit RHA in the setting of ligamentous injury warrants further investigation because of a high rate of implant loosening observed. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Effects of various presale radiographic findings for yearling Thoroughbreds on 2-year-old racing performance.

PubMed

Preston, Stephanie A; Brown, Murray P; Trumble, Troy N; Chmielewski, Terese L; Zimmel, Dana N; Hernandez, Jorge A

2012-12-01

To determine the effects of various presale radiographic findings for Thoroughbreds sold at a yearling sale on 2-year-old racing performance of those horses. 397 Thoroughbreds. Cohort study. Thoroughbreds offered for sale at a Thoroughbred sales facility in Kentucky were selected via a randomization procedure. Effects of various presale radiographic findings on the following measures of 2-year-old racing performance were determined: having started a race and having placed (ie, finished in first, second, or third place) in a race at least once, total amount of money earned, and amount of money earned per start. Of the 397 horses, 192 (48%) started in at least 1 race during the 2-year-old racing year. The odds of failure to start a race as a 2-year-old were 1.78 times as great for horses with forelimb proximal sesamoid bone osteophytes or enthesophytes as for horses without this finding (95% confidence interval, 1.01 to 3.16). The odds of failure to start a race as a 2-year-old were 2.02 times as great for horses with hind limb proximal phalanx osteochondral fragments as for horses without this finding (95% confidence interval, 0.95 to 4.31), although this result was not significant. Radiographic findings did not have an effect on total amount of money earned, amount of money earned per start, or whether horses placed in a race. Presale radiographic detection of forelimb proximal sesamoid bone osteophytes or enthesophytes or hind limb proximal phalanx osteochondral fragments in yearlings were associated with failure to start a race during the 2-year-old racing year in study horses.

Radiographic evaluation of nasal septal deviation from computed tomography correlates poorly with physical exam findings.

PubMed

Sedaghat, Ahmad R; Kieff, David A; Bergmark, Regan W; Cunnane, Mary E; Busaba, Nicolas Y

2015-03-01

Performance of septoplasty is dependent on objective evidence of nasal septal deviation. Although physical examination including anterior rhinoscopy and endoscopic examination is the gold standard for evaluation of septal deviation, third-party payors' reviews of septoplasty claims are often made on computed tomography (CT) findings. However, the correlation between radiographic evaluation of septal deviation with physical examination findings is unknown. Retrospective, blinded, independent evaluation of septal deviation in 39 consecutive patients from physical examination, including anterior rhinoscopy and endoscopic examination, by an otolaryngologist and radiographic evaluation of sinus CT scan by a neuroradiologist. Four distinct septal locations (nasal valve, cartilaginous, inferior/maxillary crest and osseous septum) were evaluated on a 4-point scale representing (1) 0% to 25%, (2) >25% to 50%, (3) >50% to 75%, and (4) >75% obstruction. Correlation between physical examination and radiographic evaluations was made by Pearson's correlation and quantitative agreement assessed by Krippendorf's alpha. Statistically significant correlation was detected between physical examination including nasal endoscopy and radiographic assessment of septal deviation only at the osseous septum (p = 0.007, r = 0.425) with low quantitative agreement (α = 0.290). No significant correlation was detected at the cartilaginous septum (p = 0.286, r = 0.175), inferior septum (p = 0.117, r = 0.255), or nasal valve (p = 0.174, r = 0.222). Quantitative agreement at the nasal valve suggested a bias in CT to underestimate physical exam findings (α = -0.490). CT is a poor substitute for physical examination, the gold standard, in assessment of septal deviation. Clinical decisions about pursuit of septoplasty or third-party payors' decisions to approve septoplasty should not be made on radiographic evidence. © 2014 ARS-AAOA, LLC.

Association of Hip Radiograph Findings With Pain and Function in Patients Presenting With Low Back Pain.

PubMed

Prather, Heidi; Cheng, Abby; Steger-May, Karen; Maheshwari, Vaibhav; VanDillen, Linda

2018-01-01

Relationships between low back pain (LBP) and the hip in patient cohorts have been described primarily in patients with moderate to severe hip osteoarthritis (OA). Less is known about the links of LBP with hip radiographic findings of hip deformity and minimal OA. To describe the incidence of radiographic hip deformity or hip OA; to describe and compare spine- and hip-related pain and function in the subset of patients who were found to have radiographic hip deformity or hip OA; and to compare patients with evidence of radiographic hip deformity or hip OA to patients without hip radiographic findings. Prospective cohort study with cross-sectional design. Tertiary university. A total of 63 patients (40 women, 23 men) with a mean age of 48.5 ± 14 years with LBP and a minimum of one positive provocative hip test. Hip radiographs were assessed by an independent examiner for hip OA and deformity. Comparisons of hip and lumbar spine pain and function were completed for patients with radiographic findings of hip OA or deformity. Moderate to severe hip OA was found in 12 of 60 patients (20.0%). At least one measurement of femoroacetabular impingement (FAI) was found in 14 of 60 patients (23.3%) to 33 of 45 patients (73.3%). At least one measurement of developmental hip dysplasia (DDH) was found in 7 of 60 patients (11.6%) to 11 of 63 patients (17.4%). Greater pain and reduced hip and lumbar spine function were found in the patients with moderate to severe hip OA. Patients with LBP and FAI were found to have significantly greater extremes of pain and reduced lumbar spine function. Links between the hip and the spine affecting pain and function may be found in patients with LBP and hip deformity and before the onset of radiographic hip OA, and may be associated with hip deformity. Further investigation is needed to better understand these links and their potential impact on prognosis and treatment of LBP. II. Copyright © 2018 American Academy of Physical Medicine and

Correlation between clinical and radiographic findings on the occurrence of furcation involvement in patients with periodontitis.

PubMed

Gusmão, Estela Santos; Picarte, Ana Carolina Lessa Cavalcanti; Ben Barbosa, Maria Bernadete Cavalcanti; Rösing, Cassiano Kuchenbecker; Cimoes, Renata

2014-01-01

Aim : The aim of the present study was to determine the occurrence of furcation involvement in the molars of patients with chronic periodontitis and correlate clinical and radiographic findings. Seventy subjects aged 35-69 years enrolled for treatment at a periodontics specialization program in Pernambuco, Brazil (EAP-SCDP-ABO/PE) participated in the study, comprising a total of 350 molars examined. The clinical diagnosis of furcation involvement was performed with a horizontal Nabers probe, whereas the radiographic examination was performed with periapical and bite-wing radiographs. The images were analyzed with an X-ray viewer at 3× magnification. The Chi-square test was used, with the level of significance set at 5%. A total of 64.5% individuals presented with furcation involvement, 43.1% of whom had degree II furcation. A significant association (P = 0.0060) was found between tooth type and frequency of furcation involvement. The first lower and upper molars were affected in 64.5 and 58.5% of cases, respectively. Adequate agreement (0.65) was observed between the clinical and radiographic findings. Taking into consideration the method employed and the results obtained, it may be concluded that the clinical and radiographic examinations performed are effective tools for diagnosing furcation involvement in teeth affected with periodontal disease.

The x-ray light valve: a potentially low-cost, digital radiographic imaging system--a liquid crystal cell design for chest radiography.

PubMed

Szeto, Timothy C; Webster, Christie Ann; Koprinarov, Ivaylo; Rowlands, J A

2008-03-01

Digital x-ray radiographic systems are desirable as they offer high quality images which can be processed, transferred, and stored without secondary steps. However, current clinical systems are extraordinarily expensive in comparison to film-based systems. Thus, there is a need for an economical digital imaging system for general radiology. The x-ray light valve (XLV) is a novel digital x-ray detector concept with the potential for high image quality and low cost. The XLV is comprised of a photoconductive detector layer and liquid crystal (LC) cell physically coupled in a sandwich structure. Upon exposure to x rays, charge is collected at the surface of the photoconductor, causing a change in the reflective properties of the LC cell. The visible image so formed can subsequently be digitized with an optical scanner. By choosing the properties of the LC cell in combination with the appropriate photoconductor thickness and bias potentials, the XLV can be optimized for various diagnostic imaging tasks. Specifically for chest radiography, we identified three potentially practical reflective cell designs by selecting from those commonly used in LC display technology. The relationship between reflectance and x-ray exposure (i.e., the characteristic curve) was determined for all three cells using a theoretical model. The results indicate that the reflective electrically controlled birefringence (r-ECB) cell is the preferred choice for chest radiography, provided that the characteristic curve can be shifted towards lower exposures. The feasibility of the shift of the characteristic curve is shown experimentally. The experimental results thus demonstrate that an XLV based on the r-ECB cell design exhibits a characteristic curve suitable for chest radiography.

Spectrum of high resolution computed tomography findings in occupational lung disease: experience in a tertiary care institute.

PubMed

Bhawna, Satija; Ojha, U C; Kumar, Sanyal; Gupta, Rajiv; Gothi, Dipti; Pal, R S

2013-01-01

To study the spectrum of high resolution computed tomography (HRCT) findings in occupational lung disease in industrial workers and to assess the utility of International classification of HRCT for occupational and environmental respiratory diseases (ICHOERD). Retrospective analysis of radiological data (radiographs and computed tomography chest scans) gathered over a period of 3 years (January 2010- December 2012) of industrial workers in an organised sector who presented with respiratory complaints. The HRCT findings were evaluated using ICHOERD. There were 5 females and 114 males in the study, with a mean age of 49 years. These workers were exposed to different harmful agents including silica, asbestos, cotton dust, metal dust, iron oxide, organic dust, rubber fumes, plastic fumes, acid fumes, and oil fumes. There were 10 smokers in the study. The radiograph of chest was normal in 53 patients. 46% of these normal patients (21.8% of total) demonstrated positive findings on HRCT. When the radiograph was abnormal, HRCT provided more accurate information and excluded the other diagnosis. The HRCT findings were appropriately described using the ICHOERD. Bronchiectasis was the most common finding (44.5%) with mild central cylindrical bronchiectasis as the most common pattern. Pleural thickening was seen in 41 patients (34.5%). Enlarged hilar or mediastinal lymphnodes were seen in 10 patients (8.4%) with egg-shell calcification in 1 patient exposed to silica. Bronchogenic carcinoma was seen in 1 patient exposed to asbestos. Occupational lung disease is a common work related condition in industrial workers even in the organized sector. Though chest radiograph is the primary diagnostic tool, HRCT is the undisputed Gold Standard for evaluation of these patients. Despite the disadvantage of radiation exposure, low dose CT may serve as an important tool for screening and surveillance. The ICHOERD is a powerful and reliable tool not only for diagnosis, but also for

A 26-year-old man with dyspnea and chest pain.

PubMed

Mittal, Saurabh; Jain, Akanksha; Arava, Sudheer; Hadda, Vijay; Mohan, Anant; Guleria, Randeep; Madan, Karan

2017-01-01

A 26-year-old smoker male presented with a history of sudden onset dyspnea and right-sided chest pain. Chest radiograph revealed large right-sided pneumothorax which was managed with tube thoracostomy. High-resolution computed tomography thorax revealed multiple lung cysts, and for a definite diagnosis, a video-assisted thoracoscopic surgery-guided lung biopsy was performed followed by pleurodesis. This clinicopathologic conference discusses the clinical and radiological differential diagnoses, utility of lung biopsy, and management options for patients with such a clinical presentation.

Chest wall myositis in a patient with acute coronary syndrome

PubMed Central

Hussein, Laila; Al-Rawi, Harith

2014-01-01

We describe a case of a 42-year-old man who presented to the emergency department with severe left-sided chest pain and chest tenderness of 1-day duration. The pain was episodic and was aggravated by any chest wall movement. His initial blood tests and ECG were suggestive of acute coronary syndrome (ACS). However, his pattern of pain, lack of response to opiates, raised creatine kinase and signs of pleurisy on chest radiograph raised a suspicion of an alternative diagnosis. The patient showed a dramatic response in pain relief to non-steroidal anti-inflammatory medication. He was suspected to have chest wall myositis with pleural involvement in the form of pleurodynia. His serology test was positive for coxsackie virus antibodies. We will discuss in this case report the pathognomonic features, diagnosis and treatment of a rare infectious condition known as Bornholm disease. PMID:25312897

Impact of Chest Radiography on Antibiotic Treatment for Children With Suspected Pneumonia.

PubMed

Nelson, Kyle A; Morrow, Christopher; Wingerter, Sarah L; Bachur, Richard G; Neuman, Mark I

2016-08-01

National guidelines discourage routine chest radiographs (CXRs) to confirm suspected pneumonia in children managed as outpatients. However, limiting CXRs may lead to antibiotic overuse. We examined the impact of CXRs and clinical suspicion on antibiotic treatment for children with suspected pneumonia. Children aged 3 months to 18 years undergoing CXR for suspected pneumonia in a pediatric emergency department were prospectively enrolled. Before CXR, physicians indicated their initial plan for antibiotics (yes or no) and clinical suspicion for radiographic pneumonia (<5%, 5-10%, 11-20%, 21-50%, 51-75%, >75%). Subjects had radiographic pneumonia if their CXRs demonstrated definite or possible findings of pneumonia. We compared antibiotic treatment according to pre-CXR antibiotic plan and suspicion for pneumonia and CXR results. Among the 107 children with a plan for antibiotics before CXR, 72% ultimately received antibiotics compared with 19% of the 1503 children without a pre-CXR plan for antibiotics (P < 0.001). Among those patients with a pre-CXR plan for antibiotics, 96% of children with radiographic pneumonia were ultimately treated compared with 54% without radiographic pneumonia (P < 0.001). If antibiotics were not initially planned, 37% with radiographic pneumonia were treated compared with 8% without radiographic pneumonia (P < 0.001). The use of CXR was more likely to influence antibiotic prescribing patterns when the clinical suspicion of pneumonia was low (<20%). Among children with high suspicion for pneumonia, CXRs infrequently altered the initial plan for antibiotics. However, when clinical suspicion for pneumonia was low, the use of CXR may reduce unnecessary antibiotic use.

Contrast-detail curves in chest radiography

NASA Astrophysics Data System (ADS)

Ogden, Kent; Scalzetti, Ernest; Huda, Walter; Saluja, Jasjeet; Lavallee, Robert

2005-04-01

We investigated how size and lesion location affect detection of simulated mass lesions in chest radiography. Simulated lesions were added to the center of 10 cm x 10 cm regions of digital chest radiographs, and used in 4-Alternative Forced-Choice (4-AFC) experiments. We determined the lesion contrast required to achieve a 92% correct detection rate I(92%). The mass size was manipulated to range from 1 to 10 mm, and we investigated lesion detection in the lung apex, hilar region, and in the sub-diaphragmatic region. In these experiments, the observer obtained I(92%) from randomized repeats obtained at each of seven lesion sizes, with the results plotted as I(92%) versus lesion size. In addition we investigated the effect of using the same background in the four 4-AFC experiments (twinned) and random backgrounds from the same anatomical region taken from 20 different radiographs. In all three anatomical regions investigated, the slopes of the contrast detail curve for the random background experiments were negative for lesion sizes less than 2.5, 3.5, and 5.5 mm in the hilar (slope of -0.26), apex (slope of -0.54), and sub-diaphragmatic (slope of -0.53) regions, respectively. For lesion sizes greater than these, the slopes were 0.34, 0.23, and 0.40 in the hilar, apex, and sub-diaphragmatic regions, respectively. The positive slopes for portions of the contrast-detail curves in chest radiography are a result of the anatomical background, and show that larger lesions require more contrast for visualization.

[Optimal beam quality for chest digital radiography].

PubMed

Oda, Nobuhiro; Tabata, Yoshito; Nakano, Tsutomu

2014-11-01

To investigate the optimal beam quality for chest computed radiography (CR), we measured the radiographic contrast and evaluated the image quality of chest CR using various X-ray tube voltages. The contrast between lung and rib or heart increased on CR images obtained by lowering the tube voltage from 140 to 60 kV, but the degree of increase was less. Scattered radiation was reduced on CR images with a lower tube voltage. The Wiener spectrum of CR images with a low tube voltage showed a low value under identical conditions of amount of light stimulated emission. The quality of chest CR images obtained using a lower tube voltage (80 kV and 100 kV) was evaluated as being superior to those obtained with a higher tube voltage (120 kV and 140 kV). Considering the problem of tube loading and exposure in clinical applications, a tube voltage of 90 to 100 kV (0.1 mm copper filter backed by 0.5 mm aluminum) is recommended for chest CR.

Lower esophageal mucosal ring: correlation of referred symptoms with radiographic findings using a marshmallow bolus.

PubMed

Smith, D F; Ott, D J; Gelfand, D W; Chen, M Y

1998-11-01

The purpose of this investigation was to determine the prevalence of lower esophageal mucosal rings and to correlate the relationship between these mucosal rings and the presence and anatomic level of symptoms evoked using a marshmallow bolus. Our prospective study included 130 patients who underwent barium examination of the esophagus. All patients completed a questionnaire regarding the anatomic location of their symptoms of dysphagia. In addition to a multiphasic examination of the esophagus, all patients also underwent fluoroscopic observation and videotaping while swallowing a marshmallow bolus; any symptoms that were provoked were recorded. Lower esophageal mucosal rings were shown in 26 (20%) of the 130 patients. The diameter of the rings was 9-12 mm in six patients, 13-20 mm in 18 patients, and larger than 20 mm in two patients. In 16 (62%) of the 26 patients, a marshmallow bolus became impacted at the ring; the impaction caused dysphagia in 12 (75%) of the 16 patients. In these 12 patients, dysphagia was referred to the neck in seven, the sternal angle in two, the mid chest in two, and the lower chest in one patient. None of the 12 patients had a pharyngeal or cervical esophageal abnormality that would account for their symptoms. Because proximal referral of symptoms is common in patients with lower esophageal mucosal rings, a thorough radiographic examination of the entire esophagus and esophagogastric region is required regardless of the level of their swallowing complaints.

A 26-year-old man with dyspnea and chest pain

PubMed Central

Mittal, Saurabh; Jain, Akanksha; Arava, Sudheer; Hadda, Vijay; Mohan, Anant; Guleria, Randeep; Madan, Karan

2017-01-01

A 26-year-old smoker male presented with a history of sudden onset dyspnea and right-sided chest pain. Chest radiograph revealed large right-sided pneumothorax which was managed with tube thoracostomy. High-resolution computed tomography thorax revealed multiple lung cysts, and for a definite diagnosis, a video-assisted thoracoscopic surgery-guided lung biopsy was performed followed by pleurodesis. This clinicopathologic conference discusses the clinical and radiological differential diagnoses, utility of lung biopsy, and management options for patients with such a clinical presentation. PMID:29099006

Chest computed tomography for penetrating thoracic trauma after normal screening chest roentgenogram.

PubMed

Mollberg, Nathan M; Wise, Stephen R; De Hoyos, Alberto L; Lin, Fang-Ju; Merlotti, Gary; Massad, Malek G

2012-06-01

Chest computed tomography (CCT) is a method of screening for intrathoracic injuries in hemodynamically stable patients with penetrating thoracic trauma. The objective of this study was to examine the changes in utilization of CCT over time and evaluate its contribution to guiding therapeutic intervention. A level 1 trauma center registry was queried between 2006 and 2011. Patients undergoing CCT in the emergency department after penetrating thoracic trauma as well as patients undergoing thoracic operations for penetrating thoracic trauma were identified. Patient demographics, operative indications, use of CCT, injuries, and hospital admissions were analyzed. In all, 617 patients had CCTs performed, of whom 61.1% (371 of 617) had a normal screening plain chest radiograph (CXR). In 14.0% (51 of 371) of these cases, the CCT revealed findings not detected on screening CXR. The majority of these injuries were occult pneumothoraces or hemothoraces (84.3%; 43 of 51), of which 27 (62.8%) underwent tube thoracostomy. In only 0.5% (2 of 371), did the results of CCT alone lead to an operative indication: exploration for hemopericardium. The use of CCT in our patients significantly increased overall (28.8% to 71.4%) as well as after a normal screening CXR (23.3% to 74.6%) over the study period. The use of CCT for penetrating thoracic trauma increased 3.5-fold during the study period with a concurrent increase in findings of uncertain clinical significance. Patients with a normal screening CXR should be triaged with 3-hour delayed CXR, serial physical examinations, and focused assessment with sonography for trauma; and CCT should only be used selectively as a diagnostic modality. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Ultrasonographic and radiographic findings in 503 cattle with traumatic reticuloperitonitis.

PubMed

Braun, Ueli; Gerspach, Christian; Warislohner, Sonja; Nuss, Karl; Ohlerth, Stefanie

2018-05-26

This study involved 503 cattle with traumatic reticuloperitonitis (TRP), 494 of which underwent ultrasonographic and 484 radiographic examination of the reticulum. Ultrasonography revealed changes in the reticulum and/or peritoneum suggestive of peritonitis in 403 (83%) cattle, a decrease in the amplitude of reticular contractions in 244 (54%) and reduced or absent reticular motility in 173 (37%). A total of 536 foreign bodies were seen on 465 (96%) radiographs and a magnet was seen on 311 (64%) radiographs. Of the 536 foreign bodies, 300 (56%) were not attached to a magnet and 236 (44%) were attached. Of 300 radiographs showing foreign bodies not attached to a magnet, the foreign body was lying flat on the floor of the reticulum on 98 (18%) radiographs, was at an angle of greater than 30 degrees to the ventral aspect of the reticulum on 54 (10%), had penetrated the dorsal reticular wall on 76 (14%), had perforated the reticulum on 64 (12%) and was completely outside of the reticulum on 8 (1%) radiographs. Ultrasonography provides information about the scale and localisation of inflammatory changes of the peritoneum, and radiography allows the visualisation of ferromagnetic foreign bodies and magnets. Copyright © 2018. Published by Elsevier Ltd.

Evaluation of pulmonary function using breathing chest radiography with a dynamic flat panel detector: primary results in pulmonary diseases.

PubMed

Tanaka, Rie; Sanada, Shigeru; Okazaki, Nobuo; Kobayashi, Takeshi; Fujimura, Masaki; Yasui, Masahide; Matsui, Takeshi; Nakayama, Kazuya; Nanbu, Yuko; Matsui, Osamu

2006-10-01

Dynamic flat panel detectors (FPD) permit acquisition of distortion-free radiographs with a large field of view and high image quality. The present study was performed to evaluate pulmonary function using breathing chest radiography with a dynamic FPD. We report primary results of a clinical study and computer algorithm for quantifying and visualizing relative local pulmonary airflow. Dynamic chest radiographs of 18 subjects (1 emphysema, 2 asthma, 4 interstitial pneumonia, 1 pulmonary nodule, and 10 normal controls) were obtained during respiration using an FPD system. We measured respiratory changes in distance from the lung apex to the diaphragm (DLD) and pixel values in each lung area. Subsequently, the interframe differences (D-frame) and difference values between maximum inspiratory and expiratory phases (D-max) were calculated. D-max in each lung represents relative vital capacity (VC) and regional D-frames represent pulmonary airflow in each local area. D-frames were superimposed on dynamic chest radiographs in the form of color display (fusion images). The results obtained using our methods were compared with findings on computed tomography (CT) images and pulmonary functional test (PFT), which were examined before inclusion in the study. In normal subjects, the D-frames were distributed symmetrically in both lungs throughout all respiratory phases. However, subjects with pulmonary diseases showed D-frame distribution patterns that differed from the normal pattern. In subjects with air trapping, there were some areas with D-frames near zero indicated as colorless areas on fusion images. These areas also corresponded to the areas showing air trapping on computed tomography images. In asthma, obstructive abnormality was indicated by areas continuously showing D-frame near zero in the upper lung. Patients with interstitial pneumonia commonly showed fusion images with an uneven color distribution accompanied by increased D-frames in the area identified as

Measurement of Clavicle Fracture Shortening Using Computed Tomography and Chest Radiography.

PubMed

Omid, Reza; Kidd, Chris; Yi, Anthony; Villacis, Diego; White, Eric

2016-12-01

Nonoperative management of midshaft clavicle fractures has resulted in widely disparate outcomes and there is growing evidence that clavicle shortening poses the risk of unsatisfactory functional outcomes due to shoulder weakness and nonunion. Unfortunately, the literature does not clearly demonstrate the superiority of one particular method for measuring clavicle shortening. The purpose of this study was to compare the accuracy of clavicle shortening measurements based on plain radiographs with those based on computed tomography (CT) reconstructed images of the clavicle. A total of 51 patients with midshaft clavicle fractures who underwent both a chest CT scan and standardized anteroposterior chest radiography on the day of admission were included in this study. Both an orthopedic surgeon and a musculoskeletal radiologist measured clavicle shortening for all included patients. We then determined the accuracy and intraclass correlation coefficients for the imaging modalities. Bland-Altman plots were created to analyze agreement between the modalities and a paired t-test was used to determine any significant difference between measurements. For injured clavicles, radiographic measurements significantly overestimated the clavicular length by a mean of 8.2 mm (standard deviation [SD], ± 10.2; confidence interval [CI], 95%) compared to CT-based measurements ( p < 0.001). The intraclass correlation was 0.96 for both plain radiograph- and CT-based measurements ( p = 0.17). We found that plain radiograph-based measurements of midshaft clavicle shortening are precise, but inaccurate. When clavicle shortening is considered in the decision to pursue operative management, we do not recommend the use of plain radiograph-based measurements.

Measurement of Clavicle Fracture Shortening Using Computed Tomography and Chest Radiography

PubMed Central

Omid, Reza; Kidd, Chris; Villacis, Diego; White, Eric

2016-01-01

Background Nonoperative management of midshaft clavicle fractures has resulted in widely disparate outcomes and there is growing evidence that clavicle shortening poses the risk of unsatisfactory functional outcomes due to shoulder weakness and nonunion. Unfortunately, the literature does not clearly demonstrate the superiority of one particular method for measuring clavicle shortening. The purpose of this study was to compare the accuracy of clavicle shortening measurements based on plain radiographs with those based on computed tomography (CT) reconstructed images of the clavicle. Methods A total of 51 patients with midshaft clavicle fractures who underwent both a chest CT scan and standardized anteroposterior chest radiography on the day of admission were included in this study. Both an orthopedic surgeon and a musculoskeletal radiologist measured clavicle shortening for all included patients. We then determined the accuracy and intraclass correlation coefficients for the imaging modalities. Bland-Altman plots were created to analyze agreement between the modalities and a paired t-test was used to determine any significant difference between measurements. Results For injured clavicles, radiographic measurements significantly overestimated the clavicular length by a mean of 8.2 mm (standard deviation [SD], ± 10.2; confidence interval [CI], 95%) compared to CT-based measurements (p < 0.001). The intraclass correlation was 0.96 for both plain radiograph- and CT-based measurements (p = 0.17). Conclusions We found that plain radiograph-based measurements of midshaft clavicle shortening are precise, but inaccurate. When clavicle shortening is considered in the decision to pursue operative management, we do not recommend the use of plain radiograph-based measurements. PMID:27904717

Chest tomosynthesis: technical principles and clinical update.

PubMed

Dobbins, James T; McAdams, H Page

2009-11-01

Digital tomosynthesis is a radiographic technique that can produce an arbitrary number of section images of a patient from a single pass of the X-ray tube. It utilizes a conventional X-ray tube, a flat-panel detector, a computer-controlled tube mover, and special reconstruction algorithms to produce section images. While it does not have the depth resolution of computed tomography (CT), tomosynthesis provides some of the tomographic benefits of CT but at lower cost and radiation dose than CT. Compared to conventional chest radiography, chest tomosynthesis results in improved visibility of normal structures such as vessels, airway and spine. By reducing visual clutter from overlying normal anatomy, it also enhances detection of small lung nodules. This review article outlines the components of a tomosynthesis system, discusses results regarding improved lung nodule detection from the recent literature, and presents examples of nodule detection from a clinical trial in human subjects. Possible implementation strategies for use in clinical chest imaging are discussed.

High-Throughput Classification of Radiographs Using Deep Convolutional Neural Networks.

PubMed

Rajkomar, Alvin; Lingam, Sneha; Taylor, Andrew G; Blum, Michael; Mongan, John

2017-02-01

The study aimed to determine if computer vision techniques rooted in deep learning can use a small set of radiographs to perform clinically relevant image classification with high fidelity. One thousand eight hundred eighty-five chest radiographs on 909 patients obtained between January 2013 and July 2015 at our institution were retrieved and anonymized. The source images were manually annotated as frontal or lateral and randomly divided into training, validation, and test sets. Training and validation sets were augmented to over 150,000 images using standard image manipulations. We then pre-trained a series of deep convolutional networks based on the open-source GoogLeNet with various transformations of the open-source ImageNet (non-radiology) images. These trained networks were then fine-tuned using the original and augmented radiology images. The model with highest validation accuracy was applied to our institutional test set and a publicly available set. Accuracy was assessed by using the Youden Index to set a binary cutoff for frontal or lateral classification. This retrospective study was IRB approved prior to initiation. A network pre-trained on 1.2 million greyscale ImageNet images and fine-tuned on augmented radiographs was chosen. The binary classification method correctly classified 100 % (95 % CI 99.73-100 %) of both our test set and the publicly available images. Classification was rapid, at 38 images per second. A deep convolutional neural network created using non-radiological images, and an augmented set of radiographs is effective in highly accurate classification of chest radiograph view type and is a feasible, rapid method for high-throughput annotation.

Effect of localizer radiograph on radiation dose associated with automatic exposure control: human cadaver and patient study.

PubMed

Singh, Sarabjeet; Petrovic, Dean; Jamnik, Ethen; Aran, Shima; Pourjabbar, Sarvenaz; Kave, Maggie L; Bradley, Stephen E; Choy, Garry; Kalra, Mannudeep K

2014-01-01

To evaluate the effect of localizing radiograph on computed tomography (CT) radiation dose associated with automatic exposure control with a human cadaver and patient study. Institutional review board approved the study with a waiver of informed consent. Two chest CT image series with fixed tube current and combined longitudinal-angular automatic exposure control (AEC) were acquired in a human cadaver (64-year-old man) after each of the 8 combinations of localizer radiographs (anteroposterior [AP], AP lateral, AP-posteroanterior [PA], lateral AP, lateral PA, PA, PA-AP, and PA lateral). Applied effective milliampere second, volume CT dose index (CTDIvol) and image noise were recorded for all 24-image series. Volume CT dose indexes were also recorded in 20 patients undergoing chest and abdominal CT after PA and PA-lateral radiographs with the use of AEC. Data were analyzed using analysis of variance and linear correlation tests. With AEC, the CTDIvol fluctuates with the number and projection of localizer radiographs (P < 0.0001). Lowest CTDIvol values are seen when 2 orthogonal localizer radiographs are acquired, whereas highest values are seen when single PA or AP-PA projection localizer radiographs are acquired for planning (P < 0.0001). In 20 patients, CT scanning with AEC after acquisition of 2 orthogonal projection localizer radiographs was associated with significant reduction in radiation dose compared to PA projection radiographs alone (P < 0.0001). When scanning with AEC, acquisition of 2 orthogonal localizer radiographs is associated with lower CTDIvol compared to a single localizer radiograph.

ACR Appropriateness Criteria® Routine Chest Radiography.

PubMed

McComb, Barbara L; Chung, Jonathan H; Crabtree, Traves D; Heitkamp, Darel E; Iannettoni, Mark D; Jokerst, Clinton; Saleh, Anthony G; Shah, Rakesh D; Steiner, Robert M; Mohammed, Tan-Lucien H; Ravenel, James G

2016-03-01

Chest radiographs are sometimes taken before surgeries and interventional procedures on hospital admissions and outpatients. This manuscript summarizes the American College of Radiology review of the literature and recommendations on routinely performed chest radiographies in these settings. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Unusual Radiographic Presentation of Pneumocystis Pneumonia in a Patient with AIDS.

PubMed

Block, Brian L; Mehta, Tejas; Ortiz, Gabriel M; Ferris, Sean P; Vu, Thienkhai H; Huang, Laurence; Cattamanchi, Adithya

2017-01-01

Pneumocystis jirovecii pneumonia (PCP) typically presents as an interstitial and alveolar process with ground glass opacities on chest computed tomography (CT). The absence of ground glass opacities on chest CT is thought to have a high negative predictive value for PCP in individuals with AIDS. Here, we report a case of PCP in a man with AIDS who presented to our hospital with subacute shortness of breath and a nonproductive cough. While his chest CT revealed diffuse nodular rather than ground glass opacities, bronchoscopy with bronchoalveolar lavage and transbronchial biopsies confirmed the diagnosis of PCP and did not identify additional pathogens. PCP was not the expected diagnosis based on chest CT, but it otherwise fit well with the patient's clinical and laboratory presentation. In the era of combination antiretroviral therapy, routine prophylaxis for PCP, and increased use of computed tomography, it may be that PCP will increasingly present with nonclassical chest radiographic patterns. Clinicians should be aware of this presentation when selecting diagnostic and management strategies.

[A case of group G Streptococcus sepsis, chest wall abscess, and vertebral osteomyelitis mimicking a primary lung cancer with bone metastasis].

PubMed

Hayashi, Yumeko; Ishii, Yoshiki; Arai, Ryo; Obara, Kazuki; Kamada, Aya; Takizawa, Hidenori; Hase, Isano; Mashio, Kazuki; Yamada, Issei; Takemasa, Akihiro; Sugiyama, Kumiya; Fukushima, Yasutsugu; Fukuda, Takeshi

2007-01-01

A 73-year-old woman who had been followed in our department of gynecology because of ovarian cancer since 2002, was admitted with liver dysfunction and complaining of back pain and light precordial chest pain. The chest radiograph on admission revealed a tumor in her left upper lung field, and chest CT revealed a tumor adjacent to the chest wall and mediastinum. FDG-positron emission tomography (PET) showed abnormal uptake in the tumor and Th6/7, and the subaortic lymph nodes. On the basis of these findings, primary lung cancer with bone metastasis was suspected. She had a high grade fever on admission, and blood cultures were positive for group G streptococcus. The treatment with intravenous penicillin was started. Percutaneous biopsy of the tumor in her left chest showed an abscess wall in the chest wall, but no evidence of malignancy. Transbronchial lung biopsy and CT-guided biopsy also showed no malignant cells. Since the tumor decreased in size and back pain improved gradually by only antibiotic treatment, a diagnosis of sepsis of group G streptococcus, chest wall abscess, and vertebral osteomyelitis was made. She was treated with intravenous penicillin for 4 weeks and oral amoxicillin for another 4 weeks. After 60 days of antibiotic treatment, the tumor vanished.

[Radiographic findings in raptors affected with a mycosis of the respiratory tract].

PubMed

Vorbrüggen, S; Bailey, T; Krautwald-Junghanns, M-E

2013-01-01

Summary of typical radiographic signs in birds of prey with aspergillosis compared to signs previously established in parrots. Evaluation of radiographs of 110 falcons (Falco spp.) with aspergillosis confirmed by endoscopy. Compared to parrots primarily subtle radiographic signs were detected in falcons (especially inhomogeneously increased radiodensities of the airsacs/lungs). Two typical signs for diseased falcons consisted of the poor delineation of the cardiac silhouette and the line-shaped increased radiodensity of the caudal lung border. Radiographic diagnosis of the lung is limited due to the strong flight musculature. The varying results between avian species can be explained by the different radiographic anatomy, husbandry conditions and x-ray technique (digital versus analog). A pet bird-experienced practitioner should be aware of specific radiographic signs in birds of prey suspected of having aspergillosis.

Pre-radiographic MRI findings are associated with onset of knee symptoms: the most study

PubMed Central

Javaid, M. K.; Lynch, J. A.; Tolstykh, I.; Guermazi, A.; Roemer, F.; Aliabadi, P.; McCulloch, C.; Curtis, J.; Felson, D.; Lane, N. E.; Torner, J.; Nevitt, M.

2010-01-01

Summary Objective Magnetic resonance imaging (MRI) has greater sensitivity to detect osteoarthritis (OA) damage than radiographs but it is uncertain which MRI findings in early OA are clinically important. We examined MRI abnormalities detected in knees without radiographic OA and their association with incident knee symptoms. Method Participants from the Multicenter Osteoarthritis Study (MOST) without frequent knee symptoms (FKS) at baseline were eligible if they also lacked radiographic features of OA at baseline. At 15 months, knees that developed FKS were defined as cases while control knees were drawn from those that remained without FKS. Baseline MRIs were scored at each subregion for cartilage lesions (CARTs); osteophytes (OST); bone marrow lesions (BML) and cysts. We compared cases and controls using marginal logistic regression models, adjusting for age, gender, race, body mass index (BMI), previous injury and clinic site. Results 36 case knees and 128 control knees were analyzed. MRI damage was common in both cases and controls. The presence of a severe CART (P = 0.03), BML (P = 0.02) or OST (P = 0.02) in the whole knee joint was more common in cases while subchondral cysts did not differ significantly between cases and controls (P > 0.1). Case status at 15 months was predicted by baseline damage at only two locations; a BML in the lateral patella (P = 0.047) and at the tibial subspinous subregions (P = 0.01). Conclusion In knees without significant symptoms or radiographic features of OA, MRI lesions of OA in only a few specific locations preceded onset of clinical symptoms and suggest that changes in bone play a role in the early development of knee pain. Confirmation of these findings in other prospective studies of knee OA is warranted. PMID:19919856

Correlation of B-Lines on Ultrasonography With Interstitial Lung Disease on Chest Radiography and CT Imaging.

PubMed

Dubinsky, Theodore J; Shah, Hardik; Sonneborn, Rachelle; Hippe, Daniel S

2017-11-01

We prospectively identified B-lines in patients undergoing ultrasonographic (US) examinations following liver transplantation who also had chest radiography (CXR) or chest CT imaging, or both, on the same day to determine if an association between the presence of B-lines from the thorax on US images correlates with the presence of lung abnormalities on CXR. Following institutional review board (IRB) approval, patients who received liver transplants and underwent routine US examinations and chest radiography or CT imaging, or both, on the same day between January 1, 2015 through July 1, 2016 were prospectively identified. Two readers who were blinded to chest films and CT images and reports independently reviewed the US interreader agreement for the presence or absence of B-lines and performed an evaluation for the presence or absence of diffuse parenchymal lung disease (DPLD) on chest films and CT images as well as from clinical evaluation. Receiver operating characteristic (ROC) curves were constructed. There was good agreement between the two readers on the presence of absence of B-lines (kappa = 0.94). The area under the ROC curve for discriminating between positive DPLD and negative DPLD for both readers was 0.79 (95% CI, 0.71-0.87). There is an association between the presence of extensive B-lines to the point of confluence and "dirty shadowing" on US examinations of the chest and associated findings on chest radiographs and CT scans of DPLD. Conversely, isolated B-lines do not always correlate with abnormalities on chest films and in fact sometimes appear to be a normal variant. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Can routine chest radiography be used to diagnose mild COPD? A nested case-control study.

PubMed

den Harder, A M; Snoek, A M; Leiner, T; Suyker, W J; de Heer, L M; Budde, R P J; Lammers, J W J; de Jong, P A; Gondrie, M J A

2017-07-01

To determine whether mild stage chronic obstructive pulmonary disease (COPD) can be detected on chest radiography without substantial overdiagnosis. A retrospective nested case-control study (case:control, 1:1) was performed in 783 patients scheduled for cardiothoracic surgery who underwent both spirometry and a chest radiograph preoperative. Diagnostic accuracy of chest radiography for diagnosing mild COPD was investigated using objective measurements and overall appearance specific for COPD on chest radiography. Inter-observer variability was investigated and variables with a kappa >0.40 as well as baseline characteristics were used to make a diagnostic model which was aimed at achieving a high positive predictive value (PPV). Twenty percent (155/783) had COPD. The PPV of overall appearance specific for COPD alone was low (37-55%). Factors in the diagnostic model were age, type of surgery, gender, distance of the right diaphragm apex to the first rib, retrosternal space, sternodiaphragmatic angle, maximum height right diaphragm (lateral view) and subjective impression of COPD (using both views). The model resulted in a PPV of 100%, negative predictive value (NPV) of 82%, sensitivity of 10% and specificity of 100% with an area under the curve of 0.811. Detection of mild COPD without substantial overdiagnosis was not feasible on chest radiographs in our cohort. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparison of dual and single exposure techniques in dual-energy chest radiography.

