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Aim: To determine interobserver agreement between paediatric radiologists interpreting tuberculosis (TB) screening chest radiographs (CXR) in children in the UK, and the TB detection rate., Materials and Methods: A retrospective review was undertaken of electronic request, notes, and CXRs (>7 years) in children exposed to an infectious case of TB and new entrants to the UK, at a tertiary children's hospital. Included were those with positive Mantoux/interferon gamma release assay (IGRA), positive culture, or high clinical suspicion of TB. CXR reports were categorised as normal, abnormal without features of TB, or abnormal with features of pulmonary TB. Three paediatric radiologists from a dedicated paediatric radiology department evaluated available CXRs, aware of the TB screening indication, using a published CXR reporting tool and blinded to the initial CXR report and to each other. A majority decision was collated, and considered lymphadenopathy and miliary nodules as diagnostic of primary TB. Interobserver agreement was calculated using Cohen's kappa., Results: One hundred and forty-eight children underwent TB screening with a CXR. One hundred and twenty-five had available CXR reports and case notes, which indicated 20/125 (16%) had CXR features of TB. One hundred and twenty-one of the 125 had CXRs available to for panel review. Twenty of these 121 (17%) yielded a majority decision of pulmonary TB. Inter-reader agreement was moderate in all aspects (kappa 0.4-0.6)., Conclusion: The high percentage of pulmonary TB on CXR (16% original reports; 17% by panel review) suggests that it is worthwhile investigating childhood TB contacts; however, the routine use and recommendation for CXR is questionable because of only moderate interpretation reliability (kappa 0.5), even by experts., (Copyright © 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Chest radiographs are frequently requested prior to diagnostic angiography, though there is no published evidence of their clinical utility. This study was undertaken to evaluate their contribution to patient management. The routine chest radiographs obtained prior to peripheral and coronary angiography in 240 patients were prospectively reviewed for abnormalities likely to affect management. Two hundred and twenty (91.7%) examinations were performed, of which 164 were obtained within 24 h of angiography. Previous radiographs were available in 154 patients (64.2%). One hundred and sixteen radiographs were normal. There were 117 abnormalities on the radiographs of 104 patients, mainly cardiac enlargement and heart failure. No angiogram was postponed or cancelled because of abnormalities detected on a routine radiograph, although radiographic findings led to a change in the volume of contrast medium injected into dilated aortic roots in 10 patients undergoing cardiac catheterization. Pre-angiography radiographs had no effect on the practice of peripheral angiography. In only one patient were further investigations and therapy instigated because of findings, but even in this case these findings were present on previous studies. We conclude that routine pre-angiography chest radiographs are not necessary in the absence of specific clinical indications.

The chest radiographs of 600 consecutive patients undergoing insertion of a permanent cardiac pacemaker were reviewed to determine the incidence and nature of abnormalities present. Abnormalities were detected on the chest radiographs of 131 patients (21.8%). Unsatisfactory electrode tip position and other features related to the electrode wire were commonest (14.4%). Complications related to the lungs and pleura were present in 5.5%, and those related to the generator and pouch least frequent (1.9%). Complications occurred more frequently following installation of a replacement system (48.3%) compared to new systems (17.2%). Important complications not initially detected included pneumothorax (8/15) and poor electrode loop (26/27). Chest radiographs following permanent cardiac pacing frequently demonstrate significant abnormalities whose detection is improved by awareness of their incidence and nature.