Chest radiography in the ICU

Henschke, Claudia I.; Yankelevitz, David F.; Wand, Austin; Davis, Stephanie; Shiau, Maria C.

doi:10.1016/0899-7071(95)00097-6

Cited by 42 publications

(27 citation statements)

References 36 publications

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“…This may well lead to a reduction in the number of invasive procedure-related adverse events and has the potential of improving the treatment of critically ill patients. Additionally, the CXR evaluation provides a significant increase in important information about the patient’s condition, such as the presence of an infiltrate or a pneumothorax or about the position of artificial devices such as central venous catheters or the endotracheal tube [35]. There is no comparable, commonly available and cost-effective diagnostic approach which offers such a wide spectrum of information as that provided by bedside CXRs [36, 37].…”

Section: Discussionmentioning

confidence: 99%

Improving diagnostic accuracy in assessing pulmonary edema on bedside chest radiographs using a standardized scoring approach

et al. 2014

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BackgroundTo assess the value of a score-based system which allows standardized evaluation of pulmonary edema on bedside chest radiographs (CXRs) under routine clinical conditions.MethodsSeven experienced readers assessed bedside CXRs of ten patients with an extravascular lung water (EVLW)-value of ≤ 8 mL/kg (range: 4–8 mL/kg; indicates no pulmonary edema) and a series of ten patients with an EVLW-value of ≥ 15 mL/kg (range: 15–21 mL/kg; = indicates a pulmonary edema) with and without customized software which would permit a standardized assessment of the various indications of pulmonary edema. The software provides a score that identifies patients with and without pulmonary edema. EVLW-values were measured instantly after bedside CXR imaging using a pulse contour cardiac output (PiCCO) system and served as a reference standard. The patients were non-traumatic and not treated with diuretics or dobutamine during bedside CXR imaging and the PiCCO measurements. Mean sensitivity, specificity, positive and negative predictive value, the percentage of overall agreement and the free-marginal multirater kappa value was calculated for both the standard and the standardized score-based approach. The net reclassification index was calculated for each reader as well as for all readers.ResultsEvaluation of bedside CXRs by means of the score-based approach took longer (23 ± 12 seconds versus 7 ± 3 seconds without the use of the software) but improved radiologists’ sensitivity (from 57 to 77%), specificity (from 90 to 100%) and the free-marginal multirater kappa value (from 0.34 to 0.68). The positive predictive value was raised from 85 to 100% and the negative predictive value from 68 to 81%. A net reclassification index of 0.3 (all readers) demonstrates an improvement in prediction performance gained by the score-based approach. The percentage of overall agreement was 67% with the standard approach and 84% with the software-based approach.ConclusionsThe diagnostic accuracy of bedside CXRs to discriminate patients with elevated EVLW-values from those with a normal value can be improved with the use of a standardized score-based approach. The investigated system is freely available as a web-based application (accessible via: http://www.radiologie.uk-erlangen.de/aerzte-und-zuweiser/edema).

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Section: Discussionmentioning

confidence: 99%

Improving diagnostic accuracy in assessing pulmonary edema on bedside chest radiographs using a standardized scoring approach

et al. 2014

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“…In addition the transportation of critically ill patients to the radiology department combined with the radiation exposure carries a measurable risk. On the other hand, limitations of bedside CXR have been well described and lead to poor-quality X-ray films with low sensitivity [2][3][4]. Indeed it has been shown that even under carefully controlled exposure conditions more than 30% of the X-ray films are considered suboptimal [2,5].…”

Section: Introductionmentioning

confidence: 99%

Lung ultrasound in critically ill patients: comparison with bedside chest radiography

et al. 2011

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“…Monitoring of the proper position of devices and possible lung pathologies plays an important role in the ICU due to its significant impact on patient management [2]. A malpositioned device may not have the desired effect or, in the worst case, may harm the patient.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, monitoring of proper position of devices and possible lung pathologies is important due to its significant impact on patient management [2].…”

Section: Introductionmentioning

confidence: 99%

Interpretation of bedside chest X-rays in the ICU: is the radiologist still needed?

et al. 2015

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Chest radiography in the ICU

Cited by 42 publications

References 36 publications

Improving diagnostic accuracy in assessing pulmonary edema on bedside chest radiographs using a standardized scoring approach

Improving diagnostic accuracy in assessing pulmonary edema on bedside chest radiographs using a standardized scoring approach

Lung ultrasound in critically ill patients: comparison with bedside chest radiography

Interpretation of bedside chest X-rays in the ICU: is the radiologist still needed?

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