PubMed

Ho, J T; Kruger, R A; Sorenson, J A

1989-01-01

Conventional chest radiography is the most effective tool for lung cancer detection and diagnosis; nevertheless, a high percentage of lung cancer tumors are missed because of the overlap of lung nodule image contrast with bone image contrast in a chest radiograph. Two different energy subtraction strategies, dual exposure and single exposure techniques, were studied for decomposing a radiograph into bone-free and soft tissue-free images to address this problem. For comparing the efficiency of these two techniques in lung nodule detection, the performances of the techniques were evaluated on the basis of residual tissue contrast, energy separation, and signal-to-noise ratio. The evaluation was based on both computer simulation and experimental verification. The dual exposure technique was found to be better than the single exposure technique because of its higher signal-to-noise ratio and greater residual tissue contrast. However, x-ray tube loading and patient motion are problems.

Does training improve diagnostic accuracy and inter-rater agreement in applying the Berlin radiographic definition of acute respiratory distress syndrome? A multicenter prospective study.

PubMed

Peng, Jin-Min; Qian, Chuan-Yun; Yu, Xiang-You; Zhao, Ming-Yan; Li, Shu-Sheng; Ma, Xiao-Chun; Kang, Yan; Zhou, Fa-Chun; He, Zhen-Yang; Qin, Tie-He; Yin, Yong-Jie; Jiang, Li; Hu, Zhen-Jie; Sun, Ren-Hua; Lin, Jian-Dong; Li, Tong; Wu, Da-Wei; An, You-Zhong; Ai, Yu-Hang; Zhou, Li-Hua; Cao, Xiang-Yuan; Zhang, Xi-Jing; Sun, Rong-Qing; Chen, Er-Zhen; Du, Bin

2017-01-20

Poor inter-rater reliability in chest radiograph interpretation has been reported in the context of acute respiratory distress syndrome (ARDS), although not for the Berlin definition of ARDS. We sought to examine the effect of training material on the accuracy and consistency of intensivists' chest radiograph interpretations for ARDS diagnosis. We conducted a rater agreement study in which 286 intensivists (residents 41.3%, junior attending physicians 35.3%, and senior attending physician 23.4%) independently reviewed the same 12 chest radiographs developed by the ARDS Definition Task Force ("the panel") before and after training. Radiographic diagnoses by the panel were classified into the consistent (n = 4), equivocal (n = 4), and inconsistent (n = 4) categories and were used as a reference. The 1.5-hour training course attended by all 286 intensivists included introduction of the diagnostic rationale, and a subsequent in-depth discussion to reach consensus for all 12 radiographs. Overall diagnostic accuracy, which was defined as the percentage of chest radiographs that were interpreted correctly, improved but remained poor after training (42.0 ± 14.8% before training vs. 55.3 ± 23.4% after training, p < 0.001). Diagnostic sensitivity and specificity improved after training for all diagnostic categories (p < 0.001), with the exception of specificity for the equivocal category (p = 0.883). Diagnostic accuracy was higher for the consistent category than for the inconsistent and equivocal categories (p < 0.001). Comparisons of pre-training and post-training results revealed that inter-rater agreement was poor and did not improve after training, as assessed by overall agreement (0.450 ± 0.406 vs. 0.461 ± 0.575, p = 0.792), Fleiss's kappa (0.133 ± 0.575 vs. 0.178 ± 0.710, p = 0.405), and intraclass correlation coefficient (ICC; 0.219 vs. 0.276, p = 0.470). The radiographic diagnostic accuracy and

Satisfaction of Search in Chest Radiography 2015.

PubMed

Berbaum, Kevin S; Krupinski, Elizabeth A; Schartz, Kevin M; Caldwell, Robert T; Madsen, Mark T; Hur, Seung; Laroia, Archana T; Thompson, Brad H; Mullan, Brian F; Franken, Edmund A

2015-11-01

Two decades have passed since the publication of laboratory studies of satisfaction of search (SOS) in chest radiography. Those studies were performed using film. The current investigation tests for SOS effects in computed radiography of the chest. Sixty-four chest computed radiographs half demonstrating various "test" abnormalities were read twice by 20 radiologists, once with and once without the addition of a simulated pulmonary nodule. Receiver-operating characteristic detection accuracy and decision thresholds were analyzed to study the effects of adding the nodule on detecting the test abnormalities. Results of previous studies were reanalyzed using similar modern techniques. In the present study, adding nodules did not influence detection accuracy for the other abnormalities (P = .93), but did induce a reluctance to report them (P < .001). Adding nodules did not affect inspection time (P = .58) so the reluctance to report was not associated with reduced search. Reanalysis revealed a similar decision threshold shift that had not been recognized in the early studies of SOS in chest radiography (P < .01) in addition to reduced detection accuracy (P < .01). The nature of SOS in chest radiography has changed, but it is not clear why. SOS may be changing as a function of changes in radiology education and practice. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

Frequency and number of ultrasound lung rockets (B-lines) using a regionally based lung ultrasound examination named vet BLUE (veterinary bedside lung ultrasound exam) in dogs with radiographically normal lung findings.

PubMed

Lisciandro, Gregory R; Fosgate, Geoffrey T; Fulton, Robert M

2014-01-01

Lung ultrasound is superior to lung auscultation and supine chest radiography for many respiratory conditions in human patients. Ultrasound diagnoses are based on easily learned patterns of sonographic findings and artifacts in standardized images. By applying the wet lung (ultrasound lung rockets or B-lines, representing interstitial edema) versus dry lung (A-lines with a glide sign) concept many respiratory conditions can be diagnosed or excluded. The ultrasound probe can be used as a visual stethoscope for the evaluation of human lungs because dry artifacts (A-lines with a glide sign) predominate over wet artifacts (ultrasound lung rockets or B-lines). However, the frequency and number of wet lung ultrasound artifacts in dogs with radiographically normal lungs is unknown. Thus, the primary objective was to determine the baseline frequency and number of ultrasound lung rockets in dogs without clinical signs of respiratory disease and with radiographically normal lung findings using an 8-view novel regionally based lung ultrasound examination called Vet BLUE. Frequency of ultrasound lung rockets were statistically compared based on signalment, body condition score, investigator, and reasons for radiography. Ten left-sided heart failure dogs were similarly enrolled. Overall frequency of ultrasound lung rockets was 11% (95% confidence interval, 6-19%) in dogs without respiratory disease versus 100% (95% confidence interval, 74-100%) in those with left-sided heart failure. The low frequency and number of ultrasound lung rockets observed in dogs without respiratory disease and with radiographically normal lungs suggests that Vet BLUE will be clinically useful for the identification of canine respiratory conditions. © 2014 American College of Veterinary Radiology.

[Radiographic findings in 4 cows with traumatic reticuloperitonitis caused by a nonmagnetic copper wire].

PubMed

Braun, U; Gansohr, B; Flückiger, M

2003-04-01

The goal of this study was to describe the findings in four cows with non-magnetic reticular foreign bodies composed of copper. The cows were referred to our clinic because of reduced appetite and a marked decrease in milk production. Based on the clinical findings, a tentative diagnosis of traumatic reticuloperitonitis was made in all cows. The reticulum of all cows was then examined ultrasonographically and radiographically. In all cows, radiographs of the reticulum showed wire-shaped foreign bodies, ranging from 3 to 7 cm in length, which appeared to have penetrated the reticular wall. Two cows (No. 3, 4) had a magnet in the reticulum close to the foreign body but there was no direct contact between the two. A magnet was administered to cows No. 1 and 2, and radiography of the reticulum was performed for a second time the following day. The magnets were observed in the reticulum; however, they did not contact the foreign bodies. Because all the magnets were correctly placed in the reticulum yet, despite close proximity, did not contact the foreign bodies, the latter were thought to be non-magnetic. Cow No. 1 was slaughtered. Left flank laparoruminotomy was performed in the remaining three cows. In all cows, copper foreign bodies ranging in length from 3.0 to 7.0 cm, were found in the reticulum. They had penetrated the reticular wall and were not attached to magnets. The radiographic findings described in the present study are strongly indicative of a non-magnetic foreign body. Ruminotomy is the treatment of choice but slaughter may also be considered.

Small lung cancers: improved detection by use of bone suppression imaging--comparison with dual-energy subtraction chest radiography.

PubMed

Li, Feng; Engelmann, Roger; Pesce, Lorenzo L; Doi, Kunio; Metz, Charles E; Macmahon, Heber

2011-12-01

To determine whether use of bone suppression (BS) imaging, used together with a standard radiograph, could improve radiologists' performance for detection of small lung cancers compared with use of standard chest radiographs alone and whether BS imaging would provide accuracy equivalent to that of dual-energy subtraction (DES) radiography. Institutional review board approval was obtained. The requirement for informed consent was waived. The study was HIPAA compliant. Standard and DES chest radiographs of 50 patients with 55 confirmed primary nodular cancers (mean diameter, 20 mm) as well as 30 patients without cancers were included in the observer study. A new BS imaging processing system that can suppress the conspicuity of bones was applied to the standard radiographs to create corresponding BS images. Ten observers, including six experienced radiologists and four radiology residents, indicated their confidence levels regarding the presence or absence of a lung cancer for each lung, first by using a standard image, then a BS image, and finally DES soft-tissue and bone images. Receiver operating characteristic (ROC) analysis was used to evaluate observer performance. The average area under the ROC curve (AUC) for all observers was significantly improved from 0.807 to 0.867 with BS imaging and to 0.916 with DES (both P < .001). The average AUC for the six experienced radiologists was significantly improved from 0.846 with standard images to 0.894 with BS images (P < .001) and from 0.894 to 0.945 with DES images (P = .001). Use of BS imaging together with a standard radiograph can improve radiologists' accuracy for detection of small lung cancers on chest radiographs. Further improvements can be achieved by use of DES radiography but with the requirement for special equipment and a potential small increase in radiation dose. © RSNA, 2011.

Standardized Interpretation of Chest Radiographs in Cases of Pediatric Pneumonia From the PERCH Study.

PubMed

Fancourt, Nicholas; Deloria Knoll, Maria; Barger-Kamate, Breanna; de Campo, John; de Campo, Margaret; Diallo, Mahamadou; Ebruke, Bernard E; Feikin, Daniel R; Gleeson, Fergus; Gong, Wenfeng; Hammitt, Laura L; Izadnegahdar, Rasa; Kruatrachue, Anchalee; Madhi, Shabir A; Manduku, Veronica; Matin, Fariha Bushra; Mahomed, Nasreen; Moore, David P; Mwenechanya, Musaku; Nahar, Kamrun; Oluwalana, Claire; Ominde, Micah Silaba; Prosperi, Christine; Sande, Joyce; Suntarattiwong, Piyarat; O'Brien, Katherine L

2017-06-15

Chest radiographs (CXRs) are a valuable diagnostic tool in epidemiologic studies of pneumonia. The World Health Organization (WHO) methodology for the interpretation of pediatric CXRs has not been evaluated beyond its intended application as an endpoint measure for bacterial vaccine trials. The Pneumonia Etiology Research for Child Health (PERCH) study enrolled children aged 1-59 months hospitalized with WHO-defined severe and very severe pneumonia from 7 low- and middle-income countries. An interpretation process categorized each CXR into 1 of 5 conclusions: consolidation, other infiltrate, both consolidation and other infiltrate, normal, or uninterpretable. Two members of a 14-person reading panel, who had undertaken training and standardization in CXR interpretation, interpreted each CXR. Two members of an arbitration panel provided additional independent reviews of CXRs with discordant interpretations at the primary reading, blinded to previous reports. Further discordance was resolved with consensus discussion. A total of 4172 CXRs were obtained from 4232 cases. Observed agreement for detecting consolidation (with or without other infiltrate) between primary readers was 78% (κ = 0.50) and between arbitrators was 84% (κ = 0.61); agreement for primary readers and arbitrators across 5 conclusion categories was 43.5% (κ = 0.25) and 48.5% (κ = 0.32), respectively. Disagreement was most frequent between conclusions of other infiltrate and normal for both the reading panel and the arbitration panel (32% and 30% of discordant CXRs, respectively). Agreement was similar to that of previous evaluations using the WHO methodology for detecting consolidation, but poor for other infiltrates despite attempts at a rigorous standardization process. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Computerized Classification of Pneumoconiosis on Digital Chest Radiography Artificial Neural Network with Three Stages.

PubMed

Okumura, Eiichiro; Kawashita, Ikuo; Ishida, Takayuki

2017-08-01

It is difficult for radiologists to classify pneumoconiosis from category 0 to category 3 on chest radiographs. Therefore, we have developed a computer-aided diagnosis (CAD) system based on a three-stage artificial neural network (ANN) method for classification based on four texture features. The image database consists of 36 chest radiographs classified as category 0 to category 3. Regions of interest (ROIs) with a matrix size of 32 × 32 were selected from chest radiographs. We obtained a gray-level histogram, histogram of gray-level difference, gray-level run-length matrix (GLRLM) feature image, and gray-level co-occurrence matrix (GLCOM) feature image in each ROI. For ROI-based classification, the first ANN was trained with each texture feature. Next, the second ANN was trained with output patterns obtained from the first ANN. Finally, we obtained a case-based classification for distinguishing among four categories with the third ANN method. We determined the performance of the third ANN by receiver operating characteristic (ROC) analysis. The areas under the ROC curve (AUC) of the highest category (severe pneumoconiosis) case and the lowest category (early pneumoconiosis) case were 0.89 ± 0.09 and 0.84 ± 0.12, respectively. The three-stage ANN with four texture features showed the highest performance for classification among the four categories. Our CAD system would be useful for assisting radiologists in classification of pneumoconiosis from category 0 to category 3.

Radiographic findings in cats with intranasal neoplasia or chronic rhinitis: 29 cases (1982-1988).

PubMed

O'Brien, R T; Evans, S M; Wortman, J A; Hendrick, M J

1996-02-01

To compare radiographic findings and determine useful criteria to differentiate between intranasal neoplasia and chronic rhinitis in cats. Retrospective study. Cats with chronic nasal disease caused by neoplasia (n = 18) or by chronic rhinitis (n = 11). Radiographs were reviewed by 3 radiologists, followed by group review. Diagnosis was determined by intranasal biopsy or necropsy, and specimens were reviewed by a pathologist to confirm cause and histologic diagnosis. Lymphosarcoma was the most common (n = 5) of the 6 histopathologic types in the neoplasia group. Cats in the neoplasia and chronic rhinitis groups had a high prevalence of aggressive radiographic lesions. Prevalence of a facial mass in cats with neoplasia (8/18) versus in those with chronic rhinitis (4/11) and of deviation (9/18 vs 6/11, respectively) or lysis (12/18 vs 7/11) of the nasal septum was similar. However, significantly (P = 0.02) more cats with neoplasia than with chronic rhinitis (13/16 vs 3/7, respectively) had unilateral turbinate destruction/lysis. Additionally, unilateral lateral bone erosion and loss of teeth associated with adjacent intranasal disease were more prevalent in cats with neoplasia (7/8 and 5/18, respectively) than in cats with chronic rhinitis (1/3 and 0/11, respectively). Features that may assist in radiographic diagnosis of neoplasia include the appearance of unilateral aggressive lesions, such as lysis of lateral bones, nasal turbinate destruction, and loss of teeth. Bilaterally symmetric lesions are more suggestive of chronic rhinitis than of neoplasia.

Unusual Radiographic Presentation of Pneumocystis Pneumonia in a Patient with AIDS

PubMed Central

Mehta, Tejas; Ortiz, Gabriel M.; Ferris, Sean P.; Vu, Thienkhai H.; Huang, Laurence; Cattamanchi, Adithya

2017-01-01

Pneumocystis jirovecii pneumonia (PCP) typically presents as an interstitial and alveolar process with ground glass opacities on chest computed tomography (CT). The absence of ground glass opacities on chest CT is thought to have a high negative predictive value for PCP in individuals with AIDS. Here, we report a case of PCP in a man with AIDS who presented to our hospital with subacute shortness of breath and a nonproductive cough. While his chest CT revealed diffuse nodular rather than ground glass opacities, bronchoscopy with bronchoalveolar lavage and transbronchial biopsies confirmed the diagnosis of PCP and did not identify additional pathogens. PCP was not the expected diagnosis based on chest CT, but it otherwise fit well with the patient's clinical and laboratory presentation. In the era of combination antiretroviral therapy, routine prophylaxis for PCP, and increased use of computed tomography, it may be that PCP will increasingly present with nonclassical chest radiographic patterns. Clinicians should be aware of this presentation when selecting diagnostic and management strategies. PMID:29362681

Pathological findings in a sample of Mexican pediatric patients. Clinical and radiographic survey.

PubMed

Ledesma-Montes, C; Salcido-García, J F; Hernández-Flores, F; Garcés-Ortíz, M

2012-05-01

The findings of a clinical-radiological review of 467 children attending the Oral Diagnosis Clinic of the Facultad de Odontología, UNAM, Mexico, are presented. All patients were clinically reviewed, clinical history was taken, and an orthopantomogram obtained by last year dentistry students. Patients and radiographs were then reviewed by the panel and all alterations in teeth, soft tissues and bone were recorded. Clinical and/or radiographic alterations were found in 132 (28.26%) children. The main alterations were developmental (75%) and inflammatory/infectious and traumatic (6.06% each). The most common entities were: supernumeraries (30.77%); hypodontia (29.7%); osteosclerotic lesions and microdontia (4.4% each). The data on the frequency of alterations in the pediatric population attending at our institution reinforce the importance of this kind of study in efforts to improve the quality of stomatologic services in the pediatric population.

A method to optimize the processing algorithm of a computed radiography system for chest radiography.

PubMed

Moore, C S; Liney, G P; Beavis, A W; Saunderson, J R

2007-09-01

A test methodology using an anthropomorphic-equivalent chest phantom is described for the optimization of the Agfa computed radiography "MUSICA" processing algorithm for chest radiography. The contrast-to-noise ratio (CNR) in the lung, heart and diaphragm regions of the phantom, and the "system modulation transfer function" (sMTF) in the lung region, were measured using test tools embedded in the phantom. Using these parameters the MUSICA processing algorithm was optimized with respect to low-contrast detectability and spatial resolution. Two optimum "MUSICA parameter sets" were derived respectively for maximizing the CNR and sMTF in each region of the phantom. Further work is required to find the relative importance of low-contrast detectability and spatial resolution in chest images, from which the definitive optimum MUSICA parameter set can then be derived. Prior to this further work, a compromised optimum MUSICA parameter set was applied to a range of clinical images. A group of experienced image evaluators scored these images alongside images produced from the same radiographs using the MUSICA parameter set in clinical use at the time. The compromised optimum MUSICA parameter set was shown to produce measurably better images.

Lung nodule detection by microdose CT versus chest radiography (standard and dual-energy subtracted).

PubMed

Ebner, Lukas; Bütikofer, Yanik; Ott, Daniel; Huber, Adrian; Landau, Julia; Roos, Justus E; Heverhagen, Johannes T; Christe, Andreas

2015-04-01

The purpose of this study was to investigate the feasibility of microdose CT using a comparable dose as for conventional chest radiographs in two planes including dual-energy subtraction for lung nodule assessment. We investigated 65 chest phantoms with 141 lung nodules, using an anthropomorphic chest phantom with artificial lung nodules. Microdose CT parameters were 80 kV and 6 mAs, with pitch of 2.2. Iterative reconstruction algorithms and an integrated circuit detector system (Stellar, Siemens Healthcare) were applied for maximum dose reduction. Maximum intensity projections (MIPs) were reconstructed. Chest radiographs were acquired in two projections with bone suppression. Four blinded radiologists interpreted the images in random order. A soft-tissue CT kernel (I30f) delivered better sensitivities in a pilot study than a hard kernel (I70f), with respective mean (SD) sensitivities of 91.1%±2.2% versus 85.6%±5.6% (p=0.041). Nodule size was measured accurately for all kernels. Mean clustered nodule sensitivity with chest radiography was 45.7%±8.1% (with bone suppression, 46.1%±8%; p=0.94); for microdose CT, nodule sensitivity was 83.6%±9% without MIP (with additional MIP, 92.5%±6%; p<10(-3)). Individual sensitivities of microdose CT for readers 1, 2, 3, and 4 were 84.3%, 90.7%, 68.6%, and 45.0%, respectively. Sensitivities with chest radiography for readers 1, 2, 3, and 4 were 42.9%, 58.6%, 36.4%, and 90.7%, respectively. In the per-phantom analysis, respective sensitivities of microdose CT versus chest radiography were 96.2% and 75% (p<10(-6)). The effective dose for chest radiography including dual-energy subtraction was 0.242 mSv; for microdose CT, the applied dose was 0.1323 mSv. Microdose CT is better than the combination of chest radiography and dual-energy subtraction for the detection of solid nodules between 5 and 12 mm at a lower dose level of 0.13 mSv. Soft-tissue kernels allow better sensitivities. These preliminary results indicate that

Diagnosis of Pediatric Foreign Body Ingestion: Clinical Presentation, Physical Examination, and Radiologic Findings.

PubMed

Sink, Jacquelyn R; Kitsko, Dennis J; Mehta, Deepak K; Georg, Matthew W; Simons, Jeffrey P

2016-04-01

(1) To describe clinical and radiologic findings in patients with esophageal foreign bodies. (2) To examine the sensitivity and specificity of history, physical examination, and radiologic studies in children with suspected foreign body ingestion. A retrospective cohort study was performed evaluating all children who underwent esophagoscopy for suspected foreign body ingestion at our institution from 2006 to 2013. Five hundred forty-three patients were included (54% male). Average age was 4.7 years (SD = 4.1 years). Foreign bodies were identified on esophagoscopy in 497 cases (92%). Ingestion was witnessed in 23% of cases. Most common presenting symptoms were choking/gagging (49%), vomiting (47%), and dysphagia/odynophagia (42%). Most patients with foreign bodies had a normal exam (76%). Most foreign bodies were radiopaque (83%). In 59% of patients with normal chest radiographs, a foreign body was present. Sensitivity and specificity of 1 or more findings on history, physical examination, and imaging were 99% and 0%, 21% and 76%, and 83% and 100%, respectively. Most patients with esophageal foreign bodies are symptomatic. Although many patients will have a normal physical examination, an abnormal exam should increase suspicion for a foreign body. Most esophageal foreign bodies are radiopaque, but a normal chest radiograph cannot rule out a foreign body. © The Author(s) 2015.

Group A beta-haemolytic streptococcal acute chest event in a child with sickle cell anaemia.

PubMed

Suara, R O

2001-06-01

Acute chest syndrome is a major cause of death and hospitalisation in children with sickle cell anaemia. It is often initiated by an infection, particularly pneumonia. Microbial agents previously not associated with acute chest syndrome are becoming increasingly important. Group A beta-haemolytic Streptococcus (GABHS) is thought to be an uncommon cause of pneumonia in children with sickle cell anaemia. We report a 15-year-old African-American girl who presented with an acute chest event characterised by fever, cough, chest pain, shortness of breath, right upper abdominal quadrant pain, jaundice and otitis media. Chest radiograph showed multi-lobar pneumonia with left pleural effusion. Group A beta-haemolytic Streptococcus was isolated from culture of pleural and middle ear fluids. She responded to therapy that included antibiotics, exchange blood transfusion, oxygen, thoracotomy chest tube drainage and decortication. In a child with sickle cell anaemia presenting with fever and an acute chest event, pneumonia should be considered and GABHS recognised as a possible aetiological agent. In addition, a chest X-ray should be obtained and antibiotics against agents causing community-acquired pneumonia instituted.

Post-traumatic diaphragmatic hernias - importance of basic radiographic investigations.

PubMed

Mansoor, E

2013-05-03

This case presentation highlights important principles in the management of post-traumatic diaphragmatic hernia. A suggestive history should prompt early diagnosis even if the patient appears well. The chest radiograph, although not pathognomonic, is extremely useful in the detection of diaphragmatic hernia if accurately interpreted. Herniated bowel is at high risk of strangulation, especially in the presence of a 'ribbon sign'. Delayed operative intervention can prove fatal.

Image quality and radiation dose on digital chest imaging: comparison of amorphous silicon and amorphous selenium flat-panel systems.

PubMed

Bacher, Klaus; Smeets, Peter; Vereecken, Ludo; De Hauwere, An; Duyck, Philippe; De Man, Robert; Verstraete, Koenraad; Thierens, Hubert

2006-09-01

The aim of this study was to compare the image quality and radiation dose in chest imaging using an amorphous silicon flat-panel detector system and an amorphous selenium flat-panel detector system. In addition, the low-contrast performance of both systems with standard and low radiation doses was compared. In two groups of 100 patients each, digital chest radiographs were acquired with either an amorphous silicon or an amorphous selenium flat-panel system. The effective dose of the examination was measured using thermoluminescent dosimeters placed in an anthropomorphic Rando phantom. The image quality of the digital chest radiographs was assessed by five experienced radiologists using the European Guidelines on Quality Criteria for Diagnostic Radiographic Images. In addition, a contrast-detail phantom study was set up to assess the low-contrast performance of both systems at different radiation dose levels. Differences between the two groups were tested for significance using the two-tailed Mann-Whitney test. The amorphous silicon flat-panel system allowed an important and significant reduction in effective dose in comparison with the amorphous selenium flat-panel system (p < 0.0001) for both the posteroanterior and lateral views. In addition, clinical image quality analysis showed that the dose reduction was not detrimental to image quality. Compared with the amorphous selenium flat-panel detector system, the amorphous silicon flat-panel detector system performed significantly better in the low-contrast phantom study, with phantom entrance dose values of up to 135 muGy. Chest radiographs can be acquired with a significantly lower patient radiation dose using an amorphous silicon flat-panel system than using an amorphous selenium flat-panel system, thereby producing images that are equal or even superior in quality to those of the amorphous selenium flat-panel detector system.

Diagnostic accuracy of oblique chest radiograph for occult pneumothorax: comparison with ultrasonography.

PubMed

Matsumoto, Shokei; Sekine, Kazuhiko; Funabiki, Tomohiro; Orita, Tomohiko; Shimizu, Masayuki; Hayashida, Kei; Kazamaki, Taku; Suzuki, Tatsuya; Kishikawa, Masanobu; Yamazaki, Motoyasu; Kitano, Mitsuhide

2016-01-01

An occult pneumothorax is a pneumothorax that is not seen on a supine chest X-ray but is detected by computed tomography scanning. However, critical patients are difficult to transport to the computed tomography suite. We previously reported a method to detect occult pneumothorax using oblique chest radiography (OXR). Several authors have also reported that ultrasonography is an effective technique for detecting occult pneumothorax. The aim of this study was to evaluate the usefulness of OXR in the diagnosis of the occult pneumothorax and to compare OXR with ultrasonography. All consecutive blunt chest trauma patients with clinically suspected pneumothorax on arrival at the emergency department were prospectively included at our tertiary-care center. The patients underwent OXR and ultrasonography, and underwent computed tomography scans as the gold standard. Occult pneumothorax size on computed tomography was classified as minuscule, anterior, or anterolateral. One hundred and fifty-nine patients were enrolled. Of the 70 occult pneumothoraces found in the 318 thoraces, 19 were minuscule, 32 were anterior, and 19 were anterolateral. The sensitivity and specificity of OXR for detecting occult pneumothorax was 61.4 % and 99.2 %, respectively. The sensitivity and specificity of lung ultrasonography was 62.9 % and 98.8 %, respectively. Among 27 occult pneumothoraces that could not be detected by OXR, 16 were minuscule and 21 could be conservatively managed without thoracostomy. OXR appears to be as good method as lung ultrasonography in the detection of large occult pneumothorax. In trauma patients who are difficult to transfer to computed tomography scan, OXR may be effective at detecting occult pneumothorax with a risk of progression.

[Detection of lung nodules. New opportunities in chest radiography].

PubMed

Pötter-Lang, S; Schalekamp, S; Schaefer-Prokop, C; Uffmann, M

2014-05-01

Chest radiography still represents the most commonly performed X-ray examination because it is readily available, requires low radiation doses and is relatively inexpensive. However, as previously published, many initially undetected lung nodules are retrospectively visible in chest radiographs. The great improvements in detector technology with the increasing dose efficiency and improved contrast resolution provide a better image quality and reduced dose needs. The dual energy acquisition technique and advanced image processing methods (e.g. digital bone subtraction and temporal subtraction) reduce the anatomical background noise by reduction of overlapping structures in chest radiography. Computer-aided detection (CAD) schemes increase the awareness of radiologists for suspicious areas. The advanced image processing methods show clear improvements for the detection of pulmonary lung nodules in chest radiography and strengthen the role of this method in comparison to 3D acquisition techniques, such as computed tomography (CT). Many of these methods will probably be integrated into standard clinical treatment in the near future. Digital software solutions offer advantages as they can be easily incorporated into radiology departments and are often more affordable as compared to hardware solutions.

SU-E-I-48: The Behavior of AEC in Scan Regions Outside the Localizer Radiograph FOV: An In Phantom Study of CT Systems From Four Vendors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Supanich, M; Bevins, N

Purpose: This review of scanners from 4 major manufacturers examines the clinical impact of performing CT scans that extend into areas of the body that were not acquired in the CT localizer radiograph. Methods: Anthropomorphic chest and abdomen phantoms were positioned together on the tables of CT scanners from 4 different vendors. All of the scanners offered an Automatic Exposure Control (AEC) option with both lateral and axial tube current modulation. A localizer radiograph was taken covering the entire extent of both phantoms and then the scanner's Chest-Abdomen-Pelvis (CAP) study was performed with the clinical AEC settings employed and themore » scan and reconstruction range extending from the superior portion of the chest phantom through the inferior portion of the abdomen phantom. A new study was then initiated with a localizer radiograph extending the length of the chest phantom (not covering the abdomen phantom). The same CAP protocol and AEC settings were then used to scan and reconstruct the entire length of both phantoms. Scan parameters at specific locations in the abdomen phantom from both studies were investigated using the information contained in the DICOM metadata of the reconstructed images. Results: The AEC systems on all scanners utilized different tube current settings in the abdomen phantom for the scan completed without the full localizer radiograph. The AEC system behavior was also scanner dependent with the default manual tube current, the maximum tube current and the tube current at the last known position observed as outcomes. Conclusion: The behavior of the AEC systems of CT scanners in regions not covered by the localizer radiograph is vendor dependent. To ensure optimal image quality and radiation exposure it is important to include the entire planned scan region in the localizer radiograph.« less

Chest CT scan findings in World Trade Center workers.

PubMed

de la Hoz, Rafael E; Weber, Jonathan; Xu, Dongming; Doucette, John T; Liu, Xiaoyu; Carson, Deborah A; Celedón, Juan C

2018-03-15

We examined the chest CT scans of 1,453 WTC responders using the International Classification of High-resolution CT for Occupational and Environmental Respiratory Diseases. Univariate and bivariate analyses of potential work-related pleural abnormalities were performed with pre-WTC and WTC-related occupational exposure data, spirometry, demographics and quantitative CT measurements. Logistic regression was used to evaluate occupational predictors of those abnormalities. Chest CT scans were performed first at a median of 6.8 years after 9/11/2001. Pleural abnormalities were the most frequent (21.1%) across all occupational groups In multivariable analyses, significant pre-WTC occupational asbestos exposure, and work as laborer/cleaner were predictive of pleural abnormalities, with prevalence being highest for the Polish subgroup (n = 237) of our population. Continued occupational lung disease surveillance is warranted in this cohort.

Migrating Lobar Atelectasis of the Right Lung: Radiologic Findings in Six Patients

PubMed Central

Kim, Tae Sung; Hwang, Jung Hwa; Choo, In Wook; Lim, Jae Hoon

2000-01-01

Objective To describe the radiologic findings of migrating lobar atelectasis of the right lung. Materials and Methods Chest radiographs (n = 6) and CT scans (n = 5) of six patients with migrating lobar atelectasis of the right lung were analyzed retrospectively. The underlying diseases associated with lobar atelectasis were bronchogenic carcinoma (n = 4), bronchial tuberculosis (n = 1), and tracheobronchial amyloidosis (n = 1). Results Atelectasis involved the right upper lobe (RUL) (n = 3) and both the RUL and right middle lobe (RML) (n = 3). On supine anteroposterior radiographs (n = 5) and on an erect posteroanterior radiograph (n = 1), the atelectatic lobe(s) occupied the right upper lung zone, with a wedge shape abutting onto the right mediastinal border. On erect posteroanterior radiographs (n = 6), the heavy atelectatic lobe(s) migrated downward, forming a peri- or infrahilar area of increased opacity and obscuring the right cardiac margin. Erect lateral radiographs (n = 4) showed inferior shift of the anterosuperiorly located atelectatic lobe(s) to the anteroinferior portion of the hemithorax. Conclusion Atelectatic lobe(s) can move within the hemithorax according to changes in a patient's position. This process involves the RUL or both the RUL and RML. PMID:11752926

Bone marrow edema pattern in advanced hip osteoarthritis: quantitative assessment with magnetic resonance imaging and correlation with clinical examination, radiographic findings, and histopathology.

PubMed

Taljanovic, Mihra S; Graham, Anna R; Benjamin, James B; Gmitro, Arthur F; Krupinski, Elizabeth A; Schwartz, Stephanie A; Hunter, Tim B; Resnick, Donald L

2008-05-01

To correlate the amount of bone marrow edema (BME) calculated by magnetic resonance imaging(MRI) with clinical findings, histopathology, and radiographic findings, in patients with advanced hip osteoarthritis(OA). The study was approved by The Institutional Human Subject Protection Committee. Coronal MRI of hips was acquired in 19 patients who underwent hip replacement. A spin echo (SE) sequence with four echoes and separate fast spin echo (FSE) proton density (PD)-weighted SE sequences of fat (F) and water (W) were acquired with water and fat suppression, respectively. T2 and water:fat ratio calculations were made for the outlined regions of interest. The calculated MRI values were correlated with the clinical, radiographic, and histopathologic findings. Analyses of variance were done on the MRI data for W/(W + F) and for T2 values (total and focal values) for the symptomatic and contralateral hips. The values were significantly higher in the study group. Statistically significant correlations were found between pain and total W/(W + F), pain and focal T2 values, and the number of microfractures and calculated BME for the focal W/(W + F) in the proximal femora. Statistically significant correlations were found between the radiographic findings and MRI values for total W/(W + F), focal W/(W + F) and focal T2 and among the radiographic findings, pain, and hip movement. On histopathology, only a small amount of BME was seen in eight proximal femora. The amount of BME in the OA hip, as measured by MRI, correlates with the severity of pain, radiographic findings, and number of microfractures.

WE-G-204-09: Medical Physics 2.0 in Practice: Automated QC Assessment of Clinical Chest Images

DOE Office of Scientific and Technical Information (OSTI.GOV)

Willis, C; Willis, C; Nishino, T

2015-06-15

Purpose: To determine whether a proposed suite of objective image quality metrics for digital chest radiographs is useful for monitoring image quality in our clinical operation. Methods: Seventeen gridless AP Chest radiographs from a GE Optima portable digital radiography (DR) unit (Group 1), seventeen (routine) PA Chest radiographs from a GE Discovery DR unit (Group 2), and sixteen gridless (non-routine) PA Chest radiographs from the same Discovery DR unit (Group 3) were chosen for analysis. Groups were selected to represent “sub-standard” (Group 1), “standard-of-care” (Group 2), and images with a gross technical error (Group 3). Group 1 images were acquiredmore » with lower kVp (90 vs. 125), shorter source-to-image distance (127cm vs 183cm) and were expected to have lower quality than images in Group 2. Group 3 was expected to have degraded contrast versus Group 2.This evaluation was approved by the institutional Quality Improvement Assurance Board (QIAB). Images were anonymized and securely transferred to the Duke University Clinical Imaging Physics Group for analysis using software previously described{sup 1} and validated{sup 2}. Image quality for individual images was reported in terms of lung grey level(Lgl); lung noise(Ln); rib-lung contrast(RLc); rib sharpness(Rs); mediastinum detail(Md), noise(Mn), and alignment(Ma); subdiaphragm-lung contrast(SLc); and subdiaphragm area(Sa). Metrics were compared across groups. Results: Metrics agreed with published Quality Consistency Ranges with three exceptions: higher Lgl, lower RLc, and SDc. Higher bit depth (16 vs 12) accounted for higher Lgl values in our images. Values were most internally consistent for Group 2. The most sensitive metric for distinguishing between groups was Mn followed closely by Ln. The least sensitive metrics were Md and RLc. Conclusion: The software appears promising for objectively and automatically identifying substandard images in our operation. The results can be used to

Radiologists remember mountains better than radiographs, or do they?

PubMed

Evans, Karla K; Marom, Edith M; Godoy, Myrna C B; Palacio, Diana; Sagebiel, Tara; Cuellar, Sonia Betancourt; McEntee, Mark; Tian, Charles; Brennan, Patrick C; Haygood, Tamara Miner

2016-01-01

Expertise with encoding material has been shown to aid long-term memory for that material. It is not clear how relevant this expertise is for image memorability (e.g., radiologists' memory for radiographs), and how robust over time. In two studies, we tested scene memory using a standard long-term memory paradigm. One compared the performance of radiologists to naïve observers on two image sets, chest radiographs and everyday scenes, and the other radiologists' memory with immediate as opposed to delayed recognition tests using musculoskeletal radiographs and forest scenes. Radiologists' memory was better than novices for images of expertise but no different for everyday scenes. With the heterogeneity of image sets equated, radiologists' expertise with radiographs afforded them better memory for the musculoskeletal radiographs than forest scenes. Enhanced memory for images of expertise disappeared over time, resulting in chance level performance for both image sets after weeks of delay. Expertise with the material is important for visual memorability but not to the same extent as idiosyncratic detail and variability of the image set. Similar memory decline with time for images of expertise as for everyday scenes further suggests that extended familiarity with an image is not a robust factor for visual memorability.

Radiologists remember mountains better than radiographs, or do they?

PubMed Central

Evans, Karla K.; Marom, Edith M.; Godoy, Myrna C. B.; Palacio, Diana; Sagebiel, Tara; Cuellar, Sonia Betancourt; McEntee, Mark; Tian, Charles; Brennan, Patrick C.; Haygood, Tamara Miner

2015-01-01

Abstract. Expertise with encoding material has been shown to aid long-term memory for that material. It is not clear how relevant this expertise is for image memorability (e.g., radiologists’ memory for radiographs), and how robust over time. In two studies, we tested scene memory using a standard long-term memory paradigm. One compared the performance of radiologists to naïve observers on two image sets, chest radiographs and everyday scenes, and the other radiologists’ memory with immediate as opposed to delayed recognition tests using musculoskeletal radiographs and forest scenes. Radiologists’ memory was better than novices for images of expertise but no different for everyday scenes. With the heterogeneity of image sets equated, radiologists’ expertise with radiographs afforded them better memory for the musculoskeletal radiographs than forest scenes. Enhanced memory for images of expertise disappeared over time, resulting in chance level performance for both image sets after weeks of delay. Expertise with the material is important for visual memorability but not to the same extent as idiosyncratic detail and variability of the image set. Similar memory decline with time for images of expertise as for everyday scenes further suggests that extended familiarity with an image is not a robust factor for visual memorability. PMID:26870748

Can Chest Computed Tomography Be Replaced by Lung Ultrasonography With or Without Plain Chest Radiography in Pediatric Pneumonia?

PubMed

Hajalioghli, Parisa; Nemati, Masoud; Dinparast Saleh, Leila; Fouladi, Daniel F

2016-07-01

The purpose of this study was to answer the following question: can chest computed tomography (CT) requested by pediatricians be replaced by lung ultrasonography (US) with or without chest radiography in pediatric pneumonia? A total of 98 children with suspected pneumonia who were referred by pediatricians for CT examinations were prospectively studied. Levels of agreement between CT findings and plain radiography, lung US, and chest radiography plus lung US results were investigated. CT defined pneumonia in 84 patients, among which 26 cases were complicated. κ values between radiography and CT findings were 0.82 in complicated cases, 0.67 in uncomplicated cases, and 0.72 overall. The corresponding values between US and CT findings were 1, 0.52, and 0.62, respectively, and between radiography plus US and CT findings were 1, 0.86, and 0.88, respectively. CT can be replaced by US when complex effusions are present in children with pneumonia. In case of an ambiguous diagnosis of pediatric pneumonia with or without complex effusions, a combination of chest radiography and US is a reliable surrogate for chest CT.

Is traditional reading of the bedside chest radiograph appropriate to detect intraatrial central venous catheter position?

