The value of routine preoperative chest X-rays

Preoperative chest X-rays are performed routinely in many surgical units. But is the procedure of value? Do the benefits to patients justify the costs and risks? In this paper, the evidence is reviewed and the conclusion reached that routine preoperative chest X-rays should be abandoned in elective non-cardiopulmonary surgery.     

Risk group chest X-ray for the early detection of lung cancer

In Hungary, one of the most important components of anti-TB fight was the initiation of chest X-ray based obligatory and yearly screening of the population. In the 1970s, approximately the entire adult population was regularly screened for lung diseases. However, with the improvement of TB epidemiology, early detection of lung cancer--as a "byproduct" of X-ray screening--seems to have a growing significance. In the near future, concentration needs to be given to the risk group for lung cancer, namely smokers who are older than 40 years. To demonstrate the advances of the above strategy, we investigated the lung cancer prevalence in Budapest, retrospectively. Based on the data of 2511 patients, we found that 60% of the patients with 5-year survival were identified with screening. The operability rate was 34% in the group of patients identified by screening. This was only 14% in the case of patients who had been identified based on their symptoms at the time of diagnosis. We also found that radical tumor resection offers a significant short-term (3-4 years) survival advantage, because of the long-term recurrence of the tumors, the overall mortality rate remains unchanged in the target population. Based on the current screening data, there is a chance for short-term survival advantage for 5-600 patients in every year. With the screening of the risk population (smokers, >40 years), the operability rate could be improved which, in turn, could offer a prolonged survival for 1100-1200 lung cancer patients.     

Inter-observer variation in interpretation of chest X-rays

139 chest x-rays of children with solid tumours or leukaemia were examined independently by three observers (a radiologist and two physicians) and a consensus report determined. There was total agreement between observers on 40 x-rays (29%). The radiologist agreed with the consensus report on a significantly greater number of x-rays (91%) than both physicians (62% and 46%). There was a high incidence of over-reporting of abnormalities by both physicians. This study reinforces the need for regular dialogue between radiologists and clinicians for optimum interpretation of chest x-rays.     

老年肺癌全肺切除术的临床观察

目的探讨老年肺癌全肺切除术的临床效果。方法采用回顾性分析的方法,分析笔者所在医院收治的老年肺癌患者临床资料,依据治疗方式不同分为治疗I组（支气管袖状肺叶切除术组）和治疗Ⅱ组（全肺切除术组）。结果治疗Ⅱ组切缘阳性率、复发率及淋巴结转移率明显低于治疗I组,差异均有统计学意义（P〈0．05）。两组患者手术治疗后生活质量评分无显著性差异,两组1、3、5年生存率无明显差异（P〉0．05）。结论老年肺癌全肺切除术临床疗效显著,值得临床推广应用。     

Annual chest X-ray in patients after treatment for laryngeal or oral cancer: only a limited number of second primary lung cancers detected]

OBJECTIVE: To evaluate the detection of second primary lung cancer in patients treated for laryngeal or oral cancer by means of the current annual chest radiography screening program. DESIGN: Retrospective follow-up. METHOD: In a source population of Utrecht University Hospital consisting of patients treated for laryngeal or oral cancer, the occurrence of non-simultaneous second primary lung cancer was analysed. The charts of the patients who developed second primary lung cancer were reviewed with respect to diagnosis (either by means of routine annual chest radiography or triggered by symptoms and signs) and treatment of lung cancer. A Kaplan-Meier survival analysis was performed for both routes of diagnosis and for each form of lung cancer treatment. RESULTS: The source population consisted of 2067 patients. Second primary lung cancer was diagnosed in 44 patients (37 with laryngeal and 7 with oral cancer). In 21 patients lung cancer was diagnosed by means of annual chest radiography (routine group). The remaining 23 patients presented with symptoms and signs (symptomatic group). In 13 patients, surgery with curative intent was performed. These patients had the best prognosis. Of the surgical cases, 12 out of 13 patients (27% of the total of 44) were in the routine group. Patients in the routine group had better survival than those in the symptomatic group. CONCLUSION: In view of the limited number of patients with second primary lung cancer and the small percentage of patients eligible for curative surgical treatment detected by annual radiography, screening in its present form is of little benefit.     

