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PubMed1996

[Aspiration-induced lung complications following emergency endoscopy in upper gastrointestinal hemorrhage: incidence and localization by thoracic radiography].

PURPOSE: Determination of incidence and mortality of pulmonary pathologies arising after gastroscopy for acute bleeding, of left to right ratio of pulmonary findings in postgastroscopic chest films, and determination of a possible relationship between bleeding activity and frequency of aspiration. METHODS: 174 patients with emergency gastroscopies for upper gastrointestinal haemorrhage with pre-/postendoscopy chest films, retrospective analysis. Of the pulmonary findings, infiltrates and atelectases were considered. RESULTS: After emergency gastroscopy, 16% of patients had infiltrates or atelectases at chest radiography. Mortality within 30 days in the study group was 18%, and 39% among the subgroup with radiologically proven pulmonary complications. The distribution of chest findings between left and right side was 1:1,3. In the subgroup with gastroscopic signs of bleeding the share of postgastroscopic pulmonary findings was slightly superior to that of patients without direct signs of bleeding; however, the difference was statistically not significant. CONCLUSION: Endoscopy-related aspirations do not seem to account for an increased rate of pulmonary complications after emergency gastroscopy.

Adult↗
PubMed1996

[Experiences with a new film-screen system in pediatric thoracic radiography].

PURPOSE: To compare the x-ray images made by the Kodak InSight Pediatric Imaging System (InSight P) with conventional film-screen systems in pediatric chest radiography. MATERIAL AND METHODS: The comparison involved chest radiographs made using Quanta-Fast-Detail/Cronex 4 (DuPont), Trimax 16/XDA (3 M) and DuPont UVR/UVL systems. The image quality of critical structures and the physical parameters of quantum interference, contrast and resolution were assessed. The energy path of the system was assessed by preparing density curves. Test conditions were in accordance with the latest guidelines of the Bundesärztekammer (German Physician's Association). RESULTS: The mediastinal area, retrocardiac and paravertebral spaces and the peripheral vessels of the lung were all displayed more distinctly using InSight P. The reason for this seems to be a lower degree of quantum interference associated with this system. With tube voltages between 60 and 80 kV, InSight P displayed a relatively low degree of sensitivity. CONCLUSION: InSight P can be used to produce predominantly high quality chest radiographs of infants between one and five years of age. However, this system has limited sensitivity in the tube voltage range recommended by the German Physicians' Association.

Age Factors↗
PubMed1995

[ROC analysis in post-processing of image data in digital thoracic radiography].

PURPOSE: To examine the extent to which digital luminescence radiography (DLR) can be used for the imaging of pulmonary nodules and interstitial lung disease in chest radiography without any loss of image quality. Additionally: to examine whether post-processing of image data can optimise the recognizability of varied image details. MATERIALS AND METHODS: Detail perceptibility studies were performed on an anthropomorphic thorax phantom with simulated nodules and small linear and reticular details. Under standard conditions, digital luminescence radiographs were obtained in 7 different image modes, and these were compared with a 200-speed screen-film system. The detection of these systems was evaluated in an ROC analysis on the basis of 19,200 individual observations. RESULTS: Edge enhancement or application of high-frequency-enhancing small filter kernels (S 5) slightly improves the detection of linear structures; however, the illustration of nodular details is markedly reduced. Larger filter kernels (S 20, S 40) make a definitive detection possible--not only of circular, but also of linear details. CONCLUSIONS: Storage phosphor radiographs are equal to the tested analog screen-film-system. The optimization of post-processing can be helpful in the prevention of routine multiple documentations.

Adult↗
PubMed1995

[Pulmonary manifestations in HIV patients: role of thoracic radiography, CT and HRCT].

AIM: To determine the prevalence of pulmonary changes on chest radiographs and computed tomography (CT/HRCT) in HIV patients and their relation to pulmonary symptoms. MATERIAL AND METHOD: 64 HIV patients were examined prospectively. 15 had no respiratory symptoms (group I), 30 had non-specific respiratory symptoms (group II), 19 complained of dyspnoea (group III). Chest radiographs and CT were performed within a week. In patients with positive findings, bronchoscopy was carried out with bacteriological and histological examinations. RESULTS: In group 1, 13% of chest radiographs and 40% of CTs showed infiltrative changes. In group II, the figures were 27% and 57% respectively. In group III, abnormalities were found in all cases by both examinations. CONCLUSIONS: In the absence of pulmonary symptoms, imaging is not indicated since it has no clinical consequences. In the presence of pulmonary symptoms, CT/HRCT should be performed whether the chest radiograph is normal or not, since it may reveal additional information.

Adult↗
PubMed1995

[Value of thoracic radiography in the assessment of cardiac size. A comparison with left ventricular cardiography].