PubMed

Wirsing, Melanie; Schummer, Claudia; Neumann, Rotraud; Steenbeck, Jörg; Schmidt, Peter; Schummer, Wolfram

2008-09-01

Traditionally, the positioning of central venous catheters (CVCs) outside the right atrium (RA) in patients receiving intensive care is determined by surrogate landmarks on bedside chest radiographs (CXRs). The validity of this method was examined by comparing readings of radiologists with the results of transesophageal echocardiography (TEE). Prospective study at university hospital. Two hundred thirteen adults scheduled for cardiothoracic surgery were randomized to right or left internal jugular vein catheterization under ECG guidance. One senior radiologist and two radiologists in training independently read the CXRs, and determined whether the CVC tip ended in the RA and measured the vertical distance from the CVC tip to the carina (TC-distance). Two hundred twelve CVC tips could be identified by TEE. Only left-sided CVCs (n = 5) ended in the upper RA (2.4%). Three of those patients were shorter than 160 cm. Specificity was 94% for senior radiologist, 44% for the first radiologist in training, and 60% for the second radiologist in training. The TC-distance of intraatrial catheters was 39, 55, 59, 80, and 83 mm, respectively. Thus, a TC-distance < or = 55 mm ensured extraatrial tip position in four of five intraatrial CVCs (80%, p = 0.002). The TC-distance of extraatrial catheters ranged from - 26 to 102 mm. Reading of a bedside CXR alone is not very accurate to identify intraatrial CVC tip position. TC-distance is a helpful marker, and its specificity is as good as that of an experienced radiologist if a cutoff value of 55 mm is chosen.

On-demand rather than daily-routine chest radiography prescription may change neither the number nor the impact of chest computed tomography and ultrasound studies in a multidisciplinary intensive care unit.

PubMed

Kröner, Anke; Binnekade, Jan M; Graat, Marleen E; Vroom, Margreeth B; Stoker, Jaap; Spronk, Peter E; Schultz, Marcus J

2008-01-01

Elimination of daily-routine chest radiographs (CXRs) may influence chest computed tomography (CT) and ultrasound practice in critically ill patients. This was a retrospective cohort study including all patients admitted to a university-affiliated intensive care unit during two consecutive periods of 5 months, one before and one after elimination of daily-routine CXR. Chest CT and ultrasound studies were identified retrospectively by using the radiology department information system. Indications for and the diagnostic/therapeutic yield of chest CT and ultrasound studies were collected. Elimination of daily-routine CXR resulted in a decrease of CXRs per patient day from 1.1 +/- 0.3 to 0.6 +/- 0.4 (P < 0.05). Elimination did not affect duration of stay or mortality rates. Neither the number of chest CT studies nor the ratio of chest CT studies per patient day changed with the intervention: Before elimination of daily-routine CXR, 52 chest CT studies were obtained from 747 patients; after elimination, 54 CT studies were obtained from 743 patients. Similarly, chest ultrasound practice was not affected by the change of CXR strategy: Before and after elimination, 21 and 27 chest ultrasound studies were performed, respectively. Also, timing of chest CT and ultrasound studies was not different between the two study periods. During the two periods, 40 of 106 chest CT studies (38%) and 18 of 48 chest ultrasound studies (38%) resulted in a change in therapy. The combined therapeutic yield of chest CT and ultrasound studies did not change with elimination of daily-routine CXR. Elimination of daily-routine CXRs may not affect chest CT and ultrasound practice in a multidisciplinary intensive care unit.

Extrapulmonary Findings and Malignancies in Participants Screened With Chest CT in the National Lung Screening Trial.

PubMed

Nguyen, Xuan V; Davies, Louise; Eastwood, James D; Hoang, Jenny K

2017-03-01

The aim of this study was to measure the prevalence of clinically significant extrapulmonary findings on chest CT for lung cancer screening in the National Lung Screening Trial (NLST). Prospectively acquired data on 17,309 participants who underwent low-dose screening chest CT from August 2002 through September 2007 during the NLST were retrospectively analyzed for extrapulmonary findings. NLST radiologist readers coded such findings as "minor" or "potentially significant." On the basis of review of recorded text descriptions, extrapulmonary findings were assigned to five organ groupings (cardiovascular, thyroid, adrenal, renal, and hepatobiliary). Extrapulmonary malignancies diagnosed during screening were also identified from medical and vital status records in the same population. The prevalence rates of organ-specific findings and newly diagnosed extrapulmonary malignancies were calculated. Exemption from human subjects research review was obtained. Extrapulmonary findings were noted in 58.7% of CT-screened participants, and 19.6% had findings coded as potentially significant. The prevalence of potentially significant abnormalities was highest for cardiovascular findings (8.5%), followed by renal (2.4%), hepatobiliary (2.1%), adrenal (1.2%), and thyroid (0.6%) findings. Sixty-seven of 17,309 participants (0.39%) had primary extrathoracic cancers diagnosed during screening. The prevalence of cancers among screened participants was 0.26% (n = 45) for kidney, 0.08% (n = 14) for thyroid, and 0.05% (n = 8) for liver cancers. One in five patients screened with CT for lung cancer will have extrapulmonary findings potentially requiring further evaluation. Indiscriminate workups of incidental extrapulmonary findings could place a significant burden on the health care system with little benefit because extrapulmonary malignancies diagnosed during screening are uncommon. Radiologists reporting screening CT should be familiar with existing recommendations for

Practical applications of digital tomosynthesis of the chest.

PubMed

Galea, A; Durran, A; Adlan, T; Gay, D; Riordan, R; Dubbins, P; Williams, M P

2014-04-01

Digital tomosynthesis is a radiographic technique that generates a number of coronal raw images of a patient from a single pass of the x-ray tube. Tomosynthesis provides some of the tomographic benefits of computed tomography (CT), but at a much lower dose of radiation and cost when compared to CT. This review illustrates the range of practical applications of digital tomosynthesis of the chest. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

TU-CD-BRA-11: Application of Bone Suppression Technique to Inspiratory/expiratory Chest Radiography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tanaka, R; Sanada, S; Sakuta, K

Purpose: The bone suppression technique based on advanced image processing can suppress the conspicuity of bones on chest radiographs, creating soft tissue images normally obtained by the dual-energy subtraction technique. This study was performed to investigate the usefulness of bone suppression technique in quantitative analysis of pulmonary function in inspiratory/expiratory chest radiography. Methods: Commercial bone suppression image processing software (ClearRead; Riverain Technologies) was applied to paired inspiratory/expiratory chest radiographs of 107 patients (normal, 33; abnormal, 74) to create corresponding bone suppression images. The abnormal subjects had been diagnosed with pulmonary diseases, such as pneumothorax, pneumonia, emphysema, asthma, and lung cancer.more » After recognition of the lung area, the vectors of respiratory displacement were measured in all local lung areas using a cross-correlation technique. The measured displacement in each area was visualized as displacement color maps. The distribution pattern of respiratory displacement was assessed by comparison with the findings of lung scintigraphy. Results: Respiratory displacement of pulmonary markings (soft tissues) was able to be quantified separately from the rib movements on bone suppression images. The resulting displacement map showed a left-right symmetric distribution increasing from the lung apex to the bottom region of the lung in many cases. However, patients with ventilatory impairments showed a nonuniform distribution caused by decreased displacement of pulmonary markings, which were confirmed to correspond to area with ventilatory impairments found on the lung scintigrams. Conclusion: The bone suppression technique was useful for quantitative analysis of respiratory displacement of pulmonary markings without any interruption of the rib shadows. Abnormal areas could be detected as decreased displacement of pulmonary markings. Inspiratory/expiratory chest radiography

Utility of complete trauma series radiographs in alert pediatric patients presenting to Emergency Department of a Tertiary Care Hospital.

PubMed

Alam Khan, T; Jamil Khattak, Y; Awais, M; Alam Khan, A; Husen, Y; Nadeem, N; Rehman, A

2015-06-01

To assess the utility of trauma series radiographs in the management of alert pediatric patients with traumatic injury and to ascertain whether it is necessary to acquire the entire trauma series in these children. A total of 176 consecutive children below the age of 15 years and having Glasgow Coma Scale score greater than 12, who presented to the emergency department of a tertiary care hospital with a history of recent trauma, were retrospectively reviewed. All the children had undergone a thorough clinical examination followed by complete trauma series radiographs, according to the American College of Surgery guidelines. A total of 558 radiographs were reviewed by a consultant pediatric radiologist including 528 trauma series radiographs and 30 additional radiographs. Among the trauma series radiographs, 35 (6.63 %) had evidence of injury; 24 (4.54 %) and 11 (2.08 %) involving the chest and pelvic regions, respectively. All children with normal physical examination had normal cervical spine and chest radiographs. Among the 11 positive pelvic X-rays, only two had radiological signs of injury in the absence of localizing physical signs, and all these children were less than 3 years of age. In all the remaining cases, children had localizing signs on physical examination. Out of the 30 additional X-rays, 27 (90 %) had radiological evidence of injury. The routine use of entire radiological trauma series in alert pediatric patients with a normal physical examination has a very low yield. In these children, the localizing signs and symptoms can help us in determining the specific radiological examination to be utilized.

Radiographic abnormalities among construction workers exposed to quartz containing dust

PubMed Central

Tjoe, N; Burdorf, A; Parker, J; Attfield, M; van Duivenbooden, C; Heederik, D

2003-01-01

Background: Construction workers are exposed to quartz containing respirable dust, at levels that may cause fibrosis in the lungs. Studies so far have not established a dose-response relation for radiographic abnormalities for this occupational group. Aims: To measure the extent of radiographic abnormalities among construction workers primarily exposed to quartz containing respirable dust. Methods: A cross sectional study on radiographic abnormalities indicative of pneumoconiosis was conducted among 1339 construction workers mainly involved in grinding, (jack)-hammering, drilling, cutting, sawing, and polishing. Radiological abnormalities were determined by median results of the 1980 International Labour Organisation system of three certified "B" readers. Questionnaires were used for assessment of occupational history, presence of respiratory diseases, and symptoms and smoking habits. Results: An abnormality of ILO profusion category 1/0 and greater was observed on 10.2% of the chest radiographs, and profusion category of 1/1 or greater on 2.9% of the radiographs. The average duration of exposure of this group was 19 years and the average age was 42. The predominant type of small opacities (irregularly shaped) is presumably indicative of mixed dust pneumoconiosis. The prevalence of early signs of nodular silicosis (small rounded opacities of category 1/0 or greater) was low (0.8%). Conclusions: The study suggests an elevated risk of radiographic abnormalities among these workers with expected high exposure. An association between radiographic abnormalities and cumulative exposure to quartz containing dust from construction sites was observed, after correction for potentially confounding variables. PMID:12771392

Inflammation and Rupture of a Congenital Pericardial Cyst Manifesting Itself as an Acute Chest Pain Syndrome.

PubMed

Aertker, Robert A; Cheong, Benjamin Y C; Lufschanowski, Roberto

2016-12-01

We present the case of a 63-year-old woman with a remote history of supraventricular tachycardia and hyperlipidemia, who presented with recurrent episodes of acute-onset chest pain. An electrocardiogram showed no evidence of acute coronary syndrome. A chest radiograph revealed a prominent right-sided heart border. A suspected congenital pericardial cyst was identified on a computed tomographic chest scan, and stranding was noted around the cyst. The patient was treated with nonsteroidal anti-inflammatory drugs, and the pain initially abated. Another flare-up was treated similarly. Cardiac magnetic resonance imaging was then performed after symptoms had resolved, and no evidence of the cyst was seen. The suspected cause of the patient's chest pain was acute inflammation of a congenital pericardial cyst with subsequent rupture and resolution of symptoms.

Local-global classifier fusion for screening chest radiographs

NASA Astrophysics Data System (ADS)

Ding, Meng; Antani, Sameer; Jaeger, Stefan; Xue, Zhiyun; Candemir, Sema; Kohli, Marc; Thoma, George

2017-03-01

Tuberculosis (TB) is a severe comorbidity of HIV and chest x-ray (CXR) analysis is a necessary step in screening for the infective disease. Automatic analysis of digital CXR images for detecting pulmonary abnormalities is critical for population screening, especially in medical resource constrained developing regions. In this article, we describe steps that improve previously reported performance of NLM's CXR screening algorithms and help advance the state of the art in the field. We propose a local-global classifier fusion method where two complementary classification systems are combined. The local classifier focuses on subtle and partial presentation of the disease leveraging information in radiology reports that roughly indicates locations of the abnormalities. In addition, the global classifier models the dominant spatial structure in the gestalt image using GIST descriptor for the semantic differentiation. Finally, the two complementary classifiers are combined using linear fusion, where the weight of each decision is calculated by the confidence probabilities from the two classifiers. We evaluated our method on three datasets in terms of the area under the Receiver Operating Characteristic (ROC) curve, sensitivity, specificity and accuracy. The evaluation demonstrates the superiority of our proposed local-global fusion method over any single classifier.

Effect of Picture Archiving and Communication System Image Manipulation on the Agreement of Chest Radiograph Interpretation in the Neonatal Intensive Care Unit.

PubMed

Castro, Denise A; Naqvi, Asad Ahmed; Vandenkerkhof, Elizabeth; Flavin, Michael P; Manson, David; Soboleski, Donald

2016-01-01

Variability in image interpretation has been attributed to differences in the interpreters' knowledge base, experience level, and access to the clinical scenario. Picture archiving and communication system (PACS) has allowed the user to manipulate the images while developing their impression of the radiograph. The aim of this study was to determine the agreement of chest radiograph (CXR) impressions among radiologists and neonatologists and help determine the effect of image manipulation with PACS on report impression. Prospective cohort study included 60 patients from the Neonatal Intensive Care Unit undergoing CXRs. Three radiologists and three neonatologists reviewed two consecutive frontal CXRs of each patient. Each physician was allowed manipulation of images as needed to provide a decision of "improved," "unchanged," or "disease progression" lung disease for each patient. Each physician repeated the process once more; this time, they were not allowed to individually manipulate the images, but an independent radiologist presets the image brightness and contrast to best optimize the CXR appearance. Percent agreement and opposing reporting views were calculated between all six physicians for each of the two methods (allowing and not allowing image manipulation). One hundred percent agreement in image impression between all six observers was only seen in 5% of cases when allowing image manipulation; 100% agreement was seen in 13% of the cases when there was no manipulation of the images. Agreement in CXR interpretation is poor; the ability to manipulate the images on PACS results in a decrease in agreement in the interpretation of these studies. New methods to standardize image appearance and allow improved comparison with previous studies should be sought to improve clinician agreement in interpretation consistency and advance patient care.

Clinical, radiographic, and magnetic resonance imaging findings of gastrocnemius musculotendinopathy in various dog breeds.

PubMed

Kaiser, Susanne M; Harms, Oliver; Konar, Martin; Staudacher, Anne; Langer, Anna; Thiel, Cetina; Kramer, Martin; Schaub, Sebastian; von Pückler, Kerstin H

2016-11-23

To describe clinical, radiographic, and magnetic resonance imaging (MRI) findings in 16 dogs diagnosed with gastrocnemius musculotendinopathy. Retrospective evaluation of medical records, radiographs, and MRI results, as well as follow-up completed by telephone questionnaire. Most dogs had chronic hindlimb lameness with no history of trauma or athletic activities. Clinical examination revealed signs of pain on palpation without stifle joint instability. Seven dogs had radiographic signs of osteophyte formation on the lateral fabella. Magnetic resonance imaging revealed T2 hyperintensity and uptake of contrast agent in the region of the origin of the gastrocnemius muscle. Changes were found in the lateral and medial heads of the gastrocnemius. Conservative treatment resulted in return to full function in 11 dogs. Two dogs showed partial restoration of normal function, one dog showed no improvement. Two dogs were lost to follow-up. Gastrocnemius musculotendinopathy is a potential cause of chronic hindlimb lameness in medium to large breed dogs. A history of athletic activity must not necessarily be present. Magnetic resonance imaging shows signal changes and uptake of contrast agent in the region of the origin of the gastrocnemius muscle. A combination of T1 pre- and post-contrast administration and T2 weighted sequences completed by a fat-suppressed sequence in the sagittal plane are well-suited for diagnosis. Conservative treatment generally results in return to normal function.

Aortic valve calcification - a commonly observed but frequently ignored finding during CT scanning of the chest.

PubMed

Raju, Prashanth; Sallomi, David; George, Bindu; Patel, Hitesh; Patel, Nikhil; Lloyd, Guy

2012-06-01

To describe the frequency and severity of Aortic valve calcification (AVC) in an unselected cohort of patients undergoing chest CT scanning and to assess the frequency with which AVC was being reported in the radiology reports. Consecutive CT scan images of the chest and the radiological reports (December 2009 to May 2010) were reviewed at the district general hospital (DGH). AVC on CT scan was visually graded on a scale ranging from 0 to IV (0 = no calcification, IV = severe calcification). Total of 416 (232 male; 184 female) CT chest scans [Contrast enhanced 302 (72%), unenhanced 114 (28%)] were reviewed. Mean age was 70.55 ± 11.48 years. AVC in CT scans was identified in 95 of the 416 patients (22.83%). AVC classification was as follows: Grade I: 60 (63.15%), Grade II: 22 (23.15%), Grade III: 9 (9.47%), Grade IV: 4 (4.21%). Only one CT report mentioned AVC. Only 31 of 95 AVC had Transthoracic echocardiogram (TTE). The interval time between CT scan and TTE was variable.   Aortic valve calcification in CT chest scans is a common finding and studies have shown that it is strongly related to the presence and severity of aortic valve disease. As CT scans are considered as a valuable additional screening tool for detection of aortic stenosis, AVC should always be commented upon in the radiology reports. Furthermore, patients with at least Grade III and IV AVC should be sent for TTE. © 2012 Blackwell Publishing Ltd.

Chest pain of gastrointestinal origin.

PubMed Central

Berezin, S; Medow, M S; Glassman, M S; Newman, L J

1988-01-01

Twenty seven children who had been diagnosed as having idiopathic chest pain were investigated to find out if the pain was of gastrointestinal origin. The symptoms had lasted from two weeks to eight months. In 21 of the 27 children (78%) the chest pain had a gastrointestinal cause: 16 had oesophagitis, four had gastritis, and one had diffuse oesophageal spasm. All patients responded to medical treatment of their gastrointestinal symptoms, resulting in disappearance of the chest pain. PMID:3232993

Long-term follow-up of ventilator treated low birthweight infants. I. Chest X-ray, pulmonary mechanics, clinical lung disease and growth.

PubMed

Lindroth, M; Mortensson, W

1986-09-01

Chest X-ray, pulmonary mechanics, clinical lung disease and growth were studied in 48 low birthweight infants surviving after ventilator treatment in the neonatal period. Bronchopulmonary dysplasia (BPD) was present in 14 infants shortly after weaning off ventilator. At 4 to 6 years of age most patients had normal chest radiographs but 13 still showed signs of pulmonary fibrosis and hyperinflation. Most patients had low dynamic compliance and high pulmonary resistance shortly after ventilator treatment. All but 8, however, had normal findings at 1 to 1 1/2 years of age. Pneumonias and bronchitis were common during the first two years but thereafter declined in frequency. Weight and length development were retarded for BPD patients during the first two years and for non-BPD patients for the first year. Both groups had a complete catch-up.

Radiology residents' skill level in chest x-ray reading.

PubMed

Fabre, C; Proisy, M; Chapuis, C; Jouneau, S; Lentz, P-A; Meunier, C; Mahé, G; Lederlin, M

2018-05-04

To evaluate the mean skill level of radiology residents in chest X-ray (CXR) reading, with regard to cognitive mechanisms involved in this task and to investigate for potential factors influencing residents' skill. Eighty-one residents were evaluated through a test set including CXR expected to mobilize detection skills (n=10), CXR expected to mobilize interpretation skills (n=10) and normal CXR (n=4). For each radiograph, residents were asked to answer three questions: Does this radiograph show normal or abnormal findings? Does it require complementary computed tomography study? What is your diagnosis? Residents' answers were evaluated against an experts' consensus and analyzed according to year of residency, attendance at CXR training course during residency and the average number of CXR read per week. Residents' mean success rate was 90.4%, 76.6% and 52.7% for the three questions, respectively. Year of residency was associated with better diagnostic performances in the detection CXR category (P=0.025), while attendance at CXR training course was associated with better performances in the interpretation CXR category (P=0.031). There was no influence of the number of CXR read per week. These results may suggest promoting systematic CXR theoretical training course in the curriculum of radiology residents. Copyright © 2018 Société française de radiologie. Published by Elsevier Masson SAS. All rights reserved.

Comparing deep learning models for population screening using chest radiography

NASA Astrophysics Data System (ADS)

Sivaramakrishnan, R.; Antani, Sameer; Candemir, Sema; Xue, Zhiyun; Abuya, Joseph; Kohli, Marc; Alderson, Philip; Thoma, George

2018-02-01

According to the World Health Organization (WHO), tuberculosis (TB) remains the most deadly infectious disease in the world. In a 2015 global annual TB report, 1.5 million TB related deaths were reported. The conditions worsened in 2016 with 1.7 million reported deaths and more than 10 million people infected with the disease. Analysis of frontal chest X-rays (CXR) is one of the most popular methods for initial TB screening, however, the method is impacted by the lack of experts for screening chest radiographs. Computer-aided diagnosis (CADx) tools have gained significance because they reduce the human burden in screening and diagnosis, particularly in countries that lack substantial radiology services. State-of-the-art CADx software typically is based on machine learning (ML) approaches that use hand-engineered features, demanding expertise in analyzing the input variances and accounting for the changes in size, background, angle, and position of the region of interest (ROI) on the underlying medical imagery. More automatic Deep Learning (DL) tools have demonstrated promising results in a wide range of ML applications. Convolutional Neural Networks (CNN), a class of DL models, have gained research prominence in image classification, detection, and localization tasks because they are highly scalable and deliver superior results with end-to-end feature extraction and classification. In this study, we evaluated the performance of CNN based DL models for population screening using frontal CXRs. The results demonstrate that pre-trained CNNs are a promising feature extracting tool for medical imagery including the automated diagnosis of TB from chest radiographs but emphasize the importance of large data sets for the most accurate classification.

A chest radiograph scoring system in patients with severe acute respiratory infection: a validation study.

PubMed

Taylor, Emma; Haven, Kathryn; Reed, Peter; Bissielo, Ange; Harvey, Dave; McArthur, Colin; Bringans, Cameron; Freundlich, Simone; Ingram, R Joan H; Perry, David; Wilson, Francessa; Milne, David; Modahl, Lucy; Huang, Q Sue; Gross, Diane; Widdowson, Marc-Alain; Grant, Cameron C

2015-12-29

The term severe acute respiratory infection (SARI) encompasses a heterogeneous group of respiratory illnesses. Grading the severity of SARI is currently reliant on indirect disease severity measures such as respiratory and heart rate, and the need for oxygen or intensive care. With the lungs being the primary organ system involved in SARI, chest radiographs (CXRs) are potentially useful for describing disease severity. Our objective was to develop and validate a SARI CXR severity scoring system. We completed validation within an active SARI surveillance project, with SARI defined using the World Health Organization case definition of an acute respiratory infection with a history of fever, or measured fever of ≥ 38 °C; and cough; and with onset within the last 10 days; and requiring hospital admission. We randomly selected 250 SARI cases. Admission CXR findings were categorized as: 1 = normal; 2 = patchy atelectasis and/or hyperinflation and/or bronchial wall thickening; 3 = focal consolidation; 4 = multifocal consolidation; and 5 = diffuse alveolar changes. Initially, four radiologists scored CXRs independently. Subsequently, a pediatrician, physician, two residents, two medical students, and a research nurse independently scored CXR reports. Inter-observer reliability was determined using a weighted Kappa (κ) for comparisons between radiologists; radiologists and clinicians; and clinicians. Agreement was defined as moderate (κ > 0.4-0.6), good (κ > 0.6-0.8) and very good (κ > 0.8-1.0). Agreement between the two pediatric radiologists was very good (κ = 0.83, 95% CI 0.65-1.00) and between the two adult radiologists was good (κ = 0.75, 95% CI 0.57-0. 93). Agreement of the clinicians with the radiologists was moderate-to-good (pediatrician:κ = 0.65; pediatric resident:κ = 0.69; physician:κ = 0.68; resident:κ = 0.67; research nurse:κ = 0.49, medical students: κ = 0.53 and κ = 0.56). Agreement between clinicians was good-to-very good (pediatrician vs

Xanthogranulomatous pyelonephritis presenting as acute pleuritic chest pain: a case report.

PubMed

Chow, Justin; Kabani, Rameez; Lithgow, Kirstie; Sarna, Magdalena A

2017-04-12

Xanthogranulomatous pyelonephritis is a rare and serious manifestation of chronic kidney inflammation that can be life-threatening if not recognized and treated appropriately, often with antibiotics and surgery. Affected patients are most commonly females in their fifth or sixth decade of life with a background of obstructive uropathy, nephrolithiasis, or recurrent urinary tract infections who present with vague nonspecific symptoms. A 43-year-old woman of Russian ethnicity with a history of nephrolithiasis presented to our emergency department with new left-sided pleuritic chest pain amid a 6-week history of constitutional symptoms including fevers, night sweats, and 7 kg of weight loss. Workup for acute coronary syndrome and pulmonary embolism in our emergency department was negative. Given that she was clinically unwell, she was admitted to internal medicine to expedite workup for the cause of her symptoms. A broad differential diagnosis for various infectious, inflammatory/autoimmune, and neoplastic processes was considered. Based on classic radiographic and histopathologic findings, she was ultimately diagnosed with xanthogranulomatous pyelonephritis of her left kidney, which was a direct consequence of chronic inflammation. This inflammation exhibited spread to local tissues and across her left hemidiaphragm, resulting in a unilateral pleural effusion which explained her chest discomfort. She was treated with antibiotics administered intravenously and urgent total nephrectomy with a good functional outcome. Our case illustrates an uncommon but clinically important do-not-miss diagnosis that underlies a common clinical presentation of pleuritic chest pain. The case underscores the importance of maintaining a broad differential diagnosis and organized approach when treating patients with undifferentiated clinical presentations.

Rib fractures induced by coughing: an unusual cause of acute chest pain.

PubMed

De Maeseneer, M; De Mey, J; Debaere, C; Meysman, M; Osteaux, M

2000-03-01

We report three patients with stress fractures of the ribs induced by coughing. Standard radiographs of the chest and ribs did not reveal evidence of rib fractures in any of the patients. Bone scintigraphy, performed 1 to 2 weeks after initial onset of symptoms, showed a focal area of increased uptake along the chest wall in all cases. Thin section angulated helical CT directly visualized the subtle rib fractures. Initial diagnosis of a cough-induced fracture of the rib may be difficult because of the associated underlying disorder, and unnecessary examinations are commonly performed. Identification of a cough-induced fracture of the rib using helical CT may be clinically important to avoid unnecessary concern and additional examinations.

Rib Radiography versus Chest Computed Tomography in the Diagnosis of Rib Fractures.

PubMed

Sano, Atsushi

2018-05-01

 The accurate diagnosis of rib fractures is important in chest trauma. Diagnostic images following chest trauma are usually obtained via chest X-ray, chest computed tomography, or rib radiography. This study evaluated the diagnostic characteristics of rib radiography and chest computed tomography.  Seventy-five rib fracture patients who underwent both chest computed tomography and rib radiography between April 2008 and December 2013 were included. Rib radiographs, centered on the site of pain, were taken from two directions. Chest computed tomography was performed using a 16-row multidetector scanner with 5-mm slice-pitch without overlap, and axial images were visualized in a bone window.  In total, 217 rib fractures were diagnosed in 75 patients. Rib radiography missed 43 rib fractures in 24 patients. The causes were overlap with organs in 15 cases, trivial fractures in 21 cases, and injury outside the imaging range in 7 cases. Left lower rib fractures were often missed due to overlap with the heart, while middle and lower rib fractures were frequently not diagnosed due to overlap with abdominal organs. Computed tomography missed 21 rib fractures in 17 patients. The causes were horizontal fractures in 10 cases, trivial fractures in 9 cases, and insufficient breath holding in 1 case.  In rib radiography, overlap with organs and fractures outside the imaging range were characteristic reasons for missed diagnoses. In chest computed tomography, horizontal rib fractures and insufficient breath holding were often responsible. We should take these challenges into account when diagnosing rib fractures. Georg Thieme Verlag KG Stuttgart · New York.

Melorheostosis involving the cervical and upper thoracic spine: radiographic, CT, and MR imaging findings.

PubMed

Motimaya, A M; Meyers, S P

2006-01-01

Melorheostosis, an uncommon mesenchymal dysplasia, rarely affects the axial skeleton. We describe the imaging findings of melorheostosis involving the cervical and upper thoracic spine. Radiographs and CT showed unilateral well-marginated undulating zones of cortical hyperostosis involving multiple vertebrae that were contiguous with a coalescent ossified right paravertebral mass. MR imaging showed zones of signal intensity void on all pulse sequences without contrast enhancement. Conservative management was elected because of lack of interval clinical and imaging changes for 8 years.

Low-Level Fiber-induced Radiographic Changes Caused by Libby Vermiculite

PubMed Central

Rohs, Amy M.; Lockey, James E.; Dunning, Kari K.; Shukla, Rakesh; Fan, Huihao; Hilbert, Tim; Borton, Eric; Wiot, Jerome; Meyer, Cristopher; Shipley, Ralph T.; LeMasters, Grace K.; Kapil, Vikas

2008-01-01

Rationale: From 1921 to 1990, vermiculite ore from Libby, Montana, was shipped worldwide for commercial and residential use. A 1980 study of a manufacturing facility using Libby vermiculite was the first to demonstrate a small but significant prevalence of pleural chest radiographic changes associated with amphibole fibers contained in the ore. Objectives: This follow-up study of the original cohort evaluated the extent of radiographic changes and cumulative fiber exposure (CFE) 25 years after cessation of exposure. Methods: From the original cohort of 513 workers, 431 (84%) were living and available for participation and exposure reconstruction. Of these, 280 (65%) completed both chest radiographs and interviews. Primary outcomes were pleural and/or interstitial changes. Measurements and Main Results: Pleural and interstitial changes were demonstrated in 80 (28.7%) and 8 (2.9%) participants, respectively. Of those participants with low lifetime CFE of less than 2.21 fiber/cc-years, 42 (20%) had pleural changes. A significant (P < 0.001) exposure–response relationship of pleural changes with CFE was demonstrated, ranging from 7.1 to 54.3% from the lowest to highest exposure quartile. Removal of individuals with commercial asbestos exposure did not alter this trend. Conclusions: This study indicates that exposure within an industrial process to Libby vermiculite ore is associated with pleural thickening at low lifetime CFE levels. The propensity of the Libby amphibole fibers to dramatically increase the prevalence of pleural changes 25 years after cessation of exposure at low CFE levels is a concern in view of the wide national distribution of this ore for commercial and residential use. PMID:18063841

Frequency of rib and sternum fractures associated with out-of-hospital cardiopulmonary resuscitation is underestimated by conventional chest X-ray.

PubMed

Lederer, Wolfgang; Mair, Dieter; Rabl, Walter; Baubin, Michael

2004-02-01

Fractured ribs and sternum are frequent complications of thoracic compression during CPR in adults. This study was conducted to determine whether findings of plain chest radiography (CXR) correlate with post-mortem findings in patients who underwent cardiopulmonary resuscitation (CPR) after out-of-hospital cardiac arrest. CXR findings and autopsy results of CPR-related chest injuries comprising rib and sternum fractures were compared prospectively in 19 patients. Fractures were diagnosed in nine of 19 patients by means of radiology and in 18 of 19 patients by autopsy (rib fractures in 6/19 versus 17/19, P=0.002; sternum fractures in 5/19 versus in 9/19, P=0.227. The total number of isolated bone fractures detected by CXR was 18 (12 rib and six sternum fractures) and by autopsy 92 (83 rib and nine sternum fractures). The majority of rib fractures was located in the anterior part of the thoracic cage. Sternum fractures predominantly occurred in the lower third. Eight of 19 patients received either thrombolytic or antithrombotic treatment during CPR but no major bleeding complication associated with CPR was detected by autopsy. The findings of this study indicate that fractures associated with CPR are underreported in conventional radiographic investigations. No major bleeding complications related to CPR-associated fractures was detected.

A computer-aided diagnosis system to detect pathologies in temporal subtraction images of chest radiographs

NASA Astrophysics Data System (ADS)

Looper, Jared; Harrison, Melanie; Armato, Samuel G.

2016-03-01

Radiologists often compare sequential radiographs to identify areas of pathologic change; however, this process is prone to error, as human anatomy can obscure the regions of change, causing the radiologists to overlook pathology. Temporal subtraction (TS) images can provide enhanced visualization of regions of change in sequential radiographs and allow radiologists to better detect areas of change in radiographs. Not all areas of change shown in TS images, however, are actual pathology. The purpose of this study was to create a computer-aided diagnostic (CAD) system that identifies which regions of change are caused by pathology and which are caused by misregistration of the radiographs used to create the TS image. The dataset used in this study contained 120 images with 74 pathologic regions on 54 images outlined by an experienced radiologist. High and low ("light" and "dark") gray-level candidate regions were extracted from the images using gray-level thresholding. Then, sampling techniques were used to address the class imbalance problem between "true" and "false" candidate regions. Next, the datasets of light candidate regions, dark candidate regions, and the combined set of light and dark candidate regions were used as training and testing data for classifiers by using five-fold cross validation. Of the classifiers tested (support vector machines, discriminant analyses, logistic regression, and k-nearest neighbors), the support vector machine on the combined candidates using synthetic minority oversampling technique (SMOTE) performed best with an area under the receiver operating characteristic curve value of 0.85, a sensitivity of 85%, and a specificity of 84%.

Application of thin-section low-dose chest CT (TSCT) in the management of pediatric AIDS.

PubMed

Ambrosino, M M; Roche, K J; Genieser, N B; Kaul, A; Lawrence, R M

1995-01-01

The aim of this study was to evaluate the usefulness of thin-section low-dose computed tomography (TSCT) in the management of children with AIDS, as chest radiographs (CXR) often fail to adequately explain the patients' clinical status. We performed 54 noncontrast TSCTs on 32 children. The patients aged from 3 months to 14.6 years, were diagnosed as having bacterial pneumonia, lumphocytic interstitial pneumonitis (LIP), Pneumocystis carinii pneumonia (PCP), or Mycobacterium avium-intracellulare infection (MAI). The scans were correlated with the clinical diagnosis, T-lymphocyte-subset percentages, and p24-antigen levels. Subsegmental consolidations were seen in patients with LIP, PCP, and MAI, and as an isolated finding in those with only bacterial pneumonia. Ground-glass haziness was seen exclusively with acute PCP. Reticulonodular thickening was identified only in patients with LIP. Mosaic perfusion was seen with MAI, LIP, and pneumonia. The presence of adenopathy correlated with CD4+ T-cell subset percentages. The greatest value of CT in this study was in detecting new disease when chest films failed to correlate with a patient's clinical state, and in demonstrating acute/subacute disease in patients with severe baseline chest-film changes. Recurrent pneumonias may represent progression of "smoldering" disease, rather than true recurrent disease following complete clearing. Adenopathy with low CD4+ levels should suggest lymphoma or infection with MAI.

Viewing Another Person's Eye Movements Improves Identification of Pulmonary Nodules in Chest X-Ray Inspection

ERIC Educational Resources Information Center

Litchfield, Damien; Ball, Linden J.; Donovan, Tim; Manning, David J.; Crawford, Trevor

2010-01-01

Double reading of chest x-rays is often used to ensure that fewer abnormalities are missed, but very little is known about how the search behavior of others affects observer performance. A series of experiments investigated whether radiographers benefit from knowing where another person looked for pulmonary nodules, and whether the expertise of…

Evaluation of clinical, radiographical and cytological findings compared to arthroscopic findings in shoulder joint lameness in the dog.

PubMed

Akerblom, S; Sjöström, L

2007-01-01

Forty-two dogs with lameness emanating from the shoulder joint were studied by clinical examination, radiographic examination, joint fluid analysis, and arthroscopic examination, following a set protocol. Dogs with mild clinical signs, absent or mild radiographic signs of osteoarthrosis, and without or with very mild changes in the synovial fluid, may still have moderate to severe degenerative pathological changes in the shoulder joint.

A discrimination method for the detection of pneumonia using chest radiograph.

PubMed

Noor, Norliza Mohd; Rijal, Omar Mohd; Yunus, Ashari; Abu-Bakar, S A R

2010-03-01

This paper presents a statistical method for the detection of lobar pneumonia when using digitized chest X-ray films. Each region of interest was represented by a vector of wavelet texture measures which is then multiplied by the orthogonal matrix Q(2). The first two elements of the transformed vectors were shown to have a bivariate normal distribution. Misclassification probabilities were estimated using probability ellipsoids and discriminant functions. The result of this study recommends the detection of pneumonia by constructing probability ellipsoids or discriminant function using maximum energy and maximum column sum energy texture measures where misclassification probabilities were less than 0.15. 2009 Elsevier Ltd. All rights reserved.

Experiences with the European guidelines on quality criteria for radiographic images in Tanzania

PubMed Central

Muhogora, W. E.; Nyanda, A. M.; Kazema, R. R.

2001-01-01

Objective assessment of the quality of radiographic images is practically a difficult task and protocols that address this problem are few. In 1996, the European union published nearly objective image quality criteria to unify the practices in Europe. However, experience with these criteria in countries of lower health care levels is little documented. As a case study in Tanzania, we present the general performance of European guidelines in some Tanzanian hospitals to a total of 200 radiographs obtained from some common x‐ray examinations. The results show that more than 70% of chest (PA), lumbar spine (AP), and pelvis AP radiographs passed the quality criteria, while the performance of lumbar spine LAT x‐ray examinations was about 50% and therefore less satisfactory. The corresponding mean entrance dose to the patient for specified x‐ray techniques was of range 0.08–0.56 mGy, 3.1–7.7 mGy, 2.53–5.4 mGy, and 4.0–16.78 mGy for chest PA, lumbar spine AP, pelvis AP and lumbar spine LAT x‐ray examinations, respectively. Although a good number of observers were not well familiar to the guidelines, the quality criteria have been found useful and their adoption in the country recommended. The need to provide relevant education and training to staff in the radiology departments is of utmost importance. PACS number(s): 87.57.–s, 87.52.–g PMID:11686743

Patient exposure dose for chest and skull radiographies in Mazandaran hospitals.

PubMed

Etemadinezhad, Siavash; Rahimi, Seyed Ali

2010-01-01

Radiographic techniques are essential methods of diagnosis, and their use has been increased, especially with the development of the new technologies. Inappropriate administration of these techniques may put both the patients and personnel at unnecessary risks. The objective of this research was to measure the skin dose of chest and skull radiographies used in Mazandaran hospitals and to compare these doses with national and international standards. In this cross-sectional study, six X-ray generators at six hospitals affiliated to Mazandaran University of Medical Sciences were included. One hundred and twenty patients referred to the radiology wards for radiographic examinations of chest and skull with normal body mass index (BMI) were selected (20 patients for each radiography unit). The generators were matched for mAs, kvp, type of amplifier sheets, and technical conditions as much as possible. Calibrated thermo luminescence dosimeters (TLD-USA, Lif-100) were used to measure the skin dose by placing them on the patients' back and the absorbed doses by TLDs were read by a TLD reader (model: Harshuu, TLD3500, Japan). The mean values of the skin dose were 0.51 mGray for posteroanterior (PA), chest X-ray (CXR), 3.36 mGray for lateral CXR, 7.25 mGray for anterroposterior (AP) or PA skull X-rays, and 7.59 mGray for lateral skull X-rays. The measured values were higher than the national and international standards. The results of this research revealed that the conditions of the X-ray generators should be monitored and modified periodically. Modifying the X-ray generators plus improving technicians' skills would, to some extent, reduce the radiation exposure of the patients.

Comparison of hard- and soft-copy digital chest images with different matrix sizes for managing coronary care unit patients.

PubMed

Steckel, R J; Batra, P; Johnson, S; Sayre, J; Brown, K; Haker, K; Young, D; Zucker, M

1995-04-01

This study was to determine whether different digital display formats for portable chest radiographs of coronary care unit patients would provide comparable information for clinical care. In particular, we tried to ascertain whether 1024 x 1024 pixel (1K) images on a picture archiving and communication system (PACS) workstation would be comparable to 1760 x 2140 pixel (2K) images on workstations or to digital films. If comparability could be proved, we hypothesized that 1K workstations could considerably lower equipment and film costs and facilitate image transmission from point to point. Four chest radiologists read a panel of chest studies assembled from 98 coronary care unit patients, comparing 1K and 2K soft-copy images with digital hard copies. For all three image types for the 98 patients, the readers evaluated nine image parameters that the cardiologists deemed essential for clinical decision making. Two other chest radiologists reviewed each patient's three image types, historical chest images, current and prior radiologic reports, and medical record to determine the consensus, or "truth findings." With one exception (small pleural effusions), the receiver operating characteristic analysis showed no significant differences in the clinical information derived from the three image types. For clinical management in a coronary care unit, comparable information can be obtained from digital radiologic chest studies using a 1K x 1K soft-copy format, a 2K x 2K soft-copy format, or a hard copy (film). Substantial savings in cost and time are therefore possible by using soft-copy images and lower resolution (1K x 1K) workstations and, when necessary, by transmitting images on regular telephone lines.

