Novel Method to Improve Radiologist Agreement in Interpretation of Serial Chest Radiographs in the ICU

Comparison of the Diagnostic and Therapeutic Efficacies of Portable Recruited Chest Radiography with Conventional Portable Radiography in Mechanically Ventilated Patients

BACKGROUND

In mechanically ventilated patients, portable chest radiography (CXR) can provide important information for selecting the optimal therapeutic approach. This study aimed to determine the diagnostic and therapeutic efficacies of portable recruited chest radiography with maximum inspiratory volume and pause in comparison with conventional portable radiography.

MATERIALS AND METHODS

This diagnostic accuracy study was conducted on 75 mechanically ventilated patients admitted to the intensive care unit (ICU) of Imam Khomeini Hospital in Sari, Iran, during 2013-2015. For every patient, in addition to conventional portable CXR, another CXR was performed with mechanical ventilator adjustments (tidal volume up to 10-12 ml/kg to maintain the inspiratory plateau pressure below 35 cmH₂O and inspiratory time of 2-3 seconds). CXR was performed after 5-10 respiratory cycles, synchronized with the inspiratory pause. The radiographs were acquired using a Shimadzu portable radiography system in the anteroposterior supine position and randomly presented to two radiologists for reporting.

RESULTS

The mean age of the patients was 63.5±14 years. Overall, 43 (57.3%) patients were male, and 32 (42.7%) were female. Therapeutic interventions were performed for only 8% of cases with conventional CXR versus 21.3% of cases with recruited CXR; the difference was found to be statistically significant (P<0.05). The diagnostic efficacy of portable recruited CXR versus conventional portable CXR was 45% versus 18.6%. Also, the therapeutic efficacy of portable recruited CXR versus conventional portable CXR was 21.3% versus 8%.

CONCLUSION

Portable recruited CXR seems to be a valuable diagnostic approach for clinical decision-making, with higher diagnostic and therapeutic efficacies in mechanically ventilated patients.

Comparative effectiveness study of face-to-face and teledermatology workflows for diagnosing skin cancer

BACKGROUND

The effectiveness and value of teledermatology and face-to-face workflows for diagnosing lesions are not adequately understood.

OBJECTIVE

We compared the risks of biopsy and cancer diagnosis among 2 face-to-face workflows (direct referral and roving dermatologist) and 4 teledermatology workflows.

METHODS

Retrospective study of 59,279 primary care patients presenting with a lesion from January through June 2017.

RESULTS

One teledermatology workflow achieved high-resolution images with use of a dermatoscope-fitted digital camera, a picture archiving and communication system, and image retrieval to a large computer monitor (in contrast to a smartphone screen). Compared with direct referral, this workflow was associated with a 9% greater probability of cancer detection (95% confidence interval [CI], 2%-16%), a 4% lower probability of biopsy (relative risk, 0.96; 95% CI, 0.93-0.99), and 39% fewer face-to-face visits (relative risk, 0.61; 95% CI, 0.57-0.65). Other workflows were less effective.

LIMITATIONS

Differing proficiencies across teledermatology workflows and selection of patients for direct referral could have caused bias.

CONCLUSION

Implementation is critical to the effectiveness of teledermatology.