PURPOSE: To determine the value of standard chest radiographs in the assessment of cardiac size. METHODS: In 193 patients cardiac size was compared between standard chest radiographs in the posteroanterior and lateral projection and left ventricular angiograms. The following parameters were determined: transverse diameter, lateral horizontal transverse diameter, cardiothoracic ratio and end-diastolic volume index (EDVI) and ejection fraction (EF). RESULTS: Subjective assessment of the left ventricular size resulted in a mean sensitivity/specificity/accuracy of 69.7%/87.4%/82.0% respectively, in comparison to EDVI. Estimation of global heart size yielded a mean sensitivity/specificity/accuracy of 48.8%/93.6%/77.8%, respectively, in comparison to EF. Cardiothoracic ratio for the detection of pathological EDVI or EF had a sensitivity of 77.3%/57.4% a specificity of 79.3%/80.8% and an accuracy of 78.9%/72.5%. CONCLUSIONS: Standard chest radiographs with the determination of cardiothoracic ratio remain a clinically relevant procedure for screening and follow-up of heart disease.

Adult↗
PubMed1995

[Thoracic radiography in intensive care units. Comparison of an asymmetric film-screen-grid combination with an L-film].

PURPOSE: Using an asymmetrical screen-film-grid combination with an ITC-VHC special grid (Kodak), the effect of the individual components was evaluated with regard to detail in the lungs and mediastinum as well as patient dose. MATERIALS AND METHODS: The system was compared with the Curix Ortho screen film system (Agfa L-film) using phantoms and 62 patients in an intensive care unit. The results were analysed by three independent observers. Dose measurements on phantoms were carried out with a WD 10 (Wellhoefer) dosimeter and with a thermoluminescence dosimeter for patients. RESULTS: Both phantom and patient images showed improved demonstration of mediastinal structures with similar details of lung structure. Details in the peripheral lungs are significantly better shown with the ITC-VHC system with the special grid than they are without the grid. However, there is an increase about three to four times in radiation dose when using the grid. CONCLUSION: Our trial shows that the use of the ITC-VHC grid system is to be recommended for routine clinical use because of the better demonstration of details, but one must be aware of the increased radiation dose to the patient.

Evaluation Studies as Topic↗
PubMed1994

[The aftercare of breast carcinoma. The value of plain thoracic radiography, abdominal sonography and mammography].

7865 follow-up examinations were performed on 420 patients who had had surgery for carcinoma of the breast; there were 2755 radiographs of the chest, 2660 sonographic examinations of the upper abdomen and 2450 contralateral mammograms. The most common findings were metastases seen on the chest radiographs during the 13-24 and 25-60 months intervals in 4.7% of cases. The incidence increased with initially higher tumour stages and in ductal carcinomas. Sonography of the upper abdomen showed 4.3% of liver involvement, mostly between the second and fifth year; this was independent of tumour stage or the histology of the primary tumour. Positive mammography of the contralateral breast was found in 3% within the first three months after surgery. A contralateral carcinoma was more common in case of lobular primary tumours. There was no direct correlation with the initial tumour stage. We evaluated the routine use of these imaging procedures as part of the follow up of carcinoma of the breast in relation to the additional cost.

Abdomen↗
PubMed1991

[High-resolution CT of the lung versus thoracic radiography after adjuvant radiotherapy in breast carcinoma].

We examined the lungs of 35 women following postoperative radiotherapy for breast cancer by using high-resolution computed tomography (HR-CT). Radiotherapy was performed on a cobalt 60 unit using a five-field technique. The average interval between the end of radiotherapy and HR-CT examinations was 23.8 months. HR-CT was limited to those lung areas that were at risk for radiation-induced changes. In 40% of patients minimal interstitial damage (e.g. thickened septal lines, curvilinear densities) invisible on chest x-ray was demonstrated by HR-CT. Massive fibrosis as reported by others was not seen in our study. We conclude that in case lung involvement is suspected clinically during or after radiotherapy, HR-CT is the method of choice for demonstrating these morphological changes.

Adult↗
PubMed1991

[Value of supine thoracic radiography in the diagnosis and quantification of pleural effusions: comparison with sonography].

The purpose of this prospective study was to verify the value of the supine chest radiograph with regard to the recognition and quantification of pleural effusions. The findings of supine chest radiographs were compared to those of chest sonography in a total of 320 pleural cavities. The correct identification and quantification of a pleural effusion was possible by supine chest radiograph alone in only 55% of cases (176/320). In 20% (64/320) supine chest x-ray was falsely negative and in 15% (48/320) falsely positive. In 10% an existing effusion was in fact recognised on supine chest x-ray; however the amount of effusion was wrongly estimated.