Clinical and laboratory features of children with community-acquired pneumonia are associated with distinct radiographic presentations.

PubMed

Falup-Pecurariu, Oana G; Diez-Domingo, Javier; Esposito, Susanna; Finn, Adam; Rodrigues, Fernanda; Spoulou, Vana; Syrogiannopoulos, George A; Usonis, Vytautas; Greenberg, David

2018-07-01

Chest radiographs from children with community-acquired pneumonia (CAP) were categorized into three distinct presentations and each presentation was correlated to clinical and laboratory findings. Children < 59 months with CAP presenting to pediatric emergency rooms during two years were enrolled prospectively in eight centers across Europe. Clinical and laboratory data were documented and radiographs obtained from patients. Of the 1107 enrolled patients, radiographs were characterized as 74.9% alveolar CAP, 8.9% non-alveolar CAP, and 16.3% clinical CAP. Alveolar CAP patients had significantly higher rates of fever (90.7%), vomiting (27.6%), and abdominal pain (18.6%), while non-alveolar CAP patients presented more with cough (96.9%). A model using independent parameters that characterize alveolar, non-alveolar, and clinical CAP demonstrated that alveolar CAP patients were significantly older (OR = 1.02) and had significantly lower oxygen saturation than non-alveolar CAP patients (OR = 0.54). Alveolar CAP patients had significantly higher mean WBC (17,760 ± 8539.68 cells/mm 3 ) and ANC (11.5 ± 7.5 cells/mm 3 ) than patients categorized as non-alveolar CAP (WBC 15,160 ± 5996 cells/mm 3 , ANC 9.2 ± 5.1 cells/mm 3 ) and clinical CAP (WBC 13,180 ± 5892, ANC 7.3 ± 4.7). Alveolar CAP, non-alveolar CAP, and clinical CAP are distinct entities differing not only by chest radiographic appearance but also in clinical and laboratory characteristics. Alveolar CAP has unique characteristics, which suggest association with bacterial etiology. Trial number 3075 (Soroka Hospital, Israel) What is Known: • Community-acquired pneumonia in children is diagnosed based on clinical and radiological definitions. • Radiological criteria were standardized by WHO-SICR and have been utilized in vaccine studies. What is New: • Correlation between the WHO-SICR radiological definitions and clinical and laboratory parameters has not been studied

Quantitative kinetic analysis of lung nodules by temporal subtraction technique in dynamic chest radiography with a flat panel detector

NASA Astrophysics Data System (ADS)

Tsuchiya, Yuichiro; Kodera, Yoshie; Tanaka, Rie; Sanada, Shigeru

2007-03-01

Early detection and treatment of lung cancer is one of the most effective means to reduce cancer mortality; chest X-ray radiography has been widely used as a screening examination or health checkup. The new examination method and the development of computer analysis system allow obtaining respiratory kinetics by the use of flat panel detector (FPD), which is the expanded method of chest X-ray radiography. Through such changes functional evaluation of respiratory kinetics in chest has become available. Its introduction into clinical practice is expected in the future. In this study, we developed the computer analysis algorithm for the purpose of detecting lung nodules and evaluating quantitative kinetics. Breathing chest radiograph obtained by modified FPD was converted into 4 static images drawing the feature, by sequential temporal subtraction processing, morphologic enhancement processing, kinetic visualization processing, and lung region detection processing, after the breath synchronization process utilizing the diaphragmatic analysis of the vector movement. The artificial neural network used to analyze the density patterns detected the true nodules by analyzing these static images, and drew their kinetic tracks. For the algorithm performance and the evaluation of clinical effectiveness with 7 normal patients and simulated nodules, both showed sufficient detecting capability and kinetic imaging function without statistically significant difference. Our technique can quantitatively evaluate the kinetic range of nodules, and is effective in detecting a nodule on a breathing chest radiograph. Moreover, the application of this technique is expected to extend computer-aided diagnosis systems and facilitate the development of an automatic planning system for radiation therapy.

[TUBERCULOSIS SCREENING BY CHEST RADIOGRAPHY AMONG INTERNATIONAL STUDENTS AT JAPANESE LANGUAGE SCHOOLS IN OSAKA CITY].

PubMed

Tsuda, Yuko; Matsumoto, Kenji; Komukai, Jun; Furukawa, Kanae; Saito, Kazumi; Shimouchi, Akira

2015-10-01

With a broader aim of controlling pulmonary tuberculosis (TB) among foreigners, here, we have reported the findings of chest radiography screening for TB among international students at Japanese language schools in Osaka city. Between April 2011 and December 2013, 4,529 international students from 19 Japanese language schools in Osaka city underwent chest radiography for TB screening. The chest radiographs were studied in reference to the student's sex, age, nationality, and date of entry to Japan as well as any health conditions present at the time of screening. We further analyzed the bacterial information and pulmonary TB classification based on chest radiography findings of students who were identified to be positive for TB. Information on the implementation of health education was also gathered. The results revealed that 52.5% of the students who underwent chest radiography came from China, 20.3 % from South Korea, and 16.3% from Vietnam. Of the students, 52.9% were male and 47.1% were female. The median age of students was 23 years (range: 14-70 years). The median number of days from the first date of entry to Japan up until the radiography screening was 63 days. Based on the chest radiography findings, 71 students (1.6%) were suspected to have TB; however, further detailed examination confirmed that 19 students (0.4%) had active TB. This percentage is significantly higher than the 0.1% TB identification rate among residents in Osaka city of the same time period (P<0.001), which was also determined by chest radiography. The median age of the 19 TB positive patients was 23 years. Among them, 14 (73.7%) were male. The median time from the date of entry to Japan to the date of the chest radiography screening was 137 days. For 16 of those students, the entry to Japan was within 1 year of the radiography. Of the 19 TB positive patients, 16 (84.2%) did not have respiratory symptoms, 15 (79.0%) had sputum smear negative results, and 17 (89.5%) had no cavity. Health

Development of an improved CAD scheme for automated detection of lung nodules in digital chest images.

PubMed

Xu, X W; Doi, K; Kobayashi, T; MacMahon, H; Giger, M L

1997-09-01

Lung cancer is the leading cause of cancer deaths in men and women in the United States, with a 5-year survival rate of only about 13%. However, this survival rate can be improved to 47% if the disease is diagnosed and treated at an early stage. In this study, we developed an improved computer-aided diagnosis (CAD) scheme for the automated detection of lung nodules in digital chest images to assist radiologists, who could miss up to 30% of the actually positive cases in their daily practice. Two hundred PA chest radiographs, 100 normals and 100 abnormals, were used as the database for our study. The presence of nodules in the 100 abnormal cases was confirmed by two experienced radiologists on the basis of CT scans or radiographic follow-up. In our CAD scheme, nodule candidates were selected initially by multiple gray-level thresholding of the difference image (which corresponds to the subtraction of a signal-enhanced image and a signal-suppressed image) and then classified into six groups. A large number of false positives were eliminated by adaptive rule-based tests and an artificial neural network (ANN). The CAD scheme achieved, on average, a sensitivity of 70% with 1.7 false positives per chest image, a performance which was substantially better as compared with other studies. The CPU time for the processing of one chest image was about 20 seconds on an IBM RISC/6000 Powerstation 590. We believe that the CAD scheme with the current performance is ready for initial clinical evaluation.

ACR appropriateness criteria blunt chest trauma.

PubMed

Chung, Jonathan H; Cox, Christian W; Mohammed, Tan-Lucien H; Kirsch, Jacobo; Brown, Kathleen; Dyer, Debra Sue; Ginsburg, Mark E; Heitkamp, Darel E; Kanne, Jeffrey P; Kazerooni, Ella A; Ketai, Loren H; Ravenel, James G; Saleh, Anthony G; Shah, Rakesh D; Steiner, Robert M; Suh, Robert D

2014-04-01

Imaging is paramount in the setting of blunt trauma and is now the standard of care at any trauma center. Although anteroposterior radiography has inherent limitations, the ability to acquire a radiograph in the trauma bay with little interruption in clinical survey, monitoring, and treatment, as well as radiography's accepted role in screening for traumatic aortic injury, supports the routine use of chest radiography. Chest CT or CT angiography is the gold-standard routine imaging modality for detecting thoracic injuries caused by blunt trauma. There is disagreement on whether routine chest CT is necessary in all patients with histories of blunt trauma. Ultimately, the frequency and timing of CT chest imaging should be site specific and should depend on the local resources of the trauma center as well as patient status. Ultrasound may be beneficial in the detection of pneumothorax, hemothorax, and pericardial hemorrhage; transesophageal echocardiography is a first-line imaging tool in the setting of suspected cardiac injury. In the blunt trauma setting, MRI and nuclear medicine likely play no role in the acute setting, although these modalities may be helpful as problem-solving tools after initial assessment. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

The phrenic nerve with accompanying vessels: a silent cause of cardiovascular border obliteration on chest radiography.

PubMed

Farhana, Shiri; Ashizawa, Kazuto; Hayashi, Hideyuki; Ogihara, Yukihiro; Aso, Nobuya; Hayashi, Kuniaki; Uetani, Masataka

2015-12-01

Our aim was to clarify the frequency of cardiovascular border obliteration on frontal chest radiography and to prove that the phrenic nerve with accompanying vessels can be considered as a cause of obliteration of cardiovascular border on an otherwise normal chest radiography. Two radiologists reviewed chest radiographs and computed tomography (CT) images of 100 individuals. CT confirmed the absence of intrapulmonary or extrapulmonary abnormalities in all of them. We examined the frequency of cardiovascular border obliteration on frontal chest radiography and summarized the causes of obliteration as pericardial fat pad, phrenic nerve, intrafissure fat, pulmonary vessels, and others, comparing them with CT in each case. Cardiovascular border was obliterated on frontal chest radiography in 46 cases on the right and in 61 on the left. The phrenic nerve with accompanying vessels was found to be a cause of obliteration in 34 of 46 cases (74%) on the right and 29 of 61 (48%) cases on the left. The phrenic nerve was the most frequent cause of cardiovascular border obliteration on both sides. The phrenic nerve with accompanying vessels, forming a prominent fold of parietal pleura, can be attributed as a cause of cardiovascular border obliteration on frontal chest radiography.

A clinical and radiographic study of coir workers.

PubMed

Uragoda, C G

1975-02-01

Processing of coir, which is the fibre obtained from the husk of the coconut, is a dusty procedure; 779 workers in two coir processing factories in Sri Lanka were examined clincally and radiographically for evidence of respiratory disease. Respiratory symptoms were present in 20 (2-6%) of them, which is no higher than in the general population. Respiratory disease such as asthma, chronic bronchitis, byssinosis, and pulmonary tuberculosis which may occur from occupational exposures were considered, but there was no evidence to suggest a definite association between these conditions and coir dust. Twenty-two workers had abnormal chest radiographs, but when compared with a control group of 591 workers from an engineering firm where lesions were found in 20 cases, there was no significant difference. In the opinion of the medical officer, management and workers of the large factory investigated, coir dust does not produce any respiratory disability. The chemical composition of coir dust is similar to that of sisal which is also relatively inert.

A clinical and radiographic study of coir workers.

PubMed Central

Uragoda, C G

1975-01-01

Processing of coir, which is the fibre obtained from the husk of the coconut, is a dusty procedure; 779 workers in two coir processing factories in Sri Lanka were examined clincally and radiographically for evidence of respiratory disease. Respiratory symptoms were present in 20 (2-6%) of them, which is no higher than in the general population. Respiratory disease such as asthma, chronic bronchitis, byssinosis, and pulmonary tuberculosis which may occur from occupational exposures were considered, but there was no evidence to suggest a definite association between these conditions and coir dust. Twenty-two workers had abnormal chest radiographs, but when compared with a control group of 591 workers from an engineering firm where lesions were found in 20 cases, there was no significant difference. In the opinion of the medical officer, management and workers of the large factory investigated, coir dust does not produce any respiratory disability. The chemical composition of coir dust is similar to that of sisal which is also relatively inert. PMID:1125129

Localizing tuberculosis in chest radiographs with deep learning

NASA Astrophysics Data System (ADS)

Xue, Zhiyun; Jaeger, Stefan; Antani, Sameer; Long, L. Rodney; Karargyris, Alexandros; Siegelman, Jenifer; Folio, Les R.; Thoma, George R.

2018-03-01

Chest radiography (CXR) has been used as an effective tool for screening tuberculosis (TB). Because of the lack of radiological expertise in resource-constrained regions, automatic analysis of CXR is appealing as a "first reader". In addition to screening the CXR for disease, it is critical to highlight locations of the disease in abnormal CXRs. In this paper, we focus on the task of locating TB in CXRs which is more challenging due to the intrinsic difficulty of locating the abnormality. The method is based on applying a convolutional neural network (CNN) to classify the superpixels generated from the lung area. Specifically, it consists of four major components: lung ROI extraction, superpixel segmentation, multi-scale patch generation/labeling, and patch classification. The TB regions are located by identifying those superpixels whose corresponding patches are classified as abnormal by the CNN. The method is tested on a publicly available TB CXR dataset which contains 336 TB images showing various manifestations of TB. The TB regions in the images were marked by radiologists. To evaluate the method, the images are split into training, validation, and test sets with all the manifestations being represented in each set. The performance is evaluated at both the patch level and image level. The classification accuracy on the patch test set is 72.8% and the average Dice index for the test images is 0.67. The factors that may contribute to misclassification are discussed and directions for future work are addressed.

Simple X-ray versus ultrasonography examination in blunt chest trauma: effective tools of accurate diagnosis and considerations for rib fractures.

PubMed

Hwang, Eun Gu; Lee, Yunjung

2016-12-01

Simple radiography is the best diagnostic tool for rib fractures caused by chest trauma, but it has some limitations. Thus, other tools are also being used. The aims of this study were to investigate the effectiveness of ultrasonography (US) for identifying rib fractures and to identify influencing factors of its effectiveness. Between October 2003 and August 2007, 201 patients with blunt chest trauma were available to undergo chest radiographic and US examinations for diagnosis of rib fractures. The two modalities were compared in terms of effectiveness based on simple radiographic readings and US examination results. We also investigated the factors that influenced the effectiveness of US examination. Rib fractures were detected on radiography in 69 patients (34.3%) but not in 132 patients. Rib fractures were diagnosed by using US examination in 160 patients (84.6%). Of the 132 patients who showed no rib fractures on radiography, 92 showed rib fractures on US. Among the 69 patients of rib fracture detected on radiography, 33 had additional rib fractures detected on US. Of the patients, 76 (37.8%) had identical radiographic and US results, and 125 (62.2%) had fractures detected on US that were previously undetected on radiography or additional fractures detected on US. Age, duration until US examination, and fracture location were not significant influencing factors. However, in the group without detected fractures on radiography, US showed a more significant effectiveness than in the group with detected fractures on radiography ( P =0.003). US examination could detect unnoticed rib fractures on simple radiography. US examination is especially more effective in the group without detected fractures on radiography. More attention should be paid to patients with chest trauma who have no detected fractures on radiography.

A radiographic survey of monumental masonry workers in Aberdeen

PubMed Central

Davies, T. A. Lloyd; Doig, A. T.; Fox, A. J.; Greenberg, M.

1973-01-01

Lloyd Davies, T. A., Doig, A. T., Fox, A. J., and Greenberg, M. (1973).British Journal of Industrial Medicine,30, 227-231. A radiographic survey of monumental masonry workers in Aberdeen. A survey of radiographic appearances of the lungs of monumental masonry workers in Aberdeen was carried out to determine the present prevalence of abnormalities and to serve as a standard for future comparisons in view of changes in methods of working. No major change could be detected in the status of these granite workers in Aberdeen over the past 20 years but the different methods of survey used by Mair in 1951 and by the present study did not allow of strict comparison. Chest radiographs were reported on by three readers independently using the National Coal Board elaboration of the ILO classification and a score was given to each film using Oldham's method. Multiple regression analysis showed that ϰ-ray changes were related to years in granite but progression was slow in comparison with foundry workers. The prevalence of radiographic appearances of category 1 or greater was 3·0% overall and 4·6% for workers in dusty jobs. Evidence of pneumoconiosis was not observed in workers exposed for less than 20 years. With the environmental control attained the threshold limit values for respirable dust were not often much exceeded. PMID:4353240

Bone images from dual-energy subtraction chest radiography in the detection of rib fractures.

PubMed

Szucs-Farkas, Zsolt; Lautenschlager, Katrin; Flach, Patricia M; Ott, Daniel; Strautz, Tamara; Vock, Peter; Ruder, Thomas D

2011-08-01

To assess the sensitivity and image quality of chest radiography (CXR) with or without dual-energy subtracted (ES) bone images in the detection of rib fractures. In this retrospective study, 39 patients with 204 rib fractures and 24 subjects with no fractures were examined with a single exposure dual-energy subtraction digital radiography system. Three blinded readers first evaluated the non-subtracted posteroanterior and lateral chest radiographs alone, and 3 months later they evaluated the non-subtracted images together with the subtracted posteroanterior bone images. The locations of rib fractures were registered with confidence levels on a 3-grade scale. Image quality was rated on a 5-point scale. Marks by readers were compared with fracture localizations in CT as a standard of reference. The sensivity for fracture detection using both methods was very similar (34.3% with standard CXR and 33.5% with ES-CXR, p=0.92). At the patient level, both sensitivity (71.8%) and specificity (92.9%) with or without ES were identical. Diagnostic confidence was not significantly different (2.61 with CXR and 2.75 with ES-CXR, p=0.063). Image quality with ES was rated higher than that on standard CXR (4.08 vs. 3.74, p<0.001). Despite a better image quality, adding ES bone images to standard radiographs of the chest does not provide better sensitivity or improved diagnostic confidence in the detection of rib fractures. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Comparison of Computed Tomography and Chest Radiography in the Detection of Rib Fractures in Abused Infants

ERIC Educational Resources Information Center

Wootton-Gorges, Sandra L.; Stein-Wexler, Rebecca; Walton, John W.; Rosas, Angela J.; Coulter, Kevin P.; Rogers, Kristen K.

2008-01-01

Purpose: Chest radiographs (CXR) are the standard method for evaluating rib fractures in abused infants. Computed tomography (CT) is a sensitive method to detect rib fractures. The purpose of this study was to compare CT and CXR in the evaluation of rib fractures in abused infants. Methods: This retrospective study included all 12 abused infants…

Comparison of patient specific dose metrics between chest radiography, tomosynthesis, and CT for adult patients of wide ranging body habitus

PubMed Central

Zhang, Yakun; Li, Xiang; Segars, W. Paul; Samei, Ehsan

2014-01-01

Purpose: Given the radiation concerns inherent to the x-ray modalities, accurately estimating the radiation doses that patients receive during different imaging modalities is crucial. This study estimated organ doses, effective doses, and risk indices for the three clinical chest x-ray imaging techniques (chest radiography, tomosynthesis, and CT) using 59 anatomically variable voxelized phantoms and Monte Carlo simulation methods. Methods: A total of 59 computational anthropomorphic male and female extended cardiac-torso (XCAT) adult phantoms were used in this study. Organ doses and effective doses were estimated for a clinical radiography system with the capability of conducting chest radiography and tomosynthesis (Definium 8000, VolumeRAD, GE Healthcare) and a clinical CT system (LightSpeed VCT, GE Healthcare). A Monte Carlo dose simulation program (PENELOPE, version 2006, Universitat de Barcelona, Spain) was used to mimic these two clinical systems. The Duke University (Durham, NC) technique charts were used to determine the clinical techniques for the radiographic modalities. An exponential relationship between CTDIvol and patient diameter was used to determine the absolute dose values for CT. The simulations of the two clinical systems compute organ and tissue doses, which were then used to calculate effective dose and risk index. The calculation of the two dose metrics used the tissue weighting factors from ICRP Publication 103 and BEIR VII report. Results: The average effective dose of the chest posteroanterior examination was found to be 0.04 mSv, which was 1.3% that of the chest CT examination. The average effective dose of the chest tomosynthesis examination was found to be about ten times that of the chest posteroanterior examination and about 12% that of the chest CT examination. With increasing patient average chest diameter, both the effective dose and risk index for CT increased considerably in an exponential fashion, while these two dose metrics

Comparison of patient specific dose metrics between chest radiography, tomosynthesis, and CT for adult patients of wide ranging body habitus

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, Yakun; Li, Xiang; Segars, W. Paul

2014-02-15

Purpose: Given the radiation concerns inherent to the x-ray modalities, accurately estimating the radiation doses that patients receive during different imaging modalities is crucial. This study estimated organ doses, effective doses, and risk indices for the three clinical chest x-ray imaging techniques (chest radiography, tomosynthesis, and CT) using 59 anatomically variable voxelized phantoms and Monte Carlo simulation methods. Methods: A total of 59 computational anthropomorphic male and female extended cardiac-torso (XCAT) adult phantoms were used in this study. Organ doses and effective doses were estimated for a clinical radiography system with the capability of conducting chest radiography and tomosynthesis (Definiummore » 8000, VolumeRAD, GE Healthcare) and a clinical CT system (LightSpeed VCT, GE Healthcare). A Monte Carlo dose simulation program (PENELOPE, version 2006, Universitat de Barcelona, Spain) was used to mimic these two clinical systems. The Duke University (Durham, NC) technique charts were used to determine the clinical techniques for the radiographic modalities. An exponential relationship between CTDI{sub vol} and patient diameter was used to determine the absolute dose values for CT. The simulations of the two clinical systems compute organ and tissue doses, which were then used to calculate effective dose and risk index. The calculation of the two dose metrics used the tissue weighting factors from ICRP Publication 103 and BEIR VII report. Results: The average effective dose of the chest posteroanterior examination was found to be 0.04 mSv, which was 1.3% that of the chest CT examination. The average effective dose of the chest tomosynthesis examination was found to be about ten times that of the chest posteroanterior examination and about 12% that of the chest CT examination. With increasing patient average chest diameter, both the effective dose and risk index for CT increased considerably in an exponential fashion, while these two

Retrospective evaluation of exposure index (EI) values from plain radiographs reveals important considerations for quality improvement

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mothiram, Ursula; Brennan, Patrick C; Robinson, John

2013-12-15

Following X-ray exposure, radiographers receive immediate feedback on detector exposure in the form of the exposure index (EI). To identify whether radiographers are meeting manufacturer-recommended EI (MREI) ranges for routine chest, abdomen and pelvis X-ray examinations under a variety of conditions and to examine factors affecting the EI. Data on 5000 adult X-ray examinations including the following variables were collected: examination parameters, EI values, patient gender, date of birth, date and time of examination, grid usage and the presence of implant or prosthesis. Descriptive statistics were used to summarize each data set and the Mann–Whitney U test was used tomore » determine significant differences, with P < 0.05 indicating significance for all tests. Most examinations demonstrated EI values that were outside the MREI ranges, with significantly higher median EI values recorded for female patient radiographs than those for male patients for all manufacturers, indicating higher detector exposures for all units except for Philips digital radiography (DR), where increased EI values indicate lower exposure (P = 0.01). Median EI values for out of hours radiography were also significantly higher compared with normal working hours for all technologies (P ≤ 0.02). Significantly higher median EI values were demonstrated for Philips DR chest X-rays without as compared to those with the employment of a grid (P = 0.03), while significantly lower median EI values were recorded for Carestream Health computed radiography (CR) chest X-rays when an implant or prosthesis was present (P = 0.02). Non-adherence to MREIs has been demonstrated with EI value discrepancies being dependent on patient gender, time/day of exposure, grid usage and the presence of an implant or prosthesis. Retrospective evaluation of EI databases is a valuable tool to assess the need of quality improvement in routine DR.« less

[Chest pain units or chest pain algorithm?].

PubMed

Christ, M; Dormann, H; Enk, R; Popp, S; Singler, K; Müller, C; Mang, H

2014-10-01

A large number of patients present to the emergency department (ED) for evaluation of acute chest pain. About 10-15% are caused by acute myocardial infarction (MI), and over 50% of cases are due to noncardiac reasons. Further improvement for chest pain evaluation appears necessary. What are current options to improve chest pain evaluation in Germany? A selective literature search was performed using the following terms: "chest pain", "emergency department", "acute coronary syndrome" and "chest pain evaluation". A working group of the German Society of Cardiology published recommendations for infrastructure, equipment and organisation of chest pain units in Germany, which should be separated from the ED of hospitals and be under the leadership of a cardiologist. A symptom-based decision for acute care would be preferable if all differential diagnoses of diseases could be managed by one medical specialty: However, all four main symptoms of patients with acute MI (chest pain, acute dyspnea, abdominal pain, dizziness) are also caused by diseases of different specialties. Evaluation and treatment of acute chest pain by representatives of one specialty would lead to over- or undertreatment of affected patients. Therefore we suggest a multidisciplinary evaluation of patients with acute chest pain including representatives of emergency and critical care physicians, cardiologists, internists, geriatricians, family physicians, premedics and emergency nurses. Definition of key indicators of performance and institutionalized feedback will help to further improve quality of care.

Improving Abnormality Detection on Chest Radiography Using Game-Like Reinforcement Mechanics.

PubMed

Chen, Po-Hao; Roth, Howard; Galperin-Aizenberg, Maya; Ruutiainen, Alexander T; Gefter, Warren; Cook, Tessa S

2017-11-01

Despite their increasing prevalence, online textbooks, question banks, and digital references focus primarily on explicit knowledge. Implicit skills such as abnormality detection require repeated practice on clinical service and have few digital substitutes. Using mechanics traditionally deployed in video games such as clearly defined goals, rapid-fire levels, and narrow time constraints may be an effective way to teach implicit skills. We created a freely available, online module to evaluate the ability of individuals to differentiate between normal and abnormal chest radiographs by implementing mechanics, including instantaneous feedback, rapid-fire cases, and 15-second timers. Volunteer subjects completed the modules and were separated based on formal experience with chest radiography. Performance between training and testing sets were measured for each group, and a survey was administered after each session. The module contained 74 cases and took approximately 20 minutes to complete. Thirty-two cases were normal radiographs and 56 cases were abnormal. Of the 60 volunteers recruited, 25 were "never trained" and 35 were "previously trained." "Never trained" users scored 21.9 out of 37 during training and 24.0 out of 37 during testing (59.1% vs 64.9%, P value <.001). "Previously trained" users scored 28.0 out of 37 during training and 28.3 out of 37 during testing phases (75.6% vs 76.4%, P value = .56). Survey results showed that 87% of all subjects agreed the module is an efficient way of learning, and 83% agreed the rapid-fire module is valuable for medical students. A gamified online module may improve the abnormality detection rates of novice interpreters of chest radiography, although experienced interpreters are less likely to derive similar benefits. Users reviewed the educational module favorably. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Value of History, Physical Examination, and Radiographic Findings in the Diagnosis of Symptomatic Meniscal Tear Among Middle-Aged Subjects With Knee Pain.

PubMed

Katz, Jeffrey N; Smith, Savannah R; Yang, Heidi Y; Martin, Scott D; Wright, John; Donnell-Fink, Laurel A; Losina, Elena

2017-04-01

To evaluate the utility of clinical history, radiographic findings, and physical examination findings in the diagnosis of symptomatic meniscal tear (SMT) in patients over age 45 years, in whom concomitant osteoarthritis is prevalent. In a cross-sectional study of patients from 2 orthopedic surgeons' clinics, we assessed clinical history, physical examination findings, and radiographic findings in patients age >45 years with knee pain. The orthopedic surgeons rated their confidence that subjects' symptoms were due to meniscal tear; we defined the diagnosis of SMT as at least 70% confidence. We used logistic regression to identify factors independently associated with diagnosis of SMT, and we used the regression results to construct an index of the likelihood of SMT. In 174 participants, 6 findings were associated independently with the expert clinician having ≥70% confidence that symptoms were due to meniscal tear: localized pain, ability to fully bend the knee, pain duration <1 year, lack of varus alignment, lack of pes planus, and absence of joint space narrowing on radiographs. The index identified a low-risk group with 3% likelihood of SMT. While clinicians traditionally rely upon mechanical symptoms in this diagnostic setting, our findings did not support the conclusion that mechanical symptoms were associated with the expert's confidence that symptoms were due to meniscal tear. An index that includes history of localized pain, full flexion, duration <1 year, pes planus, varus alignment, and joint space narrowing can be used to stratify patients according to their risk of SMT, and it identifies a subgroup with very low risk. © 2016, American College of Rheumatology.

Application of Deconvolution Algorithm of Point Spread Function in Improving Image Quality: An Observer Preference Study on Chest Radiography.

PubMed

Chae, Kum Ju; Goo, Jin Mo; Ahn, Su Yeon; Yoo, Jin Young; Yoon, Soon Ho

2018-01-01

To evaluate the preference of observers for image quality of chest radiography using the deconvolution algorithm of point spread function (PSF) (TRUVIEW ART algorithm, DRTECH Corp.) compared with that of original chest radiography for visualization of anatomic regions of the chest. Prospectively enrolled 50 pairs of posteroanterior chest radiographs collected with standard protocol and with additional TRUVIEW ART algorithm were compared by four chest radiologists. This algorithm corrects scattered signals generated by a scintillator. Readers independently evaluated the visibility of 10 anatomical regions and overall image quality with a 5-point scale of preference. The significance of the differences in reader's preference was tested with a Wilcoxon's signed rank test. All four readers preferred the images applied with the algorithm to those without algorithm for all 10 anatomical regions (mean, 3.6; range, 3.2-4.0; p < 0.001) and for the overall image quality (mean, 3.8; range, 3.3-4.0; p < 0.001). The most preferred anatomical regions were the azygoesophageal recess, thoracic spine, and unobscured lung. The visibility of chest anatomical structures applied with the deconvolution algorithm of PSF was superior to the original chest radiography.

Occult caries or pre-eruptive intracoronal resorption? A chance finding on a radiograph.

PubMed

Wong, Lilia; Khan, Sadaf

2014-01-01

The purpose of this paper was to describe a rare case of idiopathic coronal resorption of an unerupted permanent mandibular second molar, which was detected as a chance finding on an orthopantomogram taken to assess dental eruption on a young patient about to start orthodontic treatment. The affected tooth was removed and underwent histopathological investigation. This case report provides a discussion of the possible etiologies for this radiographic appearance, as well as the diagnosis and management of such lesions. Failure to identify such lesions can potentiate a guarded prognosis. Further research is required in this field to investigate the etiology and pathological process, albeit this is limited by the rarity if these lesions.

A comparison of digital tomosynthesis and chest radiography in evaluating airway lesions using computed tomography as a reference.

PubMed

Choo, Ji Yung; Lee, Ki Yeol; Yu, Ami; Kim, Je-Hyeong; Lee, Seung Heon; Choi, Jung Won; Kang, Eun-Young; Oh, Yu Whan

2016-09-01

To compare the diagnostic performance of digital tomosynthesis (DTS) and chest radiography for detecting airway abnormalities, using computed tomography (CT) as a reference. We evaluated 161 data sets from 149 patients (91 with and 70 without airway abnormalities) who had undergone radiography, DTS, and CT to detect airway problems. Radiographs and DTS were evaluated to localize and score the severity of the airway abnormalities, and to score the image quality using CT as a reference. Receiver operating characteristics (ROC), McNemar's test, weighted kappa, and the paired t-test were used for statistical analysis. The sensitivity of DTS was higher (reader 1, 93.51 %; reader 2, 94.29 %) than chest radiography (68.83 %; 71.43 %) in detecting airway lesions. The diagnostic accuracy of DTS (90.91 %; 94.70 %) was also significantly better than that of radiography (78.03 %; 82.58 %, all p < 0.05). DTS image quality was significantly better than chest radiography (1.83, 2.74; p < 0.05) in the results of both readers. The inter-observer agreement with respect to DTS findings was moderate and superior when compared to radiography findings. DTS is a more accurate and sensitive modality than radiography for detecting airway lesions that are easily obscured by soft tissue structures in the mediastinum. • Digital tomosynthesis offers new diagnostic options for airway lesions. • Digital tomosynthesis is more sensitive and accurate than radiography for airway lesions. • Digital tomosynthesis shows better image quality than radiography. • Assessment of lesion severity, via tomosynthesis is comparable to computed tomography.

Mastitis, a Radiographic, Clinical, and Histopathologic Review.

PubMed

Cheng, Lin; Reddy, Vijaya; Solmos, Gene; Watkins, Latanja; Cimbaluk, David; Bitterman, Pincas; Ghai, Ritu; Gattuso, Paolo

2015-01-01

Mastitis is a benign inflammatory process of the breast with heterogeneous histopathological findings, which clinically and radiographically may mimic a mammary carcinoma. We undertook a retrospective study on 37 cases of mastitis in our institution to correlate the radiographic imaging features and the clinical presentation with the histopathological findings. Histologically, there were 21 granulomatous, 7 fibrous, 3 plasma cell, 3 lupus, 2 lymphocytic, and 1 case of acute mastitis. Radiographically, 16/25 (64%) patients with ultrasound studies showed irregular hypoechoic masses suspicious for malignancy. Clinically, 38% of patients had an associated systemic disease. © 2015 Wiley Periodicals, Inc.

Late clotted haemothorax after blunt chest trauma.

PubMed Central

Sinha, P; Sarkar, P

1998-01-01

A clotted haemothorax can develop any time after blunt chest trauma. Two cases are described in which late clotted haemothoraces developed which were treated by limited thoracotomy and evacuation of clots. Late clotted haemothorax may occur even in the absence of any abnormal initial clinical findings. Early detection and treatment is important to avoid the complications of fibrothorax and empyema with permanent pulmonary dysfunction. After blunt chest trauma patients should be advised to return to the accident and emergency department for assessment on development of any new chest symptom. Under these circumstances a chest x ray is mandatory to exclude a haemothorax. Images Figure 1 PMID:9639184

Paleopathological findings in radiographs of ancient and modern Greek skulls.

PubMed

Papagrigorakis, Manolis J; Karamesinis, Kostas G; Daliouris, Kostas P; Kousoulis, Antonis A; Synodinos, Philippos N; Hatziantoniou, Michail D

2012-12-01

The skull, when portrayed radiologically, can be a useful tool in detecting signs of systemic diseases and results of pathological growth mechanisms. The aim of this study was therefore to examine, compare, and classify findings in cranial configuration of pathological origin, in modern and ancient skulls. The material consists of 240 modern and 141 ancient dry skulls. Three radiographs for each skull (lateral, anteroposterior, basilar) provide enough evidence for differential diagnoses. Cases of osteoporosis are among the interesting pathological findings. A prevalence of female modern skulls in those determined as osteoporotic skulls is noted. Special interest is placed on the area of the sella turcica and many variations, regarding the shape and texture, are recognized both in ancient and modern skulls. Malignancies and important causes of cranial destruction are identified in both skull collections. Diploid thickening and osteolytic areas appear commonly among ancient remains. Moreover, from the ancient skull collection, one case possibly recognizable as fibrous dysplasia is noted while another case with an unusual exostosis gives rise to many questions. Interpreted with caution, the results of the present study, which can serve as an approach of paleopathology and paleoradiology, indicate similarity trends in cranial configuration of pathologic origin in modern and ancient people. Radiography and cephalometry were the main diagnostic tools used to gather evidence and are evaluated as a quite appropriate method to examine anthropological material and assess the internal structure of skeletal remains since they are non-destructive techniques.

Association between findings on palmarodorsal radiographic images and detection of a fracture in the proximal sesamoid bones of forelimbs obtained from cadavers of racing Thoroughbreds.

PubMed

Anthenill, Lucy A; Stover, Susan M; Gardner, Ian A; Hill, Ashley E; Lee, Christina M; Anderson, Mark L; Barr, Bradd C; Read, Deryck H; Johnson, Bill J; Woods, Leslie W; Daft, Barbara M; Kinde, Hailu; Moore, Janet D; Farman, Cynthia A; Odani, Jenee S; Pesavento, Patricia A; Uzal, Francisco A; Case, James T; Ardans, Alex A

2006-05-01

To determine the distribution for limbs and bones in horses with fractures of the proximal sesamoid bones and relationships with findings on palmarodorsal radiographic images. Proximal sesamoid bones obtained from both forelimbs of cadavers of 328 racing Thoroughbreds. Osteophytes; large vascular channels; and fracture location, orientation, configuration, and margin distinctness were categorized by use of high-detail contact palmarodorsal radiographs. Distributions of findings were determined. Relationships between radiographic findings and fracture characteristics were examined by use of chi2 and logistic regression techniques. Fractures were detected in 136 (41.5%) horses. Biaxial fractures were evident in 109 (80%) horses with a fracture. Osteophytes and large vascular channels were evident in 266 (81%) and 325 (99%) horses, respectively. Medial bones typically had complete transverse or split transverse simple fractures, indistinct fracture margins, > 1 vascular channel that was > 1 mm in width, and osteophytes in abaxial wing and basilar middle or basilar abaxial locations. Lateral bones typically had an oblique fracture and distinct fracture margins. Odds of proximal sesamoid bone fracture were approximately 2 to 5 times higher in bones without radiographic evidence of osteophytes or large vascular channels, respectively. Biaxial fractures of proximal sesamoid bones were common in cadavers of racing Thoroughbreds. Differences between medial and lateral bones for characteristics associated with fracture may relate to differences in fracture pathogeneses for these bones. Osteophytes and vascular channels were common findings; however, fractures were less likely to occur in bones with these features.

Traumatic pulmonary pseudocysts after blunt chest trauma: Prevalence, mechanisms of injury, and computed tomography findings.

PubMed

Cho, Hyun Jin; Jeon, Yang Bin; Ma, Dae Sung; Lee, Jung Nam; Chung, Min

2015-09-01

Traumatic pulmonary pseudocyst (TPP) is a rare complication of blunt chest trauma and closely related with severe injury. However, it has been poorly documented. We present a retrospective review of TPP cases treated at our hospital. The medical records and chest computed tomography scans of patients with TPP treated from January 2010 to December 2013 were retrospectively studied. A total of 978 patients underwent chest computed tomography for blunt chest trauma during the study period, and 81 (8.3%) had a total of 150 TPPs. The most common mechanism of injury was being struck by a motorized vehicle (n = 25, 30.9%). The mean (SD) Injury Severity Score (ISS) of the 81 patients was 33.2 (11.4). The prevalence of TPP was higher in younger patients (p = 0.011), but the total number of fractured ribs was significantly lower (p = 0.001). In a subgroup analysis performed according to pseudocyst location, the intraparenchymal group had more severe injuries than the subpleural group (ISS, 23.3 vs. 32.4, p < 0.001; chest Abbreviated Injury Scale [AIS] score, 3.4 vs. 4.0, p < 0.001; number of associated injuries, 2.9 vs. 4.0, p = 0.001). By multivariate analysis, ISS, age, and number of associated injuries were significantly different in these two groups (p = 0.038, p = 0.006, and p = 0.045, respectively). The prevalence of TPP among cases of blunt chest trauma was 8.3% and was higher in those struck by a vehicle and younger patients. Intraparenchymal pseudocyst was found to be related to more severe injuries. TPP was a self-limiting condition that does not require specific treatment. Prognostic/epidemiologic study, level IV.

Detection failure rate of chest radiography for the identification of nursing and healthcare-associated pneumonia.

