Social Distancing with Portable Chest Radiographs During the COVID-19                     Pandemic: Assessment of Radiograph Technique and Image Quality Obtained at 6                     Feet and Through Glass

Objectives: To determine whether a novel method and device, called a variable attenuation plate (VAP), which equalizes chest radiographic appearance and allows for synchronization of manual image windowing with comparison studies, would improve consistency in interpretation. Materials and Methods: Research ethics board approved the prospective cohort pilot study, which included 50 patients in the intensive care unit (ICU) undergoing two serial chest radiographs with a VAP placed on each one of them. The VAP allowed for equalization of density and contrast between the patients’ serial chest radiographs. Three radiologists interpreted all the studies with and without the use of VAP. Kappa and percent agreement was used to calculate agreement between radiologists’ interpretations with and without the plate. Results: Radiologist agreement was substantially higher with the VAP method, as compared to that with the non-VAP method. Kappa values between Radiologists A and B, A and C, and B and C were 46%, 55%, and 51%, respectively, which improved to 73%, 81%, and 66%, respectively, with the use of VAP. Discrepant report impressions (i.e., one radiologist's impression of unchanged versus one or both of the other radiologists stating improved or worsened in their impression) ranged from 24 to 28.6% without the use of VAP and from 10 to 16% with the use of VAP (χ2 = 7.454, P < 0.01). Opposing views (i.e., one radiologist's impression of improved and one of the others stating disease progression or vice versa) were reported in 7 (12%) cases in the non-VAP group and 4 (7%) cases in the VAP group (χ2 = 0.85, P = 0.54). Conclusion: Numerous factors play a role in image acquisition and image quality, which can contribute to poor consistency and reliability of portable chest radiographic interpretations. Radiologists’ agreement of image interpretation can be improved by use of a novel method consisting of a VAP and associated software and has the potential to improve patient care.

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Peer Review #2 of "Deep-learning convolutional neural networks with transfer learning accurately classify COVID-19 lung infection on portable chest radiographs (v0.1)"

10.7287/peerj.10309v0.1/reviews/2 ◽

2020 ◽

Keyword(s):

Neural Networks ◽

Deep Learning ◽

Peer Review ◽

Transfer Learning ◽

Convolutional Neural Networks ◽

Lung Infection ◽

Chest Radiographs ◽

Portable Chest

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A pilot study evaluating erect chest imaging in children, using the Lodox Statscan digital X-ray machine

South African Journal of Radiology ◽

10.4102/sajr.v13i4.485 ◽

2009 ◽

Vol 13 (4) ◽

pp. 80 ◽

Cited By ~ 2

Author(s):

Rupesh Baloo Daya ◽

Maurice A Kibel ◽

Richard Denys Pitcher ◽

Lesley Workman ◽

Tania S Douglas ◽

...

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Diagnostic Accuracy ◽

Chest Radiography ◽

Computed Radiography ◽

Significant Proportion ◽

Chest Radiographs ◽

X Ray ◽

Airway Narrowing ◽

Cr System

ABSTRACT Background: Chest radiography accounts for a significant proportion of ionising radiation in children. The radiation dose of radiographs performed on the Lodox Statscan system has been shown to be lower than that of a computed radiography (CR) system. The role of the Lodox Statscan (hereafter referred to as the Statscan) in routine erect chest radiography in children has not been evaluated. Objective: To evaluate the image quality and diagnostic accuracy of erect paediatric chest radiographs obtained with the Statscan and compare this with conventional erect chest images obtained with a CR system. Materials and Methods: Thirty three children with suspected chest pathology were enrolled randomly over a period of three months. Erect chest radiographs were obtained with the Statscan, and a Shimadzu R-20J X-ray machine coupled with a Fuji FCR 5000 CR system. Image quality and diagnostic accuracy and diagnostic capability were evaluated between the two modalities. Results: The erect Statscan allowed superior visualisation of the three major airways. Statscan images however, demonstrated exposure and movement artifacts with hemidiaphragms and ribs most prone to movement. Bronchovascular clarity was also considered unsatisfactory on the Statscan images. Conclusion: The Statscan has limitations in erect chest radiography in terms of movement artefacts, exposure fluctuations, and poor definition of lung markings. Despite this, the Statscan allows better visualisation of the major airways, equivalent to a ‘high KV’ film at a fraction of the radiation dose. This supports the finding of an earlier study evaluating Statscan images in trauma cases, where the images were taken supine. Statscan has great potential in assisting in the diagnosis of childhood tuberculosis where airway narrowing occurs as a result of nodal compression.

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