Emergency Medicine: Open Access
Open Access
ISSN: 2165-7548
ISSN: 2165-7548
Saleh Al Hetela, Zohair Al Aseri and J Scott Delaney
Objectives: Digital radiology is relatively new technology that allows the examiner a number of advantages. The objective of this study is to evaluate the efficacy of digital chest radiography using plain expiratory and inspiratory images to detect Pneumothorax and comparison of observer performance between residents and experienced Emergency Department (ED) physicians.
Methods: Plain digital images of chest radiographs containing expiratory and inspiratory views, requested to exclude Pneumothorax from January 2000 to December 2003 were included. All images were reviewed independently by three experienced ED physician and three ED residents. The physicians were asked to decide on the presence or absence of a Pneumothorax, its site, size and its percentage of occupying area. The physician’s reports were recorded and compared with reports of consultant radiologists as a standard.
Results: A total of 252 sets of inspiratory and expiratory films were ordered. Of the 118 pairs that met the inclusion and exclusion criteria, 76 pairs (64.4%) were positive for Pneumothorax using the standard consultant radiologist’s reports. Overall sensitivity was 72.6% (CI ± 4.2) for inspiratory and 80.0% (CI ± 3.7) for expiratory films (P=0.001), with a specificity of 69.4% (CI ± 4.6) for inspiratory and 73.1% (CI ± 4.8) for expiratory films (P=0.12). The kappa for agreement was 0.65, 0.52, and 0.32 for the presence of Pneumothoraces, their size (small, medium, or large), and their percentage of occupying the area of pleural cavity respectively.
Conclusion: Expiratory images on a digital viewer are more sensitive than inspiratory images for detecting Pneumothoraces, and this difference is decreased with expert physician’s review. The agreement was poor when a percentage is used to describe the size of the Pneumothorax occupying Pleural cavity.