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Sekiya M. Chest ultrasound for lung cancer: present and future. J Med Ultrason (2001) 2024; 51:393-395. [PMID: 39052229 DOI: 10.1007/s10396-024-01476-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 06/03/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Mitsuaki Sekiya
- Kawaguchi Sekiya Respiratory and Internal Medicine Clinic, 5th Floor, Kawaguchi SI Bldg., 4-1-1 Honcho, Kawaguchi City, Saitama Prefecture, 332-0012, Japan.
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2
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Snelling PJ, Jones P, Connolly R, Jelic T, Mirsch D, Myslik F, Phillips L, Blecher G. Comparison of lung ultrasound scoring systems for the prognosis of COVID-19 in the emergency department: An international prospective cohort study. Australas J Ultrasound Med 2024; 27:75-88. [PMID: 38784699 PMCID: PMC11109992 DOI: 10.1002/ajum.12364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Purpose The purpose of this study was to evaluate whether the lung ultrasound (LUS) scores applied to an international cohort of patients presenting to the emergency department (ED) with suspected COVID-19, and subsequently admitted with proven disease, could prognosticate clinical outcomes. Methods This was an international, multicentre, prospective, observational cohort study of patients who received LUS and were followed for the composite primary outcome of intubation, intensive care unit (ICU) admission or death. LUS scores were later applied including two 12-zone protocols ('de Alencar score' and 'CLUE score'), a 12-zone protocol with lung and pleural findings ('Ji score') and an 11-zone protocol ('Tung-Chen score'). The primary analysis comprised logistic regression modelling of the composite primary outcome, with the LUS scores analysed individually as predictor variables. Results Between April 2020 to April 2022, 129 patients with COVID-19 had LUS performed according to the protocol and 24 (18.6%) met the composite primary endpoint. No association was seen between the LUS score and the composite primary end point for the de Alencar score [odds ratio (OR) = 1.04; 95% confidence interval (CI): 0.97-1.11; P = 0.29], the CLUE score (OR = 1.03; 95% CI: 0.96-1.10; P = 0.40), the Ji score (OR = 1.02; 95% CI: 0.97-1.07; P = 0.40) or the Tung-Chen score (OR = 1.02; 95% CI: 0.97-1.08). Discussion Compared to these earlier studies performed at the start of the pandemic, the negative outcome of our study could reflect the changing scenario of the COVID-19 pandemic, including patient, disease, and system factors. The analysis suggests that the study may have been underpowered to detect a weaker association between a LUS score and the primary outcome. Conclusion In an international cohort of adult patients presenting to the ED with suspected COVID-19 disease who had LUS performed and were subsequently admitted to hospital, LUS severity scores did not prognosticate the need for invasive ventilation, ICU admission or death.
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Affiliation(s)
- Peter J Snelling
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
- Sonography Innovation and Research GroupSouthportQueenslandAustralia
| | - Philip Jones
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
- Sonography Innovation and Research GroupSouthportQueenslandAustralia
| | - Rory Connolly
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
| | - Tomislav Jelic
- Department of Emergency MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Dan Mirsch
- Department of Emergency MedicineUniversity at BuffaloBuffaloNew YorkUSA
| | - Frank Myslik
- Division of Emergency MedicineWestern UniversityLondonOntarioCanada
| | - Luke Phillips
- Department of Emergency MedicineAlfred HospitalMelbourneVictoriaAustralia
- Department of Epidemiology and Preventative MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Gabriel Blecher
- Emergency Services, Peninsula HealthFrankstonVictoriaAustralia
- Peninsula Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
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3
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Ovesen SH, Clausen AH, Kirkegaard H, Løfgren B, Aagaard R, Skaarup SH, Arvig MD, Lorentzen MH, Kristensen AH, Cartuliares MB, Falster C, Tong L, Rabajoli A, Leth R, Desy J, Ma IWY, Weile J. Point-of-Care Lung Ultrasound in Emergency Medicine: A Scoping Review With an Interactive Database. Chest 2024:S0012-3692(24)00290-3. [PMID: 38458431 DOI: 10.1016/j.chest.2024.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND This scoping review was conducted to provide an overview of the evidence of point-of-care lung ultrasound (LUS) in emergency medicine. By emphasizing clinical topics, time trends, study designs, and the scope of the primary outcomes, a map is provided for physicians and researchers to guide their future initiatives. RESEARCH QUESTION Which study designs and primary outcomes are reported in published studies of LUS in emergency medicine? STUDY DESIGN AND METHODS We performed a systematic search in the PubMed/MEDLINE, Embase, Web of Science, Scopus, and Cochrane Library databases for LUS studies published prior to May 13, 2023. Study characteristics were synthesized quantitatively. The primary outcomes in all papers were categorized into the hierarchical Fryback and Thornbury levels. RESULTS A total of 4,076 papers were screened and, following selection and handsearching, 406 papers were included. The number of publications doubled from January 2020 to May 2023 (204 to 406 papers). The study designs were primarily observational (n = 375 [92%]), followed by randomized (n = 18 [4%]) and case series (n = 13 [3%]). The primary outcome measure concerned diagnostic accuracy in 319 papers (79%), diagnostic thinking in 32 (8%), therapeutic changes in 4 (1%), and patient outcomes in 14 (3%). No increase in the proportions of randomized controlled trials or the scope of primary outcome measures was observed with time. A freely available interactive database was created to enable readers to search for any given interest (https://public.tableau.com/app/profile/blinded/viz/LUSinEM_240216/INFO). INTERPRETATION Observational diagnostic studies have been produced in abundance, leaving a paucity of research exploring clinical utility. Notably, research exploring whether LUS causes changes to clinical decisions is imperative prior to any further research being made into patient benefits.
