Schiavon F, Nardini S, Favat M, Vardanega A, Tregnaghi P
Servizio di Radiologia Este-Montagnana (PD), ULSS 17.
Radiol Med. 1998 Jul-Aug;96(1-2):48-54.
More chest radiographs are presently performed in the elderly, especially the hospitalized ones. Reading these images is difficult because of the involutions in the thoracic cage, heart and lungs and the scars or calcifications from different abnormal causes. In the elderly, bronchogenic carcinoma may present as an occasional "coin" lesion and therefore such a finding may be an important diagnostic problem and require some expensive and dangerous examinations next. We investigated the relative frequency of questionable abnormal findings in the daily reading of the chest radiographs of elderly patients, the relative importance of the radiologist's experience and of the examination execution technique; the relative costs were also evaluated.
Four radiologists, two of them more experienced (FS, PT), read the consecutive chest radiographs of 811 elderly patients (273 men, 538 women) hospitalized May to December, 1997. Four hundred and ten of them were 65-75 years old and 401 over 75 (particularly, 28 were over 90). Five hundred and sixty-five chest radiographs were made with the AMBER technique and 246 with frontal views only. T-MAT G RA Kodak high-contrast films with Kodak Lanex green-transmitting intensifying screens were used in all cases. CT scans were made with conventional (CT Sytec 3000, GE) or spiral (X Vision, Toshiba) scanners.
Seven hundred and fifty-seven radiographs were considered adequate (93%) and 54 inadequate (7%) for diagnosis (25 in patients 65-75 years old, 25 in patients 75-80 and 4 in patients over 90). Thirty-eight of these 54 inadequate radiographs had been made with the AMBER technique and 16 with frontal views only. The more experienced radiologists read 27 (11%) and 19 (10%) of them and the less experienced ones read 4 (2%) and 4 (3%), respectively. The next examinations were other projections and/or radioscopy (4 cases), conventional tomography (7 cases), CT (43 cases), and US (2 cases). "Coin" lesions were the major cause of questionable diagnosis, especially in posterior (10 cases) and peripheral (7 cases) regions, where the differential diagnosis was with vertebral osteophytosis and small rib crowding, respectively.
More skilled radiologists have more doubts reading the chest radiographs of elderly patients. But the next examinations will likely balance the needless ones after an initial misdiagnosis. The chest of elderly patients remains a complex and very little known subject and the reader's experience plays an important role. The examination execution technique must be as accurate as possible in both optimal and suboptimal settings.
目前，老年患者，尤其是住院患者，进行胸部X光检查的次数更多。由于胸廓、心脏和肺部的退变以及不同异常原因导致的疤痕或钙化，解读这些影像很困难。在老年人中，支气管源性癌可能表现为偶尔的“硬币”状病变，因此这样的发现可能是一个重要的诊断问题，接下来可能需要进行一些昂贵且有风险的检查。我们调查了老年患者胸部X光片日常解读中可疑异常发现的相对频率、放射科医生经验和检查执行技术的相对重要性；还评估了相关成本。
四位放射科医生，其中两位经验更丰富（FS、PT），阅读了1997年5月至12月住院的811例老年患者（273名男性，538名女性）的连续胸部X光片。其中410人年龄在65 - 75岁之间，401人年龄在75岁以上（特别是，28人年龄在90岁以上）。565张胸部X光片采用AMBER技术拍摄，246张仅采用正位片。所有病例均使用柯达T - MAT G RA高对比度胶片和柯达Lanex绿色增感屏。CT扫描使用传统（GE公司的CT Sytec 3000）或螺旋（东芝公司的X Vision）扫描仪。
757张X光片被认为足以用于诊断（93%），54张不足以用于诊断（7%）（65 - 75岁患者中有25张，75 - 80岁患者中有25张，90岁以上患者中有4张）。这54张不充分的X光片中，38张是采用AMBER技术拍摄的，16张仅采用正位片。经验更丰富的放射科医生分别阅读了其中的27张（11%）和19张（10%），经验较少的放射科医生分别阅读了4张（2%）和4张（3%）。接下来的检查包括其他投照和/或透视（4例）、传统断层扫描（7例）、CT（43例）和超声（2例）。“硬币”状病变是可疑诊断的主要原因，尤其是在后部（10例）和周边（7例）区域，在这些区域分别需要与椎体骨质增生和小肋骨拥挤进行鉴别诊断。
经验更丰富的放射科医生在解读老年患者的胸部X光片时会有更多疑问。但在最初误诊后，接下来的检查可能会平衡不必要的检查。老年患者的胸部仍然是一个复杂且鲜为人知的主题，读者的经验起着重要作用。在最佳和次佳情况下，检查执行技术都必须尽可能准确。
