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PubMed1987

Usefulness of routine preoperative chest roentgenograms in elderly patients.

One hundred thirty-six charts of preoperative patients over the age of 59 years were reviewed to determine whether clinical criteria alone are sufficient to identify patients who would not benefit from preoperative chest roentgenograms. Thirty-four percent of the patients without risk factors and 62% of those in the high-risk group were found to have significant abnormalities on chest roentgenograms (P less than 0.05). Postoperative complications occurred in 20% of patients in the high-risk group compared to 11% complication-rate in patients without clinical risk factors. The difference is not statistically significant. The prevalence of abnormal preoperative chest roentgenograms among those over the age of 70 years (49%) was not significantly different from the prevalence in those between the ages of 60 and 70 years (59%); however, the incidence of major postoperative complications was significantly higher in the older group (17 v 4%, P less than 0.01). Because of the substantial prevalence of abnormal chest roentgenograms and postoperative complications, it is concluded that in the elderly preoperative patients, in particular those over the age of 70 years, chest roentgenograms should be done on all patients regardless of clinical history.

Aged↗

PubMed1985

Evaluation of the portable chest roentgenogram for quantitating extravascular lung water in critically ill adults.

The diagnosis of pulmonary edema is frequently made from characteristic findings on the chest roentgenogram that suggest an increase in lung water. Optimal radiographic technique depends on a cooperative upright patient, which is not possible with most critically ill patients. These patients may also have multiple radiographic abnormalities that make interpretation of the chest roentgenogram difficult. The ability of portable chest roentgenograms to accurately identify the presence of excess lung water and monitor changes in lung water has not previously been evaluated in critically ill adults who are intubated and ventilated and in the supine position when the films are exposed. In 12 patients the pulmonary edema seen on portable chest roentgenograms was given a score (0 to 390 points), which was then compared with a determination of extravascular lung water using the thermal-dye indicator dilution technique. A linear correlation was observed (r = 0.51; p less than 0.05; n = 73). Evaluation of a change in radiographic score vs a change in lung water showed no linear correlation (r = 0.1; p greater than 0.05). While portable chest roentgenograms exposed under the conditions described were a useful technique for demonstrating pulmonary edema, they were not accurate in monitoring modest changes in lung water in critically ill patients.

Adult↗

PubMed1990

Pneumothorax following transbronchial biopsy. Low diagnostic yield with routine chest roentgenograms.

A chest roentgenogram is commonly obtained after a transbronchial biopsy to exclude a pneumothorax. We hypothesized that these routine chest roentgenograms rarely demonstrate a pneumothorax in patients who have neither symptoms nor fluoroscopic findings of lung collapse. To test this hypothesis, we studied 305 consecutive patients undergoing bronchoscopy with fluoroscopically guided TBB. No patient without symptoms and fluoroscopic findings suggesting lung collapse had a pneumothorax demonstrated on the post-biopsy chest roentgenogram. At the University of Virginia, routine chest roentgenograms failed to demonstrate a single unsuspected pneumothorax among all patients undergoing TBB during a period of nearly six years. Given this low incidence of unsuspected pneumothorax, we conclude that routine chest roentgenograms have a low diagnostic yield and may not be necessary in all patients after fluoroscopically guided TBB.

Adolescent↗

PubMed1990

The correlation of subcarinal density visualized on plain chest roentgenograms with computed tomographic scans.

A prospective evaluation of 212 paired chest roentgenograms and computed tomographic (CT) scans was performed to determine the predictive value of detecting subcarinal adenopathy by finding increased subcarinal density on routine roentgenograms. Based on CT criteria for subcarinal lymphadenopathy, 37 true-positive and 124 true-negative cases of subcarinal adenopathy were found in 161 patients. Evaluation of density in the subcarinal area on the routine posteroanterior (PA) chest roentgenograms in these patients demonstrated a sensitivity of 72 percent and specificity of 96 percent for the detection of adenopathy when compared with established CT criteria. False-positive and false-negative appraisals of central mediastinal density on routine roentgenograms appear to be due to the super-imposition of other masses, bullae, or lack of appropriate roentgenographic contrast. The accuracy of predicting the presence or absence of subcarinal adenopathy from routine chest roentgenograms suggests that this observation is clinically useful and should be routinely evaluated.

False Negative Reactions↗

PubMed1991

The role of the chest roentgenogram in febrile neutropenic patients.