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Affiliation(s)
- Stig Holm Ovesen
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Emergency Department, Horsens Regional Hospital, Horsens, Denmark.
| | | | - Hans Kirkegaard
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bo Løfgren
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
| | - Rasmus Aagaard
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Helbo Skaarup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Dan Arvig
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Morten Hjarnø Lorentzen
- Department of Emergency Medicine, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Anne Heltborg Kristensen
- Department of Emergency Medicine, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Mariana Bichuette Cartuliares
- Department of Emergency Medicine, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Casper Falster
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Liting Tong
- Emergency Department, Nykøbing F. Hospital, Zealand Denmark Region, Denmark
| | - Alessandra Rabajoli
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ronja Leth
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Emergency Department, Horsens Regional Hospital, Horsens, Denmark
| | - Janeve Desy
- Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Office of Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Irene W Y Ma
- Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jesper Weile
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Emergency Department, Horsens Regional Hospital, Horsens, Denmark
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4
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Piskovská A, Kraszewska K, Hauptman K, Jekl V. The Rat Thoracic Ultrasound protocol: scanning technique and normal findings. Front Vet Sci 2024; 11:1286614. [PMID: 38440385 PMCID: PMC10909930 DOI: 10.3389/fvets.2024.1286614] [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: 09/19/2023] [Accepted: 02/01/2024] [Indexed: 03/06/2024] Open
Abstract
Respiratory diseases (especially pneumonia) are very common disorders in pet rats. The suspected diagnosis is mostly based on the clinical signs, thoracic auscultation, and thoracic radiography. However, auscultation is insensitive in determining the severity of the disease, and radiographs are often unremarkable. Non-cardiac thoracic ultrasonography is increasingly used in veterinary medicine; however, it has not been described in detail in rats. Thoracic ultrasonic examination was conducted on 400 client-owned conscious pet rats. The rats were examined in the period from June 2023 to August 2023 in two veterinary clinics. Due to the small size of the animal, different anatomical considerations, and different evaluation protocols, as well as to meet the optimal outcome of detailed thoracic ultrasound, a standard methodological protocol was developed, and the name RATTUS (Rat Thoracic Ultrasound) was proposed. Typical signs of normal RATTUS were described (bat sign, lung sliding, A-lines, abdominal curtain sign, ski jump sign, lung pulse, seashore sign in M-mode, and bamboo sign). The new evaluation of lung inflation symmetry by substernal access was also described. The methodical approach presented and the normal findings description are proposed to be used for a standard/routine thoracic ultrasound examination in pet rats.
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Affiliation(s)
- Anna Piskovská
- Jekl and Hauptman Veterinary Clinic, Brno, Czechia
- Department of Pharmacology and Pharmacy, Faculty of Veterinary Medicine, VETUNI, Brno, Czechia
| | | | | | - Vladimír Jekl
- Jekl and Hauptman Veterinary Clinic, Brno, Czechia
- Department of Pharmacology and Pharmacy, Faculty of Veterinary Medicine, VETUNI, Brno, Czechia
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Chua MT, Boon Y, Yeoh CK, Li Z, Goh CJM, Kuan WS. Point-of-care ultrasound use in COVID-19: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2024; 12:13. [PMID: 38304913 PMCID: PMC10777239 DOI: 10.21037/atm-23-1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/25/2023] [Indexed: 02/03/2024]
Abstract
Background and Objective The coronavirus disease 2019 (COVID-19) pandemic that began in early 2020 resulted in significant mortality from respiratory tract infections. Existing imaging modalities such as chest X-ray (CXR) lacks sensitivity in its diagnosis while computed tomography (CT) scan carries risks of radiation and contamination. Point-of-care ultrasound (POCUS) has the advantage of bedside testing with higher diagnostic accuracy. We aim to describe the various applications of POCUS for patients with suspected severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in the emergency department (ED) and intensive care unit (ICU). Methods We performed literature search on the use of POCUS in the diagnosis and management of COVID-19 in MEDLINE, Embase and Scopus databases using the following search terms: "ultrasonography", "ultrasound", "COVID-19", "SARS-CoV-2", "SARS-CoV-2 variants", "emergency services", "emergency department" and "intensive care units". Search was performed independently by two reviewers with any discrepancy adjudicated by a third member. Key Content and Findings Lung POCUS in patients with COVID-19 shows different ultrasonographic features from pulmonary oedema, bacterial pneumonia, and other viral pneumonia, thus useful in differentiating between these conditions. It is more sensitive than CXR, and more accessible and widely available than CT scan. POCUS can be used to diagnose COVID-19 pneumonia, screen for COVID-19-related pulmonary and extrapulmonary complications, and guide management of ICU patients, such as timing of ventilator weaning based on lung POCUS findings. Conclusions POCUS is a useful and rapid point-of-care modality that can be used to aid in diagnosis, management, and risk stratification of COVID-19 patients in different healthcare settings.
