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ACR–SPR-STR Practice Parameter for the Performance of Chest Radiography
The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States. The College is a nonprofit professional society whose primary purposes are to advance the science of radiology, improve radiologic services to the patient, study the socioeconomic aspects of the practice of radiology, and encourage continuing education for radiologists, radiation oncologists, medical physicists, and persons practicing in allied professional fields. The American College of Radiology will periodically define new practice parameters and technical standards for radiologic practice to help advance the science of radiology and to improve the quality of service to patients throughout the United States. Existing practice parameters and technical standards will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice parameter and technical standard, representing a policy statement by the College, has undergone a thorough consensus process in which it has been subjected to extensive review and approval. The practice parameters and technical standards recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice parameter and technical standard by those entities not providing these services is not authorized. Revised 2017 (Resolution 2)* ACR–SPR–STR PRACTICE PARAMETER FOR THE PERFORMANCE OF CHEST RADIOGRAPHY PREAMBLE This document is an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. Practice Parameters and Technical Standards are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care1. -
Part Two Physical Processes in Oceanography
Part Two Physical Processes in Oceanography 8 8.1 Introduction Small-Scale Forty years ago, the detailed physical mechanisms re- Mixing Processes sponsible for the mixing of heat, salt, and other prop- erties in the ocean had hardly been considered. Using profiles obtained from water-bottle measurements, and J. S. Turner their variations in time and space, it was deduced that mixing must be taking place at rates much greater than could be accounted for by molecular diffusion. It was taken for granted that the ocean (because of its large scale) must be everywhere turbulent, and this was sup- ported by the observation that the major constituents are reasonably well mixed. It seemed a natural step to define eddy viscosities and eddy conductivities, or mix- ing coefficients, to relate the deduced fluxes of mo- mentum or heat (or salt) to the mean smoothed gra- dients of corresponding properties. Extensive tables of these mixing coefficients, KM for momentum, KH for heat, and Ks for salinity, and their variation with po- sition and other parameters, were published about that time [see, e.g., Sverdrup, Johnson, and Fleming (1942, p. 482)]. Much mathematical modeling of oceanic flows on various scales was (and still is) based on simple assumptions about the eddy viscosity, which is often taken to have a constant value, chosen to give the best agreement with the observations. This approach to the theory is well summarized in Proudman (1953), and more recent extensions of the method are described in the conference proceedings edited by Nihoul 1975). Though the preoccupation with finding numerical values of these parameters was not in retrospect always helpful, certain features of those results contained the seeds of many later developments in this subject. -
VIEW Open Access Ultrasound and Non‑Ultrasound Imaging Techniques in the Assessment of Diaphragmatic Dysfunction Franco A
Laghi Jr. et al. BMC Pulm Med (2021) 21:85 https://doi.org/10.1186/s12890-021-01441-6 REVIEW Open Access Ultrasound and non-ultrasound imaging techniques in the assessment of diaphragmatic dysfunction Franco A. Laghi Jr.1, Marina Saad2 and Hameeda Shaikh3,4* Abstract Diaphragm muscle dysfunction is increasingly recognized as an important element of several diseases including neuromuscular disease, chronic obstructive pulmonary disease and diaphragm dysfunction in critically ill patients. Functional evaluation of the diaphragm is challenging. Use of volitional maneuvers to test the diaphragm can be limited by patient efort. Non-volitional tests such as those using neuromuscular stimulation are technically complex, since the