Adolescent↗
PubMed1997

[Thoracic radiography as routine within cardiological diagnosis?].

OBJECTIVE: As chest radiography is still frequently used routinely in patients suspected of heart disease, the study was undertaken prospectively to assess its value in view of the potentials of modern noninvasive methods. PATIENTS AND METHODS: History, physical examination, electrocardiography, ergometry, echocardiography and colour Doppler echocardiography as well as chest radiography were undertaken in 201 consecutive patients (113 men, 88 women, age 60 [3-88] years) with known or suspected cardiac valvular defects or heart failure. Subsequently invasive investigations were performed in 92 of these patients. RESULTS: The value of chest radiography depended on the nature and severity of the particular cardiac disease. The diagnosis was established without chest radiography in all defects (40 patients) of grade III or IV (New York Heart Association) or NYHA class III or IV heart failure (30 patients). Chest radiography provided no additional prognostic or therapeutic information. CONCLUSION: These data indicate that routine chest radiography is of no value as a screening method in patients with chronic heart failure or cardiac defects, except in a few clearly defined specific circumstances.

Adolescent↗
PubMed1986

[Multilevel structure isolation using modules based on the example of thoracic radiography].

Conventional chest radiographs were digitized and processed by multilevel band pass filtering. By this procedure different structural components are isolated according to their local spatial frequencies. In chest radiographs a textural component can be separated from a skeletal component. Evaluation of radiological images is facilitated because changes can be looked for at relevant levels. A reconstruction of the image is possible, using different weighting factors to enhance interesting structural components.

Humans↗
PubMed1988

[Assessment of fluid content of the lung by thoracic radiography. Comparison of extravascular lung water measurement and results of radiological estimation methods].

Extravascular lung water (EVLW) was determined with the thermal-dye double-indicator method (119 individual measurements) in 23 patients in an intensive-care unit, and the results were compared with estimates made from largely standardized portable chest X-ray films, using the staging method of Sibbald as well as that of Halperin. There was a significant correlation with the measured EVLW for both methods. Radiologically "normal" films corresponded to a mean EVLW value of 8.4 ml/kg body-weight. Radiologically judged adjacent stages did not in all cases compare with corresponding measured EVLW values. But when EVLW values were clearly abnormal, the X-ray films always demonstrated massive interstitial or alveolar infiltrations. Measurement of EVLW enables one accurately to judge the fluid contents of the lung and is superior to the assessment of the chest X-ray film.

Adult↗
PubMed1979

Routine thoracic radiography for psychiatric inpatients.

Screening chest x-rays are routinely obtained for psychiatric as well as other patients. The authors present data that suggest that this practice no longer has a sound medical basis and should be eliminated or modified. It is unlikely that routine radiography of the chest is of practical benefit to adult psychiatric patients who are clinically healthy and are under age 40.

Adolescent↗
PubMed1999

[Guidelines for the routine assessment of respiratory surgical risk: thoracic radiography].

Through the three years between June 1995 and June 1998 the authors applied an evaluation schedule for the respiratory surgical risk to all the patients undergoing general surgery. Chest X-ray was included in this schedule as a first-level test and it was performed systematically on all the patients. The purpose of the study was to verify the effectiveness of chest X-ray as a routine examination of the respiratory performance, evaluating its predictive value on 1715 cases. The routine employment of this preoperative test on patients resulting risk-free at an accurate clinical anamnestic examination doesn't seem to be justified, basing on the preliminary results achieved. Therefore, chest X-ray should be considered a second-level test, to be performed on the basis of a precise clinical query only. This way a significant health-care cost reduction could be achieved, without affecting the quality of patient's management.

Adult↗
PubMed1999

[Role of thoracic radiography in the management of community-acquired pneumonia].

In patients presenting with a lower respiratory tract infection, it is generally recommended to order a chest X-ray in two circumstances: when the clinical signs suggest the diagnosis of pneumonia or in case of rather atypical symptoms suggesting a potential risk of complications. Indeed, the presence of one or more recent opacities, and more specifically, homogeneous alveolar infiltration(s) remains the gold standard criterion for the diagnosis of pneumonia. One must not however let this rule overshadow certain limitations of the chest X-ray reported in the literature: 1. the misdiagnosis of certain cases of pneumonia or bronchopneumonia seen early; 2. the extent of the infiltration gives only a very relative assessment of severity; 3. the characteristics of the infiltration are only relatively specific for etiological diagnosis. In patients with community acquired pneumonia diagnosed on the basis of clinical signs and radiographic findings, systematically performed series of follow-up X-rays have shown that the initial extension of the infiltration and the rate of its resolution contribute quite variably to the diagnosis of complications. The best indication for ordering a follow-up X-ray before 6 weeks remains an unfavorable clinical course.

Acute Disease↗