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Heltborg A, Mogensen CB, Skjøt-Arkil H, Giebner M, Al-Masri A, Khatry UB, Khatry S, Heinemeier IIK, Andreasen JJ, Hariesh SSS, Termansen T, Kolnes AN, Lorentzen MH, Laursen CB, Posth S, Andersen MB, Mussmann B, Spile CS, Graumann O. Can clinicians identify community-acquired pneumonia on ultralow-dose CT? A diagnostic accuracy study. Scand J Trauma Resusc Emerg Med 2024; 32:67. [PMID: 39113114 PMCID: PMC11304923 DOI: 10.1186/s13049-024-01242-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 07/22/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Without increasing radiation exposure, ultralow-dose computed tomography (CT) of the chest provides improved diagnostic accuracy of radiological pneumonia diagnosis compared to a chest radiograph. Yet, radiologist resources to rapidly report the chest CTs are limited. This study aimed to assess the diagnostic accuracy of emergency clinicians' assessments of chest ultralow-dose CTs for community-acquired pneumonia using a radiologist's assessments as reference standard. METHODS This was a cross-sectional diagnostic accuracy study. Ten emergency department clinicians (five junior clinicians, five consultants) assessed chest ultralow-dose CTs from acutely hospitalised patients suspected of having community-acquired pneumonia. Before assessments, the clinicians attended a focused training course on assessing ultralow-dose CTs for pneumonia. The reference standard was the assessment by an experienced emergency department radiologist. Primary outcome was the presence or absence of pulmonary opacities consistent with community-acquired pneumonia. Sensitivity, specificity, and predictive values were calculated using generalised estimating equations. RESULTS All clinicians assessed 128 ultralow-dose CTs. The prevalence of findings consistent with community-acquired pneumonia was 56%. Seventy-eight percent of the clinicians' CT assessments matched the reference assessment. Diagnostic accuracy estimates were: sensitivity = 83% (95%CI: 77-88), specificity = 70% (95%CI: 59-81), positive predictive value = 80% (95%CI: 74-84), negative predictive value = 78% (95%CI: 73-82). CONCLUSION This study found that clinicians could assess chest ultralow-dose CTs for community-acquired pneumonia with high diagnostic accuracy. A higher level of clinical experience was not associated with better diagnostic accuracy.
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Affiliation(s)
- Anne Heltborg
- Department of Emergency Medicine, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Christian Backer Mogensen
- Department of Emergency Medicine, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Helene Skjøt-Arkil
- Department of Emergency Medicine, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Matthias Giebner
- Department of Emergency Medicine, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
| | - Ayham Al-Masri
- Department of Emergency Medicine, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
- The Learning and Research Centre, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Usha Bc Khatry
- Department of Internal Medicine, University Hospital of Southern Denmark, Kolding, Denmark
| | - Sangam Khatry
- Department of Internal Medicine, University Hospital of Southern Denmark, Kolding, Denmark
| | - Ina Isabell Kathleen Heinemeier
- Department of Emergency Medicine, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
| | - Jonas Jannick Andreasen
- Department of Emergency Medicine, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
| | | | - Tenna Termansen
- Department of Internal Medicine, University Hospital of Southern Denmark, Kolding, Denmark
| | - Anna Natalie Kolnes
- Department of Internal Medicine, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Morten Hjarnø Lorentzen
- Department of Emergency Medicine, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Christian Borbjerg Laursen
- Department of Respiratory Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | - Stefan Posth
- Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | | | - Bo Mussmann
- Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | | | - Ole Graumann
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Akay MA, Tatar OC, Tatar E, Tağman BN, Metin S, Varlıklı O. XRAInet: AI-based decision support for pneumothorax and pleural effusion management. Pediatr Pulmonol 2024. [PMID: 38961684 DOI: 10.1002/ppul.27133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/09/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE This study aimed to develop and assess the performance of an artificial intelligence (AI)-driven decision support system, XRAInet, in accurately identifying pediatric patients with pleural effusion or pneumothorax and determining whether tube thoracostomy intervention is warranted. METHODS In this diagnostic accuracy study, we retrospectively analyzed a data set containing 510 X-ray images from 170 pediatric patients admitted between 2005 and 2022. Patients were categorized into two groups: Tube (requiring tube thoracostomy) and Conservative (managed conservatively). XRAInet, a deep learning-based algorithm, was trained using this data set. We evaluated its performance using various metrics, including mean Average Precision (mAP), recall, precision, and F1 score. RESULTS XRAInet, achieved a mAP score of 0.918. This result underscores its ability to accurately identify and localize regions necessitating tube thoracostomy for pediatric patients with pneumothorax and pleural effusion. In an independent testing data set, the model exhibited a sensitivity of 64.00% and specificity of 96.15%. CONCLUSION In conclusion, XRAInet presents a promising solution for improving the detection and decision-making process for cases of pneumothorax and pleural effusion in pediatric patients using X-ray images. These findings contribute to the expanding field of AI-driven medical imaging, with potential applications for enhancing patient outcomes. Future research endeavors should explore hybrid models, enhance interpretability, address data quality issues, and align with regulatory requirements to ensure the safe and effective deployment of XRAInet in healthcare settings.
