Avoiding unnecessary bronchoscopy in children with suspected foreign body aspiration using computed tomography.
Creator
Gibbons AT; Casar BAM; Hanke RE; McNinch NL; Person A; Mehlman T; Rubin M; Ponsky TA
Publisher
Journal of Pediatric Surgery
Date
2020
2020-01
Description
BACKGROUND: Bronchoscopy is the standard of care for diagnosis and treatment of foreign body aspiration (FBA). Drawbacks of this approach include its invasiveness, the potential for exacerbation of reactive airway disease, and the need for general anesthesia. Computed tomography (CT) can potentially identify patients with FBA, thereby avoiding unnecessary bronchoscopies in patients with at-risk reactive airways. METHODS: A retrospective review was performed to identify patients who underwent CT and/or bronchoscopy for suspected foreign body aspiration (FBA) from June 2012 to September 2018. Variables included clinical history, exam findings, radiographic findings, and operative findings. A telephone survey was performed for patients who had a CT without bronchoscopy. Three radiologists performed rereads of all CTs. RESULTS: A total of 133 patients were evaluated for FBA, and 84 were treated with bronchoscopy. For those with a CT demonstrating a foreign body, findings were confirmed on bronchoscopy in 17/18 (94.4%). For those with bronchoscopy alone, 39/64 (60.9%) were found to have a foreign body (p < 0.01). CT excluded FBA in 49 patients. Sensitivity was 100%, specificity was 98%, and interobserver reliability was excellent (κ = 0.88). CONCLUSION: CT is an accurate and reliable diagnostic tool in the evaluation of FBA that can increase the rate of positive bronchoscopy. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: Level III.
Speed of sound imaging: improved image quality in breast sonography.
Creator
Barr Richard G; Rim Alice; Graham Ruffin; Berg Wendie; Grajo Joseph R
Publisher
Ultrasound quarterly
Date
2009
2009-09
Description
PURPOSE: The purpose of this study was to evaluate blindly breast ultrasound images corrected for the speed of sound in breast tissue compared with conventional images. MATERIALS AND METHODS: In this study, 409 images from 153 patients were obtained on an Antares Ultrasound system. The system was modified to process the radiofrequency data with the standard 1540 m/s as the speed of sound and at a corrected speed of sound for breast tissue. An offline
Subject
*Artifacts; Breast Diseases – Classification; Breast Diseases – Diagnosis; Continuing (Credit); Education; Equipment and Supplies; Female; Funding Source; Human; Humans; Image Enhancement/*methods; Mammary/*methods; Middle Aged; Observer Variation; Quality of Health Care; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography; Ultrasonography – Methods
Using the Sauvegrain method to predict peak height velocity in boys and girls.
Creator
Hans Sarah D; Sanders James O; Cooperman Daniel R
Publisher
Journal of pediatric orthopedics
Date
2008
2008-12
Description
BACKGROUND: Correlating peak height velocity (PHV) with assessments of skeletal maturity has important implications in the treatment of scoliosis and other pediatric orthopaedic disorders. This study aims to compare the appearance of the elbow to the PHV in both boys and girls. METHODS: We selected 20 children who participated in the Brush Inquiry, a comprehensive study of the development of healthy children. The PHV was identified for each subject. Three observers used the Sauvegrain method to score the elbow maturity of these subjects at 5 visits (PHV -2 years, PHV -1 year, PHV, PHV +1 year, PHV +2 years). Reliability was tested with intraclass correlation coefficients, and maturity scores were compared with the PHV timing. RESULTS: An interrater reliability score of r = 0.915 and an intrarater reliability score of r = 0.909 indicate that this method can be reliably and consistently applied to differentiate elbow x-rays of varying skeletal maturities in children. The mean total scores of boys and girls seem to be equal at the 5 visits. There were no total scores of 26 or higher for boys or girls at PHV. CONCLUSIONS: The Sauvegrain score in adolescent boys and girls is reliable, and a score of 26 or higher indicates that the child has passed PHV. There is a strong trend for the mean total score of boys to equal that of girls at each stage relative to the PHV. LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions to Authors for a complete description of levels of evidence.
