Portable Ventilation/Perfusion Scanning is Useful for Evaluating Clinically Significant Pulmonary Embolism in the ICU Despite Abnormal Chest Radiography

2018 ◽  
Vol 35 (10) ◽  
pp. 1032-1038 ◽  
Author(s):  
Aaron S. Weinberg ◽  
William Chang ◽  
Grace Ih ◽  
Alan Waxman ◽  
Victor F. Tapson
Keyword(s):  
Pulmonary Embolism ◽  
Chest Radiograph ◽  
High Probability ◽  
Hemodynamic Instability ◽  
X Rays ◽  
X Ray ◽  
Abnormal Chest ◽  
Chest X Ray ◽  
Low Probability ◽  
Clinically Significant

Objective: Computed tomography angiography is limited in the intensive care unit (ICU) due to renal insufficiency, hemodynamic instability, and difficulty transporting unstable patients. A portable ventilation/perfusion (V/Q) scan can be used. However, it is commonly believed that an abnormal chest radiograph can result in a nondiagnostic scan. In this retrospective study, we demonstrate that portable V/Q scans can be helpful in ruling in or out clinically significant pulmonary embolism (PE) despite an abnormal chest x-ray in the ICU. Design: Two physicians conducted chart reviews and original V/Q reports. A staff radiologist, with 40 years of experience, rated chest x-ray abnormalities using predetermined criteria. Setting: The study was conducted in the ICU. Patients: The first 100 consecutive patients with suspected PE who underwent a portable V/Q scan. Interventions: Those with a portable V/Q scan. Results: A normal baseline chest radiograph was found in only 6% of patients. Fifty-three percent had moderate, 24% had severe, and 10% had very-severe radiographic abnormalities. Despite the abnormal x-rays, 88% of the V/Q scans were low probability for a PE despite an average abnormal radiograph rating of moderate. A high-probability V/Q for PE was diagnosed in 3% of the population despite chest x-ray ratings of moderate to severe. Six patients had their empiric anticoagulation discontinued after obtaining the results of the V/Q scan, and no anticoagulation was started for PE after a low-probability V/Q scan. Conclusion: Despite the large percentage of moderate-to-severe x-ray abnormalities, PE can still be diagnosed (high-probability scan) in the ICU with a portable V/Q scan. Although low-probability scans do not rule out acute PE, it appeared less likely that any patient with a low-probability V/Q scan had severe hypoxemia or hemodynamic instability due to a significant PE, which was useful to clinicians and allowed them to either stop or not start anticoagulation.

scholarly journals Optimizing Chest X-ray Indication in Blunt Trauma Patients using Clinical Criteria

2017 ◽  
Vol 6 (1) ◽  
pp. 30-34
Author(s):  
Luca GA Pivetta ◽  
Cristiano Below ◽  
Giovanna Z Rondini ◽  
Jacqueline AG Perlingero ◽  
José C Assef ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Thoracic Injury ◽  
Trauma Patients ◽  
X Rays ◽  
Chest Drainage ◽  
X Ray ◽  
Clinical Criteria ◽  
Chest X Ray ◽  
Low Probability ◽  
Excessive Number

ABSTRACT Background There is an excessive number of unnecessary chest X-rays (CXRs) in minor blunt trauma patients. Objective To identify, using routine clinical criteria, a subgroup of blunt trauma patients that do not require CXR for assessment. Materials and methods This was a retrospective analysis of trauma registry data collected over a 24-month period. Adult blunt trauma patients undergoing CXR on admission were analyzed. The following clinical criteria were assessed: Normal neurologic examination on admission (NNEx), hemodynamic stability (HS), normal physical examination of the chest on admission (NCEx), age ≤ 60 years, and absence of distracting injuries (Abbreviated Injury Scale >2 in head, abdomen, and extremities). These clinical criteria were progressively merged to select a group with lowest risk of exhibiting abnormal CXR on admission. Results Out of 4,647 patients submitted to CXR on admission, 268 (5.7%) had abnormal findings on scans. Of 2,897 patients admitted with NNEx, 116 (4.0%) had abnormal CXR. Of 2,426 patients with NNEx and HS, 74 (3.0%) had abnormal CXR. Of 1,698 patients with NNEx, HS, and NCEx, 24 (1.4%) had abnormal CXR. Of 1,347 patients with NNEx, HS, NCEx, and age < 60 years, 12 had thoracic injury (0.9% of total individuals receiving CXR). A total of 4 patients underwent chest drainage. Among 1,140 cases with all clinical criteria, 8 had confirmed thoracic injuries and 2 underwent chest drainage. Conclusion A subgroup of blunt trauma patients with low probability of exhibiting abnormalities on CXR at admission was identified. The need for CXR in this subgroup should be reviewed. How to cite this article Pivetta LGA, Parreira JG, Below C, Rondini GZ, Perlingero JAG, Assef JC. Optimizing Chest X-ray Indication in Blunt Trauma Patients using Clinical Criteria. Panam J Trauma Crit Care Emerg Surg 2017;6(1):30-34.

