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To assess how early pleural and/or parenchymal abnormalities consistent with asbestos exposure could be ascertained and to identify factors associated with progression.Informed consent was obtained under an institutional review board-approved protocol. Multiple sequential chest radiographs obtained between 1955 and 2004 in 84 workers exposed to amphiboles associated with vermiculite in the town of Libby, Montana, were studied. A panel of three NIOSH B readers reviewed each worker's longitudinal chest radiograph series in reverse chronologic order and achieved a consensus reading for each radiograph. Measures of exposure were compared between workers with and those without progression of parenchymal and pleural abnormalities.Because of the way the study was designed, all subjects had pleural (n = 84) and/or parenchymal (n = 26) abnormalities on the most recent chest radiograph. Compared with other investigations that used different methods, this investigation revealed shorter latency periods (defined as the interval between date of hire and date of earliest radiographic detection) for circumscribed pleural plaque (median latency, 8.6 years) and pleural calcification (median latency, 17.5 years). Pleural abnormalities progressed in 64 workers, while parenchymal abnormalities progressed in 14. No significant differences were found with regard to measures of exposure between workers with and those without progression.The latency period for the development of pleural plaques may be shorter than previously reported. Early plaques are subtle and may not be detectable except at retrospective review.

we reviewed the imaging findings in 7 patients with idiopathic giant bullous emphysema. This is a chronic, progressive condition usually affecting young male smokers and is characterized by giant emphysematous bullae, which commonly develop in the upper lobes. Extensive paraseptal emphysema coalesces to form giant bullae, compressing the normal lung parenchyma and often displacing it centrally. These bullae occupy at least one-third of a hemithorax.Seven patients with chest radiographic evidence of a bulla or bullae occupying at least one-third of a hemithorax, who had also been examined with high-resolution computed tomography (HRCT), were included in this retrospective study. On HRCT scans, the size, location, and distribution of the bullae were documented and categorized as either subpleural or central.The HRCT scan findings in all 7 study patients included numerous bullae ranging in size from a few centimeters in diameter to giant bullae nearly filling an entire hemithorax, mimicking a pneumothorax. Five of the 7 patients had extensive upper lobe predominant bullae, 4 of the 7 patients showed severe bilateral disease with asymmetric involvement, 2 of the 7 patients demonstrated left lung predominance and whereas 1 patient showed right lung predominant disease. All of our patients had subpleural bullae, had parenchymal fibrosis, another had extensive subcutaneous emphysema, and 1 had accompanying bronchiectasis.The predominant findings on HRCT scans are extensive paraseptal emphysema coalescing into giant bullae. HRCT is helpful in confirming the diagnosis of VLS, assessing the degree of the disease, and providing information to guide treatment.

OBJECTIVE. The purpose of this study was to index the contents of the pre-MEDLINE American Journal of Roentgenology into a database that could then be accessed over the World Wide Web.CONCLUSION. The database is composed of more than 8,000 citations from the years 1914 (volume 1) to 1965 (volume 95). Using a Web browser, a user can search the database by year, volume, title word, page, or author. Results are returned sorted by year and page number in a bibliographic format. The database is accessed approximately 200 times per month.

Hemoptysis is defined as the expectoration of blood originating from the tracheobronchial tree or pulmonary parenchyma, ranging from 100 mL to 1 L in volume over a 24-hour period. This article reviews the literature on the indications and usefulness of radiologic studies for the evaluation of hemoptysis. The following recommendations are the result of evidence-based consensus by the American College of Radiology Appropriateness Criteria Expert Panel on Thoracic Radiology: (1) Initial evaluation of patients with hemoptysis should include a chest radiograph; (2) Patients at high risk for malignancy (40 y old,40 pack-year smoking history) with negative chest radiograph, computed tomography (CT) scan, and bronchoscopy can be followed with observation for the following 3 years. Radiography and CT are recommended imaging modalities for follow-up. Bronchoscopy may complement imaging during the period of observation; (3) In patients who are at high risk for malignancy and have suspicious chest radiograph findings, CT is suggested for initial evaluation; CT should also be considered in patients who are active or exsmokers, despite a negative chest radiograph; and (4) Massive hemoptysis can be effectively treated with either surgery or percutaneous embolization. Contrast-enhanced multidetector CT before embolization or surgery can define the source of hemoptysis as bronchial systemic, nonbronchial systemic, and/or pulmonary arterial. Percutaneous embolization may be used initially to halt the hemorrhage before definitive surgery.

