The role of clinical history in the interpretation of chest radiographs

ObjectiveThis review will appraise the literature pertaining to the influences that clinical history has on the action of assessing the chest radiograph.Key findingsThere remains conflicting evidence on the impact of clinical history on chest radiography. Some research suggests that clinical history has the potential to influence the reporter in a negative way by limiting their search strategy to a more focussed search. Image interpretation is more accurate when reporters are allowed to conduct a free search of the chest image, untainted by preconceived concepts.ConclusionClinical history needs to be accessed appropriately to aid and not stifle accurate image interpretation. Reporters need to be aware of the potential bias clinical history can introduce to their reporting and develop strategies to alleviate this as much as possible.Implications for practiceA greater understanding of the potential bias of clinical history on the process of image interpretation is required by all reporters. Reporters need to develop an approach and strategy when accessing clinical history. Novice reporters need to be educated regarding the impact of clinical history on their reporting.     

Optimization of acquisition parameters for reduced-dose thoracic CT: A phantom study

PurposeThe purpose of this study was to analyze the impact of different options for reduced-dose computed tomography (CT) on image noise and visibility of pulmonary structures in order to define the best choice of parameters when performing ultra-low dose acquisitions of the chest in clinical routine.Materials and methodsUsing an anthropomorphic chest phantom, CT images were acquired at four defined low dose levels (computed tomography dose index [CTDI_vol] = 0.15, 0.20, 0.30 and 0.40 mGy), by changing tube voltage, pitch factor, or rotation time and adapting tube current to reach the predefined CTDI_vol-values. Images were reconstructed using two different levels of iteration (adaptive statistical iterative reconstruction [ASIR®]-v70% and ASIR®-v100%). Signal-to-noise ratio (SNR) as well as contrast-to-noise ratio (CNR) was calculated. Visibility of pulmonary structures (bronchi/vessels) were assessed by two readers on a 5-point-Likert scale.ResultsBest visual image assessments and CNR/SNR were obtained with high tube voltage, while lowest scores were reached with lower pitch factor followed by high tube current. Protocols favoring lower pitch factor resulted in decreased visibility of bronchi/vessels, especially in the periphery. Decreasing radiation dose from 0.40 to 0.30 mGy was not associated with a significant decrease in visual scores (P < 0.05), however decreasing radiation dose from 0.30 mGy to 0.15 mGy was associated with a lower visibility of most of the evaluated structures (P < 0.001). While image noise could be significantly reduced when ASIR®-v100% instead of ASIR®-v70% was used, the visibility-scores of pulmonary structures did not change significantly.ConclusionFavoring high tube voltage is the best option for reduced-dose protocols. A decrease of SNR and CNR does not necessarily go along with reduced visibility of pulmonary structures.     

放疗期间运用CBCT调整治疗中心

目的应用锥形束CT（CBCT）评价分析放疗过程中因患者体型变化、肿瘤大小改变等因素导致的摆位误差，并修正治疗等中心。方法80例胸腹部肿瘤患者行调强放射治疗，治疗进行到一半的时候，运用CBCT的图像与靶区勾画轮廓线进行重新匹配，并以新的中心作为后半期放疗的中心。分析两次CBCT的治疗中心点的位置变化，并进行统计学分析。结果分析结果表明，56例患者治疗中心点位移等于或少于5mm，无需调整治疗中心。24例患者中心点位移大于5mm，需调整治疗中心。按调整后的治疗中心完成后期治疗。需调整比例占总病例的30％。结论利用CBCT对放疗摆位的误差测量准确有效。放疗时间跨度长，患者体型、肿瘤在治疗期间变化大，所以在治疗的中期进行合理的调整非常必要。     

Exposure to radiotherapy for first primary cancer as a risk factor for second primary thyroid cancer: A case-control study