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Affiliation(s)
- Mui Teng Chua
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yuru Boon
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chew Kiat Yeoh
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zisheng Li
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Carmen Jia Man Goh
- Emergency Department, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Pietersen PI, Konge L, Bhatnagar R, Slavicky M, Rahman NM, Maskell N, Crombag L, Tabin N, Laursen CB, Nielsen AB. The European Respiratory Society led training programme improves self-reported competency and increases the use of thoracic ultrasound. Breathe (Sheff) 2023; 19:230160. [PMID: 38264206 PMCID: PMC10805265 DOI: 10.1183/20734735.0160-2023] [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: 09/09/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024] Open
Abstract
Thoracic ultrasound has become a well-implemented diagnostic tool for assessment and monitoring of patients with respiratory symptoms or disease. However, ultrasound examinations are user dependent and sufficient competencies are needed. The European Respiratory Society (ERS) hosts a structured and evidence-based training programme in thoracic ultrasound. This study aimed to explore and discuss the self-reported activity and self-reported competency of the participants during the ERS course. Online surveys were sent to the training programme participants before the second part of the course (practical part of the course), and before and 3 months after the third part of the course (final certification exam). A total of 77 participants completed the surveys. The self-reported frequency of thoracic ultrasound examinations increased during the course, and in the final survey more than 90% of the participants used thoracic ultrasound on weekly basis. The self-reported competency (on technical execution of the thoracic ultrasound examination and overall competency) also increased. The ERS thoracic ultrasound training programme forms the basis of broad theoretical knowledge and sufficient practical skills that seem to lead to behavioural changes, whereby a large proportion of the participants implemented ultrasound in their clinical practice.
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Affiliation(s)
- Pia Iben Pietersen
- Department of Radiology, Odense University Hospital – Svendborg, Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Rahul Bhatnagar
- Southmead University Hospital Bristol, Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Marek Slavicky
- European Respiratory Society, Educational Activities, Lausanne, Switzerland
| | - Najib M. Rahman
- Oxford Centre for Respiratory Medicine, Oxford NIHR Biomedical Research Centre, Chinese Academy of Medicine Oxford Institute, Oxford, UK
| | - Nick Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Laurence Crombag
- Department of Respiratory Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Nathalie Tabin
- European Respiratory Society, Educational Activities, Lausanne, Switzerland
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense Respiratory Research Unit (ODIN), Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders Bo Nielsen
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Svendborg, Denmark
- SimC Simulation Centre, Odense University Hospital, Odense, Denmark
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7
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Chrzan R, Polok K, Antczak J, Siwiec-Koźlik A, Jagiełło W, Popiela T. The value of lung ultrasound in COVID-19 pneumonia, verified by high resolution computed tomography assessed by artificial intelligence. BMC Infect Dis 2023; 23:195. [PMID: 37003997 PMCID: PMC10064611 DOI: 10.1186/s12879-023-08173-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/17/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Lung ultrasound (LUS) is an increasingly popular imaging method in clinical practice. It became particularly important during the COVID-19 pandemic due to its mobility and ease of use compared to high-resolution computed tomography (HRCT). The objective of this study was to assess the value of LUS in quantifying the degree of lung involvement and in discrimination of lesion types in the course of COVID-19 pneumonia as compared to HRCT analyzed by the artificial intelligence (AI). METHODS This was a prospective observational study including adult patients hospitalized due to COVID-19 in whom initial HRCT and LUS were performed with an interval < 72 h. HRCT assessment was performed automatically by AI. We evaluated the correlations between the inflammation volume assessed both in LUS and HRCT, between LUS results and the HRCT structure of inflammation, and between LUS and the laboratory markers of inflammation. Additionally we compared the LUS results in subgroups depending on the respiratory failure throughout the hospitalization. RESULTS Study group comprised 65 patients, median 63 years old. For both lungs, the median LUS score was 19 (IQR-interquartile range 11-24) and the median CT score was 22 (IQR 16-26). Strong correlations were found between LUS and CT scores (for both lungs r = 0.75), and between LUS score and percentage inflammation volume (PIV) (r = 0.69). The correlations remained significant, if weakened, for individual lung lobes. The correlations between LUS score and the value of the percentage consolidation volume (PCV) divided by percentage ground glass volume (PGV), were weak or not significant. We found significant correlation between LUS score and C-reactive protein (r = 0.55), and between LUS score and interleukin 6 (r = 0.39). LUS score was significantly higher in subgroups with more severe respiratory failure. CONCLUSIONS LUS can be regarded as an accurate method to evaluate the extent of COVID-19 pneumonia and as a promising tool to estimate its clinical severity. Evaluation of LUS in the assessment of the structure of inflammation, requires further studies in the course of the disease. TRIAL REGISTRATION The study has been preregistered 13 Aug 2020 on clinicaltrials.gov with the number NCT04513210.