The use of chest X-rays for surveillance of bacterial pneumonias in children in Latin America]

The Division of Vaccines and Immunization of the Pan American Health Organization (PAHO) is promoting epidemiological surveillance of bacterial pneumonias in children in Latin America in order to generate scientific evidence to support future decisions concerning using vaccines to control such pneumonias in the countries of the Region of the Americas. The diagnosis of these diseases rarely includes bacteriological documentation of the causative agent. Therefore, studies of this type that are carried out around the world accept radiological images of alveolar consolidation as a confirmatory criterion for a presumptively bacterial pneumonia. This piece examines the theoretical rationale and requirements for using thorax radiology as an instrument for epidemiological surveillance of bacterial pneumonias. The piece also summarizes the activities carried out during 2 years of joint efforts between the Center for Vaccine Development (Centro para Vacunas en Desarrollo) of Chile and PAHO's Division of Vaccines and Immunization. During those 2 years, the two groups encouraged the epidemiological study of bacterial pneumonias in Latin American children, using internationally accepted criteria and definitions as well as tools and practical solutions adapted to the reality of the Region of the America. The activities carried out so far show both the need for and the feasibility of standardizing the interpretation of chest radiographs so that they can be used in epidemiological studies.     

Elevated mortality from lung cancer associated with arsenic exposure for a limited duration

In 1959, arsenic poisoning was detected in the town of Nakajo in Japan. The cause was exposure to inorganic arsenic in well water during 1954 to 1959. To examine the long-term effects of limited-duration arsenic exposure, we conducted mortality and survival studies for patients with chronic arsenic exposure and for control subjects from 1959 to 1992. The ratio of observed deaths to expected deaths from lung cancer was significantly high (7:0.64) for male patients. The lung cancer mortality rate was elevated markedly in subgroups with higher clinical severities of symptoms. Small cell carcinoma was specific to the exposed patients. The cumulative change of survival declined significantly in the exposed patients compared with the controls. The decline disappeared when lung cancer deaths were treated as lost to follow-up. The results showed that a 5-year period of arsenic exposure was associated with risk of lung cancer.     

胸片肺尖假结节的成因分析

目的 探讨正位胸片肺尖及侧位胸片气管中的假结节影的成因及意义.方法 随机抽取100例健康成人的正侧位胸片,正位片发现假结节者加照前弓位,侧位片发现假结节者加照斜位,所有发现假结节者均行CT扫描,并经透视观察,结合国外文献,对其X线表现进行回顾性分析.结果 100例胸片中,正位有16例显示假结节,前弓位消失,侧位正常;侧位3例显示假结节,斜位消失,正位正常;1例正位片显示左锁骨下动脉走行;所有阳性发现者（有假结节者）的CT扫描及透视观察均未发现病变.结论 正侧位胸片上的假结节均是由主动脉弓分支所致.     

Efficacy of chest CT on the staging and re-staging in patients with small cell lung cancer

Chest CT revealed to be effective to improve the quality of the staging of lung cancer concerning with the evaluation of intrathoracic lesion. The numbers of patients who had thoracic lesion as the first relapse site were higher in the group which were re-staged without the information of chest CT. The extramural review of the multi-center trial showed the inter-center bias to evaluate CR in spite of using the same X-ray imaging modalities.     

Fractures on chest radiographs in detection of alcoholism

The prevalence of fractures seen on chest radiographs among alcoholics varies in various series from 36.0% to 8.7% while that for controls remains below 5%. The aim of our study was to find out whether the selection of the alcoholic subjects could account for this four-fold variation. We therefore chose two groups of alcoholics, group 1 consisting of 76 mainly unmarried or divorced lower class alcoholics who had attended the emergency department while intoxicated, and group 2 consisting of 108 mainly married middle class alcoholics with alcoholic liver cirrhosis. The control group consisted of 98 randomly chosen hospital patients. There was no significant difference between group 1 and group 2 in the prevalence of fractures detectable with chest radiography (25% and 21.3% respectively). 8.2% of the controls also had fractures. The fracture prevalence did not correlate with socioeconomic group. Married alcoholics had significantly less thoracic fractures than unmarried, divorced or widowed alcoholics as a group. The sensitivity and specificity of the fractures visible on chest radiograph as a marker for alcoholism is not sufficient to warrant its use in clinical or research work.     

