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[The role of thoracic radiography in the intensive care unit of a department of internal medicine].

Authors review the main principles of chest X-ray examination methodology and analyse their one-year material. During this time 225 chest X-ray films were taken by means of a mobile X-ray unit. The majority of patients were treated for cardiac disorders (e.g. AMI). Authors analyse the distribution of patients according to their illnesses, the correlation between the clinical and the radiological diagnoses and the quality of the X-ray films. Authors emphasize the importance of the correct collaboration between the staff of the intensive care unit and the radiological department.

Emergencies↗

[The use of thoracic radiography in a third-level-care pediatric hospital].

OBJECTIVES: 1. To describe the frequency in which the thorax radiography is requested in a third-level pediatric hospital, 2. To identify the frequency of detected abnormalities in such a study by the radiology service, 3. To describe the frequency and the characteristics form the information considered as useful in a clinical way, not only in the radiography application but in the radiologic report and the clinical file as well, 4. To identify the frequency in which the thorax radiography result is associated with diagnosis changes and/or therapeutic ones. DESIGN OF THE INVESTIGATION: Descriptive survey. STUDY UNITS: 371 thorax X-rays completed during December 1990 and January 1991. PRIMARY RESULTS: The thorax radiographies were 32% of the entire radiological study during the survey; 335 of the latter ones (90%) were requested for inpatients. The hospital services which had the highest request for such a study were the Intensive Care Unit (n = 149, 40%) and Medical Pediatrics (n = 116, 31%). The most frequent diagnosis leading to the application was pneumonia (n = 55, 15%) and solid neoplasia (n = 51, 14%). Three-hundred forty eight of the applications had diagnostic impression given by the physician in charge(94%); whereas only 127 (34%) mentioned clinical data. The radiology report was attached to the file in 162 (44%) of the cases. It was found that form the patients who had a radiology report and the thorax radiography as an initial study (n = 95), 48 (50%) suffered from abnormalities. The results of the study were transcribed in the file in 58 cases (16%); the physician's interpretation was written down in 229 cases (62%) and in 84 studies (23%) there was no reference to the results of the study (P < 0.0001). Changes in the therapeutic plan of 93 cases (50%) were identified from the studies with official report by the radiologist, other radiology studies were requested in 65 of the patients (35%), after the interpretation of such study. CONCLUSIONS: Abnormalities in 50% were identified from the total thorax radiographies requested as the patient entered. The study application mentioned as a whole (94%) the diagnostic impression which led to the application, but only in 127 cases (34%) were supporting clinical data written down. The radiology report was attached to the file in less than half the cases (44%). In 63% of the cases the supporting reason of the study was written down whereas in 23% there was no reference to the result at all.

Adolescent↗

[The remodelling of the heart in heart failure: from thoracic radiography to magnetic resonance].

Congestive heart failure represents the most common medical hospital discharge diagnosis, and can occur in patients with preserved indexes of left ventricular systolic function, even in absence of patent coronary or valvular heart disease. The present review examines the role of imaging techniques in the diagnosis and follow-up of these patients. Imaging of the heart has undergone dramatic advances with the development and refinement of new imaging modalities such as echocardiography, computed tomography, magnetic resonance and radionuclide emission tomography. The role of "low-tech" modalities such as chest roentgenogram is discussed. The possibilities offered by ultrasounds or magnetic resonance in tissue characterization are then compared with the actual capability of cardiac imaging in detecting myocardial tissue alterations (oedema, ischemia, myocarditis, etc.) and/or degeneration (fatty degeneration, fibrosis, amyloidosis, etc.). Finally, the potential use in modern clinical medicine of magnetic resonance spectroscopy and positron emission tomography to study myocardial metabolism and cellular function are discussed.

Angiocardiography↗

[Rationalization of the use of preoperative thoracic radiography in obstetrics and gynecology].

INTRODUCTION: Rationalizing preoperative chest radiography remains a problem in our Country. Therefore, we tried to use preoperative chest films rationally in obstetrics and gynecology to assess their impact on anesthesia planning and patient management and their use in early postoperative complications. MATERIAL AND METHODS: We examined two groups of patients: group A consisted of 570 women (mean age: 31 years) scheduled to be submitted to cesarean section but with no preoperative chest radiography; group B consisted of 471 patients (homogeneous in age to group A patients) submitted to nononcologic gynecologic surgery and with a single-projection preoperative chest radiograph. Anesthesiologic assessment, preoperative biochemical tests and EKG were performed in all patients. All patients underwent abdominal surgery under general anesthesia. The first 24 postoperative hours were monitored for possible anesthesia-related complications. The anesthesiologist need of chest radiography based on clinical findings was investigated in group A patients, as well as the importance of chest film findings in possible anesthesia-related complications. RESULTS: Group A and group B were homogeneous by mean patient age and anesthesia duration; clinical findings never suggested the need of chest radiography in group A patients. Three cardiorespiratory complications occurred (two respiratory arrests in group A and a gas embolism in group B), but the (un)availability of chest film findings made no difference in treatment. DISCUSSION: The availability of the preoperative chest radiographs of a group of healthy women of 31 years mean age does not make any difference in anesthesia planning and type. In our series, the most severe cardiorespiratory complications were homogeneous in the two groups, which confirms their random character, and the (un)availability of preoperative chest film findings made no real difference, even though the lack of radiographic evidence made patient management more demanding for anesthesiologists.

