A pilot study evaluating erect chest imaging in children, using the Lodox Statscan digital X-ray machine

Abstract

Background. Chest radiography accounts for a significant proportion of ionising radiation in children. The radiation dose of radiographs performed on the Lodox Statscan system has been shown to be lower than that of a computed radiography (CR) system. The role of the Lodox Statscan (subsequently referred to as the Statscan) in routine erect chest radiography in children has not been evaluated. Objective. To evaluate the image quality and diagnostic accuracy of erect paediatric chest radiographs obtained with the Statscan and to compare these with conventional erect chest images obtained with a CR system. Materials and methods. Thirty-three children with suspected chest pathology were enrolled randomly over a period of 3 months. Erect chest radiographs were obtained with the Statscan and a Shimadzu R-20J X-ray machine coupled with a Fuji FCR 5000 CR system. Image quality and diagnostic accuracy and diagnostic capability of the two modalities were evaluated and compared. Results. The erect Statscan allowed superior visualisation of the 3 major airways. Statscan images, however, demonstrated exposure and movement artifacts, with hemidiaphragms and ribs most prone to movement. Bronchovascular clarity was also considered unsatisfactory on Statscan images. Conclusion. The Statscan has limitations in erect chest radiography in terms of movement artefacts, exposure fluctuations, and poor definition of lung markings. Despite this, the Statscan allows better visualisation of the major airways, equivalent to a 'high kV' film, at a fraction of the radiation dose, which supports the finding of an earlier study evaluating Statscan images in trauma cases, where the images were taken supine. The Statscan has great potential in assisting in the diagnosis of childhood tuberculosis where airway narrowing occurs as a result of nodal compression.

Use of a full-body digital X-ray imaging system in acute medical emergencies: a systematic review

“…1 5 8–10 12 13 17 22–24 26 All studies except one reported the assessor in charge of reviewing the radiography. The majority of studies used radiologists as their radiography assessors, and five of them used both clinical physicians and radiologists as their radiography assessors; the preliminary diagnosis was usually made by a physician and a definitive diagnosis was made by a radiologist.…”

“…Six studies evaluated the image quality, including three studies using reliability evaluation,13 17 22 two studies using attitude survey1 23 and one study using an equivalence scoring system (table 3). 26 In two pilot studies of paediatric patients with polytrauma,13 17 Lodox allowed superior visualisation of the trachea and main bronchi compared with computed radiograph, which afforded better visualisation of the right main bronchus by an average of 1.8 points and the left main bronchus by an average of 1.25 points.…”

“…26 In two pilot studies of paediatric patients with polytrauma,13 17 Lodox allowed superior visualisation of the trachea and main bronchi compared with computed radiograph, which afforded better visualisation of the right main bronchus by an average of 1.8 points and the left main bronchus by an average of 1.25 points. Lodox also showed that diagnostic quality of C-spine visualisation was similar to conventional radiographs (an average of 0.05 points better than conventional radiographs).…”

A Review of Full-Body Radiography in Nontraumatic Emergency Medicine

“…A further study on erect chest radiography in the same institution on 33 children confirmed this and advocated the use of the Statscan in the diagnosis of childhood tuberculosis (TB), where airway narrowing occurs as a result of nodal compression [24]. Figure 5 shows a Lodox supine radiograph, illustrating the superior ability to visualise the major airways.…”

“…Several authors have reported on the use of the Lodox system for imaging in paediatric emergency wards [21, 24, 27, 36–38]. In most of these situations, the system was used for traumatic emergencies, largely due to its dose-saving quality, and the particular benefit this has in paediatric cases [39], although Evangelopoulos et al [37] did not find this dose benefit in their study of 19 paediatric patients, possibly due to the inclusion of lateral full-body scans.…”