scholarly journals Data Augmentation using Auxiliary Classifier for Improved Detection of Covid 19

2021 ◽  
Vol 10 (3) ◽  
pp. 209-214
Author(s):  
Lakshmisetty Ruthvik Raj ◽  
◽  
Bitra Harsha Vardhan ◽  
Mullapudi Raghu Vamsi ◽  
Keerthikeshwar Reddy Mamilla ◽  
...  
Keyword(s):  
Data Augmentation ◽  
X Rays ◽  
Convolutional Network ◽  
X Ray ◽  
Learning Network ◽  
X Ray Imaging ◽  
Abnormal Chest ◽  
Short Period ◽  
Chest X Ray ◽  
Deep Learning Network

COVID-19 is a severe and potentially fatal respiratory infection called coronavirus 2 disease (SARS-Co-2). COVID-19 is easily detectable on an abnormal chest x-ray. Numerous extensive studies have been conducted due to the findings, demonstrating how precise the detection of coronas using X-rays within the chest is. To train a deep learning network, such as a convolutional neural network, a large amount of data is required. Due to the recent end of the pandemic, it is difficult to collect many Covid x-ray images in a short period. The purpose of this study is to demonstrate how X-ray imaging (CXR) is created using the Covid CNN model-based convolutional network. Additionally, we demonstrate that the performance of CNNs and various COVID-19 acquisition algorithms can be used to generate synthetic images from data extensions. Alone, with CNN distribution, an accuracy of 85 percent was achieved. The accuracy has been increased to 95% by adding artificial images generated from data. We anticipate that this approach will expedite the discovery of COVID-19 and result in radiological solid programs. We leverage transfer learning in this paper to reduce time complexity and achieve the highest accuracy.

Radiological diagnosis of aspirated foreign bodies in children: Review of 343 cases

1990 ◽  
Vol 104 (10) ◽  
pp. 778-782 ◽  
Author(s):  
Liancai Mu ◽  
Deqiang Sun ◽  
Ping He
Keyword(s):  
Foreign Body ◽  
Foreign Bodies ◽  
Correct Diagnosis ◽  
X Rays ◽  
Endoscopic Removal ◽  
X Ray ◽  
Abnormal Chest ◽  
Mediastinal Shift ◽  
Plain Chest ◽  
Chest X Ray

AbstractIn our series of 400 Chinese children with foreign body aspiration (FBA),343 cases were evaluated by fluoroscopy and/or plain chest X-rays before endoscopic removal of the foreign bodies. The majority of the foreign bodies (FBs) were organic (378/400, 94.5 per cent). The results showed that mainstem bronchial foreign bodies were diagnosed correctly in 68 per centof cases compared with 65 per cent correct diagnoses with segmental bronchial foreign bodies, but only 22 per cent correct diagnoses with tracheal, and 0 per cent correct diagnosis in those with laryngeal foreign bodies. Eighty per cent (32/40) of the children with laryngotracheal FBs had normal X-ray findings, whereas 67.7 per cent (205/303) of the children with bronchial FBs had abnormal chest X-ray findings. The most common positive radiological signs in the children with tracheobronchial FBs were obstructive emphysema (131/213, 62 per cent) and mediastinal shift (117/213, 55 percent). The incidence of major complications was related not only to the size of the foreign body and its location but also the duration since aspiration. The most common types of bronchial obstructions by airway FBs are discussed.