PubMed

Miyashita, Naoyuki; Kawai, Yasuhiro; Tanaka, Takaaki; Akaike, Hiroto; Teranishi, Hideto; Wakabayashi, Tokio; Nakano, Takashi; Ouchi, Kazunobu; Okimoto, Niro

2015-07-01

To clarify the detection failure rate of chest radiography for the identification of nursing and healthcare-associated pneumonia (NHCAP), we compared high-resolution computed tomography (HRCT) with chest radiography simultaneously for patients with clinical symptoms and signs leading to a suspicion of NHCAP. We analyzed 208 NHCAP cases and compared them based on four groups defined using NHCAP criteria, patients who were: Group A) resident in an extended care facility or nursing home; Group B) discharged from a hospital within the preceding 90 days; Group C) receiving nursing care and had poor performance status; and Group D) receiving regular endovascular treatment. Chest radiography was inferior to HRCT for the identification of pneumonia (149 vs 208 cases, p < 0.0001). Among the designated NHCAP criteria, chest radiography identified pneumonia cases at a significantly lower frequency than HRCT in Group A (70 vs 97 cases, p = 0.0190) and Group C (86 vs 136 cases, p < 0.0001). The detection failure rate of chest radiography differed among NHCAP criteria; 27.8% in Group A, 26.5% in Group B, 36.7% in Group C and 5.8% in Group D. Cerebrovascular disease and poor functional status were significantly more frequent in patients in Groups A and C compared with those in Groups B and D. Physicians may underestimate pneumonia shadow in chest radiographs in patients with NHCAP, and the detection failure rate of chest radiography differed among NHCAP criteria. Poor functional status may correlate with the low accuracy of chest radiography in diagnosing pneumonia. Copyright © 2015. Published by Elsevier Ltd.

Flail Chest Following Failed Cardiopulmonary Resuscitation.

PubMed

Thompson, Melissa; Langlois, Neil E I; Byard, Roger W

2017-09-01

Following the death of a woman with blunt force chest trauma, the question was asked how common was the finding at autopsy of a flail chest in decedents after failed cardiopulmonary resuscitation. It was suggested in court that this was an uncommon occurrence. To address this issue, autopsy cases in adults (>18 years) with rib fractures attributable to cardiopulmonary resuscitation were taken from the files of Forensic Science SA over a 7-year period from 2008 to 2014. Flail chest injuries were defined as those arising from fractures at two sites in at least three consecutive ribs. From 236 cases with rib fractures attributed to resuscitation, a total of 43 flail chest injuries were found in 35 cases (14.8%). The majority occurred in the 60-79-year-old age group. These data suggest that flail chest injuries are a more common sequelae of cardiopulmonary resuscitation than has been previously appreciated in autopsy cases, particularly in the elderly. © 2017 American Academy of Forensic Sciences.

Clinical comparative study with a large-area amorphous silicon flat-panel detector: image quality and visibility of anatomic structures on chest radiography.

PubMed

Fink, Christian; Hallscheidt, Peter J; Noeldge, Gerd; Kampschulte, Annette; Radeleff, Boris; Hosch, Waldemar P; Kauffmann, Günter W; Hansmann, Jochen

2002-02-01

The objective of this study was to compare clinical chest radiographs of a large-area, flat-panel digital radiography system and a conventional film-screen radiography system. The comparison was based on an observer preference study of image quality and visibility of anatomic structures. Routine follow-up chest radiographs were obtained from 100 consecutive oncology patients using a large-area, amorphous silicon flat-panel detector digital radiography system (dose equivalent to a 400-speed film system). Hard-copy images were compared with previous examinations of the same individuals taken on a conventional film-screen system (200-speed). Patients were excluded if changes in the chest anatomy were detected or if the time interval between the examinations exceeded 1 year. Observer preference was evaluated for the image quality and the visibility of 15 anatomic structures using a five-point scale. Dose measurements with a chest phantom showed a dose reduction of approximately 50% with the digital radiography system compared with the film-screen radiography system. The image quality and the visibility of all but one anatomic structure of the images obtained with the digital flat-panel detector system were rated significantly superior (p < or = 0.0003) to those obtained with the conventional film-screen radiography system. The image quality and visibility of anatomic structures on the images obtained by the flat-panel detector system were perceived as equal or superior to the images from conventional film-screen chest radiography. This was true even though the radiation dose was reduced approximately 50% with the digital flat-panel detector system.

Quantitative analysis of rib movement based on dynamic chest bone images: preliminary results

NASA Astrophysics Data System (ADS)

Tanaka, R.; Sanada, S.; Oda, M.; Mitsutaka, M.; Suzuki, K.; Sakuta, K.; Kawashima, H.

2014-03-01

Rib movement during respiration is one of the diagnostic criteria in pulmonary impairments. In general, the rib movement is assessed in fluoroscopy. However, the shadows of lung vessels and bronchi overlapping ribs prevent accurate quantitative analysis of rib movement. Recently, an image-processing technique for separating bones from soft tissue in static chest radiographs, called "bone suppression technique", has been developed. Our purpose in this study was to evaluate the usefulness of dynamic bone images created by the bone suppression technique in quantitative analysis of rib movement. Dynamic chest radiographs of 10 patients were obtained using a dynamic flat-panel detector (FPD). Bone suppression technique based on a massive-training artificial neural network (MTANN) was applied to the dynamic chest images to create bone images. Velocity vectors were measured in local areas on the dynamic bone images, which formed a map. The velocity maps obtained with bone and original images for scoliosis and normal cases were compared to assess the advantages of bone images. With dynamic bone images, we were able to quantify and distinguish movements of ribs from those of other lung structures accurately. Limited rib movements of scoliosis patients appeared as reduced rib velocity vectors. Vector maps in all normal cases exhibited left-right symmetric distributions, whereas those in abnormal cases showed nonuniform distributions. In conclusion, dynamic bone images were useful for accurate quantitative analysis of rib movements: Limited rib movements were indicated as a reduction of rib movement and left-right asymmetric distribution on vector maps. Thus, dynamic bone images can be a new diagnostic tool for quantitative analysis of rib movements without additional radiation dose.

Computer-assisted instruction and diagnosis of radiographic findings.

PubMed

Harper, D; Butler, C; Hodder, R; Allman, R; Woods, J; Riordan, D

1984-04-01

Recent advances in computer technology, including high bit-density storage, digital imaging, and the ability to interface microprocessors with videodisk, create enormous opportunities in the field of medical education. This program, utilizing a personal computer, videodisk, BASIC language, a linked textfile system, and a triangulation approach to the interpretation of radiographs developed by Dr. W. L. Thompson, can enable the user to engage in a user-friendly, dynamic teaching program in radiology, applicable to various levels of expertise. Advantages include a relatively more compact and inexpensive system with rapid access and ease of revision which requires little instruction to the user.

Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures.

PubMed

Chapman, Brandon C; Overbey, Douglas M; Tesfalidet, Feven; Schramm, Kristofer; Stovall, Robert T; French, Andrew; Johnson, Jeffrey L; Burlew, Clay C; Barnett, Carlton; Moore, Ernest E; Pieracci, Fredric M

2016-12-01

Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest. The CT finding of ≥ 3 additional fractures in patients with ≤ 3 rib fractures on CXR was considered clinically meaningful. Student's t-test and chi-square analysis were used for comparison. We identified 499 patients with rib fractures: 93 (18.6%) had CXR only, 7 (1.4%) had chest CT only, and 399 (79.9%) had both CXR and chest CT. Among these 399 patients, a total of 1,969 rib fractures were identified: 1,467 (74.5%) were missed by CXR. The median number of additional fractures identified by CT was 3 (range, 4 - 15). Of 212 (53.1%) patients with a clinically meaningful increase in the number of fractures, 68 patients underwent one or more clinical interventions: 36 SICU admissions, 20 pain catheter placements, 23 epidural placements, and 3 SSRF. Additionally, 70 patients had a chest tube placed for retained hemothorax or occult pneumothorax. Overall, 138 patients (34.5%) had a change in clinical management based upon CT chest. The chest X-ray missed ~75% of rib fractures seen on chest CT. Although patients with a clinical meaningful increase in the number of rib fractures were more likely to be admitted to the intensive care unit, there was no associated improvement in pulmonary outcomes.

Investigating the use of an antiscatter grid in chest radiography for average adults with a computed radiography imaging system

PubMed Central

Wood, T J; Avery, G; Balcam, S; Needler, L; Smith, A; Saunderson, J R; Beavis, A W

2015-01-01

Objective: The aim of this study was to investigate via simulation a proposed change to clinical practice for chest radiography. The validity of using a scatter rejection grid across the diagnostic energy range (60–125 kVp), in conjunction with appropriate tube current–time product (mAs) for imaging with a computed radiography (CR) system was investigated. Methods: A digitally reconstructed radiograph algorithm was used, which was capable of simulating CR chest radiographs with various tube voltages, receptor doses and scatter rejection methods. Four experienced image evaluators graded images with a grid (n = 80) at tube voltages across the diagnostic energy range and varying detector air kermas. These were scored against corresponding images reconstructed without a grid, as per current clinical protocol. Results: For all patients, diagnostic image quality improved with the use of a grid, without the need to increase tube mAs (and therefore patient dose), irrespective of the tube voltage used. Increasing tube mAs by an amount determined by the Bucky factor made little difference to image quality. Conclusion: A virtual clinical trial has been performed with simulated chest CR images. Results indicate that the use of a grid improves diagnostic image quality for average adults, without the need to increase tube mAs, even at low tube voltages. Advances in knowledge: Validated with images containing realistic anatomical noise, it is possible to improve image quality by utilizing grids for chest radiography with CR systems without increasing patient exposure. Increasing tube mAs by an amount determined by the Bucky factor is not justified. PMID:25571914

Morbidity and mortality of vermiculite miners and millers exposed to tremolite-actinolite: Part III. Radiographic findings

DOE Office of Scientific and Technical Information (OSTI.GOV)

Amandus, H.E.; Althouse, R.; Morgan, W.K.

1987-01-01

A study was conducted to estimate the exposure-response relationship for tremolite-actinolite fiber exposure and radiographic findings among 184 men employed at a Montana vermiculite mine and mill. Workers were included if they had been employed during 1975-1982 and had achieved at least 5 years tenure at the Montana site. Past fiber exposure was associated with an increased prevalence of parenchymal and pleural radiographic abnormalities. Smoking was not significantly related to the prevalence of small opacities. However, the number of workers who had never smoked was small, and this prevented measurement of the smoking effect. Under control for smoking and age,more » the prevalence of small opacities was significantly greater for vermiculite workers with greater than 100 fiber/cc-years exposure than for comparison groups (cement workers, blue collar workers, and coal miners) who had no known occupational fiber exposure. A logistic model predicted an increase of 1.3% in the odds ratio for small opacities at an additional exposure of 5 fiber-years.« less

Chest X-Ray (Chest Radiography)

MedlinePlus

... may be necessary to clarify the results of a chest x-ray or to look for abnormalities not visible on the chest x-ray. top of page Additional Information and Resources RTAnswers.org Radiation Therapy for Lung Cancer top of page This page ...

The morbidity and mortality of vermiculite miners and millers exposed to tremolite-actinolite: Part III. Radiographic findings.

PubMed

Amandus, H E; Althouse, R; Morgan, W K; Sargent, E N; Jones, R

1987-01-01

A study was conducted to estimate the exposure-response relationship for tremolite-actinolite fiber exposure and radiographic findings among 184 men employed at a Montana vermiculite mine and mill. Workers were included if they had been employed during 1975-1982 and had achieved at least 5 years tenure at the Montana site. Past fiber exposure was associated with an increased prevalence of parenchymal and pleural radiographic abnormalities. Smoking was not significantly related to the prevalence of small opacities. However, the number of workers who had never smoked was small, and this prevented measurement of the smoking effect. Under control for smoking and age, the prevalence of small opacities was significantly greater for vermiculite workers with greater than 100 fiber/cc-years exposure than for comparison groups (cement workers, blue collar workers, and coal miners) who had no known occupational fiber exposure. A logistic model predicted an increase of 1.3% in the odds ratio for small opacities at an additional exposure of 5 fiber-years.

A novel teaching tool using dynamic cues improves visualisation of chest lesions by naive observers

NASA Astrophysics Data System (ADS)

Mohamed Ali, M. A.; Toomey, R. J.; Ryan, J. T.; Cuffe, F. C.; Brennan, P. C.

2009-02-01

Introduction Dynamic cueing is an effective way of stimulating perception of regions of interest within radiological images. This study explores the impact of a novel teaching tool using dynamic cueing for lesion detection on plain chest radiographs. Materials and methods Observer performance studies were carried out where 36 novices examined 30 chest images in random order. Half of these contained between one and three simulated pulmonary nodules. Three groups were investigated: A (control: no teaching tool), B (retested immediately after undergoing the teaching tool) and C (retested a week after undergoing the teaching tool). The teaching tool involved dynamically displaying the same images with and without lesions. Results were compared using Receiver Operating Characteristics (ROC), sensitivity and specificity analyses. Results The second reading showed significantly greater area under the ROC curve (Az value) (p<0.0001) and higher sensitivity value (p=0.004) compared to the first reading for Group B. No differences between readings were demonstrated for groups A or C. When the magnitudes of the above changes were compared between Group B and the other two groups, greater changes in Az value for Group B were noted (B vs. A:p=0.0003, B vs. C:p=0.0005). For sensitivity, when Group B was compared to Group A, the magnitude of the change was significantly greater (p=0.0029) whereas when Group B was compared to Group C, the magnitude change demonstrated a level approaching significance (p=0.0768). Conclusions The novel teaching tool improves identification of pulmonary nodular lesions on chest radiographs in the short term.

Assessment of medial coronoid disease in 180 canine lame elbow joints: a sensitivity and specificity comparison of radiographic, computed tomographic and arthroscopic findings.

PubMed

Villamonte-Chevalier, A; van Bree, H; Broeckx, Bjg; Dingemanse, W; Soler, M; Van Ryssen, B; Gielen, I

2015-09-25

Diagnostic imaging is essential to assess the lame patient; lesions of the elbow joint have traditionally been evaluated radiographically, however computed tomography (CT) has been suggested as a useful technique to diagnose various elbow pathologies. The primary objective of this study was to determine the sensitivity and specificity of CT to assess medial coronoid disease (MCD), using arthroscopy as gold standard. The secondary objective was to ascertain the radiographic sensitivity and specificity for MCD compared with CT. For this study 180 elbow joints were assessed, of which 141 had been examined with radiography, CT and arthroscopy; and 39 joints, had radiographic and CT assessment. Sensitivity and specificity were calculated for CT and radiographic findings using available statistical software. Sensitivity and specificity of CT using arthroscopy as gold standard resulted in high values for sensitivity (100 %) and specificity (93 %) for the assessment of MCD. For the radiographic evaluation, a sensitivity of 98 % and specificity of 64 - 69 % using CT as the technique of reference, were found. These results suggest that in case of doubt during radiographic assessment, CT could be used as a non-invasive technique to assess the presence of MCD. Based on the high sensitivity and specificity obtained in this study it has been considered that CT, rather than arthroscopy, is the preferred noninvasive technique to assess MCD lesions of the canine elbow joint.

Optimization of dual-energy subtraction chest radiography by use of a direct-conversion flat-panel detector system.

PubMed

Fukao, Mari; Kawamoto, Kiyosumi; Matsuzawa, Hiroaki; Honda, Osamu; Iwaki, Takeshi; Doi, Tsukasa

2015-01-01

We aimed to optimize the exposure conditions in the acquisition of soft-tissue images using dual-energy subtraction chest radiography with a direct-conversion flat-panel detector system. Two separate chest images were acquired at high- and low-energy exposures with standard or thick chest phantoms. The high-energy exposure was fixed at 120 kVp with the use of an auto-exposure control technique. For the low-energy exposure, the tube voltages and entrance surface doses ranged 40-80 kVp and 20-100 % of the dose required for high-energy exposure, respectively. Further, a repetitive processing algorithm was used for reduction of the image noise generated by the subtraction process. Seven radiology technicians ranked soft-tissue images, and these results were analyzed using the normalized-rank method. Images acquired at 60 kVp were of acceptable quality regardless of the entrance surface dose and phantom size. Using a repetitive processing algorithm, the minimum acceptable doses were reduced from 75 to 40 % for the standard phantom and to 50 % for the thick phantom. We determined that the optimum low-energy exposure was 60 kVp at 50 % of the dose required for the high-energy exposure. This allowed the simultaneous acquisition of standard radiographs and soft-tissue images at 1.5 times the dose required for a standard radiograph, which is significantly lower than the values reported previously.

The role of hip and chest radiographs in osteoporotic evaluation among south Indian women population: a comparative scenario with DXA.

PubMed

Kumar, D Ashok; Anburajan, M

2014-05-01

Osteoporosis is recognized as a worldwide skeletal disorder problem. In India, the older as well as postmenopausal women population suffering from osteoporotic fractures has been a common issue. Bone mineral density measurements gauged by dual-energy X-ray absorptiometry (DXA) are used in the diagnosis of osteoporosis. (1) To evaluate osteoporosis in south Indian women by radiogrammetric method in a comparative perspective with DXA. (2) To assess the capability of KJH; Anburajan's Empirical formula in the prediction of total hip bone mineral density (T.BMD) with estimated Hologic T.BMD. In this cross-sectional design, 56 south Indian women were evaluated. These women were randomly selected from a health camp. The patients with secondary bone diseases were excluded. The standard protocol was followed in acquiring BMD of the right proximal femur by DPX Prodigy (DXA Scanner, GE-Lunar Corp., USA). The measured Lunar Total hip BMD was converted into estimated Hologic Total hip BMD. In addition, the studied population underwent chest and hip radiographic measurements. Combined cortical thickness of clavicle has been used in KJH; Anburajan's Empirical formula to predict T.BMD and compared with estimated Hologic T.BMD by DXA. The correlation coefficients exhibited high significance. The combined cortical thickness of clavicle and femur shaft of total studied population was strongly correlated with DXA femur T.BMD measurements (r = 0.87, P < 0.01 and r = 0.45, P < 0.01) and it is also having strong correlation with low bone mass group (r = 0.87, P < 0.01 and r = 0.67, P < 0.01) KJH; Anburajan's Empirical formula shows significant correlation with estimated Hologic T.BMD (r = 0.88, P < 0.01) in total studied population. The empirical formula was identified as better tool for predicting osteoporosis in total population and old-aged population with a sensitivity (88.8 and 95.6 %), specificity (89.6 and 90.9 %), positive predictive value (88.8 and 95.6 %) and negative

Characteristics of Rib Fractures in Child Abuse-The Role of Low-Dose Chest Computed Tomography.

PubMed

Sanchez, Thomas R; Grasparil, Angelo D; Chaudhari, Ruchir; Coulter, Kevin P; Wootton-Gorges, Sandra L

2018-02-01

Our aim is to describe the radiologic characteristics of rib fractures in clinically diagnosed cases of child abuse and suggest a complementary imaging for radiographically occult injuries in highly suspicious cases of child abuse. Retrospective analysis of initial and follow-up skeletal surveys and computed tomography (CT) scans of 16 patients younger than 12 months were reviewed after obtaining approval from our institutional review board. The number, location, displacement, and age of the rib fractures were recorded. Out of a total 105 rib fractures, 84% (87/105) were detected on the initial skeletal survey. Seventeen percent (18/105) were seen only after follow-up imaging, more than half of which (11/18) were detected on a subsequent CT. Majority of the fractures were posterior (43%) and anterior (30%) in location. An overwhelming majority (96%) of the fractures are nondisplaced. Seventeen percent of rib fractures analyzed in the study were not documented on the initial skeletal survey. Majority of fractures are nondisplaced and located posteriorly or anteriorly, areas that are often difficult to assess especially in the acute stage. The CT scan is more sensitive in evaluating these types of fractures. Low-dose chest CT can be an important imaging modality for suspicious cases of child abuse when initial radiographic findings are inconclusive.

A retrospective study of a modified 1-minute formocresol pulpotomy technique part 1: clinical and radiographic findings.

PubMed

Kurji, Zahra A; Sigal, Michael J; Andrews, Paul; Titley, Keith

2011-01-01

The purpose of this study was to assess the clinical and radiographic outcomes of a 1-minute application of full-strength Buckley's formocresol with concurrent hemostasis using the medicated cotton pledget in human primary teeth. Using a retrospective chart review, clinical and radiographic data were available for 557 primary molars in 320 patients. Descriptive statistics and survival analysis were used to assess outcomes. Overall clinical success, radiographic success, and cumulative 5-year survival rates were approximately 99%, 90%, and 87%, respectively. Internal root resorption (∼5%) and pulp canal obliteration (∼2%) were the most frequently observed radiographic failures. Thirty-nine teeth were extracted due to clinical and or radiographic failure. Mandibular molars were 6 times more prone to radiographic failure than maxillary molars. Success rates for the modified technique are comparable to techniques that use the 5-minute diluted or full-strength solutions reported in the literature. This 1-minute full-strength formocresol technique is an acceptable alternative to published traditional techniques.

Radiographic, computed tomographic, gross pathological and histological findings with suspected apical infection in 32 equine maxillary cheek teeth (2012-2015).

PubMed

Liuti, T; Smith, S; Dixon, P M

2018-01-01

Equine maxillary cheek teeth apical infections are a significant disorder because of frequent spread of infection to the supporting bones. The accuracy of computed tomographic imaging (CT) of this disorder has not been fully assessed. To compare the radiographic and CT findings in horses diagnosed with maxillary cheek teeth apical infections with pathological findings in the extracted teeth to assess the accuracy of these imaging techniques. Observational clinical study. Thirty-two maxillary cheek teeth (in 29 horses) diagnosed with apical infections by clinical, radiographic and principally by CT examinations, were extracted orally. The extracted teeth were subjected to further CT, gross pathological and histological examinations. Four normal teeth extracted from a cadaver served as controls. Pulpar and apical changes highly indicative of maxillary cheek teeth apical infection were present in all 32 teeth on CT, but in just 17/32 teeth (53%) radiographically. Gross pulpar/apical abnormalities and histological pulpar/periapical changes were present in 31/32 (97%) extracted teeth. On CT, one tooth contained small gas pockets in the apical aspect of one pulp and adjacent periodontal space, however no pathological changes were found following its extraction. The study is descriptive and is confined to a small number of cases. This study showed a 97% agreement between CT diagnosis of maxillary cheek teeth apical infection and the presence of pathological changes in the extracted teeth, confirming the diagnostic accuracy of CT compared with radiography for this disorder. © 2017 EVJ Ltd.

Limited Utility of Polymerase Chain Reaction in Induced Sputum Specimens for Determining the Causes of Childhood Pneumonia in Resource-Poor Settings: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study

PubMed Central

Seidenberg, Phil; Park, Daniel E.; Mwananyanda, Lawrence; Fu, Wei; Shi, Qiyuan; Baggett, Henry C.; Brooks, W. Abdullah; Feikin, Daniel R.; Howie, Stephen R.C.; Knoll, Maria Deloria; Kotloff, Karen L.; Levine, Orin S.; Madhi, Shabir A.; O’Brien, Katherine L.; Scott, J. Anthony G.; Antonio, Martin; Awori, Juliet O.; Baillie, Vicky L.; DeLuca, Andrea N.; Driscoll, Amanda J.; Higdon, Melissa M.; Hossain, Lokman; Jahan, Yasmin; Karron, Ruth A.; Kazungu, Sidi; Li, Mengying; Moore, David P.; Morpeth, Susan C.; Ofordile, Ogochukwu; Prosperi, Christine; Sangwichian, Ornuma; Sawatwong, Pongpun; Sylla, Mamadou; Tapia, Milagritos D.; Zeger, Scott L.; Murdoch, David R.; Hammitt, Laura L.; O., K. L.; L., O. S.; K., M. D.; F., D. R.; D., A. N.; D., A. J.; Fancourt, Nicholas; F., W.; H., L. L.; H., M. M.; Wangeci Kagucia, E.; K., R. A.; L., M.; P., D. E.; P., C.; Wu, Zhenke; Z., S. L.; Watson, Nora L.; Crawley, Jane; M., D. R.; W. A., B.; Endtz, Hubert P.; Khalequ, Zaman; Goswami, Doli; H., L.; J., Y.; Ashraf, Hasan; H., S. R. C.; Ebruke, Bernard E.; A., M.; McLellan, Jessica; Machuka, Eunice; Shamsul, Arifin; Zaman, Syed M. A.; Mackenzie, Grant; S., J. A. G.; A., J. O.; M., S. C.; Kamau, Alice; K., S.; Ominde, Micah Silaba; K., K. L.; T., M. D.; Sow, Samba O.; S., M.; Tamboura, Boubou; Onwuchekwa, Uma; Kourouma, Nana; Toure, Aliou; M., S. A.; M., D. P.; Adrian, Peter V.; B., V. L.; Kuwanda, Locadiah; Mudau, Azwifarwi; Groome, Michelle J.; Mahomed, Nasreen; B., H. C.; Thamthitiwat, Somsak; Maloney, Susan A.; Bunthi, Charatdao; Rhodes, Julia; S., P.; Akarasewi, Pasakorn; T., D. M.; M., L.; Chipeta, James; S., P.; Mwansa, James; wa Somwe, Somwe; Kwenda, Geoffrey; Anderson, Trevor P.; Mitchell, Joanne

2017-01-01

Abstract Background. Sputum examination can be useful in diagnosing the cause of pneumonia in adults but is less well established in children. We sought to assess the diagnostic utility of polymerase chain reaction (PCR) for detection of respiratory viruses and bacteria in induced sputum (IS) specimens from children hospitalized with severe or very severe pneumonia. Methods. Among children aged 1–59 months, we compared organism detection by multiplex PCR in IS and nasopharyngeal/oropharyngeal (NP/OP) specimens. To assess whether organism presence or density in IS specimens was associated with chest radiographic evidence of pneumonia (radiographic pneumonia), we compared prevalence and density in IS specimens from children with radiographic pneumonia and children with suspected pneumonia but without chest radiographic changes or clinical or laboratory findings suggestive of pneumonia (nonpneumonia group). Results. Among 4232 cases with World Health Organization–defined severe or very severe pneumonia, we identified 1935 (45.7%) with radiographic pneumonia and 573 (13.5%) with nonpneumonia. The organism detection yield was marginally improved with IS specimens (96.2% vs 92.4% for NP/OP specimens for all viruses combined [P = .41]; 96.9% vs 93.3% for all bacteria combined [P = .01]). After accounting for presence in NP/OP specimens, no organism was detected more frequently in the IS specimens from the radiographic pneumonia compared with the nonpneumonia cases. Among high-quality IS specimens, there were no statistically significant differences in organism density, except with cytomegalovirus, for which there was a higher quantity in the IS specimens from cases with radiographic pneumonia compared with the nonpneumonia cases (median cycle threshold value, 27.9 vs 28.5, respectively; P = .01). Conclusions. Using advanced molecular methods with IS specimens provided little additional diagnostic information beyond that obtained with NP/OP swab specimens. PMID

Limited Utility of Polymerase Chain Reaction in Induced Sputum Specimens for Determining the Causes of Childhood Pneumonia in Resource-Poor Settings: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study.

PubMed

Thea, Donald M; Seidenberg, Phil; Park, Daniel E; Mwananyanda, Lawrence; Fu, Wei; Shi, Qiyuan; Baggett, Henry C; Brooks, W Abdullah; Feikin, Daniel R; Howie, Stephen R C; Knoll, Maria Deloria; Kotloff, Karen L; Levine, Orin S; Madhi, Shabir A; O'Brien, Katherine L; Scott, J Anthony G; Antonio, Martin; Awori, Juliet O; Baillie, Vicky L; DeLuca, Andrea N; Driscoll, Amanda J; Higdon, Melissa M; Hossain, Lokman; Jahan, Yasmin; Karron, Ruth A; Kazungu, Sidi; Li, Mengying; Moore, David P; Morpeth, Susan C; Ofordile, Ogochukwu; Prosperi, Christine; Sangwichian, Ornuma; Sawatwong, Pongpun; Sylla, Mamadou; Tapia, Milagritos D; Zeger, Scott L; Murdoch, David R; Hammitt, Laura L

2017-06-15

Sputum examination can be useful in diagnosing the cause of pneumonia in adults but is less well established in children. We sought to assess the diagnostic utility of polymerase chain reaction (PCR) for detection of respiratory viruses and bacteria in induced sputum (IS) specimens from children hospitalized with severe or very severe pneumonia. Among children aged 1-59 months, we compared organism detection by multiplex PCR in IS and nasopharyngeal/oropharyngeal (NP/OP) specimens. To assess whether organism presence or density in IS specimens was associated with chest radiographic evidence of pneumonia (radiographic pneumonia), we compared prevalence and density in IS specimens from children with radiographic pneumonia and children with suspected pneumonia but without chest radiographic changes or clinical or laboratory findings suggestive of pneumonia (nonpneumonia group). Among 4232 cases with World Health Organization-defined severe or very severe pneumonia, we identified 1935 (45.7%) with radiographic pneumonia and 573 (13.5%) with nonpneumonia. The organism detection yield was marginally improved with IS specimens (96.2% vs 92.4% for NP/OP specimens for all viruses combined [P = .41]; 96.9% vs 93.3% for all bacteria combined [P = .01]). After accounting for presence in NP/OP specimens, no organism was detected more frequently in the IS specimens from the radiographic pneumonia compared with the nonpneumonia cases. Among high-quality IS specimens, there were no statistically significant differences in organism density, except with cytomegalovirus, for which there was a higher quantity in the IS specimens from cases with radiographic pneumonia compared with the nonpneumonia cases (median cycle threshold value, 27.9 vs 28.5, respectively; P = .01). Using advanced molecular methods with IS specimens provided little additional diagnostic information beyond that obtained with NP/OP swab specimens. © The Author 2017. Published by Oxford University Press for the

Deep learning with non-medical training used for chest pathology identification

NASA Astrophysics Data System (ADS)

Bar, Yaniv; Diamant, Idit; Wolf, Lior; Greenspan, Hayit

2015-03-01

In this work, we examine the strength of deep learning approaches for pathology detection in chest radiograph data. Convolutional neural networks (CNN) deep architecture classification approaches have gained popularity due to their ability to learn mid and high level image representations. We explore the ability of a CNN to identify different types of pathologies in chest x-ray images. Moreover, since very large training sets are generally not available in the medical domain, we explore the feasibility of using a deep learning approach based on non-medical learning. We tested our algorithm on a dataset of 93 images. We use a CNN that was trained with ImageNet, a well-known large scale nonmedical image database. The best performance was achieved using a combination of features extracted from the CNN and a set of low-level features. We obtained an area under curve (AUC) of 0.93 for Right Pleural Effusion detection, 0.89 for Enlarged heart detection and 0.79 for classification between healthy and abnormal chest x-ray, where all pathologies are combined into one large class. This is a first-of-its-kind experiment that shows that deep learning with large scale non-medical image databases may be sufficient for general medical image recognition tasks.

Radiographic follow-up of community-acquired pneumonia in children.

PubMed

Surén, Pål; Try, Kirsti; Eriksson, Jan; Khoshnewiszadeh, Behzad; Wathne, Karl-Olaf

2008-01-01

To evaluate the value of radiographic follow-up of community-acquired pneumonia in children who are previously healthy. Patient records for the years 2003 and 2004 at the Ullevål University Hospital in Oslo were reviewed, and a total of 245 children were selected for the study. Radiographs were evaluated by two paediatric radiologists independently. One hundred and thirty-three patients had control radiographs, of which 106 were normal and 27 were abnormal. Only three of 27 patients with abnormal findings had further clinical problems that could be related to the pneumonia. Two of 106 with normal findings had further clinical problems, despite the normal control radiograph. Of the 112 without radiographic follow-up, 10 had subsequent clinical problems, but most occurred within the first 4 weeks after discharge, before controls would have been scheduled. There were five patients who may have benefited from controls. One relapse could theoretically have been prevented. Four patients were cases for whom the pneumonias were the first manifestations of chronic lung disease. Such patients may have some benefit from control radiographs, but only in terms of detecting the chronic disease at an earlier stage, not in altering the clinical course. Such modest benefits must be weighed against the consequences of providing follow-up to a large number of healthy children, and making lots of abnormal findings with no clinical significance. Control radiographs are not very valuable in children who are otherwise healthy.

Demographic and clinical factors associated with radiographic severity of first metatarsophalangeal joint osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot.

PubMed

Menz, H B; Roddy, E; Marshall, M; Thomas, M J; Rathod, T; Myers, H; Thomas, E; Peat, G M

2015-01-01

To explore demographic and clinical factors associated with radiographic severity of first metatarsophalangeal joint osteoarthritis (OA) (First MTPJ OA). Adults aged ≥50 years registered with four general practices were mailed a Health Survey. Responders reporting foot pain within the last 12 months were invited to undergo a clinical assessment and weight-bearing dorso-plantar and lateral radiographs of both feet. Radiographic first MTPJ OA in the most severely affected foot was graded into four categories using a validated atlas. Differences in selected demographic and clinical factors were explored across the four radiographic severity subgroups using analysis of variance (ANOVA) and ordinal regression. Clinical and radiographic data were available from 517 participants, categorised as having no (n = 105), mild (n = 228), moderate (n = 122) or severe (n = 62) first MTPJ OA. Increased radiographic severity was associated with older age and lower educational attainment. After adjusting for age, increased radiographic first MTPJ OA severity was significantly associated with an increased prevalence of dorsal hallux and first MTPJ pain, hallux valgus, first interphalangeal joint (IPJ) hyperextension, keratotic lesions on the dorsal aspect of the hallux and first MTPJ, decreased first MTPJ dorsiflexion, ankle/subtalar joint eversion and ankle joint dorsiflexion range of motion, and a trend towards a more pronated foot posture. This cross-sectional study has identified several dose-response associations between radiographic severity of first MTPJ OA and a range of demographic and clinical factors. These findings highlight the progressive nature of first MTPJ OA and provide insights into the spectrum of presentation of the condition in clinical practice. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

[Utility of digital thoracotomy in chest trauma].

PubMed

Vélez, Sebastián E; Sarquis, Guillermo

2006-01-01

toracostomy in thoracic trauma is a good opportunity for the digital exploration of pleural cavity. To evaluate the utility of digital exploration during chest tube insertion in thoracic trauma. Hospital de Urgencias. Córdoba. patients with blunt and penetrating chest trauma by stab wound, who need chest tube insertion and treated by only one surgeon, were evaluated from July 10 to December 31st 2000. Previously to the thoracostomy with 24 french tube in 5th intercostal space, at the affected side, a digital exploration of pleural cavity was done, attempting to find intrathoracic injuries. in a six months period, 36 thoracostomy tubes were placed, due thoracic trauma (11 blunt trauma and 25 penetrating, by stab wound). Three patients had positive findings in the digital exploration, which forced to do another diagnostic or therapeutic procedures. digital thoracotomy is not considered a formal procedure, but as a part of a technique, in which, the previous exploration with the finger before chest tube insertion, allows to reach a diagnosis of the pleural space situation, to confirm suspicions, to modify a conduct, and to avoid greater morbidity to patients.

Florid cemento-osseous dysplasia: Report of a case documented with clinical, radiographic, biochemical and histological findings

PubMed Central

Çankal, Dilek A.; Bozkaya, Süleyman; Ergün, Gülfem; Bar??, Emre

2013-01-01

Florid cemento-osseous dysplasia (FCOD) has been described as a condition that characteristically affects the jaws of middle-aged black women. This condition has also been classified as gigantiform cementoma, chronic sclerosing osteomyelitis, sclerosing osteitis, multiple estenosis and sclerotic cemental masses. It usually exhibits as multiple radiopaque cementum-like masses distributed throughout the jaws. Radiographically, FCOD appears as dense, lobulated masses, often symmetrically located in various regions of the jaws. Computed tomography, because of its ability to give axial, sagittal, and frontal views, is useful in the evaluation of these lesions. This article reports the case of a 45-year-old white man who was diagnosed with FCOD on the basis of clinical, radiographic, biochemical and histological findings. It is of major importance to realize that all dentists have a unique opportunity as well as ethical obligation to assist in the struggle against wrong dental treatments that might save patients dental health. This case report illustrates the point that periapical radiolucencies may represent benign fibro-osseous lesions that may be overlooked or result in unnecessary endodontic treatment. Key words:Florid cemento-osseous dysplasia, florid osseous dysplasia, fibro-osseous lesions. PMID:24455053

Florid cemento-osseous dysplasia: Report of a case documented with clinical, radiographic, biochemical and histological findings.

PubMed

Kutluay Köklü, Harika; Cankal, Dilek A; Bozkaya, Süleyman; Ergün, Gülfem; Bar, Emre

2013-02-01

Florid cemento-osseous dysplasia (FCOD) has been described as a condition that characteristically affects the jaws of middle-aged black women. This condition has also been classified as gigantiform cementoma, chronic sclerosing osteomyelitis, sclerosing osteitis, multiple estenosis and sclerotic cemental masses. It usually exhibits as multiple radiopaque cementum-like masses distributed throughout the jaws. Radiographically, FCOD appears as dense, lobulated masses, often symmetrically located in various regions of the jaws. Computed tomography, because of its ability to give axial, sagittal, and frontal views, is useful in the evaluation of these lesions. This article reports the case of a 45-year-old white man who was diagnosed with FCOD on the basis of clinical, radiographic, biochemical and histological findings. It is of major importance to realize that all dentists have a unique opportunity as well as ethical obligation to assist in the struggle against wrong dental treatments that might save patients dental health. This case report illustrates the point that periapical radiolucencies may represent benign fibro-osseous lesions that may be overlooked or result in unnecessary endodontic treatment. Key words:Florid cemento-osseous dysplasia, florid osseous dysplasia, fibro-osseous lesions.

Using deep learning for detecting gender in adult chest radiographs

NASA Astrophysics Data System (ADS)

Xue, Zhiyun; Antani, Sameer; Long, L. Rodney; Thoma, George R.

2018-03-01

In this paper, we present a method for automatically identifying the gender of an imaged person using their frontal chest x-ray images. Our work is motivated by the need to determine missing gender information in some datasets. The proposed method employs the technique of convolutional neural network (CNN) based deep learning and transfer learning to overcome the challenge of developing handcrafted features in limited data. Specifically, the method consists of four main steps: pre-processing, CNN feature extractor, feature selection, and classifier. The method is tested on a combined dataset obtained from several sources with varying acquisition quality resulting in different pre-processing steps that are applied for each. For feature extraction, we tested and compared four CNN architectures, viz., AlexNet, VggNet, GoogLeNet, and ResNet. We applied a feature selection technique, since the feature length is larger than the number of images. Two popular classifiers: SVM and Random Forest, are used and compared. We evaluated the classification performance by cross-validation and used seven performance measures. The best performer is the VggNet-16 feature extractor with the SVM classifier, with accuracy of 86.6% and ROC Area being 0.932 for 5-fold cross validation. We also discuss several misclassified cases and describe future work for performance improvement.

Low-level fiber-induced radiographic changes caused by Libby vermiculite: a 25-year follow-up study.

PubMed

Rohs, Amy M; Lockey, James E; Dunning, Kari K; Shukla, Rakesh; Fan, Huihao; Hilbert, Tim; Borton, Eric; Wiot, Jerome; Meyer, Cristopher; Shipley, Ralph T; Lemasters, Grace K; Kapil, Vikas

2008-03-15

From 1921 to 1990, vermiculite ore from Libby, Montana, was shipped worldwide for commercial and residential use. A 1980 study of a manufacturing facility using Libby vermiculite was the first to demonstrate a small but significant prevalence of pleural chest radiographic changes associated with amphibole fibers contained in the ore. This follow-up study of the original cohort evaluated the extent of radiographic changes and cumulative fiber exposure (CFE) 25 years after cessation of exposure. From the original cohort of 513 workers, 431 (84%) were living and available for participation and exposure reconstruction. Of these, 280 (65%) completed both chest radiographs and interviews. Primary outcomes were pleural and/or interstitial changes. Pleural and interstitial changes were demonstrated in 80 (28.7%) and 8 (2.9%) participants, respectively. Of those participants with low lifetime CFE of less than 2.21 fiber/cc-years, 42 (20%) had pleural changes. A significant (P < 0.001) exposure-response relationship of pleural changes with CFE was demonstrated, ranging from 7.1 to 54.3% from the lowest to highest exposure quartile. Removal of individuals with commercial asbestos exposure did not alter this trend. This study indicates that exposure within an industrial process to Libby vermiculite ore is associated with pleural thickening at low lifetime CFE levels. The propensity of the Libby amphibole fibers to dramatically increase the prevalence of pleural changes 25 years after cessation of exposure at low CFE levels is a concern in view of the wide national distribution of this ore for commercial and residential use.