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Affiliation(s)
- Robert Chrzan
- Department of Radiology, Jagiellonian University Medical College, Kopernika 19, 31-501, Krakow, Poland.
| | - Kamil Polok
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Antczak
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Andżelika Siwiec-Koźlik
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Jagiełło
- Second Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Tadeusz Popiela
- Department of Radiology, Jagiellonian University Medical College, Kopernika 19, 31-501, Krakow, Poland
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Balabanova AA, Kurazhov AP, Zavadovskaya VD. Lung ultrasound in the diagnosis of COVID-19-associated pneumonia. BULLETIN OF SIBERIAN MEDICINE 2023. [DOI: 10.20538/1682-0363-2022-4-150-159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Over the past decades, lung ultrasound in the diagnosis of lung diseases has become widespread. Ultrasound examination has a number of advantages (no radiation exposure, real-time imaging, clear visualization of the subpleural lung regions and costophrenic angles), which make it possible to use ultrasound to monitor the dynamics of pneumonia in children and pregnant women. Currently, in the context of the COVID-19 pandemic, lung ultrasound is widely used due to its high diagnostic efficiency, which is comparable with classical radiography and X-ray computed tomography (CT) by a number of parameters.The article describes the method of lung ultrasound and the radiographic pattern of COVID-19-associated pneumonia. It also provides a review of the literature, according to which the severity of pneumonia was determined, depending on the radiographic pattern, and the need for a lung ultrasound was identified.The article indicates that information on assessment of the radiographic pattern of the lungs at runtime in different variants of the course of coronavirus infection, as well as many methodological issues, including the frequency of second-look lung ultrasound, has not been sufficiently studied.
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9
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Ciurba BE, Sárközi HK, Szabó IA, Ianoși ES, Grigorescu BL, Csipor-Fodor A, Tudor TP, Jimborean G. Applicability of lung ultrasound in the assessment of COVID-19 pneumonia: Diagnostic accuracy and clinical correlations. Respir Investig 2022; 60:762-771. [PMID: 35995704 PMCID: PMC9359491 DOI: 10.1016/j.resinv.2022.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/19/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to assess the diagnostic accuracy of lung ultrasound (LUS) in determining the severity of coronavirus disease 2019 (COVID-19) pneumonia compared with thoracic computed tomography (CT) and establish the correlations between LUS score, inflammatory markers, and percutaneous oxygen saturation (SpO2). METHODS This prospective observational study, conducted at Târgu-Mureș Pulmonology Clinic included 78 patients with confirmed severe acute respiratory syndrome coronavirus-2 infection via nasopharyngeal real-time-polymerase chain reaction (RT-PCR) (30 were excluded). Enrolled patients underwent CT, LUS, and blood tests on admission. Lung involvement was evaluated in 16 thoracic areas, using AB1 B2 C (letters represent LUS pattern) scores ranging 0-48. RESULTS LUS revealed bilateral B-lines (97.8%), pleural irregularities with thickening/discontinuity (75%), and subpleural consolidations (70.8%). Uncommon sonographic patterns were alveolar consolidations with bronchogram (33%) and pleural effusion (2%). LUS score cutoff values of ≤14 and > 22 predicted mild COVID-19 (sensitivity [Se] = 84.6%; area under the curve [AUC] = 0.72; P = 0.002) and severe COVID-19 (Se = 50%, specificity (Sp) = 91.2%, AUC = 0.69; P = 0.02), respectively, and values > 29 predicted the patients' transfer to the intensive care unit (Se = 80%, Sp = 97.7%). LUS score positively correlated with CT score (r = 0.41; P = 0.003) and increased with the decrease of SpO2 (r = -0.49; P = 0.003), with lymphocytes decline (r = -0.52; P = 0.0001). Patients with consolidation patterns had higher ferritin and C-reactive protein than those with B-line patterns (P = 0.01; P = 0.03). CONCLUSIONS LUS is a useful, non-invasive and effective tool for diagnosis, monitoring evolution, and prognostic stratification of COVID-19 patients.
