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PubMedDate not supplied

Clinical criteria for the detection of pneumonia in adults: guidelines for ordering chest roentgenograms in the emergency department.

Adults presenting to an emergency department with acute respiratory illness were studied prospectively in an effort to identify sensitive clinical criteria for the diagnosis of pneumonia. Of 308 patients studied, 118 (38%) had definite or equivocal infiltrates and were considered to have pneumonia. No single symptom or sign was reliably predictive of pneumonia. Cough was the most common symptom in patients with pneumonia (86%), but was equally common in those with other respiratory illness. Fever was absent in 36 patients with pneumonia (31%). Abnormal findings on lung examination, that is, rales, rhonchi, decreased breath sounds, wheezes, altered fremitus, egophony, and percussion dullness, were each found in fewer than half of the patients with pneumonia. Twenty-six patients (22%) with a completely normal chest examination had pneumonia. Abnormal vital signs (temperature greater than 37.8 degrees C (100 degrees F), pulse greater than 100/min, or respirations greater than 20/min) were 97% sensitive for the detection of pneumonia. These criteria retained their sensitivity when films were subjected to a second, blinded interpretation by a senior radiologist. We conclude that restricting chest roentgenograms to patients with at least one abnormal vital sign will detect almost all radiographically demonstrable pneumonia in adult emergency department patients.

Adolescent↗
PubMed2006

Contribution of right-sided heart enlargement to cardiomegaly on chest roentgenogram in diastolic and systolic heart failure.

We investigated the contribution of a dilated right-sided heart to roentgenographic cardiomegaly in patients with heart failure (HF) and a normal ejection fraction (EF; diastolic HF) and those with HF and a decreased EF (systolic HF). We compared the cardiothoracic ratio (CTR) on upright chest roentgenograms and major- and minor-axis dimensions of the 4 cardiac chambers on echocardiograms in patients with HF and a normal EF (> or =0.50, n = 35) and those with a decreased EF (<0.50, n = 37) and examined the correlation between the CTR and cardiac chamber dimensions. The CTR did not differ between patients with normal and decreased EF values (0.58 +/- 0.07 vs 0.60 +/- 0.06, p = 0.26). Left-side cardiac chamber dimensions were substantially smaller in patients with a normal EF than in those with a decreased EF (left ventricular minor-axis dimension, 4.4 +/- 0.7 vs 5.8 +/- 0.8 cm, p <0.001). In contrast, right-side cardiac chamber dimensions were generally similar between groups. The CTR correlated with major-axis dimensions of the right ventricle and right atrium (p <0.01 for the 2 comparisons), but not with the left-side cardiac chamber dimensions (all p values >0.05). In conclusion, the CTR predominantly reflects right- rather than left-sided heart size in patients with HF. Right-sided heart size is similar between patients with normal and decreased EF values. Thus, despite the substantial difference in left ventricular size and EF, there is substantial overlap in the CTR between patients with diastolic and systolic HFs and the CTR is unable to discriminate between groups.

Case-Control Studies↗
PubMed2003

Routine chest roentgenogram after central venous catheter insertion is not always necessary.

BACKGROUND: To evaluate the usefulness of routine radiologic control after the insertion of a central venous catheter as a tool that might modify treatment of patients. METHODS: A prospective study was made of 149 patients submitted to central venous catheter insertion. RESULTS: In 55% of the patients the roentgenogram showed an adequate placement of the catheter tip and in 3.6% it showed some abnormal finding. Ten modifications were carried out based on the radiologic results. The prolonged partial thromboplastin time value and the subjective degree of difficulty showed a statistical relation to the appearance of complications. The number of punctures above one related to abnormal radiologic findings. CONCLUSIONS: The results suggest that routine chest radiology after the insertion of a central venous catheter is not always necessary and that it should be ordered selectively, according to the findings made during the procedure and the subjective degree of difficulty.

Adolescent↗
PubMed1998

The futility of chest roentgenograms following routine central venous line changes.

OBJECTIVE: To demonstrate chest roentgenograms after central venous line changes over a guidewire delay the use of the central lines and increases charges with no change of morbidity or the rate of complication. METHODS: Retrospective study using the Surgical Intensive Care database followed by a nonrandomized, prospective study of central venous line changes. The total time from the catheter change until chest radiograph confirmation and an analysis of charges was done. RESULTS: The retrospective study of 1,201 central line changes demonstrated no pneumothorax and two central lines malpositioned. The prospective study of 100 patients demonstrated no pneumothorax and one catheter malpositioned. The average time from completion of the central line change until the radiographic confirmation was 60.2 minutes. The charge for the chest x-ray film was $156. CONCLUSIONS: The combined studies composed of 1,301 patients demonstrated no pneumothorax and three malpositioned catheters. This study demonstrates that radiographic confirmation of central venous line placement after routine line change is of no benefit as the malpositioned catheters caused no morbidity, produces significant delays and increases medical charges to the patient. Extrapolation predicts an annual reduction of $46,800 in the Vanderbilt Surgical Intensive Care Unit.