The 60-film set with 8-index for examining physicians' proficiency in reading pneumoconiosis chest X-rays

The 60-film set was developed by experts (Expert Group) for examining 8 indices: sensitivity (X(1)) and specificity (X(2)) for pneumoconiosis, sensitivity(X(3)) and specificity for (X(4)) large opacities, sensitivity (X(5)) and specificity (X(6)) for pleural plaque, profusion increment consistency for small opacities (X(7)), and shape differentiation for small opacities (X(8)) of physicians' reading skills on pneumoconiosis X-ray according to ILO 2000 Classification. The aim of this study was to assess the appropriateness of the exam film set for evaluating physicians' reading skills. 29 physicians (A1-Group) and 24 physicians (A2-Group) attended the 1st and 2nd "Asian Intensive Reader of Pneumoconioses" (AIR Pneumo) training course, respectively, and 22 physicians (B-Group) attended Brazilian training course. After training, they took examination of reading 60-film exam set. The examinees' reading results in terms of 8 indices were compared between the examinee groups and the Expert Group by parametric unpaired t-test. The Examinee Group consisting of A1-Group, A2-Group and B-Group was inferior to the Expert Group in all indices. There was no significant difference for X(7) of A1-Group, X(7) and X(8) of A2-Group (p>0.05) compared with the Expert Group. There was a significant difference in X(8) at p<0.05 between A1-Group and A2-Group, in X(3) at p<0.05 between A1-Group and B-Group, in both X(1) and in X(3) at p<0.05 between A2-Group and B-Group. Accordingly, the 60-film set providing 8 indices designed might be a good method for evaluation of the physicians' reading proficiency at different training settings.     

基于表面增强拉曼光谱的肺癌唾液检测方法研究

目的:拉曼光谱是一种分子散射光谱,是研究物质分子结构的有效手段.细胞在发生癌变的过程中分子水平会出现变化,并在唾液中会有所反应.采用拉曼光谱技术检测唾液成为早期诊断癌症的潜在途径.方法:分别采集已确诊肺癌患者19例和正常人45名唾液的表面增强拉曼光谱数据进行分析,对原始数据进行了归一化处理,确定有6组数据具有显著性差异,可以进行Logistic回归分析.结果:通过逐步Logistic回归,对肺癌患者判断的准确率达到96.9%,结果的灵敏度和特异度均达到94.7%;进入回归方程的2组特征峰表明,肺癌患者和正常人唾液的拉曼光谱在两个峰值处有统计学意义.结论:利用表面增强拉曼光谱检测技术,通过对唾液的检测,可以用于癌症的早期诊断.     

Tuberculosis screening in health service employees: who needs chest X-rays?

There is uncertainty in the NHS about which individuals should be offered pre-employment screening by chest X-ray and whether this procedure is of value in the detection of tuberculosis. To provide evidence for practice, pre-employment chest X-ray and tuberculin skin test status were examined retrospectively for employees of a health district. Cases were those with an abnormal chest X-ray; referents were a sample of the remainder with a normal chest X-ray. The majority of the population had positive tuberculin skin tests and there was no difference between cases (58 positive out of 68) and referents (170 positive out of 212). Most of the X-ray abnormalities were trivial; four findings were thought significant, but would have caused no problems if undetected and none of these findings was related to tuberculosis. We conclude that in new employees in Hampstead health district, X-ray abnormalities are rare and not predicted by testing tuberculin skin reactivity; neither procedure is justified routinely as a means of screening for tuberculosis. The situation in districts with a high incidence of tuberculosis needs to be investigated.     

Significance of radiation exposure from work-related chest X-rays for epidemiological studies of radiation workers

BACKGROUND: Previous epidemiologic studies of workers at nuclear weapons facilities have not included X-ray exposures as part of the occupational radiation exposure. The research objective was to determine the contribution of work-related chest X-ray (WRX) exposure relative to the cumulative occupational radiation exposure. METHODS: Cases and controls were identified from a cohort of workers whose employment began as early as 1943. Medical records for 297 subjects were used to determine the bone marrow dose from their X-ray examinations. Individual dose data, however, were only available for 45 workers. Bone marrow dose estimates were calculated by converting the entrance-skin-exposure (from X-ray procedures) and occupational exposure (from monitoring data) to dose. RESULTS: Stereoscopic photofluorography delivered a bone marrow dose nearly 100 times that delivered by today's chest X-ray technique. Photofluorography was the predominant radiation source during the 1940s and 1950s. The cumulative WRX dose was, on average, 50 times their occupational doses. No correlation between occupational and WRX dose was found, but may be due to the small study size and incomplete dose data. CONCLUSIONS: These findings illustrate the importance of including WRX doses in retrospective epidemiological studies of radiation workers, especially if photofluorographic chest X-rays were performed and occupational exposure to ionizing radiation is low.