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Affiliation(s)
- Bianca Emilia Ciurba
- Pneumology Department from Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 5, Târgu Mureș, Postal code 540098, Romania; 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania
| | - Hédi Katalin Sárközi
- Pneumology Department from Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 5, Târgu Mureș, Postal code 540098, Romania; 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania
| | - István Adorjan Szabó
- 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania.
| | - Edith Simona Ianoși
- Pneumology Department from Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 5, Târgu Mureș, Postal code 540098, Romania; 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania
| | - Bianca Liana Grigorescu
- 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania; Anesthesiology and Intensive Therapy Department from Emergency Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 50, Târgu Mureș, Postal code 540136, Romania
| | - Alpar Csipor-Fodor
- Pneumology Department from Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 5, Târgu Mureș, Postal code 540098, Romania
| | - Toma P Tudor
- University Hospital Lewisham & Greenwich, Owen Centre Lewisham Hospital Lewisham High Street, London SE13 6LH, UK
| | - Gabriela Jimborean
- Pneumology Department from Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 5, Târgu Mureș, Postal code 540098, Romania; 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania
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10
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Lugarà M, Tamburrini S, Coppola MG, Oliva G, Fiorini V, Catalano M, Carbone R, Saturnino PP, Rosano N, Pesce A, Galiero R, Ferrara R, Iannuzzi M, Vincenzo D, Negro A, Somma F, Fasano F, Perrella A, Vitiello G, Sasso FC, Soldati G, Rinaldi L. The Role of Lung Ultrasound in SARS-CoV-19 Pneumonia Management. Diagnostics (Basel) 2022; 12:diagnostics12081856. [PMID: 36010207 PMCID: PMC9406504 DOI: 10.3390/diagnostics12081856] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/24/2022] [Accepted: 07/27/2022] [Indexed: 12/22/2022] Open
Abstract
Purpose: We aimed to assess the role of lung ultrasound (LUS) in the diagnosis and prognosis of SARS-CoV-2 pneumonia, by comparing it with High Resolution Computed Tomography (HRCT). Patients and methods: All consecutive patients with laboratory-confirmed SARS-CoV-2 infection and hospitalized in COVID Centers were enrolled. LUS and HRCT were carried out on all patients by expert operators within 48−72 h of admission. A four-level scoring system computed in 12 regions of the chest was used to categorize the ultrasound imaging, from 0 (absence of visible alterations with ultrasound) to 3 (large consolidation and cobbled pleural line). Likewise, a semi-quantitative scoring system was used for HRCT to estimate pulmonary involvement, from 0 (no involvement) to 5 (>75% involvement for each lobe). The total CT score was the sum of the individual lobar scores and ranged from 0 to 25. LUS scans were evaluated according to a dedicated scoring system. CT scans were assessed for typical findings of COVID-19 pneumonia (bilateral, multi-lobar lung infiltration, posterior peripheral ground glass opacities). Oxygen requirement and mortality were also recorded. Results: Ninety-nine patients were included in the study (male 68.7%, median age 71). 40.4% of patients required a Venturi mask and 25.3% required non-invasive ventilation (C-PAP/Bi-level). The overall mortality rate was 21.2% (median hospitalization 30 days). The median ultrasound thoracic score was 28 (IQR 20−36). For the CT evaluation, the mean score was 12.63 (SD 5.72), with most of the patients having LUS scores of 2 (59.6%). The bivariate correlation analysis displayed statistically significant and high positive correlations between both the CT and composite LUS scores and ventilation, lactates, COVID-19 phenotype, tachycardia, dyspnea, and mortality. Moreover, the most relevant and clinically important inverse proportionality in terms of P/F, i.e., a decrease in P/F levels, was indicative of higher LUS/CT scores. Inverse proportionality P/F levels and LUS and TC scores were evaluated by univariate analysis, with a P/F−TC score correlation coefficient of −0.762, p < 0.001, and a P/F−LUS score correlation coefficient of −0.689, p < 0.001. Conclusions: LUS and HRCT show a synergistic role in the diagnosis and disease severity evaluation of COVID-19.
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Affiliation(s)
- Marina Lugarà
- U.O.C. Internal Medicine, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (M.G.C.); (G.O.)
- Correspondence:
| | - Stefania Tamburrini
- U.O.C. Radiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (S.T.); (V.F.); (M.C.); (R.C.); (P.P.S.); (N.R.); (A.P.)
| | - Maria Gabriella Coppola
- U.O.C. Internal Medicine, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (M.G.C.); (G.O.)
| | - Gabriella Oliva
- U.O.C. Internal Medicine, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (M.G.C.); (G.O.)
| | - Valeria Fiorini
- U.O.C. Radiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (S.T.); (V.F.); (M.C.); (R.C.); (P.P.S.); (N.R.); (A.P.)
| | - Marco Catalano
- U.O.C. Radiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (S.T.); (V.F.); (M.C.); (R.C.); (P.P.S.); (N.R.); (A.P.)
| | - Roberto Carbone
- U.O.C. Radiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (S.T.); (V.F.); (M.C.); (R.C.); (P.P.S.); (N.R.); (A.P.)
| | - Pietro Paolo Saturnino
- U.O.C. Radiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (S.T.); (V.F.); (M.C.); (R.C.); (P.P.S.); (N.R.); (A.P.)
| | - Nicola Rosano
- U.O.C. Radiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (S.T.); (V.F.); (M.C.); (R.C.); (P.P.S.); (N.R.); (A.P.)
| | - Antonella Pesce
- U.O.C. Radiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (S.T.); (V.F.); (M.C.); (R.C.); (P.P.S.); (N.R.); (A.P.)
