Use of routine chest radiography in the evaluation of fever in neutropenic pediatric oncology patients.

1988 ◽  
Vol 6 (11) ◽  
pp. 1699-1702 ◽  
Author(s):  
J Feusner ◽  
R Cohen ◽  
M O'Leary ◽  
B Beach
Keyword(s):  
Pediatric Oncology ◽  
Chest Radiography ◽  
Malignant Disease ◽  
Pulmonary Infection ◽  
Chest Radiographs ◽  
Routine Practice ◽  
Infectious Process ◽  
Febrile Episodes ◽  
Abnormal Radiograph ◽  
Routine Chest

Evaluation of febrile episodes in children who have become neutropenic during treatment for malignant disease has traditionally included radiography of the chest. It has been our impression that the yield of such examination is low. To test this hypothesis we reviewed all chest radiographs (CXRs) obtained in the above setting in our institution over the last 3 years. These radiographs were independently reviewed by two of us (R.C., J.F.). Sixty-one patients experienced 134 febrile neutropenic episodes for which a CXR was obtained. Only eight (6%) of these films revealed any abnormality. After careful review it was apparent that four of these radiographs did not represent a infectious process. Thus only four of 134 films (2.9%) indicated pulmonary infection as the probable cause of fever in the patient. All four of these patients had prominent respiratory signs or symptoms. Of patients who were febrile but without pulmonary signs/symptoms, only one of 49 had an abnormal radiograph. We feel that such a low yield (at most 2%) calls into question the routine practice of obtaining a CXR in the febrile neutropenic child who is otherwise asymptomatic.

Bronchogenic and enteric cysts presenting as asymptomatic mediastinal masses at routine chest radiography

1986 ◽  
Vol 72 (3) ◽  
pp. 153-159
Author(s):  
J. I. C. Hogg
Keyword(s):  
Chest Radiography ◽  
Mediastinal Mass ◽  
Chest Radiographs ◽  
Royal Navy ◽  
Skeletal Injury ◽  
Mediastinal Masses ◽  
Mediastinal Cysts ◽  
Exploratory Surgery ◽  
Routine Chest

AbstractRoutine radiographic chest screening—as employed upon entry and release from the Royal Navy—is intended to identify pathology which may be clinically covert. Occasionally, asymptomatic lesions of wholly benign appearance are identified. In these circumstances, cl inicians may feel obliged to undertake a series of increasingly complex investigations, even exploratory surgery, in order to confirm the diagnosis. This course of events may also follow chest radiographs taken for unrelated reasons—eg exclusion of skeletal injury following trauma.Mediastinal cysts (eg Bronchogenic and Enteric) may present as asymptomatic mediastinal masses with benign features. Two such cases are reported in which a prominent mediastinal mass was revealed at routine or post trauma chest radiography and a brief review of bronchogenic and enteric cysts is presented.

Underreporting of Vertebral Fractures on Routine Chest Radiography

2004 ◽  
Vol 182 (2) ◽  
pp. 297-300 ◽  
Author(s):  
N. Kim ◽  
B. H. Rowe ◽  
G. Raymond ◽  
H. Jen ◽  
I. Colman ◽  
...  
Keyword(s):  
Vertebral Fractures ◽  
Chest Radiography ◽  
Routine Chest

scholarly journals Training physicians in India to interpret pediatric chest radiographs according to World Health Organization research methodology

2021 ◽  
Author(s):  
Eric D. McCollum ◽  
Melissa M. Higdon ◽  
Nicholas S. S. Fancourt ◽  
Jack Sternal ◽  
William Checkley ◽  
...  
Keyword(s):  
World Health Organization ◽  
Primary Endpoint ◽  
Low Income ◽  
Chest Radiography ◽  
Epidemiological Studies ◽  
Chest Radiographs ◽  
World Health ◽  
Average Score ◽  
Pediatric Chest ◽  
Health Organization