scholarly journals Chest X-Ray Findings and Temporal Lung Changes in Patients with COVID-19 Pneumonia

2020 ◽  
Author(s):  
Liqa A Rousan ◽  
Eyhab Elobeid ◽  
Musaab Karrar ◽  
Yousef Khader
Keyword(s):  
Ct Scan ◽  
Chest Ct ◽  
Common Finding ◽  
X Rays ◽  
Radiographic Findings ◽  
X Ray ◽  
Abnormal Chest ◽  
Chest X Ray ◽  
Chest Ct Scan

Abstract Background: Chest CT scan and chest x-rays show characteristic radiographic findings in patients with COVID-19 pneumonia. Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia. The study aims at describing the chest x-ray findings and temporal radiographic changes in COVID-19 patients.Methods: From March 15 to April 20, 2020 patients with positive reverse transcription polymerase chain reaction (RT-PCR) for COVID-19 were retrospectively studied. Patients’ demographics, clinical characteristics, and chest x-ray findings were reported. Radiographic findings were correlated with the course of the illness and patients’ symptoms.Results: A total of 88 patients (50 (56.8%) females and 38 (43.2%) males) were admitted to the hospital with confirmed COVID-19 pneumonia. Their age ranged from 3-80 years (35.2 ±18.2 years). 48/88 (45%) were symptomatic, only 13/88 (45.5%) showed abnormal chest x-ray findings. A total of 190 chest x-rays were obtained for the 88 patients with a total of 59/190 (31%) abnormal chest x-rays. The most common finding on chest x-rays was peripheral ground glass opacities (GGO) affecting the lower lobes. In the course of illness, the GGO progressed into consolidations peaking around 6-11 days (GGO 70%, consolidations 30%). The consolidations regressed into GGO towards the later phase of the illness at 12-17 days (GGO 80%, consolidations 10%). There was increase in the frequency of normal chest x-rays from 9% at days 6- 11 up to 33% after 18 days indicating a healing phase. The majority (12/13, 92.3%) of patients with abnormal chest x-rays were symptomatic (P=0.005).Conclusion: The chest x-ray findings were similar to those reported on chest CT scan in patients with COVID-19, Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia.

Value of the Chest X-Ray as a Screening Test for Elective Surgery in Children

PEDIATRICS ◽  
1981 ◽  
Vol 67 (4) ◽  
pp. 447-452
Author(s):  
Robert A. Wood ◽  
Robert A. Hoekelman
Keyword(s):  
Postoperative Complications ◽  
Pediatric Patients ◽  
Elective Surgery ◽  
Healthy Children ◽  
X Rays ◽  
X Ray ◽  
Chest X Ray ◽  
Clinically Significant ◽  
Apparently Healthy ◽  
Preoperative Chest

A retrospective study was conducted to assess the value of the chest x-ray as a preoperative screening procedure in pediatric patients. Admissions for elective surgery were compared at two hospitals, one that required routine preoperative chest x-rays and one that did not. Our purpose was to determine the yield of the screening chest x-ray in detecting unknown abnormalities and to determine whether patients who had a preoperative chest x-ray taken experienced fewer anesthetic or postoperative complications than did those who did not. In all, 1,924 cases were studied; in 749 a preoperative chest film was taken. Of those 749 cases, a previously unsuspected abnormality was discovered in 35 (4.7%) patients. Nine (1.2%) of these abnormalities were considered to be clinically significant and three (0.4%) resulted in cancellation of surgery. No differences in anesthetic or postoperative complications were noted between the two groups of patients. It is recommended that the performance of routine preoperative chest x-rays on apparently healthy children be discontinued.

