The utility of routine admission chest X-ray films on patient care

Verma, Vishal; Vasudevan, Viswanath; Jinnur, Praveen; Nallagatla, Sasikanth; Majumdar, Ayanava; Arjomand, Farhad; Reminick, M. Scott

doi:10.1016/j.ejim.2010.12.007

Cited by 18 publications

(14 citation statements)

References 5 publications

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“…Although it might be time efficient, this emphasis on abnormal images may also give students a wrong impression about the prevalence of diseases in medical practice. In reality, many images in everyday clinical practice on a ward or in an emergency department are found to be normal or do not contain significant or relevant pathology . This mismatch between low prevalence of diseases in clinical practice and the emphasis on abnormal images during training can impact students’ performance in practice.…”

Section: Introductionmentioning

confidence: 99%

Chest X‐ray evaluation training: impact of normal and abnormal image ratio and instructional sequence

et al. 2018

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Context Medical image perception training generally focuses on abnormalities, whereas normal images are more prevalent in medical practice. Furthermore, instructional sequences that let students practice prior to expert instruction (inductive) may lead to improved performance compared with methods that give students expert instruction before practice (deductive). This study investigates the effects of the proportion of normal images and practice–instruction order on learning to interpret medical images. It is hypothesised that manipulation of the proportion of normal images will lead to a sensitivity–specificity trade‐off and that students in practice‐first (inductive) conditons need more time per practice case but will correctly identify more test cases. Methods Third‐year medical students (n = 103) learned radiograph interpretation by practising cases with, respectively, 30% or 70% normal radiographs prior to expert instruction (practice‐first order) or after expert instruction (instruction‐first order). After training, students performed a test (60% normal) and sensitivity (% of correctly identified abnormal radiographs), specificity (% of correctly identified normal radiographs), diagnostic performance (% of correct diagnoses) and case duration were measured. Results The conditions with 30% of normal images scored higher on sensitivity but the conditions with 70% of normal images scored higher on specificity, indicating a sensitivity and specificity trade‐off. Those who participated in inductive conditions took less time per practice case but more per test case. They had similar test sensitivity, but scored lower on test specificity. Conclusions The proportion of normal images impacted the sensitivity–specificity trade‐off. This trade‐off should be an important consideration for the alignment of training with future practice. Furthermore, the deductive conditions unexpectedly scored higher on specificity when participants took less time per case. An inductive approach did not lead to higher diagnostic performance, possibly because participants might already have relevant prior knowledge. Deductive approaches are therefore advised for the training of advanced learners.

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Section: Introductionmentioning

confidence: 99%

Chest X‐ray evaluation training: impact of normal and abnormal image ratio and instructional sequence

et al. 2018

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“…They had a low clinical impact and should probably have been avoided. Also routine admission radiography may fall into this category [2], as well as routine chest radiography in the intensive care unit (ICU). In a report on a change of strategy in an ICU, from routine to on-demand chest radiography, the same amount of abnormalities was detected on a reduced number of chest radiographs without affecting the readmission rate, ICU, or hospital mortality rates [20].…”

Section: Discussionmentioning

confidence: 99%

“…According to an old World Health Organization (WHO) survey (cited in [1]), about half of all radiology examinations worldwide are of chest, and it is the most frequently performed radiologic study in US hospitals [2]. In our hospital, around 30% of all examinations in the radiology department are chest radiographs according to annual audits, and despite the low cost per examination, thus consume a considerable part of the department resources.…”

Section: Introductionmentioning

confidence: 99%

“…One obvious way of doing this is to register and analyze how and when radiology has induced treatment changes or been used to monitor treatment. A large number of papers report the lack of clinical utility or efficacy of routine admission [2], screening [3], and preoperative [4, 5] and postoperative chest X-rays [6]. It has been reported that routine admission chest radiography has the highest utility in patients who actually have a clinical indication for chest radiography [7] and that chest radiography demonstrating pathology has a higher influence on clinical treatment decisions than chest radiography without pathologic findings [7–9].…”

Section: Introductionmentioning

confidence: 99%

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A Retrospective Analysis of the Clinical Impact of 939 Chest Radiographs Using the Medical Records

