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Reliability of frontal chest x-ray in diagnosing pulmonary opacities in children
Y Patenaude1, C Blais, C P Leduc
1Department of Radiology, Hôpital Ste-Justine, Montreal, Québec, Canada.
Insights
A single frontal chest x-ray reliably detects pulmonary opacities in children with suspected pneumonia. This finding supports WHO guidelines, though interpreting bronchial thickening remains challenging.
Area of Science:
- Pediatric Radiology
- Diagnostic Imaging
- Pulmonary Medicine
Background:
- The World Health Organization advises against routine lateral chest x-rays for pediatric pneumonia.
- The diagnostic accuracy of frontal chest x-rays alone for pulmonary opacities is not well-established.
Purpose of the Study:
- To evaluate the reliability of frontal chest x-rays compared to combined frontal and lateral views in diagnosing pulmonary opacities in children.
- To assess if frontal view interpretation aligns with interpretations using both views.
Main Methods:
- Prospective study of 373 pediatric chest x-rays (ages 0-17) for suspected pneumonia.
- One radiologist interpreted frontal views; three radiologists interpreted both frontal and lateral views.
- William's index was used to calculate inter-rater reliability.
Main Results:
- High inter-rater reliability (William's index = 0.98) was observed for frontal view interpretation.
- Radiologists using only frontal views showed agreement comparable to those using both views.
- The presence of definite pulmonary opacity on frontal views predicted its presence on combined views.
Conclusions:
- Frontal chest x-rays alone are reliable for detecting definite pulmonary opacities in children with suspected pneumonia.
- Challenges persist in interpreting bronchial thickening and peribronchial alveolar confluences, regardless of the views used.
Rationale And Objectives:
The World Health Organization recommends that the routine investigation of children with suspected pneumonia should not include lateral chest x-rays. However, the reliability of the frontal view alone in the diagnosis of pulmonary opacities has not been reported.
Methods:
The authors studied prospectively 373 consecutive chest x-rays of children, ranging in age from 0 to 17 years, who were examined for suspected pneumonia. One radiologist interpreted the frontal view, and the diagnoses were compared with those of three radiologists who interpreted both frontal and lateral x-rays.
Results:
William's index for rater reliability was 0.98 for all ages (95% confidence interval: 0.94, 1.00). Thus, a radiologist using only a frontal view would agree with members of an independent group using both frontal and lateral views as often as an isolated member of that group would agree with the other group members.
Conclusions:
Detecting a definite pulmonary opacity on the frontal view alone predicts its presence on frontal-lateral views. However, the interpretation of bronchial thickening and peribronchial alveolar confluences as opacities is a problem remaining on either frontal or frontal-lateral views.