muscle itself is relatively inaccessible. As such, there is a growing interest in using imaging techniques to characterize diaphragm muscle dysfunction. Selecting the appropriate imaging technique for a given clinical sce- nario is a critical step in the evaluation of patients suspected of having diaphragm dysfunction. In this review, we aim to present a detailed analysis of evidence for the use of ultrasound and non-ultrasound imaging techniques in the assessment of diaphragm dysfunction. We highlight the utility of the qualitative information gathered by ultrasound imaging as a means to assess integrity, excursion, thickness, and thickening of the diaphragm. In contrast, quantitative ultrasound analysis of the diaphragm is marred by inherent limitations of this technique, and we provide a detailed examination of these limitations. We evaluate non-ultrasound imaging modalities that apply static techniques (chest radiograph, computerized tomography and magnetic resonance imaging), used to assess muscle position, shape and dimension. We also evaluate non-ultrasound imaging modalities that apply dynamic imaging (fuoroscopy and dynamic magnetic resonance imaging) to assess diaphragm motion. -
Diagnostic Use of Lung Ultrasound Compared to Chest Radiograph for Suspected Pneumonia in a Resource-Limited Setting Yogendra Amatya1, Jordan Rupp2, Frances M
Amatya et al. International Journal of Emergency Medicine (2018) 11:8 International Journal of https://doi.org/10.1186/s12245-018-0170-2 Emergency Medicine ORIGINAL RESEARCH Open Access Diagnostic use of lung ultrasound compared to chest radiograph for suspected pneumonia in a resource-limited setting Yogendra Amatya1, Jordan Rupp2, Frances M. Russell3, Jason Saunders3, Brian Bales2 and Darlene R. House1,3* Abstract Background: Lung ultrasound is an effective tool for diagnosing pneumonia in developed countries. Diagnostic accuracy in resource-limited countries where pneumonia is the leading cause of death is unknown. The objective of this study was to evaluate the sensitivity of bedside lung ultrasound compared to chest X-ray for pneumonia in adults presenting for emergency care in a low-income country. Methods: Patients presenting to the emergency department with suspected pneumonia were evaluated with bedside lung ultrasound, single posterioranterior chest radiograph, and computed tomography (CT). Using CT as the gold standard, the sensitivity of lung ultrasound was compared to chest X-ray for the diagnosis of pneumonia using McNemar’s test for paired samples. Diagnostic characteristics for each test were calculated. Results: Of 62 patients included in the study, 44 (71%) were diagnosed with pneumonia by CT. Lung ultrasound demonstrated a sensitivity of 91% compared to chest X-ray which had a sensitivity of 73% (p = 0.01). Specificity of lung ultrasound and chest X-ray were 61 and 50% respectively. Conclusions: Bedside lung ultrasound demonstrated better sensitivity than chest X-ray for the diagnosis of pneumonia in Nepal. Trial registration: ClinicalTrials.gov, registration number NCT02949141. Registered 31 October 2016. -
ICD-10 Codes Are a Valid Tool for Identification of Pneumonia In
Epidemiol. Infect. (2008), 136, 232–240. f 2007 Cambridge University Press doi:10.1017/S0950268807008564 Printed in the United Kingdom ICD-10 codes are a valid tool for identification of pneumonia in hospitalized patients aged o65 years S. A. SKULL 1,2*, R. M. ANDREWS 2, G.B. BYRNES3, D.A. CAMPBELL3,4, 3 5 3,6 T. M. NOLAN , G.V. BROWN AND H.A. KELLY 1 Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Parkville, Victoria, Australia 2 Menzies School of Health Research, Darwin, Northern Territory, Australia 3 School of Population Health, University of Melbourne, Victoria, Australia 4 Monash Institute of Health Services Research, Monash Medical Centre, Clayton, Victoria, Australia 5 Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia 6 Victorian Infectious Diseases Reference Laboratory, North Melbourne, Victoria, Australia (Accepted 28 March 2007; first published online 20 April 2007) SUMMARY This study examines the validity of using ICD-10 codes to identify hospitalized pneumonia cases. Using a case-cohort design, subjects were randomly selected from monthly cohorts of patients aged