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Affiliation(s)
- Mustafa Alper Akay
- Department of Pediatric Surgery, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ozan Can Tatar
- Department of General Surgery, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Elif Tatar
- Department of Pediatric Surgery, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Beyza Nur Tağman
- Department of Pediatric Surgery, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Semih Metin
- Department of Pediatric Surgery, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Onursal Varlıklı
- Department of Pediatric Surgery, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Pochepnia S, Grabczak EM, Johnson E, Eyuboglu FO, Akkerman O, Prosch H. Imaging in pulmonary infections of immunocompetent adult patients. Breathe (Sheff) 2024; 20:230186. [PMID: 38595938 PMCID: PMC11003523 DOI: 10.1183/20734735.0186-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/06/2024] [Indexed: 04/11/2024] Open
Abstract
Pneumonia is a clinical syndrome characterised by fever, cough and alveolar infiltration of purulent fluid, caused by infection with a microbial pathogen. It can be caused by infections with bacteria, viruses or fungi, but a causative organism is identified in less than half of cases. The most common type of pneumonia is community-acquired pneumonia, which is caused by infections acquired outside the hospital. Current guidelines for pneumonia diagnosis require imaging to confirm the clinical suspicion of pneumonia. Thus, imaging plays an important role in both the diagnosis and management of pneumonia, with each modality having specific advantages and limitations. Chest radiographs are commonly used but have limitations in terms of sensitivity and specificity. Lung ultrasound shows high sensitivity and specificity. Computed tomography scans offer higher diagnostic accuracy but involve higher radiation doses. Radiological patterns, including lobar, lobular and interstitial pneumonia, provide valuable insights into causative pathogens and treatment decisions. Understanding these radiological patterns is crucial for accurate diagnosis. In this review, we will summarise the most important aspects pertaining to the role of imaging in pneumonia and will highlight the imaging characteristics of the most common causative organisms.
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Affiliation(s)
- Svitlana Pochepnia
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Elzbieta Magdalena Grabczak
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Emma Johnson
- Clinical and Molecular Medicine, University of Dundee, Dundee, UK
| | - Fusun Oner Eyuboglu
- Baskent University School of Medicine, Pulmonary Diseases Department, Baskeny University Hospital, Ankara, Turkey
| | - Onno Akkerman
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, TB center Beatrixoord, Groningen, The Netherlands
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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van den Berk IAH, Lejeune EH, Kanglie MMNP, van Engelen TSR, de Monyé W, Bipat S, Bossuyt PMM, Stoker J, Prins JM. The yield of chest X-ray or ultra-low-dose chest-CT in emergency department patients suspected of pulmonary infection without respiratory symptoms or signs. Eur Radiol 2023; 33:7294-7302. [PMID: 37115214 PMCID: PMC10511555 DOI: 10.1007/s00330-023-09664-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 03/17/2023] [Accepted: 03/30/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE The yield of pulmonary imaging in patients with suspected infection but no respiratory symptoms or signs is probably limited, ultra-low-dose CT (ULDCT) is known to have a higher sensitivity than Chest X-ray (CXR). Our objective was to describe the yield of ULDCT and CXR in patients clinically suspected of infection, but without respiratory symptoms or signs, and to compare the diagnostic accuracy of ULDCT and CXR. METHODS In the OPTIMACT trial, patients suspected of non-traumatic pulmonary disease at the emergency department (ED) were randomly allocated to undergo CXR (1210 patients) or ULDCT (1208 patients). We identified 227 patients in the study group with fever, hypothermia, and/or elevated C-reactive protein (CRP) but no respiratory symptoms or signs, and estimated ULDCT and CXR sensitivity and specificity in detecting pneumonia. The final day-28 diagnosis served as the clinical reference standard. RESULTS In the ULDCT group, 14/116 (12%) received a final diagnosis of pneumonia, versus 8/111 (7%) in the CXR group. ULDCT sensitivity was significantly higher than that of CXR: 13/14 (93%) versus 4/8 (50%), a difference of 43% (95% CI: 6 to 80%). ULDCT specificity was 91/102 (89%) versus 97/103 (94%) for CXR, a difference of - 5% (95% CI: - 12 to 3%). PPV was 54% (13/24) for ULDCT versus 40% (4/10) for CXR, NPV 99% (91/92) versus 96% (97/101). CONCLUSION Pneumonia can be present in ED patients without respiratory symptoms or signs who have a fever, hypothermia, and/or elevated CRP. ULDCT's sensitivity is a significant advantage over CXR when pneumonia has to be excluded. CLINICAL RELEVANCE STATEMENT Pulmonary imaging in patients with suspected infection but no respiratory symptoms or signs can result in the detection of clinically significant pneumonia. The increased sensitivity of ultra-low-dose chest CT compared to CXR is of added value in vulnerable and immunocompromised patients. KEY POINTS • Clinical significant pneumonia does occur in patients who have a fever, low core body temperature, or elevated CRP without respiratory symptoms or signs. • Pulmonary imaging should be considered in patients with unexplained symptoms or signs of infections. • To exclude pneumonia in this patient group, ULDCT's improved sensitivity is a significant advantage over CXR.