Subject
*Growth; Adolescence; Adolescent; Age Determination by Skeleton – Methods; Age Determination by Skeleton/*methods; Body Height – Physiology; Body Height/*physiology; Child; Elbow – Radiography; Elbow/*diagnostic imaging; Female; Follow-Up Studies; Growth; Human; Humans; Male; Observer Bias; Observer Variation; Prospective Studies; Reproducibility of Results; Reproduction; Sex Characteristics
McCulloch J; Frymoyer J; Steurer P; Riaz G; Hurst F
Publisher
Journal of spinal disorders
Date
1993
1993-10
Description
Thermography has been proposed as a diagnostic aid in patients with sciatica. Supporters of thermography state that: (a) normal patients have normal thermograms of their lower extremities, and (b) abnormal patients (with disk ruptures causing sciatica) have abnormal thermograms. To test these two hypotheses, 56 patients with clinically documented acute sciatica, with a supporting diagnostic study [computed tomography (CT), CT/myelography, and/or magnetic resonance imaging] showing a ruptured disk, had presurgical thermograms. One year after surgical intervention, they had to have had a documented success to surgical treatment intervention to stay in the study. These 56 patients were then matched with 56 control (normal) patients who had electronic thermograms. The 112 thermograms were then interpreted blindly by two thermographers. The sensitivity and specificity of thermography as a diagnostic aid in sciatica were statistically analyzed. The sensitivity of thermography (its ability to be positive when sciatica was clinically obvious) was 60% and 50% for the two thermographic readers. The specificity of thermography (its ability to be negative in asymptomatic patients) was 45% and 48% for the two thermographers. Our conclusions are no different than those published in 1985: thermography is not useful as a diagnostic aid in sciatica.
Agreement Between an Automated Volume Breast Scanner and Handheld Ultrasound for Diagnostic Breast Examinations.
Creator
Barr Richard G; DeVita Robert; Destounis Stamatia; Manzoni Federica; De Silvestri Annalisa; Tinelli Carmine
Publisher
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
Date
2017
2017-10
Description
OBJECTIVES: To compare the agreement and interobserver variability of diagnostic handheld ultrasound (US) and a single volume on an automated breast volume scanner (ABVS) and to determine whether there was a significant difference if the ABVS was used by a sonographer or mammographic technologist. METHODS: Ninety patients scheduled for diagnostic US examinations were randomized to either handheld US or the ABVS first. The AVBS was randomized between a sonographer and a mammographic technologist performing the study. The studies were blinded, randomized, and read by 2 radiologists. The lesion with the highest Breast Imaging Reporting and Data System (BI-RADS) score was used in the analysis. Final diagnoses were made by core biopsy or follow-up for 2 years. Lesions included 9 malignant and 81 benign. RESULTS: The 90 patients had a mean age +/- SD of 53.1 +/- 16.3 years. The kappa value for agreement between the ABVS and handheld US was 0.831 (95% confidence interval, 0.744-0.925), whereas the global agreement for a 7-point BI-RADS score was 0.488 (0.372-0.560). The agreement between the ABVS and handheld US was nearly the same when the ABVS was used by a mammographic technologist (kappa = 0.858 [0.723-0.963]) or sonographer (kappa = 0.803 [0.596-1.000]; P = .47). The areas under the receiver operating characteristic curves for characterization by the ABVS were 0.91 (0.84-0.96) for reader 1 and 0.91 (0.83-0.96) for reader 2; those for handheld US were 0.91 (0.84-0.96) for reader 1 and 0.83 (0.74-0.90) for reader 2, with no statistical difference. The agreement based on pathologic images was kappa = 0.831 (0.718-0.944); for handheld US, kappa = 0.795 (0.623-0.967); and for the AVBS, kappa = 0.869 (0.725-1.000). CONCLUSIONS: Performing a single-view diagnostic ABVS examination has good agreement with a handheld diagnostic US workup. There is no difference if the ABVS is used by a sonographer or mammographic technologist.
Subject
automated breast ultrasound; Automated/*methods; breast; Breast Neoplasms/*diagnostic imaging; breast ultrasound; Breast/diagnostic imaging; diagnostic workup; Female; Humans; Mammary/*instrumentation/*methods; Middle Aged; Observer Variation; Pattern Recognition; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography; ultrasound; volumetric breast ultrasound