o65 years discharged from April 2000 to March 2002 from two large tertiary Australian hospitals. Cases had ICD-10-AM codes J10–J18 (pneumonia); the cohort sample was randomly selected from all discharges, frequency matched to cases by month. Codes were validated against three comparators: medical record notation of pneumonia, chest radiograph (CXR) report and both. Notation of pneumonia was determined for 5098/5101 eligible patients, and CXR reports reviewed for 3349/3464 (97%) patients with a CXR. Coding performed best against notation of pneumonia: kappa 0.95, sensitivity 97.8% (95% CI 97.1–98.3), specificity 96.9% (95% CI 96.2–97.5), positive predictive value (PPV) 96.2% (95% CI 95.4–97.0) and negative predictive value (NPV) 98.2% (95% CI 97.6–98.6). -
Diffusion at Work
or collective redistirbution of any portion of this article by photocopy machine, reposting, or other means is permitted only with the approval of The Oceanography Society. Send all correspondence to: [email protected] ofor Th e The to: [email protected] Oceanography approval Oceanography correspondence POall Box 1931, portionthe Send Society. Rockville, ofwith any permittedUSA. articleonly photocopy by Society, is MD 20849-1931, of machine, this reposting, means or collective or other redistirbution article has This been published in hands - on O ceanography Oceanography Diffusion at Work , Volume 20, Number 3, a quarterly journal of The Oceanography Society. Copyright 2007 by The Oceanography Society. All rights reserved. Permission is granted to copy this article for use in teaching and research. Republication, systemmatic reproduction, reproduction, Republication, systemmatic research. for this and teaching article copy to use in reserved.by The 2007 is rights ofAll granted journal Copyright Oceanography The Permission 20, NumberOceanography 3, a quarterly Society. Society. , Volume An Interactive Simulation B Y L ee K arp-B oss , E mmanuel B oss , and J ames L oftin PURPOSE OF ACTIVITY or small particles due to their random (Brownian) motion and The goal of this activity is to help students better understand the resultant net migration of material from regions of high the nonintuitive concept of diffusion and introduce them to a concentration to regions of low concentration. Stirring (where variety of diffusion-related processes in the ocean. As part of material gets stretched and folded) expands the area available this activity, students also practice data collection and statisti- for diffusion to occur, resulting in enhanced mixing compared cal analysis (e.g., average, variance, and probability distribution to that due to molecular diffusion alone. -
Assessment of High Resolution Computed Tomography in the Diagnosis of Interstitial Lung Disease
International Journal of Research in Medical Sciences Ayush M et al. Int J Res Med Sci. 2018 Jul;6(7):2251-2255 www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20182403 Original Research Article Assessment of high resolution computed tomography in the diagnosis of interstitial lung disease Mridul Ayush1*, Ishita Jakhanwal2 1Department of Radio-Diagnosis and Imaging, Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India 2Director, Ayucare Diagnostic Centre, Pune, Maharashtra, India Received: 15 May 2018 Accepted: 21 May 2018 *Correspondence: Dr. Mridul Ayush, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Interstitial lung disease (ILD) are group of pulmonary disorders characterized by inflammation and fibrosis of gas exchanging portion of the lung and diffuse abnormalities on lung radiograph. Conventional computerized tomography plays a limited role in evaluation of interstitial lung disease due to its inability to demonstrate fine parenchymal details. High Resolution Computed Tomography (HRCT) is currently the most accurate non invasive modality for evaluating lung- parenchyma. So, the purpose of the study was to assess high resolution computed tomography in the diagnosis of interstitial lung disease. Methods: 50 patients with clinical suspicion of interstitial lung disease who were referred to Department of Radio- Diagnosis and Imaging for diagnosis and evaluation were subjected to both conventional radiography and HRCT. -
What Is the Difference Between Osmosis and Diffusion?