Abdomen↗

[Usefulness of the ASA scale and thoracic radiography as indicators of perioperative cardiovascular risk].

This paper evaluates the usefulness of ASA physical status classification and the multifactorial index of cardiac risk in the preoperative assessment, without considering arterial blood gases. With the results of this study we propose to add the ASA physical status classification, the radiologic diagnosis of chronic obstructive pulmonary disease and the multifactorial index of cardiac risk. This strategy increases the diagnostic certainty of Goldman's index of cardiac risk, is practical, not expensive and favors a better establishment of the risk of perioperative cardiovascular morbidity.

Aged↗

Comparison of results of thoracic radiography, cytologic evaluation of bronchoalveolar lavage fluid, and histologic evaluation of lung specimens in dogs with respiratory tract disease: 16 cases (1996-2000).

OBJECTIVE: To compare results of thoracic radiography, cytologic evaluation of bronchoalveolar lavage (BAL) fluid, and histologic evaluation of biopsy and necropsy specimens in dogs with respiratory tract disease and to determine whether histologic evaluation provides important diagnostic information not attainable by the other methods. DESIGN: Retrospective study. ANIMALS: 16 dogs. PROCEDURE: BAL fluid was classified as normal, neutrophilic, eosinophilic, mononuclear, mixed, neoplastic, or nondiagnostic. Radiographic abnormalities were classified as interstitial, bronchial, bronchointerstitial, or alveolar. Histologic lesions were classified as inflammatory, fibrotic, or neoplastic, and the predominant site of histologic lesions was classified as the alveoli, interstitium, or airway. RESULTS: The predominant radiographic location of lesions correlated with the histologic location in 8 dogs. Of 11 dogs with histologic evidence of inflammatory disease, 8 had inflammatory BAL fluid. Of the 2 dogs with histologic evidence of neoplasia, 1 had BAL fluid suggestive of neoplasia, and the other had BAL fluid consistent with septic purulent inflammation. Two dogs without any histologic abnormalities had mononuclear or nondiagnostic BAL fluid. Two dogs with histologic evidence of fibrosis had mononuclear or mixed inflammatory BAL fluid. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that although thoracic radiography, cytologic evaluation of BAL fluid, and histologic evaluation of lung specimens are complementary, each method has limitations in regard to how well results reflect the underlying disease process in dogs with respiratory tract disease. Lung biopsy should be considered in cases where results of radiography and cytology are nondiagnostic.

Animals↗

Thoracic radiography, bronchoalveolar lavage cytopathology, and pulmonary parenchymal histopathology: a comparison of diagnostic results in 11 cats.

The purpose of this study was to compare the diagnostic results and value of thoracic radiography, bronchoalveolar lavage (BAL) fluid cytopathology, and lung histopathology in 11 cats with spontaneous respiratory disease in which radiography and cytopathology were inadequate in establishing a definitive diagnosis. In these cats, radiographic patterns were characterized as bronchial (n=6), interstitial (n=3), and alveolar (n=2); other features included hyperinflation (n=3), bronchiectasis (n=2), pleural fissure lines (n=2), pulmonary nodules (n=2), atelectasis (n=1), and a tracheal mass (n=1). Bronchoalveolar lavage fluid was unremarkable in two cats. Abnormal BAL fluid showed inflammation (n=5), hemorrhage (n=2), epithelial hyperplasia (n=1), or was suspicious for neoplasia (n=1). Histopathological evaluation revealed inflammation (n=8), neoplasia (n=2), and vascular congestion (n=1). The predominant radiographic location of disease correlated with the same histopathological location in seven cats, and the cytopathological class of BAL fluid was consistent with the histopathological class of disease in seven cats. There was poor correlation between the types of cells found in the BAL fluid and the pathologist's prediction of the types of cells likely to be found in the BAL fluid based on the amount and type of airway cellularity seen on histopathological examination. The results of this study suggest that in some cats, BAL fluid cytopathology does not always correlate with the type of pulmonary disease identified on histopathology. In respiratory diseases where radiography and cytopathology fail to provide a definitive diagnosis, histopathological examination of the lung may be necessary.

Animals↗

Comparison of low contrast detectability between a digital amorphous silicon and a screen-film based imaging system for thoracic radiography.

