Eisenberg Ronald L, Romero Janneth, Litmanovich Diana, Boiselle Phillip M, Bankier Alexander A
Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
Radiology. 2009 Sep;252(3):882-7. doi: 10.1148/radiol.2523082019. Epub 2009 Jun 9.
To test the hypothesis that lateral radiography adds no clinically relevant information to that acquired with posteroanterior (PA) radiography in individuals with positive purified protein derivative (PPD) skin test results.
As part of routine practice, all 875 adults with positive PPD skin test results at pre-employment examinations performed at a medical center during 2007 underwent PA and lateral chest radiography. In this institutional review board-approved HIPAA-compliant study, the patient informed consent requirement was waived. Two radiologists retrospectively and independently interpreted each radiograph for evidence of abnormalities that were indicative of acute or chronic tuberculosis (TB) infection. First, only the PA radiograph was analyzed. Thereafter, both the PA radiograph and the lateral radiograph were analyzed together to determine if any observed finding was identified on only the lateral radiograph. If a finding was seen on both images, a determination was made as to whether the finding on the lateral radiograph changed the radiologist's decision based on the PA radiograph alone.
The PA radiograph revealed abnormalities in all 91 (10.4%) subjects with positive findings at radiography. The lateral radiograph revealed no abnormality in 75 subjects (83.4%). All abnormalities seen on lateral radiographs were also seen on PA radiographs. When abnormalities were seen on both images, the information on the lateral image never caused the radiologist to change the decision he or she made on the basis of the PA image alone.
In a pre-employment setting, one PA radiograph is sufficient for TB screening of individuals with positive PPD skin test results. Elimination of the acquisition of lateral radiographs would substantially reduce radiation exposure.
验证以下假设，即在结核菌素纯蛋白衍生物（PPD）皮肤试验结果呈阳性的个体中，侧位X线摄影相较于后前位（PA）X线摄影未提供任何具有临床相关性的额外信息。
作为常规检查的一部分，2007年在一家医疗中心进行入职前检查时，所有875名PPD皮肤试验结果呈阳性的成年人都接受了PA位和侧位胸部X线摄影。在这项经机构审查委员会批准且符合《健康保险流通与责任法案》（HIPAA）的研究中，患者的知情同意要求被豁免。两名放射科医生对每张X线片进行回顾性且独立的解读，以寻找提示急性或慢性结核（TB）感染的异常证据。首先，仅分析PA位X线片。此后，同时分析PA位和侧位X线片，以确定是否有任何观察到的异常仅在侧位X线片上被发现。如果在两张图像上均发现异常，则判断侧位X线片上的异常是否改变了放射科医生仅基于PA位X线片所做出的诊断。
PA位X线片显示，所有91名（10.4%）X线摄影有阳性结果的受试者均存在异常。侧位X线片显示75名受试者（83.4%）无异常。在侧位X线片上看到的所有异常在PA位X线片上也均可见。当两张图像上均出现异常时，侧位图像上的信息从未导致放射科医生改变其仅基于PA位图像所做出的诊断。
在入职前检查中，一张PA位X线片足以对PPD皮肤试验结果呈阳性的个体进行结核病筛查。取消侧位X线片的拍摄将大幅减少辐射暴露。