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80121 Naples, Italy; (R.G.); (R.F.); (F.C.S.); (L.R.)
| | - Roberta Ferrara
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80121 Naples, Italy; (R.G.); (R.F.); (F.C.S.); (L.R.)
| | - Michele Iannuzzi
- Department of Anesthesia and Intensive care Medicine, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy;
| | - D’Agostino Vincenzo
- U.O.C. Neurodiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (D.V.); (A.N.); (F.S.); (F.F.)
| | - Alberto Negro
- U.O.C. Neurodiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (D.V.); (A.N.); (F.S.); (F.F.)
| | - Francesco Somma
- U.O.C. Neurodiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (D.V.); (A.N.); (F.S.); (F.F.)
| | - Fabrizio Fasano
- U.O.C. Neurodiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy; (D.V.); (A.N.); (F.S.); (F.F.)
| | - Alessandro Perrella
- Infectious Diseases at Health Direction, AORN A. Cardarelli, 80131 Naples, Italy;
| | - Giuseppe Vitiello
- Healt Direction, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy;
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80121 Naples, Italy; (R.G.); (R.F.); (F.C.S.); (L.R.)
| | - Gino Soldati
- Diagnostic and Interventional Ultrasound Unit, Valle del Serchio General Hospital, Castelnuovo Garfagnana, 55032 Lucca, Italy;
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80121 Naples, Italy; (R.G.); (R.F.); (F.C.S.); (L.R.)
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11
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What Is COVID 19 Teaching Us about Pulmonary Ultrasound? Diagnostics (Basel) 2022; 12:diagnostics12040838. [PMID: 35453889 PMCID: PMC9027485 DOI: 10.3390/diagnostics12040838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/22/2022] [Accepted: 03/26/2022] [Indexed: 12/12/2022] Open
Abstract
In lung ultrasound (LUS), the interactions between the acoustic pulse and the lung surface (including the pleura and a small subpleural layer of tissue) are crucial. Variations of the peripheral lung density and the subpleural alveolar shape and its configuration are typically connected to the presence of ultrasound artifacts and consolidations. COVID-19 pneumonia can give rise to a variety of pathological pulmonary changes ranging from mild diffuse alveolar damage (DAD) to severe acute respiratory distress syndrome (ARDS), characterized by peripheral bilateral patchy lung involvement. These findings are well described in CT imaging and in anatomopathological cases. Ultrasound artifacts and consolidations are therefore expected signs in COVID-19 pneumonia because edema, DAD, lung hemorrhage, interstitial thickening, hyaline membranes, and infiltrative lung diseases when they arise in a subpleural position, generate ultrasound findings. This review analyzes the structure of the ultrasound images in the normal and pathological lung given our current knowledge, and the role of LUS in the diagnosis and monitoring of patients with COVID-19 lung involvement.
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12
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Ruggeri P, Nair AS, Esquinas A. Comments on "Post severe COVID-19 infection lung damages study. The experience of early three months multidisciplinary follow-up" by De Michele et al. Monaldi Arch Chest Dis 2022; 92. [PMID: 35244354 DOI: 10.4081/monaldi.2022.2219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/18/2022] [Indexed: 11/23/2022] Open
Abstract
To the Editor, We read the original study by De Michele et al. titled "Post severe COVID-19 infection lung damages study. The experience of early three months multidisciplinary follow-up" with great interest...
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Affiliation(s)
- Paolo Ruggeri
- Pulmonology Unit, Department of Biomedical and Dental Sciences, Morphological and Functional Images (BIOMORF), University of Messina.
| | - Abhijit S Nair
- Department of Anaesthesiology, Ibra Hospital, Ministry of Health-Oman.