Chronic dyspnea of pulmonary origin raises concern for chronic obstructive pulmonary disease or interstitial lung disease. A chest radiograph is recommended as the initial imaging study. When chest radiography is nonrevealing or provides no definitive diagnosis, a high-resolution chest computed tomography is indicated. The high-resolution chest computed tomography should include expiratory imaging in patients with known or suspected air trapping.

This study was designed to achieve a final modeling, validation, and standardization plan for the Wisconsin cystic fibrosis (CF) chest radiographic scoring system. Sixty chest radiographs were selected to reflect a range of severity of lung pathology in children with CF. Seven experienced volunteer raters (three radiologists and four pediatric pulmonologists) from five institutions were recruited to evaluate and score the films. Analysis of scores revealed that the subcomponents of the Wisconsin system showed considerable variation from rater to rater, but reliability assessment indicated satisfactory Cronbach's alpha coefficients (0.83-0.90) among the seven raters. It was found that an additive method of total score computation is significantly more reliable (P < 0.05) than either the original multiplicative model or the traditional Brasfield scoring system. Comparison of radiologists and pulmonologists revealed a marked, systematic difference in scoring with the former group being more conservative in interpretation of abnormalities than the pulmonologists, and some of the raters showing very limited sensitivity. Quantitative chest radiology applied to children with cystic fibrosis studied long-term in longitudinal research projects requires the careful use of sensitive scoring methods and careful selection and training of multiple raters. This is particularly important since pulmonologists and radiologists can differ systematically in interpreting/scoring abnormalities.

Study objective We hypothesized that the radiographic distribution of disease is important in determining pulmonary function, with the lower lung zones of more importance than the upper lung zones. To test this hypothesis, we retrospectively studied patients with cystic fibrosis, a disease with a known proclivity for the upper lung zones. Subjects and methods Two hundred seventy-six chest radiographs obtained at 2- to 3-year intervals from 51 patients were scored by two radiologists using a 100-point visual severity scale. The distribution of disease was assessed by dividing the lungs into four equal horizontal zones and scoring each zone for the severity of disease. There were 146 concurrent chest radiographs and pulmonary function tests from which multiple linear regression was used to correlate these zonal scores with FEV 1 /FVC percent predicted. Results There was excellent interobserver agreement, intraclass correlation coefficients >0.7. The distribution of disease became predominant in the upper lung zones as the patients aged. Although the median score in the upper lung zones was nearly twice that of the lower lung zones, the lower lung zones were nearly three times (partial F ratio; 6.9 lower zone score vs 2.4 upper lung zone score) as important in determining pulmonary function. Conclusions The regional distribution of disease is important in determining pulmonary function. Sparing of the lower lung zones is important in preserving pulmonary function.

More than 10 million airway branches exist in the normal human lung. Radiographic visualization is < 1% of this total. Many diseases affect the airways, each pathologic insult ultimately resulting in obstruction to airflow. Normally there is little resistance to airflow in the small airways (< 2 mm diameter); thus extensive disease may be present before it becomes clinically evident. Centrilobular emphysema is characterized by dilation and destruction of small airways, whereas bronchiolitis obliterans is characterized by concentric fibrous obliteration of small airways. High-resolution computed tomography, particularly comparison of images at full inspiration and full expiration, is the most sensitive radiographic method with which to image small airways disease.

Advanced multiple beam equalization radiography (AMBER) and conventional chest radiography were prospectively evaluated in the detection and quantitation of alveolar (air-space) consolidation. Thirty-seven healthy volunteers underwent bronchoalveolar lavage (BAL), the retained lavage fluid serving as a model for alveolar consolidation. After BAL, the subjects underwent AMBER and conventional chest radiography. The lower lung zones on the radiographs were divided into four zones and graded for alveolar consolidation by three observers. There was no significant difference in the area under the receiver operating characteristic curve between the two techniques in the detection of lavage fluid. The grade of opacification was rated significantly higher (P.05) on conventional radiographs for three of the four lung zones examined, and the correlation between the quantity of retained lavage fluid and grade of opacity was better on conventional radiographs. Detection of lavage fluid was poor with either technique. The exposure compensation of AMBER was evident in this model of air-space disease but did not affect overall observer performance.

