Chest
Postgraduate Education CornerChest Imaging ReviewInterpretation of Plain Chest Roentgenogram
Section snippets
The Importance of Dual Readings
There are three reasons for our emphasis on the importance of dual reading of the CXR by the radiologist and the clinician. First, subtle lesions may be missed on the plain CXR either by the clinician or the radiologist. The number may be as high as 19% of early lung cancers.8 Therefore, a dual “backup” and independent reading of the CXR by a radiologist and a clinician may reduce the number of such missed lesions. Quality of care has become the mantra of all medical centers, so a “free second
Clinical History and Physical Examination
The clinical history and physical examination should provide the basis for differential diagnoses before the CXR is obtained.15 Duration and severity of symptoms and signs of infection, risk of lung cancer, or coronary artery disease will help to narrow the differential diagnosis. Social, occupational, and travel history are equally important. For example, a person who lived in an area endemic for histoplasmosis may present with mediastinal and hilar adenopathy (Fig 1). Although the
Advancements in Imaging of Plain Chest Radiographs
There have been remarkable advances in the quality of digital chest images since a letter appeared in this journal by Bennett E. Ojserkis24 that questioned the diagnostic quality of plain film chest images obtained using digital equipment. The present status of plain chest imaging is that digital images have become the norm in many radiology departments, especially in the United States and Europe. The resolution of the images is now equal to or greater than the resolution of hard-copy plain
Summary
Understanding the properties of plain chest radiography, including its advantages and pitfalls, is important to successful interpretation. Skills in interpreting CXR must be maintained, since every pulmonary patient does not need a CT scan of the chest. Pursuing a systematic search for lesions on the CXR will minimize missed lesions. The most difficult film to read is a normal CXR. Confidence in calling a CXR as normal comes from the accrued experience gained after reading hundreds of CXRs.
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Sung was the principal investigator for Broncus Technologies 2007 to 2009. Drs Suhail Raoof, Feigin, Sabiha Raoof, Irugulpati, and Rosenow have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
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