Schiavon F, Nardini S, Tregnaghi P, Favat M, Sandri P, Bergamo S
Servizio di Radiologia, U.L.S.S. 17, Este-Montagnana, PD.
Radiol Med. 1997 Sep;94(3):193-7.
We investigated the capabilities of chest radiography in the elderly considering that the examination must meet the main clinical indications of this population and that it is necessary in the elderly because the correct clinical assessment is often difficult or impossible.
We reviewed the chest radiographs of 756 consecutive elderly patients admitted to our hospital from September 1 to October 31, 1996. If possible, chest radiographs were performed with the AMBER technique (156 patients, 20.7%); 240 patients (31.7%) underwent conventional radiography and the others frontal projections only (360 patients, 47.6%). T-MAT G RA Kodak high contrast films with Kodak Lanex green transmitting intensifying screens were used in all cases. The AMBER examinations of 48/156 patients with hemodynamic clinical indications were repeated with conventional frontal projections. Radiographic reports were made separately by different radiologists who considered especially the diagnostic accuracy of every examination in determining the venous overload of pulmonary circulation.
Hemodynamic studies are the most frequent clinical indication of chest radiography in elderly patients (228/756 patients in our series, 30.2%); moreover, even if careful cardiac and pulmonary circulation studies are very important in these patients, only 52.4% of all radiographs could be made in two orthogonal projections. The blurred appearance of vascular landmarks indicating increased extravascular fluid is better depicted by conventional radiography (59.7% of cases) than by AMBER (40.3%).
We conclude that the reduced pulmonary contrast obtained with the so-called "hard X-ray" technique poorly depicts the blurred appearance of pulmonary vessels in pulmonary venous overload. Moreover, "hard X-ray" techniques can be only sporadically used because elderly patients are often in very critical conditions, which prevents this type of examination.
鉴于胸部X线检查必须满足该人群的主要临床指征，且在老年人中进行此项检查很有必要，因为正确的临床评估往往困难或无法进行，我们对老年人胸部X线检查的能力进行了研究。
我们回顾了1996年9月1日至10月31日连续收治入院的756例老年患者的胸部X线片。若可能，采用AMBER技术进行胸部X线检查（156例患者，占20.7%）；240例患者（占31.7%）接受了传统X线检查，其余患者仅进行了正位投照（360例患者，占47.6%）。所有病例均使用柯达高对比度T-MAT G RA胶片及柯达Lanex绿色增感屏。对48/156例有血流动力学临床指征的患者，用传统正位投照重复进行了AMBER检查。不同放射科医生分别撰写放射学报告，特别考虑了每次检查在确定肺循环静脉超负荷方面的诊断准确性。
血流动力学研究是老年患者胸部X线检查最常见的临床指征（我们系列中的228/756例患者，占30.2%）；此外，即使在这些患者中仔细的心脏和肺循环研究非常重要，但所有X线片中只有52.4%能在两个相互垂直的投照位上进行。显示血管外液增多的血管标志模糊外观，传统X线检查（59.7%的病例）比AMBER检查（40.3%）显示得更好。
我们得出结论，所谓“硬X线”技术获得的肺部对比度降低，难以很好地显示肺静脉超负荷时肺血管的模糊外观。此外，“硬X线”技术只能偶尔使用，因为老年患者往往病情危急，无法进行此类检查。