The Value of History, Physical Examination, and Radiographic Findings in the Diagnosis of Symptomatic Meniscal Tear among Middle-Age Subjects with Knee Pain

PubMed Central

Katz, Jeffrey N.; Smith, Savannah R.; Yang, Heidi Y.; Martin, Scott D.; Wright, John; Donnell-Fink, Laurel A.; Losina, Elena

2016-01-01

Objective To evaluate the utility of clinical history, radiographic and physical exam findings in the diagnosis of symptomatic meniscal tear (SMT) in patients over age 45, in whom concomitant osteoarthritis is prevalent. Methods In a cross-sectional study of patients from two orthopedic surgeons’ clinics we assessed clinical history, physical examination and radiographic findings in patients over 45 with knee pain. The orthopedic surgeons rated their confidence that subjects’ symptoms were due to MT; we defined the diagnosis of SMT as at least 70% confidence. We used logistic regression to identify factors independently associated with diagnosis of SMT and we used the regression results to construct an index of the likelihood of SMT. Results In 174 participants, six findings were associated independently with the expert clinician having ≥70% confidence that symptoms were due to MT: localized pain, ability to fully bend the knee, pain duration <1 year, lack of varus alignment, lack of pes planus, and absence of joint space narrowing on radiographs. The index identified a low risk group with 3% likelihood of SMT. Conclusion While clinicians traditionally rely upon mechanical symptoms in this diagnostic setting, our findings did not support the conclusion that mechanical symptoms were associated with the expert’s confidence that symptoms were due to MT. An index that includes history of localized pain, full flexion, duration <1 year, pes planus, varus alignment, and joint space narrowing can be used to stratify patients according to their risk of SMT and it identifies a subgroup with very low risk. PMID:27390312

The 'ABC' of examining foot radiographs.

PubMed

Pearse, Eyiyemi O; Klass, Benjamin; Bendall, Stephen P

2005-11-01

We report a simple systematic method of assessing foot radiographs that improves diagnostic accuracy and can reduce the incidence of inappropriate management of serious forefoot and midfoot injuries, particularly the Lisfranc-type injury. Five recently appointed senior house officers (SHOs), with no casualty or Orthopaedic experience prior to their appointment, were shown a set of 10 foot radiographs and told the history and examination findings recorded in the casualty notes of each patient within 6 weeks of taking up their posts. They were informed that the radiographs might or might not demonstrate an abnormality. They were asked to make a diagnosis and decide on a management plan. The test was repeated after they were taught the 'ABC' method of evaluating foot radiographs. Diagnostic accuracy improved after SHOs were taught a systematic method of assessing foot radiographs. The proportion of correct diagnoses increased from 0.64 to 0.78 and the probability of recognising Lisfranc injuries increased from 0 to 0.6. The use of this simple method of assessing foot radiographs can reduce the incidence of inappropriate management of serious foot injuries by casualty SHOs, in particular the Lisfranc type injury.

Improving early diagnosis of pulmonary infections in patients with febrile neutropenia using low-dose chest computed tomography.

PubMed

Gerritsen, M G; Willemink, M J; Pompe, E; van der Bruggen, T; van Rhenen, A; Lammers, J W J; Wessels, F; Sprengers, R W; de Jong, P A; Minnema, M C

2017-01-01

We performed a prospective study in patients with chemotherapy induced febrile neutropenia to investigate the diagnostic value of low-dose computed tomography compared to standard chest radiography. The aim was to compare both modalities for detection of pulmonary infections and to explore performance of low-dose computed tomography for early detection of invasive fungal disease. The low-dose computed tomography remained blinded during the study. A consensus diagnosis of the fever episode made by an expert panel was used as reference standard. We included 67 consecutive patients on the first day of febrile neutropenia. According to the consensus diagnosis 11 patients (16.4%) had pulmonary infections. Sensitivity, specificity, positive predictive value and negative predictive value were 36%, 93%, 50% and 88% for radiography, and 73%, 91%, 62% and 94% for low-dose computed tomography, respectively. An uncorrected McNemar showed no statistical difference (p = 0.197). Mean radiation dose for low-dose computed tomography was 0.24 mSv. Four out of 5 included patients diagnosed with invasive fungal disease had radiographic abnormalities suspect for invasive fungal disease on the low-dose computed tomography scan made on day 1 of fever, compared to none of the chest radiographs. We conclude that chest radiography has little value in the initial assessment of febrile neutropenia on day 1 for detection of pulmonary abnormalities. Low-dose computed tomography improves detection of pulmonary infiltrates and seems capable of detecting invasive fungal disease at a very early stage with a low radiation dose.

Improving early diagnosis of pulmonary infections in patients with febrile neutropenia using low-dose chest computed tomography

PubMed Central

Pompe, E.; van der Bruggen, T.; van Rhenen, A.; Lammers, J. W. J.; Wessels, F.; Sprengers, R. W.; de Jong, P. A.; Minnema, M. C.

2017-01-01

We performed a prospective study in patients with chemotherapy induced febrile neutropenia to investigate the diagnostic value of low-dose computed tomography compared to standard chest radiography. The aim was to compare both modalities for detection of pulmonary infections and to explore performance of low-dose computed tomography for early detection of invasive fungal disease. The low-dose computed tomography remained blinded during the study. A consensus diagnosis of the fever episode made by an expert panel was used as reference standard. We included 67 consecutive patients on the first day of febrile neutropenia. According to the consensus diagnosis 11 patients (16.4%) had pulmonary infections. Sensitivity, specificity, positive predictive value and negative predictive value were 36%, 93%, 50% and 88% for radiography, and 73%, 91%, 62% and 94% for low-dose computed tomography, respectively. An uncorrected McNemar showed no statistical difference (p = 0.197). Mean radiation dose for low-dose computed tomography was 0.24 mSv. Four out of 5 included patients diagnosed with invasive fungal disease had radiographic abnormalities suspect for invasive fungal disease on the low-dose computed tomography scan made on day 1 of fever, compared to none of the chest radiographs. We conclude that chest radiography has little value in the initial assessment of febrile neutropenia on day 1 for detection of pulmonary abnormalities. Low-dose computed tomography improves detection of pulmonary infiltrates and seems capable of detecting invasive fungal disease at a very early stage with a low radiation dose. PMID:28235014

Pulmonary aspergillosis in patients with AIDS. Clinical and radiographic correlations.

PubMed

Miller, W T; Sais, G J; Frank, I; Gefter, W B; Aronchick, J M; Miller, W T

1994-01-01

To evaluate the clinical and radiographic features of pulmonary aspergillosis as they present in AIDS patients; in particular, to determine similarities and differences between Aspergillus infection in patients with AIDS vs those without AIDS. Six new cases of confirmed or probable pulmonary aspergillosis were discovered during a search of hospital records. These are reviewed with 30 previously reported cases with special attention to radiographic appearance of disease and how radiographic appearance influences clinical outcome. Symptoms of pulmonary aspergillosis in AIDS were nonspecific, most often including fever, cough, and dyspnea, and less commonly, chest pain or hemoptysis. Major risk factors for the development of pulmonary aspergillosis in patients with AIDS were steroid administration and neutropenia. Neutropenia was often a complication of therapies for AIDS, in particular, ganciclovir and zidovudine. Radiographic appearance of disease could be divided into three general categories. One third of the patients (13/36) presented with cavitary upper lobe disease resembling noninvasive or chronic necrotizing aspergillosis. Fatal hemoptysis occurred in 42 percent of patients with this form of disease. Twenty-two percent (8/36) of the cases presented as a nondescript focal alveolar opacity similar to invasive aspergillosis. In several patients, the focal infiltrate remained stable for several months, a feature that is unusual for aspergillosis in non-AIDS patients. The air crescent sign was present in none of the 36 reported cases. Patients with only focal disease had the best prognosis of patients with pulmonary aspergillosis. Bilateral alveolar or interstitial disease similar to invasive aspergillosis was present in 23 percent (9/36) of the patients. Bilateral disease appears to be a marker for disseminated infection and was associated with a high mortality due to aspergillosis. Two new forms of bronchial aspergillosis (5/36 cases) have been described

Design and testing of artifact-suppressed adaptive histogram equalization: a contrast-enhancement technique for display of digital chest radiographs.

PubMed

Rehm, K; Seeley, G W; Dallas, W J; Ovitt, T W; Seeger, J F

1990-01-01

One of the goals of our research in the field of digital radiography has been to develop contrast-enhancement algorithms for eventual use in the display of chest images on video devices with the aim of preserving the diagnostic information presently available with film, some of which would normally be lost because of the smaller dynamic range of video monitors. The ASAHE algorithm discussed in this article has been tested by investigating observer performance in a difficult detection task involving phantoms and simulated lung nodules, using film as the output medium. The results of the experiment showed that the algorithm is successful in providing contrast-enhanced, natural-looking chest images while maintaining diagnostic information. The algorithm did not effect an increase in nodule detectability, but this was not unexpected because film is a medium capable of displaying a wide range of gray levels. It is sufficient at this stage to show that there is no degradation in observer performance. Future tests will evaluate the performance of the ASAHE algorithm in preparing chest images for video display.

Clinical, radiographic, and histological findings of florid cemento-osseous dysplasia: a case report.

PubMed

Kim, Jeong-Hee; Song, Byeong-Chul; Kim, Sun-Ho; Park, Yang-Soon

2011-09-01

Cemento-osseous dysplasias are a group of disorders known to originate from periodontal ligament tissue and involve, essentially, the same pathological process. They are usually classified into three main groups: periapical, florid, and focal cemental dysplasias depending on their extent and radiographic appearances. Radiographically, florid cementoosseous dysplasia (FCOD) appears as dense, lobulated masses, often symmetrically located in various regions of the jaws. The best management for the asymptomatic FCOD patient consists of regular recall examinations with prophylaxis. The management of the symptomatic patient is more difficult. A case of FCOD occurring in a 52-year-old edentulous Korean female is reported which is rare with regard to race and sex.

Radiographic abnormalities and exposure to asbestos-contaminated vermiculite in the community of Libby, Montana, USA.

PubMed

Peipins, Lucy A; Lewin, Michael; Campolucci, Sharon; Lybarger, Jeffrey A; Miller, Aubrey; Middleton, Dan; Weis, Christopher; Spence, Michael; Black, Brad; Kapil, Vikas

2003-11-01

Mining, handling, processing, and personal or commercial use of asbestos-contaminated vermiculite have led to widespread contamination of the Libby, Montana, area. We initiated a medical testing program in response to reports of respiratory illness in the community. The purpose of this analysis was to identify and quantify asbestos-related radiographic abnormalities among persons exposed to vermiculite in Libby and to examine associations between these outcomes and participants' self-reported exposures. A cross-sectional interview and medical testing were conducted in Libby from July through November 2000 and from July through September 2001. A total of 7,307 persons who had lived, worked, or played in Libby for at least 6 months before 31 December 1990 completed the interview. Of those, 6,668 participants > or = 18 years of age received chest radiographs to assess the prevalence of pleural and interstitial abnormalities. We observed pleural abnormalities in 17.8% of participants and interstitial abnormalities in < 1% of participants undergoing chest radiography. We examined 29 occupational, recreational, household, and other exposure pathways in the analysis. The prevalence of pleural abnormalities increased with increasing number of exposure pathways, ranging from 6.7% for those who reported no apparent exposures to 34.6% for those who reported > or = 12 pathways. The factors most strongly associated with pleural abnormalities were being a former W.R. Grace worker, being older, having been a household contact of a W.R. Grace worker, and being a male. In addition to being a former W.R. Grace worker, environmental exposures and other nonoccupational risk factors were also important predictors of asbestos-related radiographic abnormalities.

Computer-Aided Diagnostic System For Mass Survey Chest Images

NASA Astrophysics Data System (ADS)

Yasuda, Yoshizumi; Kinoshita, Yasuhiro; Emori, Yasufumi; Yoshimura, Hitoshi

1988-06-01

In order to support screening of chest radiographs on mass survey, a computer-aided diagnostic system that automatically detects abnormality of candidate images using a digital image analysis technique has been developed. Extracting boundary lines of lung fields and examining their shapes allowed various kind of abnormalities to be detected. Correction and expansion were facilitated by describing the system control, image analysis control and judgement of abnormality in the rule type programing language. In the experiments using typical samples of student's radiograms, good results were obtained for the detection of abnormal shape of lung field, cardiac hypertrophy and scoliosis. As for the detection of diaphragmatic abnormality, relatively good results were obtained but further improvements will be necessary.

Chest Reconstruction and Chest Dysphoria in Transmasculine Minors and Young Adults: Comparisons of Nonsurgical and Postsurgical Cohorts.

PubMed

Olson-Kennedy, Johanna; Warus, Jonathan; Okonta, Vivian; Belzer, Marvin; Clark, Leslie F

2018-05-01

was significantly higher than mean (SD) scores in those who had undergone this procedure (3.3 [3.8]; P < .001). Among the nonsurgical cohort, 64 (94%) perceived chest surgery as very important, and chest dysphoria increased by 0.33 points each month that passed between a youth initiating testosterone therapy and undergoing surgery. Among the postsurgical cohort, the most common complication of surgery was loss of nipple sensation, whether temporary (59%) or permanent (41%). Serious complications were rare and included postoperative hematoma (10%) and complications of anesthesia (7%). Self-reported regret was near 0. Chest dysphoria was high among presurgical transmasculine youth, and surgical intervention positively affected both minors and young adults. Given these findings, professional guidelines and clinical practice should consider patients for chest surgery based on individual need rather than chronologic age.

[A case of loxoprofen sodium-induced bronchiolitis obliterans organizing pneumonia (BOOP)].

PubMed

Fujita, Kazue; Sakamoto, Osamu; Matsumoto, Mitsuhiro; Kohrogi, Hirotsugu; Suga, Moritaka

2003-12-01

A 78-year-old man was referred to our department because of an abnormal shadow on the chest radiograph and liver dysfunction after lung resection for lung cancer. Following the operation, loxoprofen sodium was administered to control his chest pain. A chest radiograph on admission showed airspace consolidation in the right lower lung field. In addition, leukocytosis and elevation of CRP were observed. Although piperacillin sodium was given to him, airspace consolidation on a chest radiograph was increased. A bronchoalveolar lavage fluid study showed that total cell counts and proportion of lymphocytes were increased, and the CD4/CD8 ratio was 1.77. A transbronchial lung biopsy specimen revealed organizing pneumonia with Masson bodies. Furthermore, a lymphocyte stimulation test for loxoprofen sodium was positive. From the clinical course, laboratory data and pathologic findings, we considered this case to be loxoprofen sodium-induced BOOP. Withdrawal of loxoprofen sodium and treatment with corticosteroid resulted in marked improvement of the clinical findings. Although a rare occurrence, it is important to recognize that BOOP can be caused by loxoprofen sodium.

Baseline extent of damage predicts spinal radiographic progression in Korean patients with ankylosing spondylitis treated with golimumab.

PubMed

Lee, Jeong Seok; Song, Yeong Wook; Kim, Tae Hwan; Chung, Won Tae; Lee, Seung Geun; Park, Sung Hwan; Song, Gwan Gyu; Yu, Dae Young; Xu, Stephen; Lee, Eun Young

2018-05-01

For patients with ankylosing spondylitis (AS), golimumab has consistent efficacy in controlling disease activity over 5 years but its benefit in preventing radiographic progression was less clear at 4 years. To predict radiographic progression, we analyzed the baseline characteristics of AS patients in a Korean population. Sixty-eight Korean patients with AS participated in the phase 3, multicenter, randomized, placebo-controlled, double-blind trial (GO-RAISE) which has previously been described. Baseline modified stoke AS spine score (mSASSS) and change in mSASSS from baseline (ΔmSASSS) until week 208 were analyzed in the Korean patients enrolled in the GO-RAISE study. Although Korean patients had lower baseline mSASSS compared to non-Korean patients and received active management, radiographic progression was not prevented. Korean patients who did not undergo radiographic progression of spinal lesions of AS were younger and had shorter symptomatic duration, lower Bath AS functional and metrology indices, better chest expansion, and lower baseline mSASSS. The baseline mSASSS and ΔmSASSS were positively correlated in Korean AS patients ( p < 0.001). Radiographic progression was more prevalent (80.0%) when baseline mSASSS > 10 and less common (13.0%) with baseline mSASSS = 0. In Korean AS patients, radiographic progression of the spine after 4 years was predicted effectively by the initial severity of the spinal lesion(s) in patients treated with golimumab.

Digital radiographic imaging transfer: comparison with plain radiographs.

PubMed

Averch, T D; O'Sullivan, D; Breitenbach, C; Beser, N; Schulam, P G; Moore, R G; Kavoussi, L R

1997-04-01

Advances in digital imaging and computer display technology have allowed development of clinical teleradiographic systems. There are limited data assessing the effectiveness of such systems when applied to urologic pathology. In an effort to appraise the effectiveness of teleradiology in identifying renal calculi, the accuracy of findings on transmitted radiographic images were compared with those made when viewing the actual plain film. Plain films (KUB) were obtained from 26 patients who presented to the radiology department to rule out urinary calculous disease. The films were digitalized by a radiograph scanner into ARCNEMA-2 file format, compressed by a NASA algorithm, and transferred via a 28.8-kbps modern over standard telephone lines to a remote section 25 miles away, where they were decompressed and viewed on a 1600 x 1200-pixel monitor. Two attending urologists and two endourologic fellows were randomized to read either the transmitted image or the original radiograph with minimal clinical history provided. Of the 26 plain radiographic films, 24 were correctly interpreted by the fellows and 25 by the attending physicians (92% and 96% accuracy, respectively) for a total accuracy of 94% with no statistical difference (p = 0.16). After compression, all but one of the digital images were transferred successfully. The attending physicians correctly interpreted 24 of the 25 digital images (96%), whereas the fellows were correct on 21 interpretations (84%), resulting in a total 90% accuracy with a significant difference between the groups (p < or = 0.04). Overall, no statistical difference between the interpretations of the plain film and the digital image was revealed (p = 0.21). Using available technology, KUB images can be transmitted to a remote site, and the location of a stone can be determined correctly. Higher accuracy is demonstrated by experienced surgeons.

The frequency of various indications for plain chest radiography in Nnamdi Azikiwe University Teaching Hospital, Nnewi (NAUTH).

PubMed

Okpala, O C; Okafor, C; Aronu, M E

2013-01-01

With soaring advances in the field of medicine, the place of older radiologic imaging modalities is being reduced to basic screening tools. Yet the modern imaging modalities like computerized tomography (CT), magnetic resonance imaging (MRI), ultrasound and nuclear medicine are hardly available. To study the frequency of various indications of plain chest radiography, remind us of its uses and to enhance the preparedness of the department to maximally accomplish the ideals of this investigation. A total of 1476 consecutive patients for chest radiography in the department of radiology, NAUTH, Nnewi from the period of February 2009 and whose request form contain adequate data were recruited for this study. These data were analyzed using SSPS. A total of 1476 patient were included in this study. There was female preponderance with male to female ratio of 1.3:1. Mean Age of the patients is 39.32 years (std19.56). The most frequent indication for chest radiography is certain infections and parasitic diseases (40.9% and the greatest source of referral for this study is General outpatient (GOPD)/family medicine department. The most frequent indications for chest radiography in the study are certain infection and parasitic diseases. Chest Radiography is the most frequent plain radiography study in our environment where infectious diseases are still very rampant. This makes chest radiography an important study for screening patient for possible diagnosis and classifying the need for further radiographic investigation of our patients.

Sports participation and radiographic findings of adolescents treated nonoperatively for displaced clavicle fractures.

PubMed

Robinson, Luke; Gargoum, Riyad; Auer, Ron; Nyland, John; Chan, Gilbert

2015-07-01

There is a relative paucity of high-level evidence that guides the treatment of displaced midshaft clavicle fractures in adolescents. Some use overhead sports or significant shortening as relative indications for surgical treatment, while others rarely consider operative intervention for these patients. The purpose of this study is to determine the effect of overhead sports participation and fracture shortening on subjective and objective outcomes after nonoperative treatment of displaced midshaft clavicle fractures in those aged 10-17 years. Using a radiographic database, adolescents with displaced clavicle fractures were identified and contacted over the phone. These subjects were invited to take part in the study in return for compensation. Radiographic measurements of dedicated clavicle films around the time of injury were performed, and a custom survey aimed at elucidating participation in overhead or contact sports was given. The Nottingham Clavicle Score (NCS) and the Constant Shoulder Score were obtained for each patient to provide both subjective and objective outcome data. Statistical Package for Social Science (SPSS) software (version 22, IBM) was used to compare radiographic and sports data to the outcome measures. Gender, age at the time of fracture, time since fracture, relative and absolute radiographic shortening, and hand dominance were all not significantly correlated with subjective or objective outcomes. Five patients (23%) reported not feeling happy with the appearance of their shoulder at the beach or at the pool. This group had statistically lower NCS results. Eleven of 22 participated in ≥6 months per year of overhead or contact sports; they did not have worse subjective or objective outcomes. Fracture shortening and sports participation do not have a significant impact in adolescents on outcomes after displaced midshaft clavicle fracture. Copyright © 2015 Elsevier Ltd. All rights reserved.

Radiographic localization of unerupted teeth: further findings about the vertical tube shift method and other localization techniques.

PubMed

Jacobs, S G

2000-10-01

The parallax method (image/tube shift method, Clark's rule, Richards' buccal object rule) is recommended to localize unerupted teeth. Richards' contribution to the development of the parallax method is discussed. The favored method for localization uses a rotational panoramic radiograph in combination with an occlusal radiograph involving a vertical shift of the x-ray tube. The use of this combination when localizing teeth and supernumeraries in the premolar region is illustrated. When taking an occlusal radiograph to localize an unerupted maxillary canine, clinical situations are presented where modification of the vertical angulation of the tube of 70 degrees to 75 degrees or of the horizontal position of the tube is warranted. The limitations of axial (true, cross-sectional, vertex) occlusal radiographs are also explored.

Treatment of Morbidity with Atypical Chest Pain

PubMed Central

Cott, Arthur

1987-01-01

The appropriate management of atypical chest pain requires an integration of medical and behavioural treatments. Unnecessary medicalization can increase morbidity. A sensitivity to the behavioural factors contributing to symptoms and disability may reduce both. The purpose of this paper is to provide physicians with a cognitive-behavioural perspective of the nature of morbidity and disability associated with chronic chest discomfort; some strategies for detecting heretofore unsuspected disability associated with chronic chest pain and related discomfort in patients with organic findings (both cardiac and non-cardiac), as well those with no identifiable disease process or organic cause; and some simple behavioural and cognitive-behavioural therapeutic techniques for treating and preventing such problems. PMID:21263912

EFFECT OF RADIATION DOSE LEVEL ON ACCURACY AND PRECISION OF MANUAL SIZE MEASUREMENTS IN CHEST TOMOSYNTHESIS EVALUATED USING SIMULATED PULMONARY NODULES

PubMed Central

Söderman, Christina; Johnsson, Åse Allansdotter; Vikgren, Jenny; Norrlund, Rauni Rossi; Molnar, David; Svalkvist, Angelica; Månsson, Lars Gunnar; Båth, Magnus

2016-01-01

The aim of the present study was to investigate the dependency of the accuracy and precision of nodule diameter measurements on the radiation dose level in chest tomosynthesis. Artificial ellipsoid-shaped nodules with known dimensions were inserted in clinical chest tomosynthesis images. Noise was added to the images in order to simulate radiation dose levels corresponding to effective doses for a standard-sized patient of 0.06 and 0.04 mSv. These levels were compared with the original dose level, corresponding to an effective dose of 0.12 mSv for a standard-sized patient. Four thoracic radiologists measured the longest diameter of the nodules. The study was restricted to nodules located in high-dose areas of the tomosynthesis projection radiographs. A significant decrease of the measurement accuracy and intraobserver variability was seen for the lowest dose level for a subset of the observers. No significant effect of dose level on the interobserver variability was found. The number of non-measurable small nodules (≤5 mm) was higher for the two lowest dose levels compared with the original dose level. In conclusion, for pulmonary nodules at positions in the lung corresponding to locations in high-dose areas of the projection radiographs, using a radiation dose level resulting in an effective dose of 0.06 mSv to a standard-sized patient may be possible in chest tomosynthesis without affecting the accuracy and precision of nodule diameter measurements to any large extent. However, an increasing number of non-measurable small nodules (≤5 mm) with decreasing radiation dose may raise some concerns regarding an applied general dose reduction for chest tomosynthesis examinations in the clinical praxis. PMID:26994093

Detection of pulmonary nodule growth with dose reduced chest tomosynthesis: a human observer study using simulated nodules

NASA Astrophysics Data System (ADS)

Söderman, Christina; Johnsson, Ã. se; Vikgren, Jenny; Rossi Norrlund, Rauni; Molnar, David; Mirzai, Maral; Svalkvist, Angelica; Mânsson, Lars Gunnar; Bâth, Magnus

2016-03-01

Chest tomosynthesis may be a suitable alternative to computed tomography for the clinical task of follow up of pulmonary nodules. The aim of the present study was to investigate the detection of pulmonary nodule growth suggestive of malignancy using chest tomosynthesis. Previous studies have indicated remained levels of detection of pulmonary nodules at dose levels corresponding to that of a conventional lateral radiograph, approximately 0.04 mSv, which motivated to perform the present study this dose level. Pairs of chest tomosynthesis image sets, where the image sets in each pair were acquired of the same patient at two separate occasions, were included in the study. Simulated nodules with original diameters of approximately 8 mm were inserted in the pairs of image sets, simulating situations where the nodule had remained stable in size or increased isotropically in size between the two different imaging occasions. Four different categories of nodule growth were included, corresponding to a volume increase of approximately 21 %, 68 %, 108 % and 250 %. All nodules were centered in the depth direction in the tomosynthesis images. All images were subjected to a simulated dose reduction, resulting in images corresponding to an effective dose of 0.04 mSv. Four observers were given the task of rating their confidence that the nodule was stable in size or not on a five-level rating scale. This was done both before any size measurements were made of the nodule as well as after measurements were performed. Using Receiver operating characteristic analysis, the rating data for the nodules that were stable in size was compared to the rating data for the nodules simulated to have increased in size. Statistically significant differences between the rating distributions for the stable nodules and all of the four nodule growth categories were found. For the three largest nodule growths, nearly perfect detection of nodule growth was seen. In conclusion, the present study

Deep Learning at Chest Radiography: Automated Classification of Pulmonary Tuberculosis by Using Convolutional Neural Networks.

PubMed

Lakhani, Paras; Sundaram, Baskaran

2017-08-01

Purpose To evaluate the efficacy of deep convolutional neural networks (DCNNs) for detecting tuberculosis (TB) on chest radiographs. Materials and Methods Four deidentified HIPAA-compliant datasets were used in this study that were exempted from review by the institutional review board, which consisted of 1007 posteroanterior chest radiographs. The datasets were split into training (68.0%), validation (17.1%), and test (14.9%). Two different DCNNs, AlexNet and GoogLeNet, were used to classify the images as having manifestations of pulmonary TB or as healthy. Both untrained and pretrained networks on ImageNet were used, and augmentation with multiple preprocessing techniques. Ensembles were performed on the best-performing algorithms. For cases where the classifiers were in disagreement, an independent board-certified cardiothoracic radiologist blindly interpreted the images to evaluate a potential radiologist-augmented workflow. Receiver operating characteristic curves and areas under the curve (AUCs) were used to assess model performance by using the DeLong method for statistical comparison of receiver operating characteristic curves. Results The best-performing classifier had an AUC of 0.99, which was an ensemble of the AlexNet and GoogLeNet DCNNs. The AUCs of the pretrained models were greater than that of the untrained models (P < .001). Augmenting the dataset further increased accuracy (P values for AlexNet and GoogLeNet were .03 and .02, respectively). The DCNNs had disagreement in 13 of the 150 test cases, which were blindly reviewed by a cardiothoracic radiologist, who correctly interpreted all 13 cases (100%). This radiologist-augmented approach resulted in a sensitivity of 97.3% and specificity 100%. Conclusion Deep learning with DCNNs can accurately classify TB at chest radiography with an AUC of 0.99. A radiologist-augmented approach for cases where there was disagreement among the classifiers further improved accuracy. © RSNA, 2017.

Chest tube insertion

MedlinePlus

... leaks from inside the lung into the chest ( pneumothorax ) Fluid buildup in the chest (called a pleural ... on the reason a chest tube is inserted. Pneumothorax most often improves, but sometimes surgery is needed ...

Pulmonary disease in cystic fibrosis: assessment with chest CT at chest radiography dose levels.

PubMed

Ernst, Caroline W; Basten, Ines A; Ilsen, Bart; Buls, Nico; Van Gompel, Gert; De Wachter, Elke; Nieboer, Koenraad H; Verhelle, Filip; Malfroot, Anne; Coomans, Danny; De Maeseneer, Michel; de Mey, Johan

2014-11-01

. Very good agreement was found in overall Bhalla score ( ICC intraclass correlation coefficient , 0.96) with regard to the severity of bronchiectasis ( ICC intraclass correlation coefficient , 0.87) and sacculations and abscesses ( ICC intraclass correlation coefficient , 0.84). Interobserver agreement was excellent ( ICC intraclass correlation coefficient , 0.86-1). For patients with CF cystic fibrosis , a dedicated chest CT protocol can replace the two yearly follow-up chest radiographic examinations without major dose penalty and with similar diagnostic quality compared with conventional CT.

Are magnetic resonance imaging or radiographic findings correlated with clinical prognosis in spinal cord neuropathy?

PubMed Central

Neshat Halati, Fatemeh; Vajhi, Alireza; Molazem, Mohammad; Dehghan, Mohammad Mehdi; Ansari, Fereshteh

2016-01-01

Dogs presented to the Small Animal Hospital of Veterinary Medicine, University of Tehran were included in the present study if spinal or intervertebral disc involvement was suspected. Clinical signs were recorded as well as general information of the patient such as age, breed and sex. Sixty dogs were examined radiographically and two standard orthogonal lateral and ventrodorsal projections were taken from the suspected region. Then magnetic resonance imaging (MRI) was performed for all patients. Agreement between MRI and radiographic findings, comparison of sex and breed with diagnostic imaging grades, comparison between diagnostic imaging grades and mean age, recovery rate after surgery or medical treatment, effects of diagnostic imaging severity grades on surgical or medical referrals were evaluated statistically. There were no significant association between age, sex and breed and frequency of the intervertebral disk disease. Intervertebral disc involvements between L2-L3 and T13-L1 were estimated as the most frequent sites of involvements. Sensitivity and specificity of radiography were evaluated 90.0% and 46.0%, respectively, by considering the MRI as a gold standard modality. There was a significant association between severity of disease in the MRI with referral to surgery and medical treatment. The recovery rate after surgery was significantly higher than medical treatment. These results can be used as a foundation for other studies with more focuses on details of injury and larger group of patients. PMID:27872724

New bacterial composition in primary and persistent/secondary endodontic infections with respect to clinical and radiographic findings.

PubMed

Tennert, Christian; Fuhrmann, Maximilian; Wittmer, Annette; Karygianni, Lamprini; Altenburger, Markus J; Pelz, Klaus; Hellwig, Elmar; Al-Ahmad, Ali

2014-05-01

The aim of the present study was to analyze the microbiota of primary and secondary/persistent endodontic infections of patients undergoing endodontic treatment with respect to clinical and radiographic findings. Samples from the root canals of 21 German patients were taken using 3 sequential sterile paper points. In the case of a root canal filling, gutta-percha was removed with sterile files, and samples were taken using sterile paper points. The samples were plated, and microorganisms were then isolated and identified morphologically by biochemical analysis and sequencing the 16S rRNA genes of isolated microorganisms. In 12 of 21 root canals, 33 different species could be isolated. Six (50%) of the cases with isolated microorganisms were primary, and 6 (50%) cases were endodontic infections associated with root-filled teeth. Twelve of the isolated species were facultative anaerobic and 21 obligate anaerobic. Monomicrobial infections were found for Enterococcus faecalis and Actinomyces viscosus. E. faecalis was most frequently isolated in secondary endodontic infections (33%). Moraxella osloensis was isolated from a secondary endodontic infection that had an insufficient root canal filling accompanied by a mild sensation of pain. A new bacterial composition compromising Atopobium rimae, Anaerococcus prevotii, Pseudoramibacter alactolyticus, Dialister invisus, and Fusobacterium nucleatum was recovered from teeth with chronic apical abscesses. New bacterial combinations were found and correlated to clinical and radiographic findings, particularly to chronic apical abscesses. M. osloensis was detected in root canals for the second time and only in German patients. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

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

PubMed

Spaedy, Emily; Christakopoulos, Georgios E; Tarar, Muhammad Nauman J; Christopoulos, Georgios; Rangan, Bavana V; Roesle, Michele; Ochoa, Cristhiaan D; Yarbrough, William; Banerjee, Subhash; Brilakis, Emmanouil S

2016-09-15

We sought to explore the accuracy of remote chest X-ray reading using hands-free, wearable technology (Google Glass, Google, Mountain View, California). We 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. Fifteen 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. Remote 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. Published by Elsevier Ireland Ltd.

Clinical case review: a method to improve identification of true clinical and radiographic pneumonia in children meeting the World Health Organization definition for pneumonia.

PubMed

Puumalainen, Taneli; Quiambao, Beatriz; Abucejo-Ladesma, Erma; Lupisan, Socorro; Heiskanen-Kosma, Tarja; Ruutu, Petri; Lucero, Marilla G; Nohynek, Hanna; Simoes, Eric A F; Riley, Ian

2008-07-21

The World Health Organization's (WHO) case definition for childhood pneumonia, composed of simple clinical signs of cough, difficult breathing and fast breathing, is widely used in resource poor settings to guide management of acute respiratory infections. The definition is also commonly used as an entry criteria or endpoint in different intervention and disease burden studies. A group of paediatricians conducted a retrospective review of clinical and laboratory data including C-reactive protein concentration and chest radiograph findings among Filipino children hospitalised in the Bohol Regional Hospital who were enrolled in a pneumococcal vaccine efficacy study and had an episode of respiratory disease fulfilling the WHO case definition for clinical pneumonia. Our aim was to evaluate which disease entities the WHO definition actually captures and what is the probable aetiology of respiratory infections among these episodes diagnosed in this population. Among the 12,194 children enrolled to the vaccine study we recorded 1,195 disease episodes leading to hospitalisation which fulfilled the WHO criteria for pneumonia. In total, 34% of these episodes showed radiographic evidence of pneumonia and 11% were classified as definitive or probable bacterial pneumonia. Over 95% of episodes of WHO-defined severe pneumonia (with chest indrawing) had an acute lower respiratory infection as final diagnosis whereas 34% of those with non-severe clinical pneumonia had gastroenteritis or other non-respiratory infection as main cause of hospitalisation. The WHO definition for severe pneumonia shows high specificity for acute lower respiratory infection and provides a tool to compare the total burden of lower respiratory infections in different settings. ISRCTN62323832.

Delayed hemothorax superimposed on extrapleural hematoma after blunt chest injury: a case report.

PubMed

Masuda, Ryota; Ikoma, Yoichiro; Oiwa, Kana; Nakazato, Kenei; Takeichi, Haruka; Iwazaki, Masayuki

2013-09-20

We report a case showing delayed hemothorax superimposed on extrapleural hematoma after blunt chest injury. The patient was a 56-year-old man with a medical history of alcoholic hepatopathy who presented with a chief complaint of dyspnea on exertion. One month prior to presentation, he had sustained a fall that had resulted in left simple rib fracture. A chest radiograph taken at the time of injury showed notable reduction in the permeability of the left lung field along with high pulmonary collapse as well as rightward deviation of the shadow of the inferior mediastinum. Chest CT images showed a region of low absorption in the thoracic cavity with septi. Thoracic drainage was performed (1,300 mL total) and hemothorax was diagnosed. Thoracoscopic examination was then performed. When the inside of the thorax was observed, what had been presumed to be the septi of a multilocular fluid collection was found to be actually the parietal pleura, and a hematoma was confirmed inside the extrapleural cavity. The hematoma inside the extrapleural cavity was managed with lavage and drainage, and drainage tubes were placed inside both the thoracic cavity and extrapleural cavity at the end of the procedure. The patient's postoperative course was uneventful, and he was discharged on postoperative day 4.

Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

PubMed Central

Matos, António P.; Mascarenhas, Vasco; Herédia, Vasco

2014-01-01

Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall. PMID:25295188

Multidetector computer tomography: evaluation of blunt chest trauma in adults.

PubMed

Palas, João; Matos, António P; Mascarenhas, Vasco; Herédia, Vasco; Ramalho, Miguel

2014-01-01

Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

Usefulness of routine computed tomography in the evaluation of penetrating war injuries to the chest.

PubMed

Darwish, Bassam; Mahfouz, Mohammad Z; Izzat, Mohammad Bashar

2018-05-02

This review was conducted to compare the contributions of chest X-ray (CXR) and computed tomography (CT) towards detecting intrathoracic damage in patients with penetrating war injuries to the chest and to determine whether identification of additional injuries by chest CT will have an impact on the choice of therapeutic interventions and clinical outcomes. We reviewed records of 449 patients (374 men, mean age 29.3 ± 14.8 years) who were admitted to our hospital with penetrating war injuries to the chest over a 7-year period. Collected data included mechanisms of injury, associated injuries, results of CXRs and chest CTs, methods of management, in-hospital stays, complications and mortalities. Immediate screening CXRs were obtained in all patients not requiring emergent thoracotomies, of which 91.4% showed positive signs of injury. Chest CTs were performed at the discretion of the physicians in 49.4% of patients, and CXR-positive findings were confirmed in all cases, while revealing additional injuries in 11% of patients. Chest CT findings led to additional closed chest drainage in 5.6% of patients but had no impact on treatment strategy in 94.4% of scanned patients. Follow-up CXRs showed new positive findings in 22 patients, leading to additional closed chest drainage in 3 patients and delayed open thoracotomies in 7 other patients. CXRs continue as the primary diagnostic modality in the assessment of patients with penetrating war injuries to the chest. Chest CTs can be omitted in most patients, thus reducing CT imaging case-load substantially, while most clinically significant chest injuries remain sufficiently recognized.

Development of patient collation system by kinetic analysis for chest dynamic radiogram with flat panel detector

NASA Astrophysics Data System (ADS)

Tsuchiya, Yuichiro; Kodera, Yoshie

2006-03-01

In the picture archiving and communication system (PACS) environment, it is important that all images be stored in the correct location. However, if information such as the patient's name or identification number has been entered incorrectly, it is difficult to notice the error. The present study was performed to develop a system of patient collation automatically for dynamic radiogram examination by a kinetic analysis, and to evaluate the performance of the system. Dynamic chest radiographs during respiration were obtained by using a modified flat panel detector system. Our computer algorithm developed in this study was consisted of two main procedures, kinetic map imaging processing, and collation processing. Kinetic map processing is a new algorithm to visualize a movement for dynamic radiography; direction classification of optical flows and intensity-density transformation technique was performed. Collation processing consisted of analysis with an artificial neural network (ANN) and discrimination for Mahalanobis' generalized distance, those procedures were performed to evaluate a similarity of combination for the same person. Finally, we investigated the performance of our system using eight healthy volunteers' radiographs. The performance was shown as a sensitivity and specificity. The sensitivity and specificity for our system were shown 100% and 100%, respectively. This result indicated that our system has excellent performance for recognition of a patient. Our system will be useful in PACS management for dynamic chest radiography.

Are We Using Abdominal Radiographs Appropriately in the Management of Pediatric Constipation?

PubMed

Beinvogl, Beate; Sabharwal, Sabina; McSweeney, Maireade; Nurko, Samuel

2017-12-01

To identify the reasons why pediatric gastroenterologists obtain abdominal radiographs in the management of pediatric constipation. This was a prospective study surveying providers regarding their rationale, interpretation, resultant change, and confidence in their management before and after obtaining KUBs in patients seen for suspected constipation. Demographics and clinical findings were obtained from medical records. A total of 24 providers were surveyed after 72 patient encounters. Reasons for obtaining an abdominal radiograph included evaluation of stool burden (70%), need for a clean out (35%), fecal impaction (27%), cause of abdominal pain (24%), demonstration of stool burden to families (14%), assessment of response to therapy (13%), or encopresis (10%). The plan was changed in 47.6% of cases based on radiographic findings. In cases in which a plan was outlined before obtaining the radiograph (69%), the initial plan was implemented on average in 52.5%. In cases with no plans before obtaining the radiograph, previously unconsidered plans were implemented in 8.7%. Provider confidence in the management plan increased from 2.4 ± 2.7 to 4.1 ± 1.8 (P < .05) after the abdominal radiograph. Abdominal radiographs commonly are obtained by pediatric gastroenterologists in the evaluation and management of constipation. The majority used it to make a diagnosis, and nearly one-half changed their management based on the imaging findings. Overall, they reported an improved confidence in their management plan, despite evidence that radiographic findings poorly correlate with clinical severity. This study highlights the need for further provider education regarding the recommendations delineated in existing constipation guidelines. Copyright © 2017 Elsevier Inc. All rights reserved.