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13
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Inter-Observer Agreement between Low-Dose and Standard-Dose CT with Soft and Sharp Convolution Kernels in COVID-19 Pneumonia. J Clin Med 2022; 11:jcm11030669. [PMID: 35160121 PMCID: PMC8836391 DOI: 10.3390/jcm11030669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/29/2022] Open
Abstract
Computed tomography (CT) has been an essential diagnostic tool during the COVID-19 pandemic. The study aimed to develop an optimal CT protocol in terms of safety and reliability. For this, we assessed the inter-observer agreement between CT and low-dose CT (LDCT) with soft and sharp kernels using a semi-quantitative severity scale in a prospective study (Moscow, Russia). Two consecutive scans with CT and LDCT were performed in a single visit. Reading was performed by ten radiologists with 3–25 years’ experience. The study included 230 patients, and statistical analysis showed LDCT with a sharp kernel as the most reliable protocol (percentage agreement 74.35 ± 43.77%), but its advantage was marginal. There was no significant correlation between radiologists’ experience and average percentage agreement for all four evaluated protocols. Regarding the radiation exposure, CTDIvol was 3.6 ± 0.64 times lower for LDCT. In conclusion, CT and LDCT with soft and sharp reconstructions are equally reliable for COVID-19 reporting using the “CT 0-4” scale. The LDCT protocol allows for a significant decrease in radiation exposure but may be restricted by body mass index.
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14
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Fiorito I, Gori G, Perrone T, Mascolo A, Caimmi S, Palumbo I, De Silvestri A, Delliponti M, Di Sabatino A, Marseglia GL. ECHOPAEDIA: Echography in Paediatric Patients in the Age of Coronavirus Disease 2019: Utility of Lung Ultrasound and Chest X-Ray in Diagnosis of Community-Acquired Pneumonia and Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia. Front Pediatr 2022; 10:813874. [PMID: 35295703 PMCID: PMC8918613 DOI: 10.3389/fped.2022.813874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In recent years, lung ultrasound (LUS) has spread to emergency departments and clinical practise gaining great support, especially in time of pandemic, but only a few studies have been done on children. The aim of the present study is to compare the diagnostic accuracy of LUS (using Soldati LUS score) and that of chest X-ray (CXR) in CAP and COVID-19 pneumonia in paediatric patients. Secondary objective of the study is to examine the association between LUS score and disease severity. Finally, we describe the local epidemiology of paediatric CAP during the study period in the era of COVID-19 by comparing it with the previous 2 years. METHODS This is an observational retrospective single-centre study carried out on patients aged 18 or younger and over the month of age admitted to the Paediatric Unit of our Foundation for suspected community-acquired pneumonia or SARS-CoV-2 pneumonia during the third pandemic wave of COVID-19. Quantitative variables were elaborated with Shapiro-Wilks test or median and interquartile range (IQR). Student's t-test was used for independent data. Association between quantitative data was evaluated with Pearson correlation. ROC curve analysis was used to calculate best cut-off of LUS score in paediatric patients. Area under the ROC curve (AUC), sensibility, and specificity are also reported with 95% confidence interval (CI). RESULTS The diagnostic accuracy of the LUS score in pneumonia, the area underlying the ROC curve (AUC) was 0.67 (95% CI: 0.27-1) thus showing a discrete discriminatory power, with a sensitivity of 89.66% and specificity 50% setting a LUS score greater than or equal to 1 as the best cut-off. Nine patients required oxygen support and a significant statistical correlation (p = 0.0033) emerged between LUS score and oxygen therapy. The mean LUS score in patients requiring oxygen therapy was 12. RCP was positively correlated to the patient's LUS score (p = 0.0024). CONCLUSIONS Our study has shown that LUS is a valid alternative to CXR. Our results show how LUS score can be applied effectively for the diagnosis and stratification of paediatric pneumonia.
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Affiliation(s)
- Ivan Fiorito
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giulia Gori
- Department of Internal Medicine, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Amelia Mascolo
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Silvia Caimmi
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Ilaria Palumbo
- Department of Internal Medicine, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Annalisa De Silvestri
- Unit of Clinical Epidemiology and Biometrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Mariangela Delliponti
- Department of Internal Medicine, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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15
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Physiotherapy management for COVID-19 in the acute hospital setting and beyond: an update to clinical practice recommendations. J Physiother 2022; 68:8-25. [PMID: 34953756 PMCID: PMC8695547 DOI: 10.1016/j.jphys.2021.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/25/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022] Open
Abstract
This document provides an update to the recommendations for physiotherapy management for adults with coronavirus disease 2019 (COVID-19) in the acute hospital setting. It includes: physiotherapy workforce planning and preparation; a screening tool for determining requirement for physiotherapy; and recommendations for the use of physiotherapy treatments and personal protective equipment. New advice and recommendations are provided on: workload management; staff health, including vaccination; providing clinical education; personal protective equipment; interventions, including awake proning, mobilisation and rehabilitation in patients with hypoxaemia. Additionally, recommendations for recovery after COVID-19 have been added, including roles that physiotherapy can offer in the management of post-COVID syndrome. The updated guidelines are intended for use by physiotherapists and other relevant stakeholders caring for adult patients with confirmed or suspected COVID-19 in the acute care setting and beyond.