In a retrospective review of patients with neutropenia and fever, we sought to determine how often roentgenograms detected pulmonary disease, especially pneumonia, not suggested by signs and symptoms. Further, we sought to determine how often therapy was changed as a result of roentgenographic findings. Overall, 41 (22%) of 187 chest roentgenograms obtained during initial febrile episodes, recurrent fevers, or persistent fevers were abnormal. While most patients had signs and symptoms suggesting the presence of pulmonary disease, 17% had roentgenographic abnormalities detected in the absence of such findings. During initial febrile episodes, therapy was not changed in response to findings on the chest roentgenogram. However, during episodes of persistent or recurrent fever, findings on chest roentgenograms led to changes in therapy in eight (61%) of 13 episodes of which six (40%) resulted in clinical improvement. Chest roentgenograms were therefore found to be an important diagnostic tool in evaluating recurrent or persistent fever in the neutropenic patient but of little use during initial febrile episodes.

Bone Marrow Transplantation↗

PubMedDate not supplied

Interobserver variability in the interpretation of chest roentgenograms of patients with possible pneumonia.

BACKGROUND: Previous studies have found considerable interobserver variability in the roentgenographic diagnosis of pneumonia. In this study we determined the impact of experience on interobserver variability in the interpretation of chest roentgenograms of patients with pneumonia and defined the characteristics of chest roentgenograms interpreted as pneumonia by all groups. METHODS: The chest roentgenograms of 15 consecutive patients with a clinical and roentgenographic diagnosis of pneumonia were read by a convenience sample of 10 first-year and 20 fourth-year medical students, 21 medical residents, and 21 staff physicians from the department of medicine. Three board-certified radiologists served as the gold standard. The majority rule decision and logistic regression analysis were used to analyze agreement among the various groups of observers. RESULTS: Agreement with the majority decisions of the gold-standard radiologists on the presence or absence of pneumonia for all observations of the various groups were as follows: original radiologist, 87%; first-year medical students, 59%; fourth-year medical students, 54%; medical residents, 66%; and attending staff, 72%. Chest roentgenograms with dense lobar or segmental opacities were generally interpreted as pneumonia by all observers. Patchy opacities caused major disagreements and were usually read as not being due to pneumonia. Bronchopneumonia was not diagnosed by any of the observers. Air bronchograms, atelectasis, and chronic obstructive lung disease were usually not recognized by the nonradiologists. CONCLUSIONS: There is considerable interobserver variability in the roentgenographic diagnosis of pneumonia. This variability does not improve with increasing experience. Dense lobar or segmental opacities are uniformly recognized as pneumonia while patchy opacities result in a variety of interpretations.

Aged↗

PubMed1991

The value of the routine chest roentgenogram in the cardiological evaluation of infants and children. A prospective study.

The value of the routine chest roentgenogram was studied in 284 patients, newly admitted to our paediatric outpatient department. Emergency patients were excluded from the study. In 141 cases the initial diagnosis after history, physical examination and ECG was "no heart disease", while in 143 cases it was "heart disease". After a follow up of up to 4 years, 170 children appeared to have "no heart disease" and 114 definite heart disease. In 7.7% of cases the chest roentgenogram made at the first visit to the outpatient department led to a change in policy, whereas in only 3.8% was the chest roentgenogram in someway helpful in establishing the correct diagnosis. Amongst those children with initial diagnosis of innocent murmur, the chest roentgenogram led to a diagnosis of "heart disease" in only 2.8% of cases. It is concluded that for the differentiation "heart disease" or "no heart disease", a chest X-ray film is not indicated. In children with "heart disease" the chest X-ray film is also of little value, and is mostly to be used only for documentation.

Adolescent↗

PubMed1981

Comparison between transillumination and the roentgenogram in diagnosing paranasal sinus disease.

The reliability of transillumination versus roentgenogram to diagnose maxillary and frontal paranasal sinus disease was assessed in 52 subjects with rhinitis and/or asthma. Two different otolaryngologists transilluminated the sinuses while the roentgenograms were evaluated by a radiologist and a third otolaryngologist. Patients filled in questionnaires of symptoms. There was excellent agreement (p < 0.001) between otolaryngologists regarding transillumination of the frontal sinuses but not the maxillary sinuses. Similarly, transillumination of the frontal sinuses correlated well with the roentgenograms. This was not true for transillumination of the maxillary sinuses. Although pain in the upper teeth related well to the presence of frontal disease, sinus headache was a frequent complaint but not useful as a predictor of sinus disease. Even though transillumination of the frontal paranasal sinus has some predictive value, the technique of transillumination has limited usefulness as a diagnostic tool and is not an adequate substitute for roentgenogram.

Adolescent↗

PubMed1993

Selective use of pelvic roentgenograms in blunt trauma patients.

This study was initiated to investigate the need for routine pelvic roentgenograms for all blunt trauma victims. Over a 2-year period, we prospectively studied patients referred to the trauma service in the level I trauma center at our institution who met the inclusion criteria. The patients were evaluated by physical examination and, if mentally alert and reliable, were included in the study. After inclusion into the study, a routine pelvic roentgenogram was performed to substantiate the results of our physical examination. All 125 patients included in the study were found to have normal results on pelvic roentgenograms. We conclude that alert, oriented and reliable patients involved in blunt trauma do not need a routine pelvic roentgenogram if the findings on physical examination are negative.