EFFECT OF RADIATION DOSE LEVEL ON ACCURACY AND PRECISION OF MANUAL SIZE MEASUREMENTS IN CHEST TOMOSYNTHESIS EVALUATED USING SIMULATED PULMONARY NODULES.

PubMed

Söderman, Christina; Johnsson, Åse Allansdotter; Vikgren, Jenny; Norrlund, Rauni Rossi; Molnar, David; Svalkvist, Angelica; Månsson, Lars Gunnar; Båth, Magnus

2016-06-01

The aim of the present study was to investigate the dependency of the accuracy and precision of nodule diameter measurements on the radiation dose level in chest tomosynthesis. Artificial ellipsoid-shaped nodules with known dimensions were inserted in clinical chest tomosynthesis images. Noise was added to the images in order to simulate radiation dose levels corresponding to effective doses for a standard-sized patient of 0.06 and 0.04 mSv. These levels were compared with the original dose level, corresponding to an effective dose of 0.12 mSv for a standard-sized patient. Four thoracic radiologists measured the longest diameter of the nodules. The study was restricted to nodules located in high-dose areas of the tomosynthesis projection radiographs. A significant decrease of the measurement accuracy and intraobserver variability was seen for the lowest dose level for a subset of the observers. No significant effect of dose level on the interobserver variability was found. The number of non-measurable small nodules (≤5 mm) was higher for the two lowest dose levels compared with the original dose level. In conclusion, for pulmonary nodules at positions in the lung corresponding to locations in high-dose areas of the projection radiographs, using a radiation dose level resulting in an effective dose of 0.06 mSv to a standard-sized patient may be possible in chest tomosynthesis without affecting the accuracy and precision of nodule diameter measurements to any large extent. However, an increasing number of non-measurable small nodules (≤5 mm) with decreasing radiation dose may raise some concerns regarding an applied general dose reduction for chest tomosynthesis examinations in the clinical praxis. © The Author 2016. Published by Oxford University Press.

Effectiveness Of Plain Shoulder Radiograph In Detecting Degenerate Rotator Cuff Tears.

PubMed

Hussain, Adnan; Muzzammil, Muhammad; Butt, Faisal; Valsamis, Epaminondas Markos; Dwyer, Amitabh J

2018-01-01

Studies have demonstrated radiographic findings of sclerosis and cortical irregularity at the greater tuberosity can suggest a rotator cuff tear. Plain radiographs are the most easily attainable first-line investigations in evaluating shoulder injuries. This study determines the effectiveness in predicting degenerate rotator cuff tears by detecting radiographic changes on shoulder x-rays. Retrospective cross-sectional study with a consecutive series of patients conducted in Hinchingbrooke Hospital, Huntingdon, United Kingdom from January 2015 to June 2017. Anteroposterior shoulder radiographs of 150 symptomatic patients who underwent shoulder arthroscopy were independently analysed by surgeons who were blinded from the arthroscopic results. Patients aged fewer than 30 and over 70 years were excluded. Patients with advanced osteoarthritis and cuff tear arthropathy evident on x-rays were also excluded. Sixty-five patients included in the study had rotator cuff tears on arthroscopy. Radiographic changes were correlated with arthroscopic findings to determine this test's ability to predict degenerate rotator cuff tears. When both cortical irregularity and sclerosis were present on the plain radiograph, these signs had a sensitivity of 78.8% [95% CI 65.7, 87.8%] and specificity 77.4% [95% CI 67.2, 85.0%] with a positive predictive value of 68.3%, using contingency table analysis. The presence of cortical irregularity was found to be a better predictor of a tear as compared to sclerosis. This study concludes that plain radiograph are good modality for initial evaluation of rotator cuff tears and detecting when both cortical irregularity and sclerosis. Consideration of these radiographic findings serves as a useful adjunct in diagnostic workup and can guide subsequent investigations and treatment when evaluating rotator cuff tears of the shoulder.

Occupational burnout among radiographers, sonographers and radiologists in Australia and New Zealand: Findings from a national survey.

PubMed

Singh, Nabita; Knight, Kellie; Wright, Caroline; Baird, Marilyn; Akroyd, Duane; Adams, Robert D; Schneider, Michal E

2017-06-01

Evidence demonstrates that health care professionals are more prone to burnout than other professionals due to the emotionally taxing interactions they have with their patients on a daily basis. The aims of this study were to measure occupational burnout levels among sonographers, radiographers and radiologists and to examine predictors of burnout according to demographic characteristics. A cross-sectional online survey was administered in 2010 to radiographers, sonographers and radiologists who were members of the following professional bodies: Australian Institute of Radiography, Australian Sonographers Association and The Royal Australian and New Zealand College of Radiologists. The Maslach Burnout Inventory was used to measure burnout levels for each profession. Data were analysed using SPSS Ver 20 (IBM, Chicago, IL, USA) statistical software. A total of 613 radiographers, 121 sonographers and 35 radiologists participated in the survey. Radiographers, sonographers and radiologists had a high mean (±SD) burnout score for emotional exhaustion (39.9 ± 8.5, 42.2 ± 8.5 and 44.9 ± 7.1 respectively) and depersonalization (18.9 ± 5.5, 20.3 ± 5.8 and 20.6 ± 5.6) compared to MBI norms. Radiographers also had low personal achievement (30.8 ± 5.5) compared to MBI norms. Radiographers and sonographers who were male, worked >10 hours overtime and spent <10% of their time training students per week had significantly higher depersonalization scores (p < 0.05). Burnout levels among radiographers, sonographers and radiologists are high and likely to vary according to some demographic and work-related factors. Further research is needed to examine ways to alleviate burnout in these professions so that loss of experienced staff due to burnout can be minimized and quality of patient care can be maintained. © 2016 The Royal Australian and New Zealand College of Radiologists.

Factors that influence chest injuries in rollovers.

PubMed

Digges, Kennerly; Eigen, Ana; Tahan, Fadi; Grzebieta, Raphael

2014-01-01

The design of countermeasures to reduce serious chest injuries for belted occupants involved in rollover crashes requires an understanding of the cause of these injuries and of the test conditions to assure the effectiveness of the countermeasures. This study defines rollover environments and occupant-to-vehicle interactions that cause chest injuries for belted drivers. The NASS-CDS was examined to determine the frequency and crash severity for belted drivers with serious (Abbreviated Injury Scale [AIS] 3+) chest injuries in rollovers. Case studies of NASS crashes with serious chest injuries sustained by belted front occupants were undertaken and damage patterns were determined. Vehicle rollover tests with dummies were examined to determine occupant motion in crashes with damage similar to that observed in the NASS cases. Computer simulations were performed to further explore factors that could contribute to chest injury. Finite element model (FEM) vehicle models with both the FEM Hybrid III dummy and THUMS human model were used in the simulations. Simulation of rollovers with 6 quarter-turns or less indicated that increases in the vehicle pitch, either positive or negative, increased the severity of dummy chest loadings. This finding was consistent with vehicle damage observations from NASS cases. For the far-side occupant, the maximum chest loadings were caused by belt and side interactions during the third quarter-turn and by the center console loading during the fourth quarter-turn. The results showed that the THUMS dummy produced more realistic kinematics and improved insights into skeletal and chest organ loadings compared to the Hybrid III dummy. These results suggest that a dynamic rollover test to encourage chest injury reduction countermeasures should induce a roll of at least 4 quarter-turns and should also include initial vehicle pitch and/or yaw so that the vehicle's axis of rotation is not aligned with its inertial roll axis during the initial stage

Comparison of chest CT findings in nontuberculous mycobacterial diseases vs. Mycobacterium tuberculosis lung disease in HIV-negative patients with cavities.

PubMed

Kim, Cherry; Park, So Hee; Oh, Sang Young; Kim, Sung-Soo; Jo, Kyung-Wook; Shim, Tae Sun; Kim, Mi Young

2017-01-01

This article focuses on the differences between CT findings of HIV-negative patients who have cavities with nontuberculous mycobacteria (NTM) disease and those with Mycobacterium tuberculosis infections (TB). We retrospectively reviewed 128 NTM disease patients (79 males and 49 females) with cavities in chest CT, matched for age and gender with 128 TB patients in the same period. Sputum cultures of all patients were positive for pathogens. Two independent chest radiologists evaluated the characteristics of the largest cavity and related factors. Interobserver agreement was excellent (κ value, 0.853-0.938). Cavity walls in NTM disease were significantly thinner (6.9±4 mm vs 10.9±6 mm, P<0.001) and more even (the ratio of thickness, 2.6±1 vs 3.7±2, P<0.001) than those in TB. The thickening of adjacent pleura next to the cavity was also significantly thicker in NTM than TB (P<0.001). However, in the multivariate analysis, thickening of adjacent pleura was the only significant factor among the representative cavity findings (Odds ratio [OR], 6.49; P<0.001). In addition, ill-defined tree-in-bud nodules (OR, 8.82; P<0.001), number of non-cavitary nodules (≥10mm) (OR, 0.72; P = 0.003), and bronchiectasis in the RUL (OR, 5.3; P = 0.002) were significantly associated ancillary findings with NTM disease in the multivariate analysis. The major cavities in NTM disease generally have thinner and more even walls than those in TB. When cavities are associated with adjacent pleural thickening, ill-defined satellite tree-in-bud nodules, or fewer non-cavitary nodules ≥10 mm, these CT findings are highly suggestive of NTM disease rather than TB.

Trampoline related injuries in children: risk factors and radiographic findings.

PubMed

Klimek, Peter Michael; Juen, David; Stranzinger, Enno; Wolf, Rainer; Slongo, Theddy

2013-05-01

Backyard trampolines are immensely popular among children, but are associated with an increase of trampoline-related injuries. The aim of this study was to evaluate radiographs of children with trampoline related injuries and to determine the risk factors. Between 2003 and 2009, 286 children under the age of 16 with backyard trampoline injuries were included in the study. The number of injuries increased from 13 patients in 2003 to 86 in 2009. The median age of the 286 patients was 7 years (range: 1-15 years). Totally 140 (49%) patients were males, and 146 (51%) females. Medical records and all available diagnostic imaging were reviewed. A questionnaire was sent to the parents to evaluate the circumstances of each injury, the type of trampoline, the protection equipment and the experience of the children using the trampoline. The study was approved by the Institutional Ethics Committee of the University Hospital of Bern. The questionnaires and radiographs of the 104 patients were available for evaluation. A fracture was sustained in 51 of the 104 patients. More than 75% of all patients sustaining injuries and in 90% of patients with fractures were jumping on the trampoline with other children at the time of the accident. The most common fractures were supracondylar humeral fractures (29%) and forearm fractures (25%). Fractures of the proximal tibia occurred especially in younger children between 2-5 years of age. Children younger than 5 years old are at risk for specific proximal tibia fractures ("Trampoline Fracture"). A child jumping simultaneously with other children has a higher risk of suffering from a fracture.

Glycemic Control and Radiographic Manifestations of Tuberculosis in Diabetic Patients

PubMed Central

Chiang, Chen-Yuan; Lee, Jen-Jyh; Chien, Shun-Tien; Enarson, Donald A.; Chang, You-Cheng; Chen, Yi-Ting; Hu, Ting-Yu; Lin, Chih-Bin; Suk, Chi-Won; Tao, Jui-Ming; Bai, Kuan-Jen

2014-01-01

Background Radiographic manifestations of pulmonary tuberculosis (TB) in patients with diabetes mellitus (DM) have previously been reported, with inconsistent results. We conducted a study to investigate whether glycemic control has an impact on radiographic manifestations of pulmonary TB. Methods Consecutive patients with culture-positive pulmonary TB who had DM in three tertiary care hospitals from 2005–2010 were selected for review and compared with a similar number without DM. Glycemic control was assessed by glycated haemoglobin A1C (HbA1C). A pre-treatment chest radiograph was read independently by two qualified pulmonologists blinded to patients’ diabetic status. Films with any discordant reading were read by a third reader. Results 1209 culture positive pulmonary TB patients (581 with DM and 628 without DM) were enrolled. Compared with those without DM, TB patients with DM were significantly more likely to have opacity over lower lung fields, extensive parenchymal lesions, any cavity, multiple cavities and large cavities (>3 cm). The relative risk of lower lung field opacities was 0.80 (95% CI 0.46–1.42) for those with DM with A1C<7%, 2.32 (95% CI 1.36 - 3.98) for A1C 7%–9%, and 1.62 (95% CI 1.12–2.36) for A1C>9%; and that of any cavity over no cavity was 0.87 (95% CI 0.46–1.62) for patients with DM with A1C<7%, 1.84 (95% CI 1.20–2.84) for A1C 7%–9%, and 3.71 (95% CI 2.64–5.22) for A1C>9%, relative to patients without DM. Conclusions Glycemic control significantly influenced radiographic manifestations of pulmonary TB in patients with DM. PMID:24699457

Radiographical findings in patients with liver cirrhosis and hepatic encephalopathy.

PubMed

Elwir, Saleh; Hal, Hassan; Veith, Joshua; Schreibman, Ian; Kadry, Zakiyah; Riley, Thomas

2016-08-01

Hepatic encephalopathy is a common complication encountered in patients with liver cirrhosis. Hepatic encephalopathy is not reflected in the current liver transplant allocation system. Correlation was sought between hepatic encephalopathy with findings detected on radiographic imaging studies and the patient's clinical profile. A retrospective analysis was conducted of patients with cirrhosis, who presented for liver transplant evaluation in 2009 and 2010. Patients with hepatocellular carcinoma, ejection fraction less than 60% and who had a TIPS (transjugular intrahepatic portosystemic shunting) procedure or who did not complete the evaluation were excluded. Statistical analysis was performed and variables found to be significant on univariate analysis (P < 0.05) were analysed by a multivariate logistic regression model. A total of 117 patients met the inclusion criteria and were divided into a hepatic encephalopathy group (n = 58) and a control group (n = 59). Univariate analysis found that a smaller portal vein diameter, smaller liver antero-posterior diameter, liver nodularity and use of diuretics or centrally acting medications showed significant correlation with hepatic encephalopathy. This association was confirmed for smaller portal vein, use of diuretics and centrally acting medications in the multivariate analysis. A decrease in portal vein diameter was associated with increased risk of encephalopathy. Identifying patients with smaller portal vein diameter may warrant screening for encephalopathy by more advanced psychometric testing, and more aggressive control of constipation and other factors that may precipitate encephalopathy. © The Author(s) 2015. Published by Oxford University Press and the Digestive Science Publishing Co. Limited.

The 'radiographer-referrer game': image interpretation dynamics in rural practice.

PubMed

Squibb, Kathryn; Smith, Anthony; Dalton, Lisa; Bull, Rosalind M

2016-03-01

Effective interprofessional communication is intrinsic to safe health care. Despite the identified positive impact of collaborative radiographic interpretation between rural radiographers and referrers, communication difficulties still exist. This article describes the strategies that Australian rural radiographers use for communication of their radiographic opinion to the referring doctor. In a two-phase interpretive doctoral study completed in 2012, data were collected from radiographers working in rural New South Wales, Western Australia and Tasmania using a paper based questionnaire followed by in-depth semistructured interviews. Data were analysed thematically in order to identify, analyse and report the emergent themes. The overarching theme was Patient Advocacy, where in the interest of patient care radiographers took measures to ensure that a referring doctor did not miss radiographic abnormalities. Strong interprofessional relationships enabled direct communication pathways. Interprofessional boundaries shaped by historical hierarchical relationships, together with a lack of confidence and educational preparation for radiographic interpretation result in barriers to direct communication pathways. These barriers prompted radiographers to pursue indirect communication pathways, such as side-stepping and hint and hope. A lack of formal communication pathways and educational preparation for this role has resulted in radiographers playing the radiographer-referrer game to overtly or covertly assist referrers in reaching a radiographic diagnosis. The findings from this study may be used to plan interventions for strengthening interprofessional communication pathways and improve quality of healthcare for patients.

A follow-up study of neurologic and radiographic findings in working German Shepherd Dogs with and without degenerative lumbosacral stenosis.

PubMed

Steffen, Frank; Hunold, Katharina; Scharf, Gernot; Roos, Malgorzata; Flückiger, Mark

2007-11-15

To identify radiographic abnormalities associated with degenerative lumbosacral stenosis (DLSS) in German Shepherd Dogs (GSDs) and determine whether specific radiographic abnormalities could be used to identify dogs at risk of developing DLSS. Cohort study. 33 GSDs working as police dogs. Results of physical, neurologic, and orthopedic examinations were used to identify dogs with DLSS. Survey radiography of the lumbosacral junction was performed, and radiographs were compared with radiographs obtained 3 years earlier. DLSS was diagnosed in 15 of the 33 (45%) dogs. Thirteen of the 15 dogs with DLSS and 14 of the 18 dogs without DLSS had radiographic abnormalities of the lumbosacral junction. Twenty-two (67%) dogs were able to perform unrestricted duties, including 3 dogs with suspected DLSS. Six (18%) dogs had been excluded from active duty during the period of surveillance because of DLSS. Significant progression in specific clinical and radiographic signs was detected, but multiple logistic regression analysis did not identify any radiographic signs that could be used to predict the development of DLSS. Results suggested that survey radiography cannot be used to predict development of DLSS in working GSDs.

A combined pulmonary-radiology workshop for visual evaluation of COPD: study design, chest CT findings and concordance with quantitative evaluation.

PubMed

Barr, R Graham; Berkowitz, Eugene A; Bigazzi, Francesca; Bode, Frederick; Bon, Jessica; Bowler, Russell P; Chiles, Caroline; Crapo, James D; Criner, Gerard J; Curtis, Jeffrey L; Dass, Chandra; Dirksen, Asger; Dransfield, Mark T; Edula, Goutham; Erikkson, Leif; Friedlander, Adam; Galperin-Aizenberg, Maya; Gefter, Warren B; Gierada, David S; Grenier, Philippe A; Goldin, Jonathan; Han, MeiLan K; Hanania, Nicola A; Hansel, Nadia N; Jacobson, Francine L; Kauczor, Hans-Ulrich; Kinnula, Vuokko L; Lipson, David A; Lynch, David A; MacNee, William; Make, Barry J; Mamary, A James; Mann, Howard; Marchetti, Nathaniel; Mascalchi, Mario; McLennan, Geoffrey; Murphy, James R; Naidich, David; Nath, Hrudaya; Newell, John D; Pistolesi, Massimo; Regan, Elizabeth A; Reilly, John J; Sandhaus, Robert; Schroeder, Joyce D; Sciurba, Frank; Shaker, Saher; Sharafkhaneh, Amir; Silverman, Edwin K; Steiner, Robert M; Strange, Charlton; Sverzellati, Nicola; Tashjian, Joseph H; van Beek, Edwin J R; Washington, Lacey; Washko, George R; Westney, Gloria; Wood, Susan A; Woodruff, Prescott G

2012-04-01

The purposes of this study were: to describe chest CT findings in normal non-smoking controls and cigarette smokers with and without COPD; to compare the prevalence of CT abnormalities with severity of COPD; and to evaluate concordance between visual and quantitative chest CT (QCT) scoring. Volumetric inspiratory and expiratory CT scans of 294 subjects, including normal non-smokers, smokers without COPD, and smokers with GOLD Stage I-IV COPD, were scored at a multi-reader workshop using a standardized worksheet. There were 58 observers (33 pulmonologists, 25 radiologists); each scan was scored by 9-11 observers. Interobserver agreement was calculated using kappa statistic. Median score of visual observations was compared with QCT measurements. Interobserver agreement was moderate for the presence or absence of emphysema and for the presence of panlobular emphysema; fair for the presence of centrilobular, paraseptal, and bullous emphysema subtypes and for the presence of bronchial wall thickening; and poor for gas trapping, centrilobular nodularity, mosaic attenuation, and bronchial dilation. Agreement was similar for radiologists and pulmonologists. The prevalence on CT readings of most abnormalities (e.g. emphysema, bronchial wall thickening, mosaic attenuation, expiratory gas trapping) increased significantly with greater COPD severity, while the prevalence of centrilobular nodularity decreased. Concordances between visual scoring and quantitative scoring of emphysema, gas trapping and airway wall thickening were 75%, 87% and 65%, respectively. Despite substantial inter-observer variation, visual assessment of chest CT scans in cigarette smokers provides information regarding lung disease severity; visual scoring may be complementary to quantitative evaluation.

Classification of radiological errors in chest radiographs, using support vector machine on the spatial frequency features of false- negative and false-positive regions

NASA Astrophysics Data System (ADS)

Pietrzyk, Mariusz W.; Donovan, Tim; Brennan, Patrick C.; Dix, Alan; Manning, David J.

2011-03-01

Aim: To optimize automated classification of radiological errors during lung nodule detection from chest radiographs (CxR) using a support vector machine (SVM) run on the spatial frequency features extracted from the local background of selected regions. Background: The majority of the unreported pulmonary nodules are visually detected but not recognized; shown by the prolonged dwell time values at false-negative regions. Similarly, overestimated nodule locations are capturing substantial amounts of foveal attention. Spatial frequency properties of selected local backgrounds are correlated with human observer responses either in terms of accuracy in indicating abnormality position or in the precision of visual sampling the medical images. Methods: Seven radiologists participated in the eye tracking experiments conducted under conditions of pulmonary nodule detection from a set of 20 postero-anterior CxR. The most dwelled locations have been identified and subjected to spatial frequency (SF) analysis. The image-based features of selected ROI were extracted with un-decimated Wavelet Packet Transform. An analysis of variance was run to select SF features and a SVM schema was implemented to classify False-Negative and False-Positive from all ROI. Results: A relative high overall accuracy was obtained for each individually developed Wavelet-SVM algorithm, with over 90% average correct ratio for errors recognition from all prolonged dwell locations. Conclusion: The preliminary results show that combined eye-tracking and image-based features can be used for automated detection of radiological error with SVM. The work is still in progress and not all analytical procedures have been completed, which might have an effect on the specificity of the algorithm.

Pediatric chest imaging.

PubMed

Gross, G W

1992-10-01

The highlight of recent articles published on pediatric chest imaging is the potential advantage of digital imaging of the infant's chest. Digital chest imaging allows accurate determination of functional residual capacity as well as manipulation of the image to highlight specific anatomic features. Reusable photostimulable phosphor imaging systems provide wide imaging latitude and lower patient dose. In addition, digital radiology permits multiple remote-site viewing on monitor displays. Several excellent reviews of the imaging features of various thoracic abnormalities and the application of newer imaging modalities, such as ultrafast CT and MR imaging to the pediatric chest, are additional highlights.

Chest Wall Trauma.

PubMed

Majercik, Sarah; Pieracci, Fredric M

2017-05-01

Chest wall trauma is common, and contributes significantly to morbidity and mortality of trauma patients. Early identification of major chest wall and concomitant intrathoracic injuries is critical. Generalized management of multiple rib fractures and flail chest consists of adequate pain control (including locoregional modalities); management of pulmonary dysfunction by invasive and noninvasive means; and, in some cases, surgical fixation. Multiple studies have shown that patients with flail chest have substantial benefit (decreased ventilator and intensive care unit days, improved pulmonary function, and improved long-term functional outcome) when they undergo surgery compared with nonoperative management. Copyright © 2017 Elsevier Inc. All rights reserved.

Should chest examination be reinstated in the early diagnosis of chronic obstructive pulmonary disease?

PubMed Central

Oshaug, Katja; Halvorsen, Peder A; Melbye, Hasse

2013-01-01

Background Although proven to be associated with bronchial obstruction, chest signs are not listed among cues that should prompt spirometry in the early diagnosis of chronic obstructive pulmonary disease (COPD) in established guidelines. Aims We aimed to explore how chest findings add to respiratory symptoms and a history of smoking in the diagnosis of COPD. Methods In a cross-sectional study, patients aged 40 years or older, previously diagnosed with either asthma or COPD in primary care, answered questionnaires and underwent physical chest examination and spirometry. Results Among the 375 patients included, 39.7% had forced expiratory volume in 1 second/forced vital capacity <0.7. Hyperresonance to percussion was the strongest predictor of COPD, with a sensitivity of 20.8, a specificity of 97.8, and likelihood ratio of 9.5. In multivariate logistic regression, where pack-years, shortness of breath, and chest findings were among the explanatory variables, three physical chest findings were independent predictors of COPD. Hyperresonance to percussion yielded the highest odds ratio (OR = 6.7), followed by diminished breath sounds (OR = 5.0), and thirdly wheezes (OR = 2.3). These three chest signs also gave significant diagnostic information when added to shortness of breath and pack-years in receiver operating-characteristic curve analysis. Conclusion We found that chest signs may add to respiratory symptoms and a history of smoking in the diagnosis of COPD, and we conclude that chest signs should be reinstated as cues to early diagnosis of COPD in patients 40 years or older. PMID:23983462

Flat-panel-detector chest radiography: effect of tube voltage on image quality.

PubMed

Uffmann, Martin; Neitzel, Ulrich; Prokop, Mathias; Kabalan, Nahla; Weber, Michael; Herold, Christian J; Schaefer-Prokop, Cornelia

2005-05-01

To compare the visibility of anatomic structures in direct-detector chest radiographs acquired with different tube voltages at equal effective doses to the patient. The study protocol was approved by the institutional internal review board, and written informed consent was obtained from all patients. Posteroanterior chest radiographs of 48 consecutively selected patients were obtained at 90, 121, and 150 kVp by using a flat-panel-detector unit that was based on cesium iodide technology and automated exposure control. Monte Carlo simulations were used to verify that the effective dose for all kilovoltage settings was equal. Five radiologists subjectively and independently rated the delineation of anatomic structures on hard-copy images by using a five-point scale. They also ranked image quality in a blinded side-by-side comparison. Average ranking scores were compared by using one-way analysis of variance with repeated measures. Data were analyzed for the entire patient group and for two patient subgroups that were formed according to body mass index (BMI). The visibility scores of most anatomic structures were significantly superior with the 90-kVp images (mean score, 3.11), followed by the 121-kVp (mean score, 2.95) and 150-kVp images (mean score, 2.80). Differences did not reach significance (P > .05) only for the delineation of the peripheral vessels, the heart contours, and the carina. This was also true for the subgroup of patients (n = 24) with a BMI greater than and the subgroup of patients (n = 24) with a BMI less than the mean BMI (26.9 kg/m(2)). At side-by-side comparison, the readers rated 90-kVp images as having superior image quality in the majority of image triplets; the percentage of 90-kVp images rated as "first choice" ranged from 60% (29 of 48 patients) to 90% (43 of 48 patients), with a median of 88% (42 of 48 patients), among the readers. Delineation of most anatomic structures and overall image quality were ranked superior in digital

Dental radiographic guidelines: a review.

PubMed

Kim, Irene H; Mupparapu, Muralidhar

2009-05-01

The 2004 American Dental Association (ADA)/US Food and Drug Administration (FDA) radiographic selection criteria and guidelines were reviewed and compared with the prior radiographic selection criteria and guidelines. The authors reviewed the publications from the US FDA, US Department of Health and Human Services, and National Council on Radiation Protection and Measurements. The positions outlined by the Canadian Dental Association and the European Commission were also reviewed and compared to US guidelines. The FDA guidelines were first published in 1987, and several changes have been made to them over the years. Recent literature reveals that the general compliance of these guidelines is very low, especially within dental schools in the United States and Canada. Little is known about the compliance outside of the dental school environment; however, it is expected to be low for various reasons. In 2007, the International Commission on Radiological Protection (ICRP) revised its estimates of tissue radiosensitivity, which resulted in effective doses of dental radiographs 32% to 422% higher than the 1990 ICRP guidelines. Flow charts summarizing the latest guidelines were developed to facilitate general compliance among practitioners. Based on the literature reviewed and the recent ICRP findings, it would be prudent for dental health care professionals to follow dental radiographic guidelines.

Rib fixation for severe chest deformity due to multiple rib fractures.

PubMed

Igai, Hitoshi; Kamiyoshihara, Mitsuhiro; Nagashima, Toshiteru; Ohtaki, Yoichi

2012-01-01

The operative indications for rib fracture repair have been a matter of debate. However, several reports have suggested that flail chest, pain on respiration, and chest deformity/defect are potential conditions for rib fracture repair. We describe our experience of rib fixation in a patient with severe chest deformity due to multiple rib fractures. A 70-year-old woman was admitted with right-sided multiple rib fractures (2nd to 7th) and marked chest wall deformity without flailing caused by an automobile accident. Collapse of the chest wall was observed along the middle anterior axillary line. At 11 days after the injury, surgery was performed to repair the chest deformity, as it was considered to pose a risk of restrictive impairment of pulmonary function or chronic intercostal pain in the future. Operative findings revealed marked displacement of the superior 4 ribs, from the 2nd to the 5th, and collapse of the osseous chest wall towards the thoracic cavity. After exposure of the fracture regions, ribs fixations were performed using rib staplers. The total operation time was 90 minutes, and the collapsed portion of the chest wall along the middle anterior axillary line was reconstructed successfully.

Dynamic chest radiography: flat-panel detector (FPD) based functional X-ray imaging.

PubMed

Tanaka, Rie

2016-07-01

Dynamic chest radiography is a flat-panel detector (FPD)-based functional X-ray imaging, which is performed as an additional examination in chest radiography. The large field of view (FOV) of FPDs permits real-time observation of the entire lungs and simultaneous right-and-left evaluation of diaphragm kinetics. Most importantly, dynamic chest radiography provides pulmonary ventilation and circulation findings as slight changes in pixel value even without the use of contrast media; the interpretation is challenging and crucial for a better understanding of pulmonary function. The basic concept was proposed in the 1980s; however, it was not realized until the 2010s because of technical limitations. Dynamic FPDs and advanced digital image processing played a key role for clinical application of dynamic chest radiography. Pulmonary ventilation and circulation can be quantified and visualized for the diagnosis of pulmonary diseases. Dynamic chest radiography can be deployed as a simple and rapid means of functional imaging in both routine and emergency medicine. Here, we focus on the evaluation of pulmonary ventilation and circulation. This review article describes the basic mechanism of imaging findings according to pulmonary/circulation physiology, followed by imaging procedures, analysis method, and diagnostic performance of dynamic chest radiography.

Specific Radiological Findings of Traumatic Gastrointestinal Tract Injuries in Patients With Blunt Chest and Abdominal Trauma.

PubMed

Kokabi, Nima; Harmouche, Elie; Xing, Minzhi; Shuaib, Waqas; Mittal, Pardeep K; Wilson, Kenneth; Johnson, Jamlik-Omari; Nicolaou, Savvas; Khosa, Faisal

2015-05-01

Gastrointestinal hollow viscus injury after blunt chest and abdominal trauma is uncommon and complicates 0.6%-1.2% of all cases of trauma. Early recognition of such injuries significantly decreases morbidity and mortality. Since physical examination is not accurate in detecting such injuries, contrast-enhanced computed tomography has been the mainstay for diagnosis in many emergency departments. This pictorial essay aims to review the incidence, mechanisms, and signs of gastrointestinal hollow viscus injuries in the setting of blunt chest and abdominal trauma. Copyright © 2015 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

A method to incorporate the effect of beam quality on image noise in a digitally reconstructed radiograph (DRR) based computer simulation for optimisation of digital radiography

NASA Astrophysics Data System (ADS)

Moore, Craig S.; Wood, Tim J.; Saunderson, John R.; Beavis, Andrew W.

2017-09-01

The use of computer simulated digital x-radiographs for optimisation purposes has become widespread in recent years. To make these optimisation investigations effective, it is vital simulated radiographs contain accurate anatomical and system noise. Computer algorithms that simulate radiographs based solely on the incident detector x-ray intensity (‘dose’) have been reported extensively in the literature. However, while it has been established for digital mammography that x-ray beam quality is an important factor when modelling noise in simulated images there are no such studies for diagnostic imaging of the chest, abdomen and pelvis. This study investigates the influence of beam quality on image noise in a digital radiography (DR) imaging system, and incorporates these effects into a digitally reconstructed radiograph (DRR) computer simulator. Image noise was measured on a real DR imaging system as a function of dose (absorbed energy) over a range of clinically relevant beam qualities. Simulated ‘absorbed energy’ and ‘beam quality’ DRRs were then created for each patient and tube voltage under investigation. Simulated noise images, corrected for dose and beam quality, were subsequently produced from the absorbed energy and beam quality DRRs, using the measured noise, absorbed energy and beam quality relationships. The noise images were superimposed onto the noiseless absorbed energy DRRs to create the final images. Signal-to-noise measurements in simulated chest, abdomen and spine images were within 10% of the corresponding measurements in real images. This compares favourably to our previous algorithm where images corrected for dose only were all within 20%.

Improvement of the clinical use of computed radiography for mobile chest imaging: Image quality and patient dose

NASA Astrophysics Data System (ADS)

Rill, Lynn Neitzey

Chest radiography is technically difficult because of the wide variation of tissue attenuations in the chest and limitations of screen-film systems. Mobile chest radiography, performed bedside on hospital inpatients, presents additional difficulties due to geometrical and equipment limitations inherent to mobile x-ray procedures and the severity of illness in patients. Computed radiography (CR) offers a new approach for mobile chest radiography by utilizing a photostimulable phosphor. Photostimulable phosphors are more efficient in absorbing lower-energy x-rays than standard intensifying screens and overcome some image quality limitations of mobile chest imaging, particularly because of the inherent latitude. This study evaluated changes in imaging parameters for CR to take advantage of differences between CR and screen-film radiography. Two chest phantoms, made of acrylic and aluminum, simulated x-ray attenuation for average-sized and large- sized adult chests. The phantoms contained regions representing the lungs, heart and subdiaphragm. Acrylic and aluminum disks (1.9 cm diameter) were positioned in the chest regions to make signal-to-noise ratio (SNR) measurements for different combinations of imaging parameters. Disk thicknesses (contrast) were determined from disk visibility. Effective dose to the phantom was also measured for technique combinations. The results indicated that using an anti-scatter grid and lowering x- ray tube potential improved the SNR significantly; however, the dose to the phantom also increased. An evaluation was performed to examine the clinical applicability of the observed improvements in SNR. Parameter adjustments that improved phantom SNRs by more than 50% resulted in perceived image quality improvements in the lung region of clinical mobile chest radiographs. Parameters that produced smaller improvements in SNR had no apparent effect on clinical image quality. Based on this study, it is recommended that a 3:1 grid be used for

Radiographic appearance of bronchoalveolar carcinoma in nine cats.

PubMed

Ballegeer, Elizabeth A; Forrest, Lisa J; Stepien, Rebecca L

2002-01-01

Thoracic radiographs of nine cats with confirmed bronchoalveolar carcinoma (BAC) were reviewed retrospectively. Radiographic appearance of BAC was divided into three categories: mixed bronchoalveolar pattern, ill-defined alveolar mass, or mass with cavitation. In addition to these radiographic signs, all nine cats had evidence of some form of bronchial disease. Cavitary lesions were the most common finding (n = 5). In addition, three cats in this category had diffuse bronchointerstitial opacity and one cat had focal peribronchial cuffing. Five cats had either a mixed bronchoalveolar pattern with bronchiectasis (n = 3) or an ill-defined alveolar mass with peribronchial cuffing (n = 2). One cat had both a mixed bronchoalveolar pattern and a cavitary mass. Each of these nine cats had some form of bronchial disease (bronchointerstitial pattern, peribronchial cuffing, or bronchiectasis), which aids in the radiographic diagnosis of bronchoalveolar carcinoma and may represent airway metastasis.

Diagnostic value of chest ultrasound after cardiac surgery: a comparison with chest X-ray and auscultation.

PubMed

Vezzani, Antonella; Manca, Tullio; Brusasco, Claudia; Santori, Gregorio; Valentino, Massimo; Nicolini, Francesco; Molardi, Alberto; Gherli, Tiziano; Corradi, Francesco

2014-12-01

Chest auscultation and chest x-ray commonly are used to detect postoperative abnormalities and complications in patients admitted to intensive care after cardiac surgery. The aim of the study was to evaluate whether chest ultrasound represents an effective alternative to bedside chest x-ray to identify early postoperative abnormalities. Diagnostic accuracy of chest auscultation and chest ultrasound were compared in identifying individual abnormalities detected by chest x-ray, considered the reference method. Cardiac surgery intensive care unit. One hundred fifty-one consecutive adult patients undergoing cardiac surgery. All patients included were studied by chest auscultation, ultrasound, and x-ray upon admission to intensive care after cardiac surgery. Six lung pathologic changes and endotracheal tube malposition were found. There was a highly significant correlation between abnormalities detected by chest ultrasound and x-ray (k = 0.90), but a poor correlation between chest auscultation and x-ray abnormalities (k = 0.15). Chest auscultation may help identify endotracheal tube misplacement and tension pneumothorax but it may miss most major abnormalities. Chest ultrasound represents a valid alternative to chest x-ray to detect most postoperative abnormalities and misplacements. Copyright © 2014 Elsevier Inc. All rights reserved.

Algorithm of chest wall keloid treatment

PubMed Central

Long, Xiao; Zhang, Mingzi; Wang, Yang; Zhao, Ru; Wang, Youbin; Wang, Xiaojun

2016-01-01

Abstract Keloids are common in the Asian population. Multiple or huge keloids can appear on the chest wall because of its tendency to develop acne, sebaceous cyst, etc. It is difficult to find an ideal treatment for keloids in this area due to the limit of local soft tissues and higher recurrence rate. This study aims at establishing an individualized protocol that could be easily applied according to the size and number of chest wall keloids. A total of 445 patients received various methods (4 protocols) of treatment in our department from September 2006 to September 2012 according to the size and number of their chest wall keloids. All of the patients received adjuvant radiotherapy in our hospital. Patient and Observer Scar Assessment Scale (POSAS) was used to assess the treatment effect by both doctors and patients. With mean follow-up time of 13 months (range: 6–18 months), 362 patients participated in the assessment of POSAS with doctors. Both the doctors and the patients themselves used POSAS to evaluate the treatment effect. The recurrence rate was 0.83%. There was an obvious significant difference (P < 0.001) between the before-surgery score and the after-surgery score from both doctors and patients, indicating that both doctors and patients were satisfied with the treatment effect. Our preliminary clinical result indicates that good clinical results could be achieved by choosing the proper method in this algorithm for Chinese patients with chest wall keloids. This algorithm could play a guiding role for surgeons when dealing with chest wall keloid treatment. PMID:27583896

Complete blood counts, liver function tests, and chest x-rays as routine screening in early-stage breast cancer: value added or just cost?

PubMed

Louie, Raphael J; Tonneson, Jennifer E; Gowarty, Minda; Goodney, Philip P; Barth, Richard J; Rosenkranz, Kari M

2015-11-01

Current National Comprehensive Cancer Network guidelines for breast cancer staging include pre-treatment complete blood count (CBC) and liver function tests (LFT) to screen for occult metastatic disease. To date, the relevance of these tests in detecting metastatic disease in asymptomatic women with early-stage breast cancer (Stage I/II) has not been demonstrated. Although chest x-rays are no longer recommended in the NCCN guidelines, many centers continue to include this imaging as part of their screening process. We aim to determine the clinical and financial impact of these labs and x-rays in the evaluation of early-stage breast cancer patients. A single institution IRB-approved retrospective chart review was conducted of patients with biopsy-proven invasive breast cancer treated from January 1, 2005–December 31, 2009. We collected patient demographics, clinical and pathologic staging, chest x-ray, CBC, and LFT results at the time of referral. Patients were stratified according to radiographic stage at the time of diagnosis. We obtained Medicare reimbursement fees for cost analysis. From 2005 to 2009, 1609 patients with biopsy-proven invasive breast cancer were treated at our institution. Of the 1082 patients with radiographic stage I/II disease, 27.3 % of patients had abnormal CBCs. No additional testing was performed to evaluate these abnormalities. In the early-stage population, 24.7 % of patients had elevated LFTs, resulting in 84 additional imaging studies. No metastatic disease was detected. The cost of CBC, LFTs and chest x-rays was $110.20 per patient, totaling $106,410.99. Additional tests prompted by abnormal results cost $58,143.30 over the five-year period. We found that pre-treatment CBCs, LFTs, and chest x-rays did not improve detection of occult metastatic disease but resulted in additional financial costs. Avoiding routine ordering of these tests would save the US healthcare system $25.7 million annually.