What is the difference between osmosis and diffusion? Students are often asked to explain the similarities and differences between osmosis and diffusion or to compare and contrast the two forms of transport. To answer the question, you need to know the definitions of osmosis and diffusion and really understand what they mean. Osmosis And Diffusion Definitions Osmosis: Osmosis is the movement of solvent particles across a semipermeable membrane from a dilute solution into a concentrated solution. The solvent moves to dilute the concentrated solution and equalize the concentration on both sides of the membrane. Diffusion: Diffusion is the movement of particles from an area of higher concentration to lower concentration. The overall effect is to equalize concentration throughout the medium. Osmosis And Diffusion Examples Examples of Osmosis: Examples of osmosis include red blood cells swelling up when exposed to fresh water and plant root hairs taking up water. To see an easy demonstration of osmosis, soak gummy candies in water. The gel of the candies acts as a semipermeable membrane. Examples of Diffusion: Examples of diffusion include perfume filling a whole room and the movement of small molecules across a cell membrane. One of the simplest demonstrations of diffusion is adding a drop of food coloring to water. Although other transport processes do occur, diffusion is the key player. Osmosis And Diffusion Similarities Osmosis and diffusion are related processes that display similarities. Both osmosis and diffusion equalize the concentration of two solutions. Both diffusion and osmosis are passive transport processes, which means they do not require any input of extra energy to occur. -
Role of Chest X-Ray with Ultrasonography in Evaluation of Pneumonia in an Icu Setting: a Prospective Study
ARC Journal of Radiology and Medical Imaging Volume 4, Issue 2, 2019, PP 1 -14 www.arcjournals.org Role of Chest X-Ray with Ultrasonography in Evaluation of Pneumonia in an Icu Setting: A Prospective Study Dr. Som Biswas* DMRD, M.S., Dr. Satish Pande. M.D., D.N.B, Ph.D. Department of Radiodiagnosis, King Edward Memorial Hospital, Pune, India *Corresponding Author: Som Biswas, Resident, Department of Radio diagnosis, KEM Pune, India Email: [email protected] Abstract Aim: Evaluation of role of Chest X-ray & Ultrasonography in pneumonia in an ICU setting. Introduction: Critically ill patients frequently need thoracic imaging due to dynamic nature of their clinical conditions. I studied the role of Chest X-ray & Ultrasonography in patient with pneumonia in an ICU setting in KEM Hospital, Pune. Materials and Methods: The present study was carried out at KEM Hospital, Pune in the Intensive Care Unit from 1st June 2018 to 31st May 2019 on patients with findings of pneumonia. Sample size: 150 patients as per calculation Summary and Conclusion Lung sonography was able to evaluate homogeneous opacities, air bronchogram, Kerley- A line, Kerley- B line, fluid in pleural space. The limitations of ultrasonography were non visualization of inhomogeneous opacities and volume loss. Thus lung sonography is complimentary for evaluation of pneumonia along with chest radiography. 1. INTRODUCTION cause of death worldwidede, preceded only by ischemic heart disease and cerebrovascular Critically ill patients frequently need thoracic diseases. It is the leading infectious cause of imaging due to dynamic nature of their clinical death and one of the most common reasons for conditions. -
Gas Exchange and Respiratory Function
LWBK330-4183G-c21_p484-516.qxd 23/07/2009 02:09 PM Page 484 Aptara Gas Exchange and 5 Respiratory Function Applying Concepts From NANDA, NIC, • Case Study and NOC A Patient With Impaired Cough Reflex Mrs. Lewis, age 77 years, is admitted to the hospital for left lower lobe pneumonia. Her vital signs are: Temp 100.6°F; HR 90 and regular; B/P: 142/74; Resp. 28. She has a weak cough, diminished breath sounds over the lower left lung field, and coarse rhonchi over the midtracheal area. She can expectorate some sputum, which is thick and grayish green. She has a history of stroke. Secondary to the stroke she has impaired gag and cough reflexes and mild weakness of her left side. She is allowed food and fluids because she