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Affiliation(s)
- Inge A H van den Berk
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Emile H Lejeune
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Maadrika M N P Kanglie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Department of Radiology, Spaarne Gasthuis, Boerhaavelaan 22, Haarlem, the Netherlands
| | - Tjitske S R van Engelen
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Wouter de Monyé
- Department of Radiology, Spaarne Gasthuis, Boerhaavelaan 22, Haarlem, the Netherlands
| | - Shandra Bipat
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Patrick M M Bossuyt
- Department of Epidemiology & Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
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Lorentzen MH, Rosenvinge FS, Lassen AT, Graumann O, Laursen CB, Mogensen CB, Skjøt-Arkil H. Empirical antibiotic treatment for community-acquired pneumonia and accuracy for Legionella pneumophila, Mycoplasma pneumoniae, and Clamydophila pneumoniae: a descriptive cross-sectional study of adult patients in the emergency department. BMC Infect Dis 2023; 23:580. [PMID: 37670282 PMCID: PMC10481610 DOI: 10.1186/s12879-023-08565-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Many factors determine empirical antibiotic treatment of community-acquired pneumonia (CAP). We aimed to describe the empirical antibiotic treatment CAP patients with an acute hospital visit and to determine if the current treatment algorithm provided specific and sufficient coverage against Legionella pneumophila, Mycoplasma pneumoniae, and Clamydophila pneumoniae (LMC). METHODS A descriptive cross-sectional, multicenter study of all adults with an acute hospital visit in the Region of Southern Denmark between January 2016 and March 2018 was performed. Using medical records, we retrospectively identified the empirical antibiotic treatment and the microbiological etiology for CAP patients. CAP patients who were prescribed antibiotics within 24 h of admission and with an identified bacterial pathogen were included. The prescribed empirical antibiotic treatment and its ability to provide specific and sufficient coverage against LMC pneumonia were determined. RESULTS Of the 19,133 patients diagnosed with CAP, 1590 (8.3%) patients were included in this study. Piperacillin-tazobactam and Beta-lactamase sensitive penicillins were the most commonly prescribed empirical treatments, 515 (32%) and 388 (24%), respectively. Our analysis showed that 42 (37%, 95% CI: 28-47%) of 113 patients with LMC pneumonia were prescribed antibiotics with LMC coverage, and 42 (12%, 95% CI: 8-15%) of 364 patients prescribed antibiotics with LMC coverage had LMC pneumonia. CONCLUSION Piperacillin-tazobactam, a broad-spectrum antibiotic recommended for uncertain infectious focus, was the most frequent CAP treatment and prescribed to every third patient. In addition, the current empirical antibiotic treatment accuracy was low for LMC pneumonia. Therefore, future research should focus on faster diagnostic tools for identifying the infection focus and precise microbiological testing.
