Utility of chest CT after a chest X-ray in patients presenting to the ED with non-traumatic thoracic emergencies

Gezer, Naciye Sinem; Balci, Pınar; Tuna, Kemal Çaglar; Akin, İşıl Başara; Barış, Mustafa; Oray, Neşe Çolak

doi:10.1016/j.ajem.2016.12.058

Cited by 10 publications

(7 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While chest X-ray (CXR) is a standard diagnostic procedure in patients suspected of non-traumatic pulmonary disease at the emergency department (ED), chest CT highlights chest pathology better than CXR 1 2. Studies in patients with possible community-acquired pneumonia (CAP) and other non-traumatic pulmonary diseases have demonstrated that the diagnostic accuracy of CXR is limited 3–6. Three studies showed CT markedly improved diagnostic accuracy, and subsequently changed diagnoses and clinical management 4 5 7.…”

Section: Introductionmentioning

confidence: 99%

“…Studies in patients with possible community-acquired pneumonia (CAP) and other non-traumatic pulmonary diseases have demonstrated that the diagnostic accuracy of CXR is limited 3–6. Three studies showed CT markedly improved diagnostic accuracy, and subsequently changed diagnoses and clinical management 4 5 7. CT also requires more radiation and increases the risk of radiation-induced cancer 8 9.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ultra-low-dose CT versus chest X-ray for patients suspected of pulmonary disease at the emergency department: a multicentre randomised clinical trial

Berk

Engelen

Altenburg

et al. 2022

Thorax

View full text Add to dashboard Cite

BackgroundChest CT displays chest pathology better than chest X-ray (CXR). We evaluated the effects on health outcomes of replacing CXR by ultra-low-dose chest-CT (ULDCT) in the diagnostic work-up of patients suspected of non-traumatic pulmonary disease at the emergency department.MethodsPragmatic, multicentre, non-inferiority randomised clinical trial in patients suspected of non-traumatic pulmonary disease at the emergency department. Between 31 January 2017 and 31 May 2018, every month, participating centres were randomly allocated to using ULDCT or CXR. Primary outcome was functional health at 28 days, measured by the Short Form (SF)-12 physical component summary scale score (PCS score), non-inferiority margin was set at 1 point. Secondary outcomes included hospital admission, hospital length of stay (LOS) and patients in follow-up because of incidental findings.Results2418 consecutive patients (ULDCT: 1208 and CXR: 1210) were included. Mean SF-12 PCS score at 28 days was 37.0 for ULDCT and 35.9 for CXR (difference 1.1; 95% lower CI: 0.003). After ULDCT, 638/1208 (52.7%) patients were admitted (median LOS of 4.8 days; IQR 2.1–8.8) compared with 659/1210 (54.5%) patients after CXR (median LOS 4.6 days; IQR 2.1–8.8). More ULDCT patients were in follow-up because of incidental findings: 26 (2.2%) versus 4 (0.3%).ConclusionsShort-term functional health was comparable between ULDCT and CXR, as were hospital admissions and LOS, but more incidental findings were found in the ULDCT group. Our trial does not support routine use of ULDCT in the work-up of patients suspected of non-traumatic pulmonary disease at the emergency department.Trial registration numberNTR6163.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ultra-low-dose CT versus chest X-ray for patients suspected of pulmonary disease at the emergency department: a multicentre randomised clinical trial

Berk

Engelen

Altenburg

et al. 2022

Thorax

View full text Add to dashboard Cite

show abstract

“…The classic imaging approach to mediastinal mass evaluation found on radiography has generally entailed a stepwise progression from chest radiography to CT [12][13][14][15] to diagnostic intervention when needed [16,17], with or without an intervening PET/CT. However, more recent recognition of the long-literature-supported ability of MRI to characterize tissue and add diagnostic specificity [18][19][20][21][22][23], prevent unnecessary biopsy and surgery [24][25][26], and modify and guide the approach to biopsy and surgery [27] has moved MRI into a valued position in terms of workup and triage of these lesions [28][29][30][31][32][33].…”

Section: Summary Of Literature Review Introduction/backgroundmentioning

confidence: 99%

ACR Appropriateness Criteria® Imaging of Mediastinal Masses

Imaging¹,

Ackman

Chung

et al. 2021

Journal of the American College of Radiology

View full text Add to dashboard Cite

Mediastinal masses can present with symptoms, signs, and syndromes or incidentally. Selecting the appropriate diagnostic imaging study for mediastinal mass evaluation requires awareness of the strengths and weaknesses of the various imaging modalities with regard to tissue characterization, soft tissue contrast, and surveillance. This publication expounds on the differences between chest radiography, CT, PET/CT, ultrasound, and MRI in terms of their ability to decipher and surveil mediastinal masses. Making the optimal imaging choice can yield diagnostic specificity, avert unnecessary biopsy and surgery, guide the interventionist when necessary, and serve as a means of surveillance for probably benign, but indeterminate mediastinal masses.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

show abstract

“…However, the use of computed tomography (CT) has become increasingly common for emergency situations because it provides more detailed information than chest radiography, which frequently leads to changes in the diagnosis and the management of patients. CT is used especially for elderly patients and in situations requiring higher resolution than chest radiography; it can also obtain an anteroposterior view with the patient in a supine position (1).…”

Section: Introductionmentioning

confidence: 99%

“…Chest radiography was found by one study to have a sensitivity and specificity of 85% and 93%, respectively, for the diagnosis of cardiogenic pulmonary edema (1). However, if the quality of the radiograph is poor or cardiogenic pulmonary edema is combined with pneumonia or superimposed on a background of a lung disease such as emphysema, radiography findings might be atypical.…”

Section: Introductionmentioning

confidence: 99%

Imaging findings of pulmonary edema: Part 1. Cardiogenic pulmonary edema and acute respiratory distress syndrome

et al. 2019

View full text Add to dashboard Cite

Pulmonary edema has many causes; differentiating between these conditions is important. The purpose of this review article is to describe the pathophysiology of pulmonary edema, thereby explaining the imaging findings that differentiate between etiologies. Chest computed tomography provides details on the physiological response and the changes in the anatomical structures of pulmonary edema. An understanding of the pathophysiology underlying the imaging findings facilitates the correct identification of the cause of pulmonary edema.

show abstract

Utility of chest CT after a chest X-ray in patients presenting to the ED with non-traumatic thoracic emergencies

Cited by 10 publications

References 7 publications

Ultra-low-dose CT versus chest X-ray for patients suspected of pulmonary disease at the emergency department: a multicentre randomised clinical trial

Ultra-low-dose CT versus chest X-ray for patients suspected of pulmonary disease at the emergency department: a multicentre randomised clinical trial

ACR Appropriateness Criteria® Imaging of Mediastinal Masses

Imaging findings of pulmonary edema: Part 1. Cardiogenic pulmonary edema and acute respiratory distress syndrome

Contact Info

Product

Resources

About