Radiologist variability in assessing the position of the cavoatrial junction on chest radiographs

Chan, Tze Yuan; England, Andrew; Meredith, Sara; McWilliams, Richard G.

doi:10.1259/bjr.20150965

Cited by 22 publications

(14 citation statements)

References 33 publications

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“…A p value less than 0.05 was used to verify statistical significance. The intraclass correlation coefficient (ICC) was used to report the level of agreement between and within the observers [7,27,28], interpreted as follows: < 0.4, poor reproducibility; 0.4-0.75, fair to good reproducibility and > 0.75, excellent reproducibility [7,27]. The scoring scale of -2, -1, 0, 1 and 2 was adjusted to 1, 2, 3, 4 and 5 to facilitate the descriptive statistical analysis.…”

Section: Discussionmentioning

confidence: 99%

Effective dose and image optimisation of lateral lumbar spine radiography: a phantom study

2020

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Background: To investigate lateral lumbar spine radiography technical parameters for reduction of effective dose whilst maintaining image quality (IQ). Methods: Thirty-six radiograms of an anthropomorphic phantom were acquired using different exposure parameters: source-to-detector distance (SDD) (100, 130 or 150 cm), tube potential (75, 85 or 95 kVp), tube current × exposure time product (4.5, 9, 18 mAs) and additional copper (Cu) filter (no filter, 0.1-, 0.2-, or 0.3-mm thickness. IQ was assessed using an objective approach (contrast-to-noise-ratio [CNR] calculation and magnification measurement) and a perceptual approach (six observers); ED was estimated using the PCXMC 2.0 software. Descriptive statistics, paired t test, and intraclass correlation coefficient (ICC) were used. Results: The highest ED (0.022 mSv) was found with 100 cm SSD, 75 kVp, 18 mAs, and without Cu filter, whilst the highest CNR (7.23) was achieved at 130 cm SSD, 75 kVp, 18 mAs, and without Cu filter. The lowest ED and CNR were generated at 150 cm SDD, 95 kVp, 4.5 mAs, and 0.3-mm Cu filter. All observers identified the relevant anatomical structures on all images with the lowest ED and IQ. The intra-observer (0.61-0.79) and inter-observer (0.55-0.82) ICC ranged from moderate to excellent. Conclusion: All relevant anatomical structures were identified on the lateral lumbar spine radiographs despite using low-dose protocols. The lowest ED (0.002 mSv) was obtained with 150 cm SDD, 95 kVp, 4.5 mAs, and 0.3-mm Cu filter. Further technical and clinical studies are needed to verify these preliminary findings.

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Section: Discussionmentioning

confidence: 99%

Effective dose and image optimisation of lateral lumbar spine radiography: a phantom study

2020

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“…Another possible explanation for the low sensitivity might be an imperfect reference standard; some studies suggest that, in the absence of clinical symptoms, CXR should not be considered as a reliable diagnostic method [ 14 ]. There is a large inter-observer variability among radiologists in identifying the cavo-atrial junction on CXRs; therefore, reading of a bedside CXR alone may not be sufficiently accurate to identify intra-atrial tip position [ 6 , 14 , 15 ]. Off note, the risk of developing a serious complication, for example cardiac tamponade, secondary to CVC tip position in the right atrium is virtually zero [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis

et al. 2018

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BackgroundInsertion of a central venous catheter (CVC) is common practice in critical care medicine. Complications arising from CVC placement are mostly due to a pneumothorax or malposition. Correct position is currently confirmed by chest x-ray, while ultrasonography might be a more suitable option. We performed a meta-analysis of the available studies with the primary aim of synthesizing information regarding detection of CVC-related complications and misplacement using ultrasound (US).MethodsThis is a systematic review and meta-analysis registered at PROSPERO (CRD42016050698). PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched. Articles which reported the diagnostic accuracy of US in detecting the position of CVCs and the mechanical complications associated with insertion were included. Primary outcomes were specificity and sensitivity of US. Secondary outcomes included prevalence of malposition and pneumothorax, feasibility of US examination, and time to perform and interpret both US and chest x-ray. A qualitative assessment was performed using the QUADAS-2 tool.ResultsWe included 25 studies with a total of 2548 patients and 2602 CVC placements. Analysis yielded a pooled specificity of 98.9 (95% confidence interval (CI): 97.8–99.5) and sensitivity of 68.2 (95% CI: 54.4–79.4). US examination was feasible in 96.8% of the cases. The prevalence of CVC malposition and pneumothorax was 6.8% and 1.1%, respectively. The mean time for US performance was 2.83 min (95% CI: 2.77–2.89 min) min, while chest x-ray performance took 34.7 min (95% CI: 32.6–36.7 min). US was feasible in 97%. Further analyses were performed by defining subgroups based on the different utilized US protocols and on intra-atrial and extra-atrial misplacement. Vascular US combined with transthoracic echocardiography was most accurate.ConclusionsUS is an accurate and feasible diagnostic modality to detect CVC malposition and iatrogenic pneumothorax. Advantages of US over chest x-ray are that it can be performed faster and does not subject patients to radiation. Vascular US combined with transthoracic echocardiography is advised. However, the results need to be interpreted with caution since included studies were often underpowered and had methodological limitations. A large multicenter study investigating optimal US protocol, among other things, is needed.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-1989-x) contains supplementary material, which is available to authorized users.

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“…Regarding the precision of the CVC tip location, CT is superior (due to its three-dimensional nature) compared with conventional chest radiography, which includes the risk of misinterpreting the ray projection (parallax effect) and inter-individual differences in CVC tip position interpretation. [20][21][22] However, CT is not applicable for routine CVC tip position analysis due to the many-times-higher radiation exposition compared with conventional chest radiography.…”

Section: Discussionmentioning

confidence: 99%

Central venous catheterization for acute trauma resuscitation: Tip position analysis using routine emergency computed tomography

et al. 2018

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Radiologist variability in assessing the position of the cavoatrial junction on chest radiographs

Abstract: No comparisons exist between radiologists in determining CAJ position from CXRs. This report provides evidence of the large observer variability amongst radiologists and adds to the discussion regarding the use of CXRs in validating catheter tip location systems.

Cited by 22 publications

References 33 publications

Effective dose and image optimisation of lateral lumbar spine radiography: a phantom study

Effective dose and image optimisation of lateral lumbar spine radiography: a phantom study

Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis

Central venous catheterization for acute trauma resuscitation: Tip position analysis using routine emergency computed tomography

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