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Affiliation(s)
- Morten Hjarnø Lorentzen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | | | - Annmarie Touborg Lassen
- Emergency Department, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian Backer Mogensen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Helene Skjøt-Arkil
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Thomsen HS. Acta Radiologica Prizes 2022: Xenia Forsselliana 2022. Acta Radiol 2023; 64:2345. [PMID: 37221894 DOI: 10.1177/02841851231176439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Henrik S Thomsen
- Editor in Chief, Acta Radiologica, Herlev Gentofte University Hospital, Herlev, Denmark
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Bao J, Wang C, Zhang Y, Su Z, Du X, Lu J. Evaluating cardiac function with chest computed tomography in acute ischemic stroke: feasibility and correlation with short-term outcome. Front Neurol 2023; 14:1173276. [PMID: 37475736 PMCID: PMC10354548 DOI: 10.3389/fneur.2023.1173276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Background The outcomes of patients with acute ischemic stroke (AIS) are related to cardiac function. Cardiac insufficiency can manifest as hydrostatic changes in the lungs. Computed tomography (CT) of the chest is commonly used for screening pulmonary abnormalities and provides an opportunity to assess cardiac function. Purpose To evaluate the correlation between hydrostatic lung manifestations on chest CT and cardiac function with its potential to predict the short-term outcome of AIS patients. Methods We retrospectively analyzed AIS patients who had undergone chest CT at admission and echocardiogram within 48 h. Morphological and quantitative hydrostatic changes and left ventricular dimensions were assessed using chest CT. Improvement in the National Institutes of Health Stroke Scale (NIHSS) score on the seventh day determined short-term outcomes. Multivariate analysis examined the correspondence between hydrostatic lung manifestations, left ventricular dimension, and left ventricle ejection fraction (LVEF) on echocardiography, and the correlation between hydrostatic changes and short-term outcomes. Results We included 204 patients from January to December 2021. With the progression of hydrostatic changes on chest CT, the LVEF on echocardiography gradually decreased (p < 0.05). Of the 204, 53 patients (26%) with varying degrees of hypostatic lung manifestations had less improvement in the NIHSS score (p < 0.05). The density ratio of the anterior/posterior lung on CT showed a significant negative correlation with improvement in the NIHSS score (r = -5.518, p < 0.05). Additionally, patients with a baseline NIHSS ≥4 with left ventricular enlargement had significantly lower LVEF than that of patients with normal NIHSS scores. Conclusion Hydrostatic lung changes on chest CT can be used as an indicator of cardiac function and as a preliminary reference for short-term outcome in AIS patients.
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Affiliation(s)
- Jie Bao
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chen Wang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yimeng Zhang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhuangzhi Su
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Xiangying Du
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
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Kristjánsdóttir B, Taekker M, Andersen MB, Bentsen LP, Berntsen MH, Dahlin J, Fransen ML, Gosvig K, Greisen PW, Laursen CB, Mussmann B, Posth S, Rasmussen CH, Sjölander H, Graumann O. Ultra-low dose computed tomography of the chest in an emergency setting: A prospective agreement study. Medicine (Baltimore) 2022; 101:e29553. [PMID: 35945776 PMCID: PMC9351905 DOI: 10.1097/md.0000000000029553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Ultra-low dose computed tomography (ULD-CT) assessed by non-radiologists in a medical Emergency Department (ED) has not been examined in previous studies. To (i) investigate intragroup agreement among attending physicians caring for ED patients (i.e., radiologists, senior- and junior clinicians) and medical students for the detection of acute lung conditions on ULD-CT and supine chest X-ray (sCXR), and (ii) evaluate the accuracy of interpretation compared to the reference standard. In this prospective study, non-traumatic patients presenting to the ED, who received an sCXR were included. Between February and July 2019, 91 patients who underwent 93 consecutive examinations were enrolled. Subsequently, a ULD-CT and non-contrast CT were performed. The ULD-CT and sCXR were assessed by 3 radiologists, 3 senior clinicians, 3 junior clinicians, and 3 medical students for pneumonia, pneumothorax, pleural effusion, and pulmonary edema. The non-contrast CT, assessed by a chest radiologist, was used as the reference standard. The results of the assessments were compared within each group (intragroup agreement) and with the reference standard (accuracy) using kappa statistics. Accuracy and intragroup agreement improved for pneumothorax on ULD-CT compared with the sCXR for all groups. Accuracy and intragroup agreement improved for pneumonia on ULD-CT when assessed by radiologists and for pleural effusion when assessed by medical students. In patients with acute lung conditions ULD-CT offers improvement in the detection of pneumonia by radiologists and the detection of pneumothorax by radiologists as well as non-radiologists compared to sCXR. Therefore, ULD-CT may be considered as an alternative first-line imaging modality to sCXR for non-traumatic patients who present to EDs.
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Affiliation(s)
- Björg Kristjánsdóttir
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
- OPEN – Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
- *Correspondence: Björg Kristjánsdóttir, Research and Innovation Unit of Radiology, University of Southern Denmark, KlØvervænget 10, 112, 2nd floor, 5000 Odense C, Denmark (e-mail: )
| | - Maria Taekker
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
- OPEN – Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Michael B. Andersen
- Department of Radiology, Copenhagen University Hospital Herlev/Gentofte, Hellerup, Denmark
- Roskilde University Hospital, Roskilde, Denmark
| | - Lasse P. Bentsen
- Department of Emergency Medicine, Lillebaelt Hospital, Kolding, Denmark
| | | | - Jan Dahlin
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Maja L. Fransen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Kristina Gosvig
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | | | - Christian B. Laursen
- OPEN – Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Bo Mussmann
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Stefan Posth
- OPEN – Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | | | - Hannes Sjölander
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Ole Graumann
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
- OPEN – Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
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