Catheterization, Central Venous↗
PubMed1993

Observed lung markings in normal chest roentgenograms.

The digital chest posterior-anterior roentgenograms of 42 healthy individuals were ranked twice (interval of at least 5 days) in the order of increasing lung parenchymal markings. The evaluations were made by three radiologists, two residents, a medical student and a radiographer. All observers regardless of their radiological experience showed good intraobserver correlations between their two subsequent rankings (p < 0.05-0.001). The interobserver agreement on rankings was generally poor, even if the radiologists were considered. Radiologic training seemed to eliminate the influence of false leading factors (the object's respiration and body constitution). "The golden standard of evaluation" (= the added-up rankings by the radiologists) did not correlate either with the patient's ages (19-54 years) or smoking habits (0-45 pack-years, mean 4.2).

Adult↗
PubMed1991

Evaluation of pulmonary vascular pressures in cardiac patients: the role of the chest roentgenogram.

In 77 patients (34 with left heart valvulopathy, 17 with dilated cardiomyopathy, and 26 with chronic coronary artery disease) pulmonary vascular pressures were estimated from the chest film by means of a new scoring system. Standard chest x-ray films taken immediately before diagnostic right and left cardiac catheterization were analyzed independently by three readers without knowledge of the hemodynamic findings. The radiographic signs were subdivided into three groups as follows, and to each one a score derived from a retrospective statistical analysis was attributed: (A) signs of interstitial edema, (B) patterns of pulmonary blood flow distribution, and (C) alterations in the pulmonary arteries. The sum of the scores of groups A and B x-ray findings correlated well with pulmonary wedge pressure, and the sum of the scores of groups A, B, and C correlated more strongly with the mean pulmonary artery pressure. These results confirm that it is possible, in patients with chronic heart disease, to assess accurately the pulmonary artery and wedge pressures by means of the noninvasive and easily performed chest roentgenogram.

Blood Pressure↗
PubMed1998

Bone grafts to the nose in Binder's syndrome (maxillonasal dysplasia): a follow-up of eleven patients with the use of profile roentgenograms.

Bone grafts are used to lengthen the dorsum and elevate the tip of the nose in patients with Binder's syndrome. Disappointing long-term results in some patients generally have been assumed to be a result of resorption and/or displacement of the grafts. Treatment outcome was studied in 11 patients with the use of serial profile roentgenograms. At 40 months, the mean values after surgery were reduction of the initial transplant length by 28 percent and reduction of the transplant angle by 4 degrees. The initial nose length was increased by 1 mm, and nose tip projection was increased by 2 mm. Although the mean changes of nose length and nose tip projection seemed small, treatment outcome varied considerably between patients. In contrast with earlier assumptions, no correlation could be found between the degree of transplant resorption and/or displacement and the effect of surgery on nose length and nose tip projection.

Adolescent↗
PubMed1977

Routine chest roentgenograms on hospital admission do not discover tuberculosis.

Of 95 cases of tuberculosis diagnosed at Grady Memorial Hospital in 1972, only six patients were not already diagnosed or suspected of having TB at the time of admission to the hospital. In only two of these cases was the diagnosis of TB made because of the routine admission chest roentgenogram (out of a total of 39,017 hospital admissions for the year). Both of these patients had respiratory symptoms for which a diagnostic chest film was indicated. On the basis of this review, routine chest films for all hospital admissions are not of significant value in discovering unsuspected tuberculosis.

Adult↗
PubMed1983

Employment-related administrative roentgenograms: characteristics of policy formulation and current practice.

A significant proportion of diagnostic medical procedures are used in response to public or private policy rather than in response to an individual patient-physician interaction. We have studied the system whereby such policies are developed and implemented in the case of employment-related chest and lumbar spine roentgenograms, which were found to account for about 11% of the total use of diagnostic radiographs in the state of Michigan. We observed that factors influencing formulation of policy are diverse and largely nonmedical, organizational policies developed in similar environments are often very dissimilar and are highly subject to external influence, and perceptions of policy success and examination utility are typically subjective and uncertain. It is concluded that considerable opportunity exists to enhance the efficacy of such radiographic examinations through leverage provided by their policy-driven nature.

Humans↗
PubMed2005

Use of goniometry to predict inadequate flexion-extension roentgenograms: a preliminary study.

