To Find Role of Routine Chest X Ray in Case of Supracostal PCNL: Can Complains and Physical Examination Replace it

In reference to the article by Sane et al. entitled "Value of Preoperative Chest X-ray Examinations in Children" (Pediatrics 60:669, November 1977), we would like to know if the authors broke down the abnormalities by age group—for instance, five-year segments. If so, did a preponderance of abnormalities of any variety occur at any particular age? We believe that should be stated, as it would strengthen their thesis if there was no difference between 0 and 19 years of age.

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The Role of the Radiologist in Mass Chest X-Ray Survey

Radiology ◽

10.1148/53.2.274 ◽

1949 ◽

Vol 53 (2) ◽

pp. 274-275

Author(s):

George L. Sackett

Keyword(s):

X Ray ◽

Chest X Ray

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Protocol for DRAUP: a deimplementation programme to decrease routine chest radiographs after central venous catheter insertion

BMJ Open Quality ◽

10.1136/bmjoq-2020-001222 ◽

2021 ◽

Vol 10 (4) ◽

pp. e001222

Author(s):

Enyo A Ablordeppey ◽

Byron Powell ◽

Virginia McKay ◽

Shannon Keating ◽

Aimee James ◽

...

Keyword(s):

Central Venous Catheter ◽

Acute Care ◽

Imaging Modality ◽

Phase 1 ◽

Venous Catheter ◽

Point Of Care Ultrasound ◽

Central Venous ◽

X Ray ◽

Chest X Ray ◽

Routine Chest

IntroductionAvoiding low value medical practices is an important focus in current healthcare utilisation. Despite advantages of point-of-care ultrasound (POCUS) over chest X-ray including improved workflow and timeliness of results, POCUS-guided central venous catheter (CVC) position confirmation has slow rate of adoption. This demonstrates a gap that is ripe for the development of an intervention.MethodsThe intervention is a deimplementation programme called DRAUP (deimplementation of routine chest radiographs after adoption of ultrasound-guided insertion and confirmation of central venous catheter protocol) that will be created to address one unnecessary imaging modality in the acute care environment. We propose a three-phase approach to changing low-value practices. In phase 1, we will be guided by the Consolidated Framework for Implementation Research framework to explore barriers and facilitators of POCUS for CVC confirmation in a single centre, large tertiary, academic hospital via focus groups. The qualitative methods will inform the development and adaptation of strategies that address identified determinants of change. In phase 2, the multifaceted strategies will be conceptualised using Morgan’s framework for understanding and reducing medical overuse. In phase 3, we will locally implement these strategies and assess them using Proctor’s outcomes (adoption, deadoption, fidelity and penetration) in an observational study to demonstrate proof of concept, gaining valuable insights on the programme. Secondary outcomes will include POCUS-guided CVC confirmation efficacy measured by time and effectiveness measured by sensitivity and specificity of POCUS confirmation after CVC insertion.With limited data available to inform interventions that use concurrent implementation and deimplementation strategies to substitute chest X-ray for POCUS using the DRAUP programme, we propose that this primary implementation and secondary effectiveness pilot study will provide novel data that will expand the knowledge of implementation approaches to replacing low value or unnecessary care in acute care environments.Ethics and disseminationApproval of the study by the Human Research Protection Office has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means.Trial registration numberClinicalTrials.gov Identifier, NCT04324762, registered on 27 March 2020.

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Chest CT as a Complement to RT-PCR to Confirm and Follow-up COVID-19 Patients

Medicinus ◽

10.19166/med.v8i1.3122 ◽

2021 ◽

Vol 8 (1) ◽

pp. 31

Author(s):

Aziza Ghanie Icksan ◽

Muhammad Hafiz ◽

Annisa Dian Harlivasari

Keyword(s):

Chest Ct ◽

Rt Pcr ◽

High Resolution Computed Tomography ◽

X Ray ◽

First Case ◽

Chest X Ray ◽

Polymerase Chain

Background : The first case of COVID-19 in Indonesia was recorded in March 2020. Limitation of reverse-transcription polymerase chain reaction (RT-PCR) has put chest CT as an essential complementary tool in the diagnosis and follow up treatment for COVID-19. Literatures strongly suggested that High-Resolution Computed Tomography (HRCT) is essential in diagnosing typical symptoms of COVID-19 at the early phase of disease due to its superior sensitivity (97%) compared to chest x-ray (CXR).The two cases presented in this case study showed the crucial role of chest CT with HRCT to establish the working diagnosis and follow up COVID-19 patients as a complement to RT-PCR, currently deemed a gold standard.

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Is a routine chest X-ray indicated before discharge following paediatric cardiac surgery?

Cardiology in the Young ◽

10.1017/s1047951109990187 ◽

2009 ◽

Vol 19 (4) ◽

pp. 370-371 ◽

Cited By ~ 3

Author(s):

Kerstin Bosse ◽

Thomas Krasemann

Keyword(s):

Cardiac Surgery ◽

Heart Surgery ◽

Clinical Impact ◽

Chest Radiographs ◽

X Ray ◽

Paediatric Cardiac Surgery ◽

Routine Basis ◽

Chest X Ray ◽

Routine Chest

AbstractIn many paediatric cardiosurgical units, a chest X-ray is routinely performed before discharge. We sought to evaluate the clinical impact of such routine radiographs in the management of children after cardiac surgery.Of 100 consecutive children, a chest X-ray was performed in 71 prior to discharge. Of these, 38 were clinically indicated, while 33 were performed as a routine. Therapeutic changes were instituted on the basis of the X-ray in 4 patients, in all of whom the imaging had been clinically indicated. No therapeutic changes followed those radiographs performed on a routine basis.Conclusion: Routine chest radiographs can be omitted prior to discharging patients after paediatric heart surgery.