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Ibarra-Ríos D, Enríquez-Estrada AC, Serpa-Maldonado EV, Miranda-Vega AL, Villanueva-García D, Vázquez-Solano EP, Márquez-González H. Lung Ultrasound Characteristics in Neonates With Positive Real Time Polymerase Chain Reaction for SARS-CoV-2 on a Tertiary Level Referral Hospital in Mexico City. Front Pediatr 2022; 10:859092. [PMID: 35463891 PMCID: PMC9033263 DOI: 10.3389/fped.2022.859092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Acute respiratory syndrome secondary to SARS-CoV-2 virus infection has been declared a pandemic since December 2019. On neonates, severe presentations are infrequent but possible. Lung ultrasound (LUS) has been shown to be useful in diagnosing lung involvement and following up patients, giving more information, and reducing exposure compared to traditional examination. METHODS LUS was performed after the diagnosis of SARS-CoV-2 infection with respiratory Real Time Polymerase Chain Reaction RT-PCR with portable equipment protected with a silicone sleeve. If hemodynamic or cardiology consultation was necessary, a prepared complete ultrasound machine was used. Ten regions were explored (anterior superior and inferior, lateral, and posterior superior and inferior, right and left), and a semiquantitative score (LUSS) was calculated. Disease severity was determined with a pediatric modified score. RESULTS Thirty-eight patients with positive RT-PCR were admitted, 32 (81%) of which underwent LUS. Included patients had heterogenous diagnosis and gestational ages as expected on a referral neonatal intensive care unit (NICU) (median, ICR: 36, 30-38). LUS abnormalities found were B-line interstitial pattern 90%, irregular/interrupted/thick pleural line 88%, compact B-lines 65%, small consolidations (≤5 mm) 34%, and extensive consolidations (≥5 mm) 37%. Consolidations showed posterior predominance (70%). LUSS showed a median difference between levels of disease severity and ventilatory support (Kruskal-Wallis, p = 0.001) and decreased with patient improvement (Wilcoxon signed-rank test p = 0.005). There was a positive correlation between LUSS and FiO2 needed (Spearman r = 0.72, p = 0.01). The most common recommendation to the attending team was pronation (41%) and increase in positive end expiratory pressure (34%). Five patients with comorbidities died. A significant rank difference of LUSS and FiO2 needed between survivors and non-survivors was found (Mann-Whitney U-test, p = 0.005). CONCLUSION LUS patterns found were like the ones described in other series (neonatal and pediatrics). Eighty-eight percent of the studies were performed with handheld affordable equipment. While there is no specific pattern, it varies according to gestational age and baseline diagnosis LUS, which were shown to be useful in assessing lung involvement that correlated with the degree of disease severity and respiratory support.
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Affiliation(s)
- Daniel Ibarra-Ríos
- Neonatology Department, National Institutes of Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | | | - Ana Luisa Miranda-Vega
- Neonatology Department, National Institutes of Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Dina Villanueva-García
- Neonatology Department, National Institutes of Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Edna Patricia Vázquez-Solano
- Neonatology Department, National Institutes of Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Horacio Márquez-González
- Clinical Investigation Department, National Institutes of Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
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17
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Mabu S, Miyake M, Kuremoto T, Kido S. Semi-supervised CycleGAN for domain transformation of chest CT images and its application to opacity classification of diffuse lung diseases. Int J Comput Assist Radiol Surg 2021; 16:1925-1935. [PMID: 34661818 PMCID: PMC8522550 DOI: 10.1007/s11548-021-02490-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/31/2021] [Indexed: 11/05/2022]
Abstract
Purpose The performance of deep learning may fluctuate depending on the imaging devices and settings. Although domain transformation such as CycleGAN for normalizing images is useful, CycleGAN does not use information on the disease classes. Therefore, we propose a semi-supervised CycleGAN with an additional classification loss to transform images suitable for the diagnosis. The method is evaluated by opacity classification of chest CT. Methods (1) CT images taken at two hospitals (source and target domains) are used. (2) A classifier is trained on the target domain. (3) Class labels are given to a small number of source domain images for semi-supervised learning. (4) The source domain images are transformed to the target domain. (5) A classification loss of the transformed images with class labels is calculated. Results The proposed method showed an F-measure of 0.727 in the domain transformation from hospital A to B, and 0.745 in that from hospital B to A, where significant differences are between the proposed method and the other three methods. Conclusions The proposed method not only transforms the appearance of the images but also retains the features being important to classify opacities, and shows the best precision, recall, and F-measure.
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Affiliation(s)
- Shingo Mabu
- Graduate School of Sciences and Technology for Innovation, Yamaguchi University, 2-16-1, Tokiwadai, Ube, Yamaguchi, 755-8611, Japan.
| | - Masashi Miyake
- Graduate School of Sciences and Technology for Innovation, Yamaguchi University, 2-16-1, Tokiwadai, Ube, Yamaguchi, 755-8611, Japan
| | - Takashi Kuremoto
- Department of Information Technology and Media Design, Nippon Institute of Technology, 4-1 Gakuendai, Miyashiro-machi, Minamisaitama-gun, Saitama, 345-8501, Japan
| | - Shoji Kido
- Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
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