can swallow safely if she uses the chin-tuck maneuver. Visit thePoint to view a concept map that illustrates the relationships that exist between the nursing diagnoses, interventions, and outcomes for the patient’s clinical problems. LWBK330-4183G-c21_p484-516.qxd 23/07/2009 02:09 PM Page 485 Aptara Nursing Classifications and Languages NANDA NIC NOC NURSING DIAGNOSES NURSING INTERVENTIONS NURSING OUTCOMES INEFFECTIVE AIRWAY CLEARANCE— RESPIRATORY MONITORING— Return to functional baseline sta- Inability to clear secretions or ob- Collection and analysis of patient tus, stabilization of, or structions from the respiratory data to ensure airway patency improvement in: tract to maintain a clear airway and adequate gas exchange RESPIRATORY STATUS: AIRWAY PATENCY—Extent to which the tracheobronchial passages remain open IMPAIRED GAS -
Routine Chest Radiography Variant 1: No Clinical Concern on Basis of History Or Physical Examination
Date of origin: 2000 Last review date: 2015 American College of Radiology ACR Appropriateness Criteria® Clinical Condition: Routine Chest Radiography Variant 1: No clinical concern on basis of history or physical examination. Radiologic Procedure Rating Comments RRL* X-ray chest routine preoperative 3 ☢ X-ray chest routine admission 3 ☢ X-ray chest routine outpatient 2 ☢ *Relative Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate Radiation Level Variant 2: Suspicion of acute or potentially unstable chronic cardiopulmonary disease by history or physical examination. Radiologic Procedure Rating Comments RRL* X-ray chest routine admission 9 ☢ X-ray chest routine preoperative 8 ☢ X-ray chest routine outpatient 8 ☢ *Relative Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate Radiation Level Variant 3: Increased risk, patient- or procedure-related (ie, advanced age [particularly >70 years], unreliable history and physical examination, high-risk surgery). Radiologic Procedure Rating Comments RRL* X-ray chest routine preoperative 7 ☢ X-ray chest routine admission 7 ☢ X-ray chest routine outpatient 6 ☢ *Relative Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate Radiation Level ACR Appropriateness Criteria® 1 Routine Chest Radiography ROUTINE CHEST RADIOGRAPHY Expert Panel on Thoracic Imaging: Barbara L. McComb, MD1; Jonathan H. Chung, MD2; Traves D. Crabtree, MD3; Darel E. Heitkamp, MD4; Mark D. Iannettoni, MD5; Clinton Jokerst, MD6; Anthony G. Saleh, MD7; Rakesh D. Shah, MD8; Robert M. Steiner, MD9; Tan-Lucien H. Mohammed, MD10; James G. -
The Role of High Resolution Computed Tomography in the Diagnosis of Interstitial Lung Disease
Thorax 1991;46:77-84 77 THORAX Thorax: first published as 10.1136/thx.46.2.77 on 1 February 1991. Downloaded from Review The role of high resolution computed tomography in the diagnosis of interstitial lung disease David M Hansell, Ian H Kerr Until recently the chest radiograph has been study. This protocol is widely used when a the only imaging technique used in the assess- comprehensive examination of the lungs is ment of patients with suspected diffuse lung required-for example, in the search for disease. In this context the chest radiograph is metastases. The volume averaging that occurs less than ideal. Problems arise with both false within the 1 cm thickness of the scan, negative and false positive results. It is well however, substantially reduces the ability of established that the chest radiograph may conventional computed tomography to resolve appear entirely normal in up to 10% of small structures. For high resolution com- patients with biopsy proved diffuse lung dis- puted tomography the section thickness is ease of various causes,1 and a poor quality reduced to 1-3 mm and a different software chest radiograph, especially of an obese reconstruction of the image is used to improve patient, may misleadingly raise the spectre of spatial resolution (figs la and lb). These scans diffuse lung disease. The two dimensional are interspaced by at least 1 cm. Where 3 mm nature of a chest radiograph dictates that there sections are taken 1 cm apart the radiation is superimposition of structures over the lungs dose to the breast is reduced to about half that and it has been estimated that up to 40% of of conventional computed tomography.