Abstract Background Chest radiography is the standard for diagnosing pediatric lower respiratory infections in low-income and middle-income countries. A method for interpreting pediatric chest radiographs for research endpoints was recently updated by the World Health Organization (WHO) Chest Radiography in Epidemiological Studies project. Research in India required training local physicians to interpret chest radiographs following the WHO method. Objective To describe the methodology for training Indian physicians and evaluate the training’s effectiveness. Materials and methods Twenty-nine physicians (15 radiologists and 14 pediatricians) from India were trained by two WHO Chest Radiography in Epidemiological Studies members over 3 days in May 2019. Training materials were adapted from WHO Chest Radiography in Epidemiological Studies resources. Participants followed WHO methodology to interpret 60 unique chest radiographs before and after the training. Participants needed to correctly classify ≥80% of radiographs for primary endpoint pneumonia on the post-training test to be certified to interpret research images. We analyzed participant performance on both examinations. Results Twenty-six of 29 participants (89.7%) completed both examinations. The average score increased by 9.6% (95% confidence interval [CI] 5.0–14.1%) between examinations (P<0.001). Participants correctly classifying ≥80% of images for primary endpoint pneumonia increased from 69.2% (18/26) on the pretraining to 92.3% (24/26) on the post-training examination (P=0.003). The mean scores of radiologists and pediatricians on the post-training examination were not statistically different (P=0.43). Conclusion Our results demonstrate this training approach using revised WHO definitions and tools was successful, and that non-radiologists can learn to apply these methods as effectively as radiologists. Such capacity strengthening is important for enabling research to support national policy decision-making in these settings. We recommend future research incorporating WHO chest radiograph methodology to consider modelling trainings after this approach.

scholarly journals Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome

CJEM ◽  
2010 ◽  
Vol 12 (02) ◽  
pp. 128-134 ◽  
Author(s):  
Erik P. Hess ◽  
Jeffrey J. Perry ◽  
Pam Ladouceur ◽  
George A. Wells ◽  
Ian G. Stiell
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Congestive Heart Failure ◽  
Chest Pain ◽  
Chest Radiography ◽  
Clinical Decision ◽  
Chest Radiographs ◽  
Clinical Decision Rule ◽  
Coronary Syndrome ◽  
History Of

ABSTRACTObjective:We derived a clinical decision rule to determine which emergency department (ED) patients with chest pain and possible acute coronary syndrome (ACS) require chest radiography.Methods:We prospectively enrolled patients over 24 years of age with a primary complaint of chest pain and possible ACS over a 6-month period. Emergency physicians completed standardized clinical assessments and ordered chest radiographs as appropriate. Two blinded investigators independently classified chest radiographs as “normal,” “abnormal not requiring intervention” and “abnormal requiring intervention,” based on review of the radiology report and the medical record. The primary outcome was abnormality of chest radiographs requiring acute intervention. Analyses included interrater reliability assessment (with κ statistics), univariate analyses and recursive partitioning.Results:We enrolled 529 patients during the study period between Jul. 1, 2007, and Dec. 31, 2007. Patients had a mean age of 59.9 years, 60.3% were male, 4.0% had a history of congestive heart failure and 21.9% had a history of acute myocardial infarction. Only 2.1% (95% confidence interval [CI] 1.1%–3.8%) of patients had radiographic abnormality of the chest requiring acute intervention. The κ statistic for chest radiograph classification was 0.81 (95% CI 0.66–0.95). We derived the following rule: patients can forgo chest radiography if they have no history of congestive heart failure, no history of smoking and no abnormalities on lung auscultation. The rule was 100% sensitive (95% CI 32.0%–10.4%) and 36.1% specific (95% CI 32.0%–40.4%).Conclusion:This rule has potential to reduce health care costs and enhance ED patient flow. It requires validation in an independent patient population before introduction into clinical practice.

scholarly journals Sensitivity of Computer-Aided Detection (CAD) Device for Lung Nodule Detection on Chest Radiography: A Real-Life Application

2020 ◽  
pp. 1-5
Author(s):  
Ammar Chaudhry ◽  
Ammar Chaudhry ◽  
William H. Moore
Keyword(s):  
Sensitivity And Specificity ◽  
Chest Radiography ◽  
Predictive Value ◽  
Lung Nodule ◽  
Chest Radiographs ◽  
Lung Nodules ◽  
Computer Aided Detection ◽  
Cad System ◽  
Computer Aided ◽  
The Mean

Purpose: The radiographic diagnosis of lung nodules is associated with low sensitivity and specificity. Computer-aided detection (CAD) system has been shown to have higher accuracy in the detection of lung nodules. The purpose of this study is to assess the effect on sensitivity and specificity when a CAD system is used to review chest radiographs in real-time setting. Methods: Sixty-three patients, including 24 controls, who had chest radiographs and CT within three months were included in this study. Three radiologists were presented chest radiographs without CAD and were asked to mark all lung nodules. Then the radiologists were allowed to see the CAD region-of-interest (ROI) marks and were asked to agree or disagree with the marks. All marks were correlated with CT studies. Results: The mean sensitivity of the three radiologists without CAD was 16.1%, which showed a statistically significant improvement to 22.5% with CAD. The mean specificity of the three radiologists was 52.5% without CAD and decreased to 48.1% with CAD. There was no significant change in the positive predictive value or negative predictive value. Conclusion: The addition of a CAD system to chest radiography interpretation statistically improves the detection of lung nodules without affecting its specificity. Thus suggesting CAD would improve overall detection of lung nodules.

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