Abdominal Injuries↗

PubMed1995

Associated injuries in patients with blunt chest trauma: detection by abdominal roentgenograms after aortography.

To determine the value of abdominal roentgenograms after aortography for detecting additional organ injuries, we retrospectively evaluated the abdominal and pelvic roentgenograms after aortography of 170 trauma patients who underwent arch aortography to detect aortic rupture. In 160 (94%) of 170 patients, the results of arch studies were normal. Ten (6%) of 170 patients had aortic rupture (8 patients) or rupture of a major vessel (2 patients). Thirty-one (18%) of 170 patients had associated injuries demonstrated by the roentgenograms taken after aortography, including pelvic or femoral fractures (13%), pelvic hematomas (5.8%), renal injuries (1.1%), and bladder ruptures (2.9%). We conclude that abdominal and pelvic pain roentgenograms should be part of a routine arch aortography performed for blunt chest trauma to detect additional organ injuries that frequently accompany injuries from motor vehicle crashes.

Abdominal Injuries↗

PubMed1995

Traumatic chest lesions in patients with severe head trauma: a comparative study with computed tomography and conventional chest roentgenograms.

In patients with severe craniocerebral trauma, who need a continuous positive-pressure breathing, the detection of pulmonary and mediastinal traumatic lesions, especially pneumothorax, may alter the management. The aim of this study is to evaluate the efficiency and accuracy of conventional supine chest roentgenograms to detect the associated traumatic chest lesions in severe craniocerebral trauma and to compare their value as a diagnostic method for the identification of unsuspected lesions with a limited chest computed tomographic (CT) examination. Forty-seven consecutive patients with severe craniocerebral trauma underwent head CT and a prospective limited CT examination of the thorax in the same session. Nine patients (19.1%) presented a pneumothorax, bilateral in one case. Six pneumothoraces (60%) were identified both on conventional chest roentgenograms and CT, whereas in four cases (40%), the lesion was only detectable on CT. The CT study also showed 31 areas of pulmonary parenchymal contusions in 19 subjects (40%), whereas the conventional chest roentgenograms demonstrated 17 areas of contusions in 11 (23%) subjects. One thoracic aorta and one right diaphragm rupture were detected on CT study. On the conventional chest roentgenograms the mediastinal vascular injury was overlooked, whereas the right diaphragmatic rupture was highly suspected. The limited chest CT examination supplied additional information in 30% of patients. In 12.7% of patients, this information was clinically significant enough to alter the management. In patients with severe craniocerebral trauma evaluation of associated chest trauma by a supplementary limited chest CT, examination provides more and precise information about the size and severity of mediastinal and pulmonary lesions with a superior detectability of pneumothorax.

Adolescent↗

PubMed1997

Reliability of roentgenogram evaluation of pedicle screw position.

STUDY DESIGN: This was a human cadaver study of the accuracy of biplanar roentgenography in determining pedicle screw position. OBJECTIVE: To determine the independent accuracy of radiologic evaluation of screw placement and to determine if there are any particular screw malpositions that are more likely to produce a false sense of acceptable screw position. SUMMARY OF BACKGROUND DATA: Other investigators have reported the correlation between radiologic evaluation and anatomic dissection. However, in those studies the radiologic evaluation was not independent of the surgeons placing the screws. There has been no comment in the literature regarding particular screw malpositions that would lead the surgeon into a false sense of successful screw placement. METHODS: Pedicle screws were placed in cadaver spines, and biplanar roentgenograms of the specimens were evaluated by independent observers. The results of the roantgenogram evaluation then were compared to those of the anatomic dissection. RESULTS: The accuracy of roentgenogram evaluation varied from 73% to 83%, depending on the experience of the surgeon grading the roentgenograms. Screws misplaced medially into the spinal canal are more likely to give the surgeon a false sense of successful screw placement. CONCLUSIONS: The surgeon must not rely solely on the roentgenograms, but instead continue to use tactile sensory skills, anatomic knowledge, and additional modalities such as electromyography monitoring.

Bone Screws↗

PubMed1989

Bronchoscopy to evaluate hemoptysis in older men with nonsuspicious chest roentgenograms.

Six of 106 older men with hemoptysis and a nonsuspicious chest roentgenogram who underwent fiberoptic bronchoscopy were found to have cancer. Four of the five bronchogenic carcinomas appeared to be surgically resectable. Cancer patients were significantly older, had smoked within the last five years, and had a significantly higher frequency of central abnormalities on chest roentgenogram. Six additional bronchogenic carcinomas were diagnosed at follow-up. Two of these were probably present but not detected at the time of bronchoscopy. We conclude that (1) hemoptysis with a nonsuspicious chest roentgenogram carries an appreciable risk of cancer in older men with substantial smoking histories, (2) these cancers are often resectable, (3) a chest roentgenogram in which the central lung fields are obscured in any way should not be considered negative in patients with hemoptysis, and (4) a negative bronchoscopic examination does not exclude the possibility of cancer in these patients.