Workers exposed to harmful dusts such as coal often are screened for possible pneumoconiosis. A classification devised by the International Labor Office (ILO) is used for film interpretation. Film interpretation is time consuming and requires the comparison of the subject's radiograph with as many as 22 standard films and the completion of a nonintuitive form. A computer program has been written to aid in interpretation of films. This program, written in SuperCard, uses hypermedia concepts to link textual, diagrammatic, and digital images. The program includes digitized ILO radiographs, guidelines, references, and other textual and radiographic material. The program is easy to use and reduces the time required to interpret films. The concepts of how the program is constructed are emphasized so that others may devise similar program aids.

High-resolution computed tomography (CT) was correlated with pulmonary function tests in the evaluation of regional emphysema in 59 smokers. The lung was divided into upper (above the carina tracheae) and lower (below the carina tracheae) zones, and the degree of emphysema was graded with a subjective and an objective measurement. Functional emphysema was defined as a diffusion capacity less than 75% of predicted and forced expiratory volume in 1 second less than 80% of predicted. Three of 15 (20%) subjects with functional emphysema had no subjective evidence of emphysema at high-resolution CT, and 10 of 25 (40%) with emphysema at high-resolution CT had no functional abnormalities consistent with emphysema. Even though the upper lung zones were more severely affected by emphysema, the degree of emphysema in the lower zones had a stronger correlation with pulmonary function abnormalities. The upper lung zones are a relatively silent region where extensive destruction may occur before functional abnormalities become known.

In a patient with acute respiratory illness (cough, sputum production, chest pain, and/or dyspnea), the need for chest imaging depends on the severity of illness, age of the patient, clinical history, physical and laboratory findings, and other risk factors. Chest radiographs seem warranted when one or more of the following are present: ageor = 40; dementia; a positive physical examination; hemoptysis; associated abnormalities (leukocytosis, hypoxemia); or other risk factors, including coronary artery disease, congestive heart failure, or drug-induced acute respiratory failure. Chest CT may be warranted in complicated cases of severe pneumonia and in febrile neutropenic patients with normal or nonspecific chest radiographic findings. Literature on the indications and usefulness of radiologic studies for acute respiratory illness in different clinical settings is reviewed.

It is well known that gravity influences the physiology of the lung and thereby affects the intrapulmonary localization of disease processes. Less well known are the anatomic and physiologic differences in the axial or cross-sectional plane, which also affect the distribution of disease. Physiologic gradients in ventilation, perfusion, and lymph flow and stresses in the lung are present in the axial plane. Anatomic difference in branching patterns, interstitial design, and development of the secondary pulmonary lobules are also found. These regional disparities in anatomy and physiology can be applied to an old concept--the corticomedullary organization of the lung--and are used to consider why some diseases exhibit a propensity for the central or peripheral portions of the lung. The same analysis is applied to the anatomy and physiology in the secondary pulmonary lobule.

The uniform resource locator (URL) is the key element of the World Wide Web, connecting widely separate sources of information. Logically constructed URLs are important in helping users find desired information. URLs can deceive users. Cyber squatting and other practices that manipulate URLs often lead the user to unwanted information. Critical to future scholarship and education is access to full text articles online. This will require consistent and well-constructed URLs.

Preparing images for publication has dealt with film and the photographic process. With picture archiving and communications systems, many departments will no longer produce film. This will change how images are produced for publication. DICOM, the file format for radiographic images, has to be converted and then prepared for traditional publication, 35-mm slides, the newest techniques of video projection, and the World Wide Web. Tagged image file format is the common format for traditional print publication, whereas joint photographic expert group is the current file format for the World Wide Web. Each medium has specific requirements that can be met with a common image-editing program such as Adobe Photoshop (Adobe Systems, San Jose, CA). High-resolution images are required for print, a process that requires interpolation. However, the Internet requires images with a small file size for rapid transmission. The resolution of each output differs and the image resolution must be optimized to match the output of the publishing medium.