BackgroundSecond primary neoplasms are associated with high mortality and morbidity rates in cancer survivors successfully treated for the first malignancy. Studies suggested an association between the type of first neoplasm and risk of subsequent thyroid cancer, with part of this risk attributable to exposure to radiotherapy during treatment of the first primary tumor. This study aimed to determine whether radiotherapy is a risk factor for thyroid cancer in patients previously treated for another neoplasm.MethodsThis retrospective case-control study included patients diagnosed with their first cancer between 2007 and 2017. Patients who subsequently developed thyroid cancer as a second primary neoplasm were defined as “cases”, and patients who did not develop a second cancer were defined as “controls”. Exposure to radiotherapy was the primary risk factor of interest; other risk factors were the site to which radiotherapy was delivered and the first neoplasm type.ResultsExposure to radiotherapy was associated with an increased risk of thyroid cancer (odds ratio [OR] = 2.410, 95% confidence interval [CI]: 1.219–4.764), in particular, in women (OR = 3.121, 95% CI: 1.232–7.907) and in patients receiving radiotherapy to the thorax (OR = 6.298, 95% CI: 2.581–15.370). The median survival time from first cancer recovery to thyroid cancer occurrence was 63.80 months; there was no difference in survival between patients who did and did not receive radiotherapy (P = 0.899).ConclusionRadiation to the thorax can increase the risk of thyroid cancer as a second neoplasm among patients with cancer successfully treated for their first cancer.     

正常孕妇步行时骨盆与胸廓在水平面上的运动协调模式

背景：妊娠期间,女性发生了一系列的生理的和身体的变化,人们常认为妊娠引起肌肉骨骼系统的一定程度的变化,会影响孕妇的姿势或步态运动。 目的：观测妊娠步行时水平面上骨盆和胸廓的旋转运动,并进行量化研究,比较正常孕妇和正常女性的差异。 方法：选择怀孕20~34周的孕妇志愿者12人,未怀孕妇女13人为对照组。比较孕妇组和对照组的最舒适步行速度、骨盆和胸廓在水平方向上旋转运动的幅度及两者间运动协调性的差异。分别测定孕妇组和对照组的最舒适步行速度和最大的步行速度,分别计算骨盆和胸廓运动的和谐指数,应用相对傅里叶相和偶合力来描述骨盆与胸廓旋转的运动协调特征。 结果与结论：孕妇的最舒适的步行速度呈显著性下降,孕妇组和对照组的Tempa评分、骨盆和胸廓的旋转运动的和谐指数、相对傅里叶相和偶合力差异无显著性意义。实验未发现妊娠对骨盆和胸廓运动的协调有影响。在运动步态方面,孕妇能够适应怀孕引起的变化。减少最舒适步行速度可以使孕妇节约能量消耗。     

Le thorax en entonnoir : quelle prise en charge en chirurgie plastique ? À propos de 10 cas

Subject

Several controversial issues concern pectus excavatum (funnel chest), the most common chest wall deformity. The pathogenesis of this deformity is uncertain, and there is no agreement as to its psychological, cardiac and pulmonary effects. An even more debatable point is the choice of surgical treatment among the more or less radical proposals made by different teams. No consensus exists concerning the indications for surgery, the technique to be used, or the suitable age of the patient.

Materials and methods

This retrospective study concerns 10 patients with funnel chest who underwent reconstruction surgery in our unit between 1989 and 2002. Nine patients received a silicone chest implant made to measure, and one a single breast implant. Each patient was interviewed and examined to obtain information and provide a basis for evaluation. The effects of possible associated abnormalities were evidenced by complementary cardiopulmonary examinations, and the severity of funnel chest was evaluated according to the Haller pectus index.

Results

The mean period after surgery was 5 years. The effects of funnel chest deformity were essentially psychological, relating to aesthetic disgrace. Although two-thirds of the deformities were considered severe, cardiopulmonary repercussions were minor. All 10 patients were satisfied with the repair performed, and this judgment was independent of surgical assessment. Acute complications concerned 5 seromas and one minimal scar separation.

Discussion

The indications for surgery and the means of surgical treatment for funnel chest are considered after comparison of our results with those in the literature and a survey of the different existing possibilities for treatment (implant, chondrosternoplasty, fat transplant).     