Radiology

2010 ◽  
pp. 705-792
Keyword(s):  
Computed Tomography ◽  
Chest Radiograph ◽  
X Rays ◽  
Digital Radiology ◽  
X Ray ◽  
Barium Studies ◽  
Chest X Ray ◽  
Cardiac Enlargement

Radiology & the role of imaging 706 Plain X-rays 708 Digital radiology 709 Chest X-ray: useful landmarks 710 Chest radiograph 712 Patterns of lobar collapse 717 Cardiac enlargement 719 Computed tomography of the thorax 722 Abdominal X-ray: useful landmarks 724 Plain abdominal X-ray 726 Barium studies ...

scholarly journals Chest x-ray findings and temporal lung changes in patients with COVID-19 pneumonia

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Liqa A. Rousan ◽  
Eyhab Elobeid ◽  
Musaab Karrar ◽  
Yousef Khader
Keyword(s):  
Common Finding ◽  
X Rays ◽  
Radiographic Findings ◽  
Course Of Illness ◽  
X Ray ◽  
Abnormal Chest ◽  
Healing Phase ◽  
Normal Chest ◽  
Chest X Ray

Abstract Background Chest CT scan and chest x-rays show characteristic radiographic findings in patients with COVID-19 pneumonia. Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia. The study aims at describing the chest x-ray findings and temporal radiographic changes in COVID-19 patients. Methods From March 15 to April 20, 2020 patients with positive reverse transcription polymerase chain reaction (RT-PCR) for COVID-19 were retrospectively studied. Patients’ demographics, clinical characteristics, and chest x-ray findings were reported. Radiographic findings were correlated with the course of the illness and patients’ symptoms. Results A total of 88 patients (50 (56.8%) females and 38 (43.2%) males) were admitted to the hospital with confirmed COVID-19. Their age ranged from 3 to 80 years (35.2 ± 18.2 years). 48/88 (45%) were symptomatic, only 13/88 (45.5%) showed abnormal chest x-ray findings. A total of 190 chest x-rays were obtained for the 88 patients with a total of 59/190 (31%) abnormal chest x-rays. The most common finding on chest x-rays was peripheral ground glass opacities (GGO) affecting the lower lobes. In the course of illness, the GGO progressed into consolidations peaking around 6–11 days (GGO 70%, consolidations 30%). The consolidations regressed into GGO towards the later phase of the illness at 12–17 days (GGO 80%, consolidations 10%). There was increase in the frequency of normal chest x-rays from 9% at days 6–11 up to 33% after 18 days indicating a healing phase. The majority (12/13, 92.3%) of patients with abnormal chest x-rays were symptomatic (P = 0.005). Conclusion Almost half of patients with COVID-19 have abnormal chest x-ray findings with peripheral GGO affecting the lower lobes being the most common finding. Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia.

Hubungan antara Luas Lesi pada Foto Toraks Penderita TB Paru Dewasa yang Memiliki Riwayat Diabetes Melitus dengan Indeks Massa Tubuh di Rumah Sakit Hasan Sadikin Bandung

2016 ◽  
Vol 1 (3) ◽  
pp. 138-144
Author(s):  
Ina Edwina ◽  
Rista D Soetikno ◽  
Irma H Hikmat
Keyword(s):  
Chest Radiograph ◽  
Chi Square ◽  
Pulmonary Tb ◽  
X Ray ◽  
Consecutive Sampling ◽  
Close Relationship ◽  
Chi Square Test ◽  
Chest X Ray ◽  
The Relationship ◽  
Diabetes Melitus

Background: Tuberculosis (TB) and diabetes mellitus (DM) prevalence rates are increasing rapidly, especially in developing countries like Indonesia. There is a relationship between TB and DM that are very prominent, which is the prevalence of pulmonary TB with DM increased by 20 times compared with pulmonary TB without diabetes. Chest X-ray picture of TB patients with DM is atypical lesion. However, there are contradictories of pulmonary TB lesion on chest radiograph of DM patients. Nutritional status has a close relationship with the morbidity of DM, as well as TB.Objectives: The purpose of this study was to determine the relationship between the lesions of TB on the chest radiograph of patients who su?er from DM with their Body Mass Index (BMI) in Hasan Sadikin Hospital Bandung.Material and Methods: The study was conducted in Department of Radiology RSHS Bandung between October 2014 - February 2015. We did a consecutive sampling of chest radiograph and IMT of DM patients with clinical diagnosis of TB, then the data was analysed by Chi Square test to determine the relationship between degree of lesions on chest radiograph of pulmonary TB on patients who have DM with their BMI.Results: The results showed that adult patients with active pulmonary TB with DM mostly in the range of age 51-70 years old, equal to 62.22%, with the highest gender in men, equal to 60%. Chest radiograph of TB in patients with DM are mostly seen in people who are obese, which is 40% and the vast majority of lesions are minimal lesions that is equal to 40%.Conclusions: There is a signifcant association between pulmonary TB lesion degree with BMI, with p = 0.03

