Outcome of Recommendations for Radiographic Follow-Up of Pneumonia on Outpatient Chest Radiography

Little, Brent P.; Gilman, Matthew D.; Humphrey, Kathryn L.; Alkasab, Tarik K.; Gibbons, Fiona K.; Shepard, Jo Anne O.; Wu, Carol C.

doi:10.2214/ajr.13.10888

Cited by 28 publications

(7 citation statements)

References 14 publications

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“…Führt man eine Röntgenthoraxkontrolle im Verlauf durch, so findet man in ca. 5 % der Fälle bisher unbekannte maligne oder nicht-maligne Lungenerkrankungen [241]. Bei Vorliegen von Risikofaktoren für eine Tumorerkrankung, aktiven und ehemaligen Rauchern, älteren Patienten (> 65 Jahre) bzw.…”

Section: Stellenwert Der Bildgebungunclassified

Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie – Update 2021

Ewig

Kolditz²,

Pletz

et al. 2021

Pneumologie

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ZusammenfassungDie vorliegende Leitlinie umfasst ein aktualisiertes Konzept der Behandlung und Prävention von erwachsenen Patienten mit ambulant erworbener Pneumonie und löst die bisherige Leitlinie aus dem Jahre 2016 ab.Sie wurde entsprechend den Maßgaben zur Methodologie einer S3-Leitlinie erarbeitet und verabschiedet. Hierzu gehören eine systematische Literaturrecherche und -bewertung, die strukturierte Diskussion der aus der Literatur begründbaren Empfehlungen sowie eine Offenlegung und Bewertung möglicher Interessenskonflikte.Die Leitlinie zeichnet sich aus durch eine Zentrierung auf definierte klinische Situationen, eine aktualisierte Maßgabe der Schweregradbestimmung sowie Empfehlungen zu einer individualisierten Auswahl der initialen antimikrobiellen Therapie.Die Empfehlungen zielen gleichzeitig auf eine strukturierte Risikoevaluation als auch auf eine frühzeitige Bestimmung des Therapieziels, um einerseits bei kurativem Therapieziel die Letalität der Erkrankung zu reduzieren, andererseits bei palliativem Therapieziel eine palliative Therapie zu eröffnen.

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Section: Stellenwert Der Bildgebungunclassified

Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie – Update 2021

Ewig

Kolditz²,

Pletz

et al. 2021

Pneumologie

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“…We consider it essential to evaluate the value of DLAD on chest radiographs taken in outpatient clinic because a comprehensive range of patients would be included. In addition, because there are often cases where clinicians encounter chest radiographs immediately after patients are filmed (17), it is essential in helping clinicians find abnormalities on chest radiographs more quickly and accurately. Therefore, we focused on how DLAD improves the reading accuracy of radiologists and clinicians and the effect of including DLAD on interpretation time.…”

Section: Discussionmentioning

confidence: 99%

External validation of deep learning-based automated detection algorithm for chest radiograph: practical issues in outpatient clinic

Lee,

Chae,

Jin

et al. 2023

Acta Radiol

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Background There have been no reports on diagnostic performance of deep learning-based automated detection (DLAD) for thoracic diseases in real-world outpatient clinic. Purpose To validate DLAD for use at an outpatient clinic and analyze the interpretation time for chest radiographs. Material and Methods This is a retrospective single-center study. From 18 January 2021 to 18 February 2021, 205 chest radiographs with DLAD and paired chest CT from 205 individuals (107 men and 98 women; mean ± SD age: 63 ± 8 years) from an outpatient clinic were analyzed for external validation and observer performance. Two radiologists independently reviewed the chest radiographs by referring to the paired chest CT and made reference standards. Two pulmonologists and two thoracic radiologists participated in observer performance tests, and the total amount of time taken during the test was measured. Results The performance of DLAD (area under the receiver operating characteristic curve [AUC] = 0.920) was significantly higher than that of pulmonologists (AUC = 0.756) and radiologists (AUC = 0.782) without assistance of DLAD. With help of DLAD, the AUCs were significantly higher for both groups (pulmonologists AUC = 0.853; radiologists AUC = 0.854). A greater than 50% decrease in mean interpretation time was observed in the pulmonologist group with assistance of DLAD compared to mean reading time without aid of DLAD (from 67 s per case to 30 s per case). No significant difference was observed in the radiologist group (from 61 s per case to 61 s per case). Conclusion DLAD demonstrated good performance in interpreting chest radiographs of patients at an outpatient clinic, and was especially helpful for pulmonologists in improving performance.

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“…First, our experience is based on a single-center registry of a tertiary urban academic hospital. Second, the retrospective design of our study did not allow evaluation of the actual follow-through and performance of recommended follow-up chest CTs 29, 30 . Our study focused on the expected amount of recommended follow-up testing comparing prior and revised Fleischner Society Guidelines.…”

Section: Discussionmentioning

confidence: 99%

Incidental pulmonary nodules in emergent coronary CT angiography for suspected acute coronary syndrome: Impact of revised 2017 Fleischner Society Guidelines

Scholtz

Hedgire

et al. 2018

Journal of Cardiovascular Computed Tomography

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Background Pulmonary nodules (PN) are frequently detected incidentally during coronary computed tomography angiography (CTA). We evaluated whether the 2017 Fleischner Society guidelines may result in a decrease of follow-up testing of incidental PN as compared to prior guidelines in patients undergoing coronary CTA. Methods We conducted a retrospective study of a registry of emergency department patients who underwent coronary CTA for acute coronary syndrome assessment between 2012 and 2017. Based on guidelines, patients <35 years, history of cancer, or prior exams showing stability of PN were excluded. Patients >60 years, history of smoking, irregular/spiculated PN morphology, or PN size >20mm were classified as high-risk for lung cancer. Radiological findings pertaining to PN were identified (PN size, morphology, quantity) through review of radiology reports. PN follow-up recommendations were established using 2017 Fleischner Society Guidelines and compared with prior guidelines for solid (2005) and subsolid (2013) PN. Data were analyzed with Student’s t-test. Results The registry included 2,066 patients (female 45.1%, 52.9±11.0 years), of which 578 (28.0%) reported PN. 438 of those (21.2%) were eligible for guideline-based follow-up evaluation. 205 (4 6.8%) were classified as high-risk for lung cancer. 2017 guidelines reduced the number of individuals requiring follow-up by 64.5%, from 264 (12.8%) to 94 patients (4.5%) when compared to prior guidelines (p<0.001). The minimum number of follow-up chest CTs decreased by 55.8% from 430 to 190 (p<0.001). Conclusion Application of the 2017 Fleischner Society Guidelines resulted in a significant decrease of follow-up testing for incidental PN in patients undergoing coronary CTA for suspected acute coronary syndrome.

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Outcome of Recommendations for Radiographic Follow-Up of Pneumonia on Outpatient Chest Radiography

Abstract: Follow-up imaging of radiographically suspected pneumonia leads to a small number of new diagnoses of malignancy and important nonmalignant diseases, which may alter patient management.

Cited by 28 publications

References 14 publications

Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie – Update 2021

Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie – Update 2021

External validation of deep learning-based automated detection algorithm for chest radiograph: practical issues in outpatient clinic

Incidental pulmonary nodules in emergent coronary CT angiography for suspected acute coronary syndrome: Impact of revised 2017 Fleischner Society Guidelines

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