Aged↗

PubMed1976

Standing roentgenograms in spondylolisthesis.

Lateral roentgenograms of 50 patients with spondylolisthesis were made in the recumbent and standing positions and compared. Thirteen (26%) showed an increase in the percentage of displacement on standing. Those patients with demonstrable change appeared to have a higher incidence of severe symptomatology. Apparent spondylolysis on recumbent roentgenograms may change to spondylolisthesis on standing lateral roentgenograms. Degenerative spondylolisthesis may be more apparent on standing lateral roentgenograms.

Adult↗

PubMed1986

The value and cost effectiveness of abdominal roentgenograms in the evaluation of stab wounds to the abdomen.

The value of roentgenograms of the abdomen in the evaluation and management of stab wounds to the abdomen has not been well documented. This retrospective study demonstrates that the overwhelming majority of patients with injury requiring repair have normal roentgenograms. We also found that, even when abnormal, abdominal roentgenograms make a negligible contribution to the evaluation in these patients. These findings indicate that abdominal roentgenograms are not cost effective in patients with stab wounds to the abdomen and should not be obtained on a routine basis.

Abdominal Injuries↗

PubMed1980

The value of routine preoperative chest roentgenograms in infants and children.

The charts and routine preoperative roentgenograms of 350 children admitted for elective pediatric surgery were analyzed to evaluate the clinical importance of routine preoperative chest roentgenograms. This analysis, and a review of the literature, should indicate that routine preoperative roentgenograms for elective pediatric surgery are unnecessary. Indications for selected preoperative roentgenograms based on patients' history and clinical findings are enumerated.

Adolescent↗

PubMed1997

"Crushed glass" appearance of particles observed in roentgenograms after hysterosalpingography as an indicator of pelvic abnormalities.

OBJECTIVE: To evaluate the diagnostic value of the crushed glass appearance of particles observed on roentgenogram after hysterosalpingography in patients with pelvic abnormalities. DESIGN: Retrospective study of 32 patients whose roentgenogram had particles with a crushed glass appearance and 16 patients without crushed glass appearance, with laparoscopy conducted to determine the location and severity of the pelvic disease. SETTING: Fujita Health University Hospital, Aichi, Japan. PATIENT(S): A total of 240 patients underwent hysterosalpingography to determine the cause of infertility. MAIN OUTCOME MEASURE(S): We compared the location of the pelvic endometriosis and/or inflammation that was observed on roentgenogram as the crushed glass appearance versus definitive findings at laparoscopy. RESULT(S): A total of 30 of the 32 cases (93.8%) with the crushed glass appearance were confirmed as having pelvic abnormalities, such as endometriosis (73.3%) and pelvic inflammation (26.7%). The rate of the concurrence of the location of the crushed glass appearance observed on the film and that of the lesions verified by laparoscopy was 66.7%. Histopathological examination showed that specimens taken from endometriosis or inflammatory lesions that comprised the crushed glass appearance were lacking in epithelium in proportion to the size of the particles. CONCLUSION(S): Identification of the crushed glass appearance of particles was a useful noninvasive method of detecting pelvic abnormalities, such as pelvic endometriosis and inflammation, in infertile women.

Adult↗

PubMed2002

Outcome in patients with lung cancer found retrospectively to have had evidence of disease on past lung cancer mass screening roentgenograms.

This study enrolled 143 asymptomatic patients with lung cancer detected by mass screening during an 8-year period (January 1, 1993 to December 31, 2000) and who had received a lung cancer mass screening roentgenogram one year before the disease was found. There was no difference between the 5-year survival rates in patients with one-year delayed detection of lung cancer (n=62) and in patients without (n=81) (46 vs. 58%, log rank: P=0.1330, Wilcoxon: P=0.1008). However, according to the tumor size on the overlooked chest roentgenogram, the outcome in stage I+II patients with missed tumors >20 mm in dimension (n=20) was worse than those with missed tumors <10 mm (n=24) or those with missed tumors 10-20 mm (n=18) (40 vs. 82 or 81%, log rank: P=0.0047, Wilcoxon: P=0.0010). All missed tumors in the lung field that did not overlap thoracic components were <10 mm in dimension and appeared as patchy ground-glass opacities, and they could not have been recognized if there was no other information that the tumor developed in that location. This might also be related to the lack of mortality effectiveness of previous lung cancer mass screening problem. Although it may be difficult to find the tumors <10 mm on a chest roentgenogram on mass screening, one-year delayed detection of lung cancer < or = 20 mm will not affect the prognosis.

Adult↗