Description and validation of a scoring system for tomosynthesis in pulmonary cystic fibrosis

Steyern, Kristina Vult von; Björkman–Burtscher, Isabella M.; Höglund, Peter; Božović, Gracijela; Wiklund, Marie; Geijer, Mats

doi:10.1007/s00330-012-2534-y

Cited by 34 publications

(32 citation statements)

References 40 publications

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“…New strategies are, therefore, needed to provide a more reliable evaluation of bedside CXRs. It has been shown, that, in the case of radiological evaluations, a scoring-based approach which allows a standardized analysis of various radiographic indicators can be beneficial in a variety of tasks [9–12]. We developed and assessed customized scoring software, implemented as a web-based application, which facilitates a standardized assessment of the presence of pulmonary edema.…”

Section: Introductionmentioning

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: Introductionmentioning

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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“…As a next step in the evaluation of CTS in the imaging of CF patients, our group intends to compare the proposed modified version of the Brody II scoring system with the CF scoring system for CTS previously proposed by Vult von Steyern et al 17 . The comparison will be done in terms of inter-and intraobserver rating agreement, by letting a number of observers use both scoring systems on CTS images from CF patients.…”

Section: Discussionmentioning

confidence: 99%

“…The establishment of a CF scoring system appropriate for use with CTS images would be one first step in the evaluation of the use of CTS within this patient group. To the authors' knowledge, only one such scoring system has been proposed previously 17 , based on scoring systems used for both radiographs and CT images. The purpose of the present study was to develop an alternative CF scoring system for CTS, by starting from an existing scoring system dedicated for CT images and making modifications to it regarded as necessary in order to make it appropriate for use with CTS images.…”

Section: Introductionmentioning

confidence: 99%

Application of a computed tomography based cystic fibrosis scoring system to chest tomosynthesis

Söderman

Johnsson

Vikgren

et al. 2013

Medical Imaging 2013: Image Perception, Observer Performance, and Technology Assessment

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In the monitoring of progression of lung disease in patients with cystic fibrosis (CF), recurrent computed tomography (CT) examinations are often used. The relatively new imaging technique chest tomosynthesis (CTS) may be an interesting alternative in the follow-up of these patients due to its visualization of the chest in slices at radiation doses and costs significantly lower than is the case with CT. A first step towards introducing CTS imaging in the diagnostics of CF patients is to establish a scoring system appropriate for evaluating the severity of CF pulmonary disease based on findings in CTS images. Previously, several such CF scoring systems based on CT imaging have been published. The purpose of the present study was to develop a CF scoring system for CTS, by starting from an existing scoring system dedicated for CT images and making modifications regarded necessary to make it appropriate for use with CTS images. In order to determine any necessary changes, three thoracic radiologists independently used a scoring system dedicated for CT on both CT and CTS images from CF patients. The results of the scoring were jointly evaluated by all the observers, which lead to suggestions for changes to the scoring system. Suggested modifications include excluding the scoring of air trapping and doing the scoring of the findings in quadrants of the image instead of in each lung lobe.

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“…studies were focused on cystic fibrosis (3,4) and asbestosis (5). These articles suggested greater sensitivity and interobserver agreement with DTS than with radiography in detecting cystic fibrosis and asbestos-related changes (4,5); however, direct comparison between DTS and CT for detecting these disease processes has not been reported.…”

Section: Letters To the Editormentioning

confidence: 97%

Insights into Digital Tomosynthesis of Interstitial Lung Disease

Marcy¹

2014

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Description and validation of a scoring system for tomosynthesis in pulmonary cystic fibrosis

Cited by 34 publications

References 40 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

Application of a computed tomography based cystic fibrosis scoring system to chest tomosynthesis

Insights into Digital Tomosynthesis of Interstitial Lung Disease

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