The value of lung cancer detection by six-monthly chest radiographs

Results are reported of a prospective study, carried out by the Mass Radiography Service of the North-West Metropolitan Region for the purpose of evaluating early lung cancer detection by six-monthly chest radiographs. The lung cancer experience of a test group of 29,723 men aged 40 and over who were offered six-monthly chest radiographs over a period of three years is compared with a similarly constituted control group of 25,311 men who were radiographed only at the beginning and the end of the study. In the test group 29,416 men (98·9%) and in the control group 25,044 men (99%) were followed up. The methods employed to achieve this result are analysed. The six-monthly surveys of the test group yielded 65 cases of lung cancer, giving an annual incidence and detection rate of 0·9 per thousand examined. Of these cases 65% were resected. Of all cases of lung cancer in the test group, irrespective of their source of detection, 43·6% were operable, compared with 29% in the control group. The difference (P=0·03) is statistically significant. The annual mortality rate from lung cancer based on 62 deaths in the test group and 59 deaths in the control was 0·7 and 0·8 per thousand respectively. The conclusions are reached that since early detection by six-monthly chest radiographs has not significantly reduced the mortality from lung cancer in a population at risk, a policy of such large-scale surveys of men in the cancer age would not seem justified, but that the increased discovery of resectable lung cancer by this method forms a reasonable basis for encouraging individuals in high-risk groups to make regular use of existing mass radiography facilities.     

Estimation of lung volumes from chest radiographs using shape information.

The cross-sectional shapes of the chest and its contained structures have been assessed in post-mortem anatomical sections and from computerised tomographic scans in living subjects. These shapes are described by simple equations that can be used to increase the accuracy of measuring lung volumes from chest radiographs. Radiographic estimates of total lung capacity, using the equations, were compared with plethysmographic and single-breath helium dilution measurements in 35 normal subjects. The postures commonly used for taking chest radiographs were found, on average, to decrease total lung capacity (TLC) and to increase residual volume by about 200 ml when compared with the sitting positions used for the other two measurements (studies made in 18 of the subjects). After correction for this effect, the radiographic estimates of TLC, which measure the displacement volume of the lung, exceeded the plethysmographic estimates of contained gas volume by a mean of 720 ml, which was taken as the volume of tissue, blood, and water in the lungs. The single-breath dilution estimates of TLC fell short of the plethysmographic values by a mean of 480 ml, taken as the volume of contained gas that was inaccessible to helium in 10 seconds. The tomographic studies suggested that the radiographic technique of measuring lung displacement volumes has an accuracy of +/- 210 ml. The method is rapid and simple to use and has intra- and inter-observer variabilities of less than 1% and less than 5% respectively.     

Influence of radiologic expertise in detecting lung tumors on chest radiographs

Purpose

To analyze the influence of radiologic expertise in detecting lung tumors on chest radiographs.

Interpretation of bronchograms and chest radiographs in patients with chronic sputum production.

Bronchograms and plain chest radiographs of 27 patients with chronic sputum production were reported separately in random order and independently by two pulmonary radiologists to establish the diagnostic rate of each investigation and to assess interobserver variation. Both radiologists agreed on the presence of bronchiectasis on bronchography in 19 of 27 (70%) patients and in 94 of 448 (21%) bronchopulmonary segments. One radiologist only interpreted the films as showing bronchiectasis in a further two (7%) patients and 26 (6%) segments. There was more disagreement about the presence or absence of individual bronchographic abnormalities. Two main groups of patients with bronchiectasis were identified by bronchography: 11 with bronchiectasis alone and eight with bronchiectasis and bronchographic features suggestive of "chronic bronchitis". There was no clinical difference between these two groups. Plain chest radiographs were insensitive, being diagnostic (both radiologists agreeing) of bronchiectasis in only nine of 19 (47%) patients with definite bronchiectasis on bronchography.     

Introduction to the interpretation of chest radiographs during donor care

Organ procurement coordinators often provide independent interpretations of chest radiographs during donor care. Catheter or tube position, lobar atelectasis, extra-alveolar air, air bronchograms, pleural fluid, and other findings are important throughout donor care and when deciding if a lung is acceptable for transplantation. Technical factors, features of a normal chest radiograph, and abnormal radiographic findings are reviewed and examples are presented.     

Prevalence of vertebral fractures on chest radiographs of elderly African American and Caucasian women

Summary  

The prevalence of vertebral fractures on routine chest radiographs of elderly Caucasian women was only 1.3 times higher than in African American (AA) women, a difference considerably smaller than reported in population studies. AAs with medical problems may have higher risk of vertebral fractures than previously suspected.     

Comparison of postoperative cardiopulmonary examinations and chest radiographs to detect pulmonary complications after adult tracheotomy.

OBJECTIVE: To prospectively evaluate the effectiveness of clinical cardiopulmonary examination compared with that of chest radiography in detecting postoperative pulmonary complications after tracheotomy in adults. METHODS: One hundred consecutive patients undergoing tracheotomy were evaluated. Pulmonary complications were recorded, and the effectiveness of the physical examination was compared with that of the chest x-ray in detecting these complications. Patient age, sex, diagnosis, urgency of the procedure, and anesthetic technique were evaluated to determine any relationship to postoperative complications. RESULTS: Of the 100 patients, 87 patients underwent postoperative chest radiography, and all patients had postoperative cardiopulmonary examinations. One patient (1%) had a bilateral pneumothorax, which was detected clinically and confirmed by a chest radiograph. Five patients had postoperative pulmonary edema confirmed by clinical examination and radiography. Additional minor complications were noted, including minor bleeding and stomal infection, for an overall complication rate of 13%. CONCLUSIONS: All postoperative pulmonary complications were detected by physical examination. Therefore routine postoperative chest radiographs in uncomplicated tracheotomies are not necessary if a thorough postoperative cardiopulmonary examination is performed. Cost analysis reveals a savings of approximately $19,000 with the proposed criteria for postoperative chest x-ray.     

Reliability of initial chest radiographs in the diagnosis of blunt diaphragmatic rupture

BACKGROUND AND AIMS: Preoperative diagnosis of blunt diaphragamatic rupture is difficult and missed injuries can lead to severe late complications. The aim of this study was to assess the value and reliability of initial chest radiographs in diagnosing blunt diaphragmatic rupture. MATERIAL AND METHODS: A retrospective analysis of initial radiographs of 18 patients with blunt diaphragmatic rupture treated at two Greek Trauma Centers was performed. The chest radiograph was the primary diagnostic radiological tool in all of cases, and the findings were confirmed at operation in all cases. RESULTS: The preoperative diagnosis of blunt diaphragmatic rupture on the basis of chest radiographs was made in 16 out 18 patients (89%). The presence of air-containing viscera and an elevated nasogastric tube above the level of the left hemidiaphragm were the most specific signs. Although elevation of the hemidiaphragm was seen in all 18 cases, it is non-specific. A marked elevation of the right hemidiaphragm (more than 6 cm above the level of the left diaphragm), however, was a strong sign of right diaphragmatic rupture. CONCLUSIONS: In spite of the availability of newer diagnostic imaging techniques, the initial chest radiograph is very reliable in detecting most cases with blunt diaphragmatic rupture, and together with high index of suspicion and sound clinical assessment remain the cornerstone in diagnosing these challenging injuries.     

Combined lesions of the chest and abdomen

The structure of combined thoracic and abdominal trauma was analysed in 500 injured persons for 1984-1994 period. Mortality in the open trauma was 13.4% and in the closed one--20.4%.