Surveillance of small, solid pulmonary nodules at digital chest tomosynthesis: data from a cohort of the pilot Swedish CArdioPulmonary bioImage Study (SCAPIS)

Repeated Lung Ultrasound versus Chest X-ray-Which One Predicts Better Clinical Outcome in COVID-19?

The purpose of this study was to evaluate whether changes in repeated lung ultrasound (LUS) or chest X-ray (CXR) of coronavirus disease 2019 (COVID-19) patients can predict the development of severe disease and the need for treatment in the intensive care unit (ICU). In this prospective monocentric study, COVID-19 patients received standardized LUS and CXR at day 1, 3 and 5. Scores for changes in LUS (LUS score) and CXR (RALE and M-RALE) were calculated and compared. Intra-class correlation was calculated for two readers of CXR and ROC analysis to evaluate the best discriminator for the need for ICU treatment. A total of 30 patients were analyzed, 26 patients with follow-up LUS and CXR. Increase in M-RALE between baseline and follow-up 1 was significantly higher in patients with need for ICU treatment in the further hospital stay (p = 0.008). Both RALE and M-RALE significantly correlated with LUS score (r = 0.5, p < 0.0001). ROC curves with need for ICU treatment as separator were not significantly different for changes in M-RALE (AUC: 0.87) and LUS score (AUC: 0.79), both being good discriminators. ICC was moderate for RALE (0.56) and substantial for M-RALE (0.74). The present study demonstrates that both follow-up LUS and CXR are powerful tools to track the evolution of COVID-19, and can be used equally as predictors for the need for ICU treatment.

Diagnostic Accuracy of Chest Digital Tomosynthesis in Patients Recovering after COVID-19 Pneumonia

Purpose: To assess the diagnostic accuracy of traditional chest X-ray (CXR) and digital tomosynthesis (DTS) compared to computed tomography (CT) in detecting pulmonary interstitial changes in patients having recovered from severe COVID-19. Materials and Methods: This was a retrospective observational study, and received local ethics committee approval. Patients suspected of having COVID-19 pneumonia upon emergency department admission between 1 March and 31 August 2020, and who underwent CXR followed by DTS and CT, were considered. Inclusion criteria were as follows: (1) patients with previous SARS-CoV-2 infection proven by a positive RT-PCR on nasopharyngeal swabs performed upon admission to the hospital, and with complete clinical recovery; (2) a diagnosis of SARS-CoV-2-related ARDS, according to the Berlin criteria, during hospitalization; (3) no recent history of other lung disease; and (4) complete imaging follow-up by CXR, DTS, and CT for at least 6 months and up to one year. Analysis of DTS images was carried out independently by two radiologists with 16 and 10 years of experience in chest imaging, respectively. The following findings were evaluated: (1) ground-glass opacities (GGOs); (2) air-space consolidations with or without air bronchogram; (3) reticulations; and (4) linear consolidation. Indicators of diagnostic performance of RX and digital tomosynthesis were calculated using CT as a reference. All data were analyzed using R statistical software (version 4.0.2, 2020). Results: Out of 44 patients initially included, 25 patients (17 M/8 F), with a mean age of 64 years (standard deviation (SD): 12), met the criteria and were included. The overall average numbers of findings confirmed by CT were GGOs in 11 patients, lung consolidations in 8 patients, 7 lung interstitial reticulations, and linear consolidation in 20 patients. DTS showed a significantly higher diagnostic accuracy compared to CXR in recognizing interstitial lung abnormalities—especially GGOs (p = 0.0412) and linear consolidations (p = 0.0009). The average dose for chest X-ray was 0.10 mSv (0.07–0.32), for DTS was 1.03 mSv (0.74–2.00), and for CT scan was 3 mSv. Conclusions: According to our results, DTS possesses a high diagnostic accuracy, compared with CXR, in revealing lung fibrotic changes in patients who have recovered from COVID-19 pneumonia.

VIEWDEX 3.0-RECENT DEVELOPMENT OF A SOFTWARE APPLICATION FACILITATING ASSESSMENT OF IMAGE QUALITY AND OBSERVER PERFORMANCE

ViewDEX (Viewer for Digital Evaluation of X-ray Images) is an image viewer compatible with Digital Imaging and Communications in Medicine (DICOM) that has been especially designed to facilitate image perception and observer performance studies within medical imaging. The software was first released in 2004 and since then a continuous development has been ongoing. One of the major drawbacks of previous versions of ViewDEX has been that they have lacked functionality enabling the possibility to evaluate multiple images and/or image stacks simultaneously. This functionality is especially requested by researchers working with modalities, where an image acquisition can result in multiple image stacks (e.g. axial, coronal and sagittal reformations in computed tomography). In ViewDEX 3.0 this functionality has been added and it is now possible to perform image evaluations of multiple images and/or image stacks simultaneously, by using multiple monitors and/or multiple image canvases in monitors. Additionally, some of the previously available functionality has been updated and improved. This paper describes the recent developments of ViewDEX 3.0.