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Is Routine Chest X-ray After Ultrasound and Intracavitary Electrocardiogram Guided Peripherally Inserted Central Catheter Insertion Choosing Wisely? A Population-based Retrospective Study of 2857 Patients With Cancer

10.21203/rs.3.rs-711193/v1 ◽

2021 ◽

Author(s):

Yan-Fen Shen ◽

Jing Dong ◽

Xin-Peng Wang ◽

Xiao-Zheng Wang ◽

Yuan-Yuan Zheng ◽

...

Keyword(s):

Venous Access ◽

Population Based ◽

X Ray ◽

Patients With Cancer ◽

Potential Risk Factors ◽

Catheter Tip ◽

Chest X Ray ◽

Clinical Records ◽

The Cost ◽

Routine Chest

Abstract Background: In China, routine chest X-ray (CXR) is generally required for peripherally inserted central venous catheters (PICC) to determine the position of the catheter tip. The aim of this study is to assess the value of a routine post-procedural CXR in the era of ultrasound and intracavitary electrocardiography(IC-ECG) -guided PICC insertion. Methods: A retrospective population-based cohort study was conducted to review the clinical records of all patients who had PICCs in the Venous Access Center of Beijing Cancer Hospital between January 1, 2019 and June 30, 2020. The incidence of catheter misplacement after insertion was measured. A logistic regression analysis was performed to examine potential risk factors associated with PICC-related complications and a cost analysis to assess the economic impact of the use of CXR.Results: There were 2,857 samples from 2,647 patients included. The overall incidence of intraoperative and postoperative catheter misplacement was 7.4% (n=210) and 0.67% (n=19), respectively. There was a high risk of postoperative catheter misplacement when the left-arm was chosen for placement (OR: 10.478; 95% CI: 3.467-31.670; p<0.001). The cost of performing CXR for screening of PICC-related complications was $23,808 per year, and that of using CXR to diagnose one case of catheter misplacement was $1253.Conclusion: This study confirms that misplacement of PICCs guided by ultrasound and IC-ECG is rare and that postoperative CXR is very costly. In our setting, routine postoperative CXR is unnecessary and not a wise option.

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Suggests More Tests for Chest Pain Diagnosis

PEDIATRICS ◽

10.1542/peds.61.1.143b ◽

1978 ◽

Vol 61 (1) ◽

pp. 143-144

Author(s):

Michael F. Elmore ◽

Glen A. Lehman

Keyword(s):

Chest Pain ◽

Physical Examination ◽

Pediatric Patients ◽

Laboratory Studies ◽

Psychiatric Interview ◽

X Ray ◽

Pain Diagnosis ◽

Chest X Ray ◽

Pain Characteristics ◽

Diagnostic Work

Driscoll et al. (Pediatrics 57:648, May 1976) reported a series of 43 patients with chest pain evaluated by history and physical examination, psychiatric interview, screening laboratory studies, ECG, and chest x-ray film. No organic cause was identified in 45% of patients, and various psychiatric aspects of the pain were discussed. The history obtained from pediatric patients is often suboptimal, and specific pain characteristics and associations cannot be defined. We therefore propose that more vigorous diagnostic work-ups are necessary before chest pain can be classed as "idiopathic."

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Weather the Cytokine Storm: A Report of Successful Management of a Colon Cancer Survivor and a Critically Ill Patient with COVID-19

Case Reports in Oncology ◽

10.1159/000509507 ◽

2020 ◽

Vol 13 (2) ◽

pp. 754-759

Author(s):

Mansoor Khalid ◽

Tarek Dernaika ◽

Lirin Jacob ◽

Pavan Annamaraju ◽

Achuta K. Guddati

Keyword(s):

Critically Ill ◽

Cancer Survivor ◽

Critically Ill Patient ◽

Cytokine Storm ◽

Ventilator Support ◽

X Ray ◽

Chest X Ray ◽

Underlying Mechanisms ◽

Poor Outcomes

Patients with novel corona virus infection (COVID-19) can develop acute respiratory failure secondary to acute respiratory distress syndrome. Cytokine storm is suggested as one of underlying mechanisms for the rapid clinical decline. Immunocompromised patients and cancer patients are at particular risk for poor outcomes due to COVID-19 infection. This case report describes the presentation and clinical course of a cancer survivor who became critically ill and required mechanical ventilation. The patient was treated with hydroxychloroquine, azithromycin, and ceftriaxone; however, he remained febrile, hypoxemic, continued to require full mechanical ventilator support and his chest X-ray showed increased bilateral infiltrates. The patient was treated with tocilizumab, after which he improved and was successfully extubated. This report illustrates a possible role of tocilizumab in management of cytokine storm in critically ill patients with COVID-19 infection.

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