Chest Seal Placement for Penetrating Chest Wounds by Prehospital Ground Forces in Afghanistan.

PubMed

Schauer, Steven G; April, Michael D; Naylor, Jason F; Simon, Erica M; Fisher, Andrew D; Cunningham, Cord W; Morissette, Daniel M; Fernandez, Jessie Renee D; Ryan, Kathy L

Thoracic trauma represents 5% of all battlefield injuries. Communicating pneumothoraces resulting in tension physiology remain an important etiology of prehospital mortality. In addressing penetrating chest trauma, current Tactical Combat Casualty Care (TCCC) guidelines advocate the immediate placement of a vented chest seal device. Although the Committee on TCCC (CoTCCC) has approved numerous chest seal devices for battlefield use, few data exist regarding their use in a combat zone setting. To evaluate adherence to TCCC guidelines for chest seal placement among personnel deployed to Afghanistan. We obtained data from the Prehospital Trauma Registry (PHTR). Joint Trauma System personnel linked patients to the Department of Defense Trauma Registry, when available, for outcome data upon reaching a fixed facility. In the PHTR, we identified 62 patients with documented gunshot wound (GSW) or puncture wound trauma to the chest. The majority (74.2%; n = 46) of these were due to GSW, with the remainder either explosive-based puncture wounds (22.6%; n = 14) or a combination of GSW and explosive (3.2%; n = 2). Of the 62 casualties with documented GSW or puncture wounds, 46 (74.2%) underwent chest seal placement. Higher proportions of patients with medical officers in their chain of care underwent chest seal placement than those that did not (63.0% versus 37.0%). The majority of chest seals placed were not vented. Of patients with a GSW or puncture wound to the chest, 74.2% underwent chest seal placement. Most of the chest seals placed were not vented in accordance with guidelines, despite the guideline update midway through the study period. These data suggest the need to improve predeployment training on TCCC guidelines and matching of the Army logistical supply chain to the devices recommended by the CoTCCC. 2017.

Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis.

PubMed

Alrajab, Saadah; Youssef, Asser M; Akkus, Nuri I; Caldito, Gloria

2013-09-23

Ultrasonography is being increasingly utilized in acute care settings with expanding applications. Pneumothorax evaluation by ultrasonography is a fast, safe, easy and inexpensive alternative to chest radiographs. In this review, we provide a comprehensive analysis of the current literature comparing ultrasonography and chest radiography for the diagnosis of pneumothorax. We searched English-language articles in MEDLINE, EMBASE and Cochrane Library dealing with both ultrasonography and chest radiography for diagnosis of pneumothorax. In eligible studies that met strict inclusion criteria, we conducted a meta-analysis to evaluate the diagnostic accuracy of pleural ultrasonography in comparison with chest radiography for the diagnosis of pneumothorax. We reviewed 601 articles and selected 25 original research articles for detailed review. Only 13 articles met all of our inclusion criteria and were included in the final analysis. One study used lung sliding sign alone, 12 studies used lung sliding and comet tail signs, and 6 studies searched for lung point in addition to the other two signs. Ultrasonography had a pooled sensitivity of 78.6% (95% CI, 68.1 to 98.1) and a specificity of 98.4% (95% CI, 97.3 to 99.5). Chest radiography had a pooled sensitivity of 39.8% (95% CI, 29.4 to 50.3) and a specificity of 99.3% (95% CI, 98.4 to 100). Our meta-regression and subgroup analyses indicate that consecutive sampling of patients compared to convenience sampling provided higher sensitivity results for both ultrasonography and chest radiography. Consecutive versus nonconsecutive sampling and trauma versus nontrauma settings were significant sources of heterogeneity. In addition, subgroup analysis showed significant variations related to operator and type of probe used. Our study indicates that ultrasonography is more accurate than chest radiography for detection of pneumothorax. The results support the previous investigations in this field, add new valuable information

Radiographer.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Center on Education and Training for Employment.

This document, which is designed for use in developing a tech prep competency profile for the occupation of radiographer, lists technical competencies and competency builders for 18 units pertinent to the health technologies cluster in general as well as those specific to the occupation of radiographer. The following skill areas are covered in the…

Prediction of thoracic dimensions and spine length on the basis of individual pelvic dimensions: validation of the use of pelvic inlet width obtained by radiographs compared with computed tomography.

PubMed

Gold, Meryl; Dombek, Michael; Miller, Patricia E; Emans, John B; Glotzbecker, Michael P

2014-01-01

Retrospective review. To validate the pelvic inlet width (PIW) measurement obtained on radiograph as an independent standard used to correlate with thoracic dimensions (TDs) in treated and untreated patients with early-onset scoliosis. In children with early-onset scoliosis, the change in TD and spine length is a key treatment goal. Quantifying this change is confounded by varied growth rates and differing diagnoses. PIW measured on computed tomographic (CT) scan in patients without scoliosis has been shown to correlate with TD in an age-independent manner. The first arm included 49 patients with scoliosis who had both a CT scan and pelvic radiograph. Agreement between PIW measurements on CT scan and radiograph was analyzed. The second arm consisted of 163 patients (age, 0.2-18.7 yr), with minimal spinal deformity (mean Cobb, 9.0°) and radiographs in which PIW was measurable. PIW was compared with previously published CT-based TD measurements; maximal chest width, T1-T12 height, and T1-S1 height. Linear regression analysis was used to develop and validate sex-specific predictive equations for each TD measurement on the basis of PIW. Interobserver reliability was evaluated for all measurements. Bland-Altman analysis indicated agreement with no dependence on observed value, but a consistent 8.5 mm (95% CI: 7.2-9.9 mm) difference in CT scan measurement compared with radiographical PIW measurement. Sex and PIW were significantly correlated to each TD measurement (P < 0.01). Predictive models were validated and may be used to estimate TD measurements on the basis of sex and radiographical PIW. Intraclass correlation coefficients for all measurements were between 0.978 and 0.997. PIW on radiographs and CT scan correlate in patients with deformity and with spine and TD in patients with minimal deformity. It is a fast, reliable method of assessing growth while lowering patient's radiation exposure. It can be reliably used to assess patients with early-onset scoliosis and

[Chest trauma].

PubMed

Freixinet Gilart, Jorge; Ramírez Gil, María Elena; Gallardo Valera, Gregorio; Moreno Casado, Paula

2011-01-01

Chest trauma is a frequent problem arising from lesions caused by domestic and occupational activities and especially road traffic accidents. These injuries can be analyzed from distinct points of view, ranging from consideration of the most severe injuries, especially in the context of multiple trauma, to the specific characteristics of blunt and open trauma. In the present article, these injuries are discussed according to the involvement of the various thoracic structures. Rib fractures are the most frequent chest injuries and their diagnosis and treatment is straightforward, although these injuries can be severe if more than three ribs are affected and when there is major associated morbidity. Lung contusion is the most common visceral lesion. These injuries are usually found in severe chest trauma and are often associated with other thoracic and intrathoracic lesions. Treatment is based on general support measures. Pleural complications, such as hemothorax and pneumothorax, are also frequent. Their diagnosis is also straightforward and treatment is based on pleural drainage. This article also analyzes other complex situations, notably airway trauma, which is usually very severe in blunt chest trauma and less severe and even suitable for conservative treatment in iatrogenic injury due to tracheal intubation. Rupture of the diaphragm usually causes a diaphragmatic hernia. Treatment is always surgical. Myocardial contusions should be suspected in anterior chest trauma and in sternal fractures. Treatment is conservative. Other chest injuries, such as those of the great thoracic and esophageal vessels, are less frequent but are especially severe. Copyright © 2011 Sociedad Española de Neumología y Cirugía Torácica. Published by Elsevier Espana. All rights reserved.

Comparison of imaging characteristics of multiple-beam equalization and storage phosphor direct digitizer radiographic systems

NASA Astrophysics Data System (ADS)

Sankaran, A.; Chuang, Keh-Shih; Yonekawa, Hisashi; Huang, H. K.

1992-06-01

The imaging characteristics of two chest radiographic equipment, Advanced Multiple Beam Equalization Radiography (AMBER) and Konica Direct Digitizer [using a storage phosphor (SP) plate] systems have been compared. The variables affecting image quality and the computer display/reading systems used are detailed. Utilizing specially designed wedge, geometric, and anthropomorphic phantoms, studies were conducted on: exposure and energy response of detectors; nodule detectability; different exposure techniques; various look- up tables (LUTs), gray scale displays and laser printers. Methods for scatter estimation and reduction were investigated. It is concluded that AMBER with screen-film and equalization techniques provides better nodule detectability than SP plates. However, SP plates have other advantages such as flexibility in the selection of exposure techniques, image processing features, and excellent sensitivity when combined with optimum reader operating modes. The equalization feature of AMBER provides better nodule detectability under the denser regions of the chest. Results of diagnostic accuracy are demonstrated with nodule detectability plots and analysis of images obtained with phantoms.

Imaging characteristics of hemophagocytic lymphohistiocytosis.

PubMed

Fitzgerald, Nancy E; MacClain, Kenneth L

2003-06-01

Hemophagocytic lymphohistiocytosis (HLH) is a nonmalignant disorder of immune regulation, with overproduction of cytokines and diminished immune surveillance. Symptoms are nonspecific and may affect multiple organs, including the central nervous system. Neuroimaging findings have been described in case reports and small series; body imaging findings have not been described extensively. OBJECTIVE. To summarize findings of the most frequently performed imaging studies of the brain, chest and abdomen in patients with HLH. Retrospective review of chest radiographs and CT, abdominal ultrasound and CT, brain CT and MRI, skeletal surveys, and autopsy data. Twenty-five patients were diagnosed and treated for HLH at our institution over an 11-year period; 15 patients (60%) died. Common chest radiograph findings included alveolar-interstitial opacities with pleural effusions, often with rapid evolution and resolution. Hepatosplenomegaly, gallbladder wall thickening, hyperechoic kidneys and ascites were common abdominal findings, which resolved after therapy in some cases. Brain-imaging studies revealed nonspecific periventricular white-matter abnormalities, brain-volume loss and enlargement of extra-axial fluid spaces. Three infant cases, one with intracranial hemorrhage, one with multiple pathologic rib fractures and one with diaphyseal periosteal reaction involving multiple long bones on skeletal survey, raised suspicion of child abuse at presentation. Abuse was not substantiated in any case. Clinicians and radiologists should be aware of the radiographic manifestations of HLH, which are nonspecific and overlap with infectious, inflammatory and neoplastic disorders. Findings in the chest (similar to acute respiratory distress syndrome) and abdomen may progress rapidly and then regress with institution of appropriate anti-HLH therapy. CNS findings may be progressive. In some infants, initial imaging findings may mimic nonaccidental trauma.

Computerized scheme for detection of diffuse lung diseases on CR chest images

NASA Astrophysics Data System (ADS)

Pereira, Roberto R., Jr.; Shiraishi, Junji; Li, Feng; Li, Qiang; Doi, Kunio

2008-03-01

We have developed a new computer-aided diagnostic (CAD) scheme for detection of diffuse lung disease in computed radiographic (CR) chest images. One hundred ninety-four chest images (56 normals and 138 abnormals with diffuse lung diseases) were used. The 138 abnormal cases were classified into three levels of severity (34 mild, 60 moderate, and 44 severe) by an experienced chest radiologist with use of five different patterns, i.e., reticular, reticulonodular, nodular, air-space opacity, and emphysema. In our computerized scheme, the first moment of the power spectrum, the root-mean-square variation, and the average pixel value were determined for each region of interest (ROI), which was selected automatically in the lung fields. The average pixel value and its dependence on the location of the ROI were employed for identifying abnormal patterns due to air-space opacity or emphysema. A rule-based method was used for determining three levels of abnormality for each ROI (0: normal, 1: mild, 2: moderate, and 3: severe). The distinction between normal lungs and abnormal lungs with diffuse lung disease was determined based on the fractional number of abnormal ROIs by taking into account the severity of abnormalities. Preliminary results indicated that the area under the ROC curve was 0.889 for the 44 severe cases, 0.825 for the 104 severe and moderate cases, and 0.794 for all cases. We have identified a number of problems and reasons causing false positives on normal cases, and also false negatives on abnormal cases. In addition, we have discussed potential approaches for improvement of our CAD scheme. In conclusion, the CAD scheme for detection of diffuse lung diseases based on texture features extracted from CR chest images has the potential to assist radiologists in their interpretation of diffuse lung diseases.

Diagnosis of osteoporosis in rural Arctic Greenland: a clinical case using plain chest radiography for secondary prevention and consideration of tools for primary prevention in remote areas.

PubMed

Fleischer, Inuuteq; Schæbel, Louise K; Albertsen, Nadja; Sørensen, Vibeke N; Andersen, Stig

2017-01-01

Osteoporosis is a frequent disease in many populations. The hallmark is fragility fractures, which are harbingers of future fractures, disability, mortality and cost on society. The occurrence increases with age, low vitamin D level and smoking. Smoking rates are high, vitamin D is low and life expectancy is rising steeply in Greenland, as is the need for focus on osteoporosis. We report a case that uses a simple and readily available tool to diagnose osteoporosis at the hospital in Sisimiut, a town of 5000 inhabitants on the west coast of Greenland. A 51-year-old Inuit woman was seen due to lower back pain. No trauma could be recalled. Laboratory results showed a low vitamin D level and normal S-calcium, S-phosphate, S-parathyroid hormone, S-thyrotropin, erythrocyte sedimentation rate, S-creatinine and hemoglobin. The lateral chest radiograph demonstrated a reduction of anterior height of the seventh and ninth thoracic vertebral bodies of 50% and 40% respectively. Chest radiographs are frequently done in the towns along the vast coastline of Greenland, the world's largest island. They are transferred to the hospital in the capital city Nuuk using existing tele-technology, and specialist evaluations are given in electronic records available at the coastal hospitals. Effective therapies for osteoporosis are available and the identification of vertebral fractures that merit treatment may prevent future fractures, morbidity and mortality. Fragility fractures are frequent in old age and the steep rise in life expectancy and in the number of old people in Greenland emphasize the need for a focus on management of osteoporosis. Geography provides a diagnostic challenge to rural and remote areas that can be overcome by the use of lateral chest radiographs as it relies on facilities readily available. Clinical risk assessment tools with high specificity may support further osteoporosis risk prediction in remote Arctic societies.

Limiting chest computed tomography in the evaluation of pediatric thoracic trauma.

PubMed

Golden, Jamie; Isani, Mubina; Bowling, Jordan; Zagory, Jessica; Goodhue, Catherine J; Burke, Rita V; Upperman, Jeffrey S; Gayer, Christopher P

2016-08-01

Computed tomography (CT) of the chest (chest CT) is overused in blunt pediatric thoracic trauma. Chest CT adds to the diagnosis of thoracic injury but rarely changes patient management. We sought to identify a subset of blunt pediatric trauma patients who would benefit from a screening chest CT based on their admission chest x-ray (CXR) findings. We hypothesize that limiting chest CT to patients with an abnormal mediastinal silhouette identifies intrathoracic vascular injuries not otherwise seen on CXR. All blunt trauma activations that underwent an admission CXR at our Level 1 pediatric trauma center from 2005 to 2013 were retrospectively reviewed. Patients who had a chest CT were evaluated for added diagnoses and change in management after CT. An admission CXR was performed in 1,035 patients. One hundred thirty-nine patients had a CT, and the diagnosis of intra-thoracic injury was added in 42% of patients. Chest CT significantly increased the diagnosis of contusion or atelectasis (30.3% vs 60.4%; p < 0.05), pneumothorax (7.2% vs 18.7%; p < 0.05), and other fractures (4.3% vs 10.8%; p < 0.05) on CXR compared to chest CT. Chest CT changed the management of only 4 patients (2.9%). Two patients underwent further radiologic evaluation that was negative for injury, one had a chest tube placed for an occult pneumothorax before exploratory laparotomy, and one patient had a thoracotomy for repair of aortic injury. Chest CT for select patients with an abnormal mediastinal silhouette on CXR would have decreased CT scans by 80% yet still identified patients with an intrathoracic vascular injury. The use of chest CT should be limited to the identification of intrathoracic vascular injuries in the setting of an abnormal mediastinal silhouette on CXR. Therapeutic study, level IV; diagnostic study, level III.

Evaluation of a newly developed infant chest compression technique

PubMed Central

Smereka, Jacek; Bielski, Karol; Ladny, Jerzy R.; Ruetzler, Kurt; Szarpak, Lukasz

2017-01-01

Abstract Background: Providing adequate chest compression is essential during infant cardio-pulmonary-resuscitation (CPR) but was reported to be performed poor. The “new 2-thumb technique” (nTTT), which consists in using 2 thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist, was recently introduced. Therefore, the aim of this study was to compare 3 chest compression techniques, namely, the 2-finger-technique (TFT), the 2-thumb-technique (TTHT), and the nTTT in an randomized infant-CPR manikin setting. Methods: A total of 73 paramedics with at least 1 year of clinical experience performed 3 CPR settings with a chest compression:ventilation ratio of 15:2, according to current guidelines. Chest compression was performed with 1 out of the 3 chest compression techniques in a randomized sequence. Chest compression rate and depth, chest decompression, and adequate ventilation after chest compression served as outcome parameters. Results: The chest compression depth was 29 (IQR, 28–29) mm in the TFT group, 42 (40–43) mm in the TTHT group, and 40 (39–40) mm in the nTTT group (TFT vs TTHT, P < 0.001; TFT vs nTTT, P < 0.001; TTHT vs nTTT, P < 0.01). The median compression rate with TFT, TTHT, and nTTT varied and amounted to 136 (IQR, 133–144) min–1 versus 117 (115–121) min–1 versus 111 (109–113) min–1. There was a statistically significant difference in the compression rate between TFT and TTHT (P < 0.001), TFT and nTTT (P < 0.001), as well as TTHT and nTTT (P < 0.001). Incorrect decompressions after CC were significantly increased in the TTHT group compared with the TFT (P < 0.001) and the nTTT (P < 0.001) group. Conclusions: The nTTT provides adequate chest compression depth and rate and was associated with adequate chest decompression and possibility to adequately ventilate the infant manikin. Further clinical studies are necessary to confirm these initial findings. PMID

Radiographic features of cardiogenic pulmonary edema in dogs with mitral regurgitation: 61 cases (1998-2007).

PubMed

Diana, Alessia; Guglielmini, Carlo; Pivetta, Mauro; Sanacore, Antonina; Di Tommaso, Morena; Lord, Peter F; Cipone, Mario

2009-11-01

To evaluate radiographic distribution of pulmonary edema (PE) in dogs with mitral regurgitation (MR) and investigate the association between location of radiographic findings and direction of the mitral regurgitant jet (MRJ). Retrospective case series. 61 dogs with cardiogenic PE and MR resulting from mitral valve disease (MVD; 51 dogs), dilated cardiomyopathy (9), and hypertrophic cardiomyopathy (1). Thoracic radiographs of dogs with Doppler echocardiographic evidence of MR were reviewed for location (diffuse, perihilar, or focal) of PE. Also, direction (central or eccentric) of the MRJ, as evaluated by Doppler color flow mapping (DCFM), and distribution (symmetric or asymmetric) of radiographic findings were evaluated. Diffuse, perihilar, and focal increases in pulmonary opacity were observed in 11 (18.0%), 7 (11.5%), and 43 (70.5%) of 61 dogs, respectively. Radiographic evidence of asymmetric PE in a single lung lobe or 2 ipsilateral lobes was found in 21 dogs, with involvement of only the right caudal lung lobe in 17 dogs. Doppler color flow mapping of the MRJ was available for 46 dogs. Of 31 dogs with a central MRJ, 28 had radiographic findings indicative of symmetric PE. Of 15 dogs with eccentric MRJ, 11 had radiographic evidence of asymmetric PE, and all of these dogs had MVD. In dogs with cardiogenic PE, a symmetric radiographic distribution of increased pulmonary opacity was predominantly associated with a central MRJ, whereas an asymmetric radiographic distribution was usually associated with eccentric MRJ, especially in dogs with MVD.

Angina - when you have chest pain

MedlinePlus

... Coronary heart disease - chest pain; ACS - chest pain; Heart attack - chest pain; Myocardial infarction - chest pain; MI - chest pain ... AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College ...

Pulmonary fibrosis in asbestos insulation workers with lung cancer: a radiological and histopathological evaluation.

PubMed Central

Kipen, H M; Lilis, R; Suzuki, Y; Valciukas, J A; Selikoff, I J

1987-01-01

This study was undertaken to determine the relation between radiographic and histological manifestations of pulmonary asbestosis (interstitial fibrosis) in insulation workers who had died of lung cancer. Of 450 confirmed deaths from lung cancer a chest radiograph suitable for determining evidence of pneumoconiosis was obtained in 219. Of these cases, 138 also had a tissue specimen submitted that was suitable for histological study to determine the extent of histological fibrosis. There was a significant albeit limited correlation between the radiographic and histological findings (r = 0.27, p less than 0.0013). All 138 cases had histological evidence of parenchymal fibrosis; in 25 (18%), however, there was no radiographic evidence of parenchymal fibrosis. In 10 cases (7%) both parenchymal and pleural disease were undetectable on the radiograph. Thus a negative chest radiograph does not exclude the presence of interstitial fibrosis (asbestosis) in a substantial proportion of insulation workers previously exposed to asbestos who develop lung cancer. PMID:3814551

Use of Management Pathways or Algorithms in Children With Chronic Cough: CHEST Guideline and Expert Panel Report.

PubMed

Chang, Anne B; Oppenheimer, John J; Weinberger, Miles M; Rubin, Bruce K; Weir, Kelly; Grant, Cameron C; Irwin, Richard S

2017-04-01

Using management algorithms or pathways potentially improves clinical outcomes. We undertook systematic reviews to examine various aspects in the generic approach (use of cough algorithms and tests) to the management of chronic cough in children (aged ≤ 14 years) based on key questions (KQs) using the Population, Intervention, Comparison, Outcome format. We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework. Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain the final grading. Combining data from systematic reviews addressing five KQs, we found high-quality evidence that a systematic approach to the management of chronic cough improves clinical outcomes. Although there was evidence from several pathways, the highest evidence was from the use of the CHEST approach. However, there was no or little evidence to address some of the KQs posed. Compared with the 2006 Cough Guidelines, there is now high-quality evidence that in children aged ≤ 14 years with chronic cough (> 4 weeks' duration), the use of cough management protocols (or algorithms) improves clinical outcomes, and cough management or testing algorithms should differ depending on the associated characteristics of the cough and clinical history. A chest radiograph and, when age appropriate, spirometry (pre- and post-β 2 agonist) should be undertaken. Other tests should not be routinely performed and undertaken in accordance with the clinical setting and the child's clinical symptoms and signs (eg, tests for tuberculosis when the child has been exposed). Copyright © 2017 American College of Chest Physicians. All rights reserved.

Diagnosis of Grave's disease with pulmonary hypertension on chest CT.

PubMed

Lee, Hwa Yeon; Yoo, Seung Min; Kim, Hye Rin; Chun, Eun Ju; White, Charles S

To evaluate the diagnostic accuracy of chest CT findings to diagnose Grave's disease in pulmonary hypertension. We retrospectively evaluated chest CT and the medical records of 13 patients with Grave's disease with (n=6) or without pulmonary hypertension (n=7) and in 17 control patients. Presence of iso-attenuation of diffusely enlarged thyroid glands compared with adjacent neck muscle on non-enhanced CT as a diagnostic clue of Grave's disease, and assessment of pulmonary hypertension on CT has high diagnostic accuracy. Chest CT has the potential to diagnose Grave's disease with pulmonary hypertension in the absence of other information. Copyright © 2017 Elsevier Inc. All rights reserved.

Estimation of organ and effective doses from newborn radiography of the chest and abdomen.

PubMed

Ma, Hillgan; Elbakri, Idris A; Reed, Martin

2013-09-01

Neonatal intensive care patients undergo frequent chest and abdomen radiographic imaging. In this study, the organ doses and the effective dose resulting from combined chest-abdomen radiography of the newborn child are determined. These values are calculated using the Monte Carlo simulation software PCXCM 2.0 and compared with direct dose measurements obtained from thermoluminescent detectors (TLDs) in a physical phantom. The effective dose obtained from PCXMC is 21.2 ± 0.7 μSv and that obtained from TLD measurements is 22.0 ± 0.5 μSv. While the two methods are in close agreement with regard to the effective dose, there is a wide range of variation in organ doses, ranging from 85 % difference for the testes to 1.4 % for the lungs. Large organ dose variations are attributed to organs at the edge of the field of view, or organs with large experimental error or simulation uncertainty. This study suggests that PCXMC can be used to estimate organ and effective doses for newborn patients.

Pulmonary hemorrhage in acute heroin overdose: a report of two cases.

PubMed

Riccardello, Gerald J; Maldjian, Pierre D

2017-12-01

Diffuse alveolar hemorrhage (DAH) is a clinical syndrome characterized by pulmonary hemorrhage, respiratory failure, and high early mortality rates. DAH typically appears on chest radiographs as bilateral parenchymal consolidations. To our knowledge, pulmonary hemorrhage associated with heroin overdose has not been reported. We report the clinical and radiographic findings in two cases of acute DAH following heroin overdose. We speculate that an adulterating agent may be the underlying etiology in these cases. While pulmonary edema as a consequence of heroin overdose is well-documented and usually first suspected when consolidations are present on a chest radiograph in a patient with a history of recent heroin use, we believe that DAH should also be considered in the proper clinical context.

The role of chest radiography following pectus bar removal.

PubMed

Farach, Sandra M; Danielson, Paul D; Chandler, Nicole M

2016-07-01

Surgical correction of pectus excavatum (PE) via a minimally invasive approach involves placement of a steel bar, which is subsequently removed. The purpose of our study was to evaluate the incidence of pneumothorax and the role for chest radiography (CXR) in patients undergoing pectus bar removal. A retrospective review of 84 patients who underwent pectus bar removal from 2006 to 2014 was performed. Results of postoperative CXR, repeat imaging, need for chest thoracostomy tube placement, and complications were analyzed. Mean Haller index prior to correction was 4.3 ± 0.9. The mean time between PE repair and bar removal was 2.3 ± 0.6 years. Sixty-one patients (72.6 %) had a postoperative CXR. Thirty-one (50.8 %) had no acute findings, 20 (32.8 %) had findings of atelectasis or subcutaneous emphysema, and 10 (16.4 %) had a pneumothorax. One patient (1.6 %) had a second postoperative CXR for a small pneumothorax and rib fractures. There were two complications (2.4 %). No chest tubes were placed for pneumothorax, and 95 % of patients were discharged the day of surgery. Postoperative CXR following pectus bar removal is unnecessary given the low incidence of postoperative pneumothorax requiring intervention. Patients can be safely discharged the day of surgery without the need for routine postoperative chest imaging.

Blunt chest trauma.

PubMed

Stewart, Daphne J

2014-01-01

Blunt chest trauma is associated with a wide range of injuries, many of which are life threatening. This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. Literature on the diagnosis and treatment was reviewed, including both theoretical and research literature, from a variety of disciplines. The role of the advance practice nurse in trauma is also discussed as it relates to assessment, diagnosis, and treatment of patients with traumatic chest injuries.

Lung ultrasound as a diagnostic tool for radiographically-confirmed pneumonia in low resource settings.

PubMed

Ellington, Laura E; Gilman, Robert H; Chavez, Miguel A; Pervaiz, Farhan; Marin-Concha, Julio; Compen-Chang, Patricia; Riedel, Stefan; Rodriguez, Shalim J; Gaydos, Charlotte; Hardick, Justin; Tielsch, James M; Steinhoff, Mark; Benson, Jane; May, Evelyn A; Figueroa-Quintanilla, Dante; Checkley, William

2017-07-01

Pneumonia is a leading cause of morbidity and mortality in children worldwide; however, its diagnosis can be challenging, especially in settings where skilled clinicians or standard imaging are unavailable. We sought to determine the diagnostic accuracy of lung ultrasound when compared to radiographically-confirmed clinical pediatric pneumonia. Between January 2012 and September 2013, we consecutively enrolled children aged 2-59 months with primary respiratory complaints at the outpatient clinics, emergency department, and inpatient wards of the Instituto Nacional de Salud del Niño in Lima, Peru. All participants underwent clinical evaluation by a pediatrician and lung ultrasonography by one of three general practitioners. We also consecutively enrolled children without respiratory symptoms. Children with respiratory symptoms had a chest radiograph. We obtained ancillary laboratory testing in a subset. Final clinical diagnoses included 453 children with pneumonia, 133 with asthma, 103 with bronchiolitis, and 143 with upper respiratory infections. In total, CXR confirmed the diagnosis in 191 (42%) of 453 children with clinical pneumonia. A consolidation on lung ultrasound, which is our primary endpoint for pneumonia, had a sensitivity of 88.5%, specificity of 100%, and an area under-the-curve of 0.94 (95% CI 0.92-0.97) when compared to radiographically-confirmed clinical pneumonia. When any abnormality on lung ultrasound was compared to radiographically-confirmed clinical pneumonia the sensitivity increased to 92.2% and the specificity decreased to 95.2%, with an area under-the-curve of 0.94 (95% CI 0.91-0.96). Lung ultrasound had high diagnostic accuracy for the diagnosis of radiographically-confirmed pneumonia. Added benefits of lung ultrasound include rapid testing and high inter-rater agreement. Lung ultrasound may serve as an alternative tool for the diagnosis of pediatric pneumonia. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights

Radiographic and scintigraphic evaluation of total knee arthroplasty

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schneider, R.; Soudry, M.

1986-04-01

Various radiographic and scintigraphic methods are used to supplement clinical findings in the evaluation of total knee arthroplasty and its complications. Serial roentgenograms offer reliable information for diagnosing mechanical loosening. Wide and extensive radiolucency at the cement-bone interface and shift in position and alignment of prosthetic components can be seen in almost all cases by the time revision is necessary. Radiographic abnormalities are usually not present in acute infection, but are often present in chronic infection. Bone scanning has a high sensitivity for diagnosis of infection or loosening, but is nonspecific because increased uptake is often present around asymptomatic totalmore » knee arthroplasties with normal radiographs. Differential bone and Gallium scanning and scanning with Indium 111-labeled leukocytes have a greater specificity for diagnosis of infection than does bone or Gallium scanning alone. Routine radiographic and scintigraphic studies have shown a high incidence of deep vein thrombosis in the calf after total knee arthroplasty. Clinically significant pulmonary embolization is infrequent.« less

Diagnostic Accuracy of Ultrasonography and Radiography in Initial Evaluation of Chest Trauma Patients.

PubMed

Vafaei, Ali; Hatamabadi, Hamid Reza; Heidary, Kamran; Alimohammadi, Hosein; Tarbiyat, Mohammad

2016-01-01

Application of chest radiography for all multiple trauma patients is associated with a significant increase in total costs, exposure to radiation, and overcrowding of the emergency department. Ultrasound has been introduced as an alternative diagnostic tool in this regard. The aim of the present study is to compare the diagnostic accuracy of chest ultrasonography and radiography in detection of traumatic intrathoracic injuries. In the present prospective cross-sectional study, patients with traumatic intrathoracic injuries, who were referred to the emergency department from December 2013 to December 2014, were assessed. The patients underwent bedside ultrasound, radiographic and computed tomography (CT) scan examinations based on ATLS recommendations. Screening performance characteristics of ultrasonography and radiography were compared using SPSS 21.0. Chest CT scan was considered as gold standard. 152 chest trauma patients with a mean age of 31.4 ± 13.8 years (range: 4 ‒ 67), were enrolled (77.6% male). Chest CT scan showed pulmonary contusion in 48 (31.6%) patients, hemothorax in 29 (19.1%), and pneumothorax in 55 (36.2%) cases. Area under the ROC curve of ultrasonography in detection of pneumothorax, hemothorax, and pulmonary contusion were 0.91 (95% CI: 0.86‒0.96), 0.86 (95% CI: 0.78‒0.94), and 0.80 (95% CI: 0.736‒0.88), respectively. Area under the ROC curve of radiography was 0.80 (95% CI: 0.736‒0.87) for detection of pneumothorax, 0.77 (95% CI: 0.68‒0.86) for hemothorax, and 0.58 (95% CI: 0.5‒0.67) for pulmonary contusion. Comparison of areas under the ROC curve declared the significant superiority of ultrasonography in detection of pneumothorax (p = 0.02) and pulmonary contusion (p < 0.001). However, the diagnostic value of the two tests was equal in detection of hemothorax (p = 0.08). The results of the present study showed that ultrasonography is preferable to radiography in the initial evaluation of patients with traumatic injuries to the

CT angiography - chest

MedlinePlus

... aortic aneurysm - CTA chest; Venous thromboembolism - CTA lung; Blood clot - CTA lung; Embolus - CTA lung; CT pulmonary angiogram ... angiogram may be done: For symptoms that suggest blood clots in the lungs, such as chest pain, rapid ...

Nurses in OR are more assertive than radiographers.

PubMed

Johnson, L

1993-01-01

This study investigated two hypotheses: that there is a positive correlation between assertiveness and self-esteem, and that nurses rate lower than non-nurses on the constructs. A self-report survey incorporating scales for general assertiveness, situationally-specific assertiveness, global self-esteem and differentiated self-esteem was utilised. For the sample of 83 operating room nurses and 81 radiographers, correlations significant at the p < .001 level between the respective scales supported the first hypothesis. Analysis of variance yielded no significant differences between the two groups on either self-esteem measures or general assertiveness, with the nurses scoring significantly higher than radiographers on the situationally-specific assertiveness scale. Findings challenge the stereotype of the 'shrinking violet' nurse. Additional analysis revealed that the power component of differentiated self-esteem had a higher correlation with global self-esteem and with both assertiveness measures than any other component. Further, the operating room nurses were significantly more power-oriented than radiographers. The pre-eminence of power in the findings suggests that assertiveness and self-esteem are issues relating to the empowerment of nurses.

Thin chest wall is an independent risk factor for the development of pneumothorax after chest tube removal.

PubMed

Anand, Rahul J; Whelan, James F; Ferrada, Paula; Duane, Therese M; Malhotra, Ajai K; Aboutanos, Michel B; Ivatury, Rao R

2012-04-01

The factors contributing to the development of pneumothorax after removal of chest tube thoracostomy are not fully understood. We hypothesized that development of post pull pneumothorax (PPP) after chest tube removal would be significantly lower in those patients with thicker chest walls, due to the "protective" layer of adipose tissue. All patients on our trauma service who underwent chest tube thoracostomy from July 2010 to February 2011 were retrospectively reviewed. Patient age, mechanism of trauma, and chest Abbreviated Injury Scale score were analyzed. Thoracic CTs were reviewed to ascertain chest wall thickness (CW). Thickness was measured at the level of the nipple at the midaxillary line, as perpendicular distance between skin and pleural cavity. Chest X-ray reports from immediately prior and after chest tube removal were reviewed for interval development of PPP. Data are presented as average ± standard deviation. Ninety-one chest tubes were inserted into 81 patients. Patients who died before chest tube removal (n = 11), or those without thoracic CT scans (n = 13) were excluded. PPP occurred in 29.9 per cent of chest tube removals (20/67). When PPP was encountered, repeat chest tube was necessary in 20 per cent of cases (4/20). After univariate analysis, younger age, penetrating mechanism, and thin chest wall were found to be significant risk factors for development of PPP. Chest Abbreviated Injury Scale score was similar in both groups. Logistic regression showed only chest wall thickness to be an independent risk factor for development of PPP.

Chest Tube Thoracostomy

MedlinePlus

... outside the lung, causing its collapse (called a pneumothorax ). Chest tube thoracostomy involves placing a hollow plastic ... a chest tube is needed include: ■ ■ Collapsed lung (pneumothorax)— This occurs when air has built up in ...

Coronal and Intraradicular Appearances Affect Radiographic Perception of the Periapical Region.

PubMed

Strong, Julie W; Woodmansey, Karl F; Khademi, John A; Hatton, John F

2017-05-01

The influence of the radiographic appearances of the coronal and intraradicular areas on periapical radiographic interpretation has been minimally evaluated in dentistry and endodontics. The purpose of this study was to evaluate the effects that the coronal and intraradicular radiographic appearance has on endodontists' radiographic interpretations of periapical areas. In a split-group study design using an online survey format, 2 pairs of digital periapical radiographic images were evaluated by 2 groups (A and B) of endodontist readers for the presence of a periapical finding. The images in each pair were identical except that 1 image of each image pairs had coronal restorations and/or root canal fillings altered using Adobe Photoshop software (Adobe Systems, San Jose, CA). The periapical areas were not altered. Using a 5-point Likert scale, the endodontist readers were asked to "Please evaluate the periapical area(s)." A Mann-Whitney U test was used to statistically evaluate the difference between the groups. Significance was set at P < .01. There were 417 readers in group A and 442 readers in group B. The Mann-Whitney U test showed a significant difference in the responses between the groups for both image pairs (P < .01). Because the periapical areas of the image pairs were unaltered, the differing coronal and intraradicular areas of the radiographs appear to have influenced endodontists' interpretations of the periapical areas. This finding has implications for all radiographic outcome assessments. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Radiographic anatomy of the foot and ankle—part 4: the metatarsals.

PubMed

Christman, Robert A

2015-01-01

The normal radiographic anatomy of the foot and ankle, aside from my previous work, has been addressed only superficially or sparingly in the medical literature. This project correlates the detailed radiographic anatomy of the entire adult foot and ankle (two-dimensional) to osteology (three-dimensional). Each bone's position was determined after meticulous examination and correlation to an articulated skeleton relative to the image receptor and direction of the x-ray beam, with correlation to the radiograph for confirmation. Images of each foot and distal leg bone ("front" and "back" perspectives) are presented alongside a corresponding radiographic image for comparison. The normal gross and radiographic anatomy is correlated and described for each radiographic positioning technique. Foundational knowledge is provided that future researchers can use as a baseline ("normal") and that students and practitioners can use for comparison when interpreting radiographs and distinguishing abnormal findings. The results of the original project, owing to its broad scope, have been divided into five parts: the lower leg, the greater tarsus, the lesser tarsus, the metatarsals (the focus of this article), and the phalanges.

Radiographic anatomy of the foot and ankle-part 5. The phalanges.

PubMed

Christman, Robert A

2015-03-01

The normal radiographic anatomy of the foot and ankle, aside from my previous work, has been addressed only superficially or sparingly in the medical literature. This project correlates the detailed radiographic anatomy of the entire adult foot and ankle (two-dimensional) to osteology (three-dimensional). Each bone's position was determined after meticulous examination and correlation to an articulated skeleton relative to the image receptor and direction of the x-ray beam, with correlation to the radiograph for confirmation. Images of each foot and distal leg bone ("front" and "back" perspectives) are presented alongside a corresponding radiographic image for comparison. The normal gross and radiographic anatomy is correlated and described for each radiographic positioning technique. Foundational knowledge is provided that future researchers can use as a baseline ("normal") and that students and practitioners can use for comparison when interpreting radiographs and distinguishing abnormal findings. The results of the original project, owing to its broad scope, have been divided into five parts: the lower leg, the greater tarsus, the lesser tarsus, the metatarsals, and the phalanges (the focus of this article).

Convolution neural-network-based detection of lung structures

NASA Astrophysics Data System (ADS)

Hasegawa, Akira; Lo, Shih-Chung B.; Freedman, Matthew T.; Mun, Seong K.

1994-05-01

Chest radiography is one of the most primary and widely used techniques in diagnostic imaging. Nowadays with the advent of digital radiology, the digital medical image processing techniques for digital chest radiographs have attracted considerable attention, and several studies on the computer-aided diagnosis (CADx) as well as on the conventional image processing techniques for chest radiographs have been reported. In the automatic diagnostic process for chest radiographs, it is important to outline the areas of the lungs, the heart, and the diaphragm. This is because the original chest radiograph is composed of important anatomic structures and, without knowing exact positions of the organs, the automatic diagnosis may result in unexpected detections. The automatic extraction of an anatomical structure from digital chest radiographs can be a useful tool for (1) the evaluation of heart size, (2) automatic detection of interstitial lung diseases, (3) automatic detection of lung nodules, and (4) data compression, etc. Based on the clearly defined boundaries of heart area, rib spaces, rib positions, and rib cage extracted, one should be able to use this information to facilitate the tasks of the CADx on chest radiographs. In this paper, we present an automatic scheme for the detection of lung field from chest radiographs by using a shift-invariant convolution neural network. A novel algorithm for smoothing boundaries of lungs is also presented.