Skeletal development of the hand and wrist: digital bone age companion-a suitable alternative to the Greulich and Pyle atlas for bone age assessment?

PURPOSE: To assess reader performance and subjective workflow experience when reporting bone age studies with a digital bone age reference as compared to the Greulich and Pyle atlas (G&P). We hypothesized that pediatric radiologists would achieve equivalent results with each method while digital workflow would improve speed, experience, and reporting quality. MATERIALS AND METHODS: IRB approval was obtained for this HIPAA-compliant study. Two pediatric radiologists performed research interpretations of bone age studies randomized to either the digital (Digital Bone Age Companion, Oxford University Press) or G&P method, generating reports to mimic clinical workflow. Bone age standard selection, interpretation-reporting time, and user preferences were recorded. Reports were reviewed for typographical or speech recognition errors. Comparisons of agreement were conducted by way of Fisher's exact tests. Interpretation-reporting times were analyzed on the natural logarithmic scale via a linear mixed model and transformed to the geometric mean. Subjective workflow experience was compared with an exact binomial test. Report errors were compared via a paired random permutation test. RESULTS: There was no difference in bone age determination between atlases (p = 0.495). The interpretation-reporting time (p < 0.001) was significantly faster with the digital method. The faculty indicated preference for the digital atlas (p < 0.001). Signed reports had fewer errors with the digital atlas (p < 0.001). CONCLUSIONS: Bone age study interpretations performed with the digital method were similar to those performed with the Greulich and Pyle atlas. The digital atlas saved time, improved workflow experience, and reduced reporting errors relative to the Greulich and Pyle atlas when integrated into electronic workflow.

Conversion of teaching file cases from film to digital format: a comparison between use of a diagnostic-quality digitizer and use of a flatbed scanner with transparency adapter.

RATIONALE AND OBJECTIVES: The authors' institution had decided to convert its radiology teaching files from film to digital media. This study was performed to determine the simplest method for converting the analog film images to digital images without a subsequent loss in diagnostic accuracy. MATERIALS AND METHODS: Twenty chest radiographs that demonstrated interstitial lung disease were randomly selected from the departmental teaching files and matched with 20 control radiographs from healthy adults. Analog film images were converted with both a diagnostic-quality film image digitizer (digitized) and a flatbed scanner equipped with a transparency adapter (scanned). Three radiology faculty members reviewed a mixed set of corresponding analog film, digitized, and scanned images. Reviewers judged whether each image depicted interstitial lung disease, indicated their level of confidence in the diagnosis, and rated each image for quality. Image quality was assessed by each reviewer subjectively at the time of viewing the individual image, without regard to other images. A one-way analysis of variance was performed to determine whether there was a statistically significant difference in diagnostic accuracy between the three image formats. Agreement in diagnosis between corresponding images in the three different formats was evaluated for each reviewer with the McNemar test. RESULTS: There was no statistically significant difference in diagnostic accuracy between analog film and scanned images, but there was such a difference between these two groups and digitized images. Accuracy was 97% for analog film, 94% for scanned, and 89% for digitized images. Results of the McNemar test showed no statistically significant difference in agreement between the analog film images and the scanned images for any of the reviewers (P > .05). CONCLUSION: A high-end flatbed scanner with transparency adapter provided accurate, simple, and inexpensive conversion of analog film teaching files to digital format, with no loss of the ability to detect or diagnose subtle abnormalities such as interstitial lung disease.

Dexamethasone therapy in neonates treated with extracorporeal membrane oxygenation.

OBJECTIVE: To test the hypothesis that infants who received dexamethasone would have a shorter length of time on extracorporeal membrane oxygenation (ECMO). Study design Infants placed on ECMO for respiratory failure were randomly assigned to receive either dexamethasone for 3 days or placebo. Chest radiographs were scored through the use of a validated standard scoring system to assess lung injury. RESULTS: Thirty infants received dexamethasone and 29 received placebo. The median (25th%, 75th%) duration of time on ECMO was 143.5 (100, 313) hours in the dexamethasone group and 160 (111, 303) hours in the placebo group (not significant). Survival was 80% in the dexamethasone group and 83% in the placebo group. Radiographic lung injury scores (mean+/-SEM) were significantly improved in the dexamethasone group (10.5+/-0.6) versus placebo (12.3+/-0.5) on day 3 of ECMO (P=.013). Hypertension developed in 27 of the 30 infants receiving dexamethasone and 13 of the 29 infants in the placebo group during ECMO (P<.01). CONCLUSIONS: Dexamethasone given during the first 3 days of ECMO results in significant improvement in lung injury scores by day 3 of ECMO but does not significantly decrease the duration of ECMO or improve survival. The preponderance of evidence would not support the use of dexamethasone in this setting.