Spontaneous Pneumomediastinum: Uncommon Cause of Air Leak in Late Preterm Neonate

2021 ◽  
Vol 35 (2) ◽  
pp. 93-94
Author(s):  
Jyotsna Bhushan ◽  
Shagufta Iqbal ◽  
Abhishek Chopra
Keyword(s):  
Respiratory Distress ◽  
Conservative Management ◽  
Preterm Neonate ◽  
Late Preterm ◽  
Intravenous Fluids ◽  
X Rays ◽  
Blood Gas ◽  
X Ray ◽  
Spontaneous Pneumomediastinum ◽  
Chest X Ray

A clinical case report of spontaneous pneumomediastinum in a late-preterm neonate, chest x-ray showing classical “spinnaker sail sign,” which was managed conservatively and had excellent prognosis on conservative management. Respiratory distress in a preterm neonate is a common clinical finding. Common causes include respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, and pneumothorax. Pneumomediastinum is not very common cause of respiratory distress and more so spontaneous pneumomediastinum. We report here a preterm neonate with spontaneous pneumomediastinum who had excellent clinical recovery with conservative management. A male baby was delivered to G3P1A1 mother at 34 + 6 weeks through caesarean section done due to abruptio placenta. Apgar scores were 8 and 9. Maternal antenatal history was uneventful and there were no risk factors for early onset sepsis. Baby had respiratory distress soon after birth with Silverman score being 2/10. Baby was started on oxygen (O2) by nasal prongs through blender 0.5 l/min, FiO2 25%, and intravenous fluids. Blood gas done was normal. Possibility of transient tachypnea of newborn or mild hyaline membrane disease was kept. Respiratory distress increased at 20 h of life (Silverman score: 5), urgent chest x-ray done revealed “spinnaker sign” suggestive of pneumomediastinum, so baby was shifted to O2 by hood with FiO2 being 70%. Blood gas repeated was normal. Baby was managed conservatively on intravenous fluids and O2 by hood. Baby was gradually weaned off from O2 over next 5 days. As respiratory distress decreased, baby was started on orogastric feed, which baby tolerated well and then was switched to oral feeds. Serial x-rays showed resolution of pneumomediastinum. Baby was discharged on day 7 of life in stable condition on breast feeds and room air.

scholarly journals Accessory pathway analysis using a multimodal deep learning model

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Makoto Nishimori ◽  
Kunihiko Kiuchi ◽  
Kunihiro Nishimura ◽  
Kengo Kusano ◽  
Akihiro Yoshida ◽  
...  
Keyword(s):  
Deep Learning ◽  
Electrophysiological Study ◽  
Accessory Pathway ◽  
Learning Model ◽  
X Rays ◽  
X Ray ◽  
Wpw Syndrome ◽  
Chest X Ray ◽  
Deep Learning Model ◽  
Ecg Data

AbstractCardiac accessory pathways (APs) in Wolff–Parkinson–White (WPW) syndrome are conventionally diagnosed with decision tree algorithms; however, there are problems with clinical usage. We assessed the efficacy of the artificial intelligence model using electrocardiography (ECG) and chest X-rays to identify the location of APs. We retrospectively used ECG and chest X-rays to analyse 206 patients with WPW syndrome. Each AP location was defined by an electrophysiological study and divided into four classifications. We developed a deep learning model to classify AP locations and compared the accuracy with that of conventional algorithms. Moreover, 1519 chest X-ray samples from other datasets were used for prior learning, and the combined chest X-ray image and ECG data were put into the previous model to evaluate whether the accuracy improved. The convolutional neural network (CNN) model using ECG data was significantly more accurate than the conventional tree algorithm. In the multimodal model, which implemented input from the combined ECG and chest X-ray data, the accuracy was significantly improved. Deep learning with a combination of ECG and chest X-ray data could effectively identify the AP location, which may be a novel deep learning model for a multimodal model.

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