Low contrast threshold detectability is investigated theoretically and experimentally for an amorphous silicon (a-Si) x-ray detector designed for digital radiography and for a standard thoracic screen-film combination. A theoretical signal-to-noise ratio is described with a human observer signal detection model. It is calculated using the detective quantum efficiency (DQE) and the modulation transfer function of the imaging system, as well as a spatial response function for the human visual system. Using a four-alternative forced choice observer perception study, the threshold contrasts of disk shaped objects ranging in size from 0.3 to 4.0 mm are determined. Significantly better contrast detectability is obtained from the digital detector, which is attributed to its higher DQE. On average, the disk shaped objects can be detected at 45% less contrast than required for screen-film. With no free parameters the experimental data agree well with those predicted by the observer model. Based upon the data, the model predicts that x-ray exposure for the a-Si detector only needs to be 30% of the exposure required to perform equally well on the contrast-detail detectability task using screen-film.

Equipment Design↗

Assessment of the accuracy of thoracic radiography in the diagnosis of canine chronic bronchitis.

Thoracic radiographs from 23 dogs with chronic bronchitis were mixed with those taken from 11 dogs (matched by age and bodyweight) without respiratory disease and interpreted twice by two blinded, independent examiners in an attempt to determine the accuracy of radiography for the diagnosis of chronic bronchitis. The only radiographic signs found more often in dogs with chronic bronchitis were thickening of the bronchial walls and increased numbers of visible bronchial walls (P < 0.01). Other signs, including bronchial calcification and interstitial pattern, occurred with similar frequency in both groups of dogs. The examiners were consistent in their interpretations (kappa > 0.64). The accuracy of radiographic diagnosis of chronic bronchitis is limited principally by insensitivity for bronchial lesions.

Animals↗

[Thoracic CT scan in intensive care unit patients: information supplementary to thoracic radiography].

PURPOSE: To assess the diagnostic value of thoracic CT-scans in comparison with conventional chest radiographs in ICU-patients. METHODS: Chest radiographs and corresponding thoracic CT-scans of 25 consecutive surgical ICU-patients were reviewed and interpreted independently by two radiologists. We analyzed the additional information provided by CT-scans and the diagnostic and therapeutic relevance of these findings. RESULTS: In 22 patients (88%), thoracic CT revealed 35 single additional findings, in comparison with the corresponding bedside radiographs. In 7 cases (28%), these findings (tube-malpositioning, mediastinitis, mediastinal abscess and pneumothorax) required modification of patient management. Of 7 patients with tube thoracostomy, 3 tubes were malpositioned, which was only depicted on CT-scans. In 10 of 21 cases (48%), pleural effusions could only be visualized by CT. 3 of 5 (60%) pneumothoraces were detected by CT-scans only. There were no significant complications during transport or CT-examination. CONCLUSION: Thoracic CT may provide significant information in addition to plain chest radiographs, particularly when specific problems or questions, referring to the management of ICU-patients, arise.

Abscess↗

Thoracic radiography of the normal rhesus macaque (Macaca mulatta).

Thoracic radiographs of rhesus macaques should be performed with short exposure times (1/60 s or faster) and the patient in the erect position. The patient's neck should be extended dorsally, and the arms extended above and behind the head. The tracheobronchial and lobar pulmonary anatomic features of the rhesus macaque are similar to those of the dog. The pulmonary parenchymal pattern also is similar; however, the interstitial markings are somewhat more prominent in the macaque. This may be due to lung mite infestation. The macaque does not appear from a radiologic standpoint to be superior as an animal model to dogs or cats unless there is something specific about the response or susceptibility to a disease being studied.

Animals↗

Abdominal and thoracic radiography in the neonate.

Plain and contrast radiographic techniques are used infrequently in the diagnostic evaluation of abdominal or thoracic disease in the adult horse because of the animal's large body size and the limited availability and expense of suitable equipment. The importance of radiography as a critical tool has also been lessened through the accessibility of ultrasound, although this technique is limited by depth and offers only a superficial window. Traditional radiographic techniques can be readily used in young foals because of their small body size, and radiography frequently provides critical information that aids in decision making. The ability to physically restrain a foal allows not only standing lateral images, but laterally recumbent and ventrodorsal views without the necessity for general anesthesia.

Animals↗

[Digital thoracic radiography--a comparison of digital and analog imaging techniques].

New analog and digital imaging techniques for the chest became available in recent years. In this study conventional film/screen radiography was compared with slit technique ('AMBER'), storage phosphor radiography and digital image intensifier radiography by phantom exposures and patient examinations. Because of its low spatial resolution, quality of digital image intensifier radiography was insufficient for chest imaging. The slit technique demonstrated the highest image quality, especially in the fields of the mediastinum and the thoracic wall. In comparison to conventional film/screen radiography, storage phosphor radiography had advantages in the mediastinal field. Digital techniques are connected to new possibilities of image post-processing, storage and transfer. For difficult conditions of exposure (emergency unit) over- or underexposed images can be avoided by these new digital techniques. The combination of slit- and storage phosphor-technique did not increase image quality.

Analog-Digital Conversion↗