原发性颈胸结合部肿瘤的诊治

目的 总结原发性颈胸结合部肿瘤的诊治经验.方法 统计2005年3月至2009年12月在解放军总医院住院手术并经病理确诊的17例患者的临床资料,对患者的临床表现、手术方法选择及并发症预防进行分析.17例患者的肿瘤主体位于左侧9例,右侧8例.行颈侧切开(阶梯切口)1例,颈胸联合手术3例,颈根部及锁骨上切开6例,颈根部及上纵隔肿瘤切除7例,3例神经纤维瘤患者因肿瘤与局部重要组织结构粘连严重未能全部切除.结果 5例(29.4％)患者发生手术并发症,其中1例术中左锁骨下动脉破裂出血及喉返神经损伤,术后伤口感染、皮肤缺损;1例术中椎动脉和颈总动脉破裂,术后出现霍纳综合征伴上肢运动受限和不能耸肩;1例手运动障碍;2例上肢运动受限.术后病理结果:囊肿、静脉血管瘤、节细胞神经瘤、纤维源性肿瘤、纤维肉瘤、脂肪肉瘤、肌纤维母细胞瘤、异位错构瘤性胸腺瘤(腮原基混合瘤)各1例,神经纤维瘤3例,神经鞘瘤6例.随访1.0～4.5年,中位时间2.5年.2例恶性肿瘤患者随访3年8个月和2年,均无瘤存活;3例神经纤维瘤未完全切除患者带瘤生存,其余12例良性病变暂无瘤生存.结论 原发性颈根部肿瘤类型多,其中神经鞘瘤较多;当肿瘤范围广泛、与局部神经血管等重要结构粘连紧密时,手术难以彻底切除,其手术并发症发生率高.     

Multidetector computed tomography and 3-dimensional imaging: preoperative evaluation of thoracic vascular and tracheobronchial anomalies and abnormalities in pediatric patients

In the past decade, rapid technical developments and advancements of multidetector computed tomography (MDCT) have revolutionized the preoperative imaging evaluation of thoracic vascular and tracheobronchial anomalies and abnormalities in infants and children. Multidetector computed tomography enables noninvasive, rapid, high-resolution, and 3-dimensional (3D) imaging of the thorax in pediatric patients that provides comprehensive preoperative surgical guidance for pediatric surgeons. With the increasing availability of MDCT and 3D imaging, a practical review is needed for the pediatric surgeon of the evolving role of these techniques in the preoperative evaluation of surgical lesions in infants and children.This article focuses on the review of advantages and disadvantages of MDCT in comparison to other imaging modalities, 2D and 3D imaging postprocessing techniques, and MDCT and 3D imaging appearance of various thoracic vascular and tracheobronchial anomalies and abnormalities in pediatric patients. The primary aim of this article was to facilitate the pediatric surgeons' ability to successfully incorporate MDCT and 3D imaging as a routine preoperative imaging tool for the evaluation of thoracic surgical lesions in infants and children.     

肺淋巴管平滑肌瘤病影像学分析

目的探讨肺淋巴管平滑肌瘤病（PLAM）胸部X线片、多排螺旋CT（MSCT）的影像学表现特点及诊断价值。方法回顾性分析经病理证实的4例PLAM的临床和胸部X线片、MSCT表现,并复习文献进行分析。结果PLAM临床主要表现为呼吸困难（4例）,咳嗽、咳痰（2例）,咯血（2例）,反复出现的气胸（2例）和乳糜胸（1例）等。胸部X线片主要表现为弥漫性分布的网状阴影（2例）、蜂窝状透亮区（1例）、气胸（2例）和胸腔积液（1例）等;MSCT特征性表现：2例见双肺弥漫性分布、大小不一、薄壁、囊状透亮区,囊腔直径3-15mm。1例广泛性囊变合并肺间质纤维化并胸膜增厚、粘连,确诊后3个月死亡。余症状缓解出院。结论PLAM是一种罕见的弥漫性肺间质病变,胸部X线片表现缺乏特征;MSCT特征性表现对临床诊断有重要价值。