BACKGROUND: Flexion-extension roentgenograms (FER) of the cervical spine are often inadequate because of limited range of motion (ROM). The purpose of this study was to determine the utility of goniometry to predict a patient's ability to achieve sufficient ROM to obtain adequate FER. METHODS: We evaluated 65 consecutive blunt trauma patients undergoing evaluation by FER in the emergency department. Patients were evaluated by goniometry before performing FER. Adequate ROM was defined as flexion and extension of >30 degrees from neutral. RESULTS: Seventy-five percent of patients had adequate FER. All of these patients were predicted to have sufficient ROM by goniometry. Goniometry predicted limited ROM in 69% of patients who had inadequate FER. The positive predicative value of goniometry in predicting inadequate FER was 100%. The incidence of cervical spine injuries was 44% in patients with inadequate ROM by goniometry and 23.0% in patients with inadequate FER (versus 7.69% in patients with adequate FER). CONCLUSION: Goniometry accurately predicted those patients who were unable to achieve sufficient ROM for adequate FER. Patients with inadequate FER were at a higher risk for cervical spine injury compared with patients with adequate FER (23.0 versus 7.69%). Early identification of these patients will help limit the number of inadequate studies obtained and expedite evaluation of high-risk patients.

Adult↗
PubMed1976

Axillary lymphadenopathy simulating an anterior mediastinal mass on the lateral chest roentgenogram.

The radiographic impression of an anterior mediastinal mass on the lateral chest roentgenogram must be confirmed by the postero-anterior film, oblique views, or tomograms to avoid inappropriate diagnostic procedures or erroneous staging of malignant disease. Physical examination will readily demonstrate enlarged axillary lymph nodes mimicking an anterior mediastinal mass.

Diagnosis, Differential↗
PubMed1991

Pulmonary nontuberculous mycobacteriosis showing wandering shadows in chest roentgenograms.

The case of a 68-year-old woman with pulmonary nontuberculous mycobacteriosis, whose chest roentgenograms showed unusual wandering shadows on separate occasions, is presented. Acid-fast bacilli were detected in her sputa and by bronchial washing, and were identified as Mycobacterium chelonae, subspecies abscessus. The findings of computed tomography and transbronchial lung biopsy were also unique because of multiple peribronchial inflammations. Chemotherapy with anti-tuberculosis agents and a new quinolone drug was successful in this case.

Aged↗
PubMed1982

Attitudes of patients toward diagnostic tests. The case of the upper gastrointestinal series roentgenogram.

As part of a study of the clinical value of the upper gastrointestinal roentgenogram series (UGI), we assessed patient attitudes toward the UGI and toward tests in general. We surveyed 483 people undergoing 495 outpatient UGIs at three different hospitals. The majority of the patients wanted to have the UGI, were reassured by the test, thought it helped their physicians, would undergo it again for the same problem, and would have requested the test had their physicians not ordered it. Factors that were associated with favorable attitudes toward tests included male sex, older age, having been told the results of the UGI, improvement in symptoms, and lower educational achievement. We conclude that patients place a high value on certain diagnostic tests and that these attitudes may be associated with sociodemographic factors, patient-physician communication and patient symptom status.

Adult↗
PubMed1992

Prediction of interstitial lung involvement in rheumatoid arthritis. The value of clinical data, chest roentgenogram, lung function, and serologic parameters.

We initiated the present study to predict interstitial lung involvement in rheumatoid arthritis (RA) by means of logistic regression analysis of clinical data, lung function, chest roentgenogram, and serologic parameters. Fifty-eight nonsmoking patients with RA were randomized from the rheumatologic unit and sent for investigation to the pulmonary department. Bronchoalveolar lavage (BAL) was performed in the middle lobe and the BAL fluid was considered abnormal in case of increased cell count per milliliter and/or lymphocytosis and/or neutrophil granulocytosis; these findings or combinations thereof were found in 42 (72.4 percent) of 58 cases. The patients' data that had an impact on the normality of BAL were the sex (p = 0.001), vital capacity (p = 0.028), peripheral blood T-helper cells (OKT4+) (p = 0.025), DR(+)-lymphocytes (p = 0.002), and antinuclear antibodies (p = 0.025). By means of the logistic regression analysis, it was possible to reach high significance in the prediction of interstitial lung involvement, with a sensitivity of 92.9 percent and a specificity of 75.0 percent (p less than 10(-6)). The efficiency of prediction was 87.9 percent. From these results, we conclude that interstitial lung involvement in RA is predictable from laboratory findings that have been yielded by noninvasive diagnostic techniques. These data should be used in clinical routine monitoring and they may help to facilitate the assessment of whether bronchoscopy is indicated.

Arthritis, Rheumatoid↗
PubMed1975

Remote interpretation of chest roentgenograms.

A series of 98 chest films was interpreted by two physicians on the basis of monitor display of the transmitted television signal representing the roentgenographic image. The transmission path was 14 miles long, and included one active repeater station. Receiver operating characteristic curves were drawn to compare interpretations rendered on television view of the image with classic, direct view interpretations of the same films. Performance in these two viewing modes was found to be quite similar. When films containing only hazy densities lacking internal structure or sharp margins, were removed from the sample, interpretation of the remaining films was essentially identical via the two modes. Since hazy densities are visible on retrospective examination, interpretation of roentgenograms at a distance via television appears to be a feasible route for delivery of radiologic services.

False Negative Reactions↗