Web publishing is becoming a more common method of disseminating information. JavaScript is an object-orientated language embedded into modern browsers and has a wide variety of uses. The use of JavaScript in radiology is illustrated by calculating the indices of sensitivity, specificity, and predictive values from a table of true positives, true negatives, false positives, and false negatives. In addition, a single line of JavaScript code can be used to annotate images, which has a wide variety of uses.

Chronic obstructive pulmonary disease is a group of disorders that have in common abnormal airway structure that results in obstruction to airflow. In emphysema, obstruction is thought to be due to the loss of normal elastic tension in the lung parenchyma. Cigarette smoke is the most important cause of emphysema. Injurious agents, either in the gas or particulate phase, incite a proteolytic reaction in the lung. The type of emphysema and its topographic distribution in the lung stem from normal physiologic processes that concentrate the cigarette puff both within the lung and within the secondary pulmonary lobule.

To test a neural network in differentiation of benign from malignant solitary pulmonary nodules.Neural networks were trained and tested on the characteristics of 318 nodules. Predictive accuracy of the network was judged for calibration and discrimination. Network results were compared with those with a simpler Bayesian method.The Brier score was 0.142 (calibration, 0.003; discrimination, 0.139) for the neural network and 0.133 for the Bayesian analysis (calibration, 0.012; discrimination, 0.121). Analysis of the calibration curve revealed no significant difference (P.05) between the slope (b = 1.09) and the line of identity (b = 1) for the neural network or the Bayesian analysis. The area under the receiver operating characteristic curve was 0.871 for the neural network and 0.894 for the Bayesian analysis (P.05). There were 23 and 21 false-positive predictions and 18 and six false-negative predictions for the neural network and Bayesian analysis, respectively.The Bayesian method was better than the neural network in prediction of probability of malignancy in solitary pulmonary nodules.

Allergic bronchopulmonary aspergillosis (ABPA) is a destructive disease of the lung characteristically associated with central bronchiectasis. This study was designed to determine if high-resolution computerized tomography (CT) could be used to define bronchiectasis in patients with suspected disease. Sixteen patients with asthma were studied. All demonstrated immediate cutaneous reactivity to common aeroallergens including Aspergillus fumigatus. Eight patients had clinical and immunologic evidence of ABPA. Six to 12 high-resolution CT sections (1.5 mm) were obtained at 1- to 2-cm intervals from the aortic knob to the dome of the diaphragm. All radiographs were evaluated separately by two readers in a blinded fashion and graded as to the presence and type of bronchial dilatation and bronchial wall thickening. Bronchial dilatation was seen in 41% of lung lobes in the ABPA group compared to 15% in the non-ABPA asthmatic control group. Upper lobe involvement and bronchial wall thickening was common to both groups. The presence of bronchiectasis in the control group may indicate that asthma is a more destructive lung disease than is currently appreciated. High-resolution CT of the chest has been shown in previous studies to have a sensitivity and specificity approaching that of bronchography, and the current findings support its use in the detection of bronchiectasis in patients with asthma suspected of having ABPA.

A rare pulmonary manifestation of the acquired immunodeficiency syndrome or intravenous (IV) drug abuse is upper lobe cystic disease--pneumatoceles in Pneumocystis carinii pneumonia (PCP) and bullous emphysema in IV drug abuse. Because these disorders overlap, the radiographic findings in 56 patients were compared. During a 12-month period, 16 patients less than 40 years of age were found to have bullous emphysema; the 10 who were IV drug abusers constituted group 1. In the same time period, 40 patients with PCP were encountered; the eight (20%) who had or developed pneumatoceles constituted group 2. In both groups, the conventional radiographic manifestations of upper lobe cystic disease were similar. Eight patients underwent computed tomography of the chest. In five patients with bullous disease, the distribution of the bullous lesions was peripheral, with sparing of the central portions of the lungs. In contrast, PCP pneumatoceles in three patients were dispersed throughout the lung parenchyma.

A case of chest-wall collapse following atelectasis of the lung is reported. The presumed mechanism is abnormal compliance of the chest wall.