Geijer

Ivarsson

Göthlin

2012

Radiology Research and Practice

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Objective. Between one-third and half of all radiology examinations worldwide are probably chest studies. The aim of the current study was to retrospectively evaluate the clinical influence of chest radiography. Methods. In a tertiary referral hospital, 939 consecutive daytime chest radiography examinations were evaluated. The outcome was classified as normal, incidental, or pathologic. The referring physician's reaction to radiologic outcome was classified as highly expected, moderately expected, or unexpected. The influence on the patients' treatment was divided into four groups from major to no influence. Results. In all, 71.6% of the studies had a highly expected outcome. Moderately expected or unexpected outcomes were noted in 36.6% of 500 pathologic examinations. Unexpected outcome was noted in 11.6% of all studies. The radiologic outcome influenced treatment in 65.4% of patients where pathology was demonstrated. Patients with normal or incidental findings had treatment influenced in 1/3 of the cases. Unexpected findings influenced treatment more than moderately expected findings. When radiological findings were highly expected, treatment was influenced in less than half of the cases. Surprisingly few chest radiology examinations were commented upon in the medical records.

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“…Chest X-ray is the most widely performed radiological study in patients during hospital stays [19]. Recent studies have revealed that aortic arch calcification (AAC) on chest X-ray reflects systemic atherosclerosis and is associated with cardiovascular events [20,21,22,23,24].…”

Section: Introductionmentioning

confidence: 99%

A Novel Evaluation for Predicting Aortic Complicated Lesions Using Calcification on Chest X-ray

Yamaguchi¹,

Yoshimura²,

Koga

et al. 2017

Cerebrovasc Dis

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Background: The aorta is a significant source of cerebral thromboembolisms. Aortic complicated lesions (ACLs) are key findings on transesophageal echocardiography (TEE) for assessing aortic sources of emboli to the brain. TEE is sometimes avoided due to its invasiveness. However, few reports have examined alternative methods for predicting ACLs. We investigated relationships between aortic arch calcification (AAC) on chest X-ray and ACLs. Methods: Participants comprised 300 patients with acute ischemic stroke or transient ischemic attack who underwent TEE for the evaluation of the aortic arch and heart. A postero-anterior plain chest X-ray in the recumbent position was evaluated on admission for each patient. AAC was evaluated using 4 grades (0-3) and “AAC thickness” defined as the distance from the inner margin of the most distant AAC to the outer margin of the aortic vessel wall. ACLs were defined by intima-media thickness (IMT) ≥4.0 mm or presence of ulcerated or mobile plaques. Carotid maximum IMT on ultrasonography was also evaluated. Comparison of the diagnostic ability to predict ACL was performed between AAC grades and AAC thickness or AAC thickness and carotid maximum IMT using the Delong method. Results: ACLs were identified in 71 patients (23.7%), including ACLs with ulcerated plaques in 24 (8.0%) and ACLs with mobile plaques in 9 (3.0%). Plaque thickness was greater in higher AAC grades or higher quartiles of AAC thickness (p for trend <0.001 each). The Cochran-Armitage test showed that both higher AAC grade and higher quartile of AAC thickness were significantly associated with the presence of ACLs, as well as the presence of ulcerated or mobile plaques (p for trend < 0.001 each). Receiver-operating characteristic (ROC) analysis showed optimal cut-off values for AAC thickness of 5.6 mm for ACLs and 6.0 mm for ulcerated or mobile plaques. Multivariate logistic regression revealed a higher grade of AAC (grades 2-3) and AAC thickness (≥6 mm) as significantly associated with ACLs and ulcerated or mobile plaques (p < 0.001 each). ROC curve comparisons showed that AAC thickness offered a better marker of ACLs than AAC grade (p = 0.019), although no significant difference was evident between AAC thickness and carotid maximum IMT (p = 0.567). Conclusions: AAC on chest X-ray, evaluated by both AAC grade and AAC thickness to the outer aortic vessel wall, was significantly associated with ACLs on TEE. AAC thickness was suggested as more useful than AAC grade and equivalent to carotid IMT in predicting ACLs.

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The utility of routine admission chest X-ray films on patient care

Cited by 18 publications

References 5 publications

Chest X‐ray evaluation training: impact of normal and abnormal image ratio and instructional sequence

Chest X‐ray evaluation training: impact of normal and abnormal image ratio and instructional sequence

A Retrospective Analysis of the Clinical Impact of 939 Chest Radiographs Using the Medical Records

A Novel Evaluation for Predicting Aortic Complicated Lesions Using Calcification on Chest X-ray

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