Enhanced visualization of mobile chest X-ray images in the intensive care setting using software scatter correction.

BACKGROUND: Mobile chest X-ray (CXR) scans are performed within intensive treatment units (ITU) without anti-scatter grids for confirming tube and line hardware placement. Assessment is therefore challenging due to degraded subject contrast resulting from scatter. PURPOSE: To evaluate the efficacy of a software scatter correction method (commercially named Trueview) for enhanced hardware visualization and diagnostic quality in the ITU setting. MATERIAL AND METHODS: A total of 30 CXR scans were processed using Trueview and compared with standard original equipment manufacturer (OEM) images via observer scoring study involving two radiology and four ITU doctors to compare visualization of tubes and lines. Results were analyzed to determine observer preference and likelihood of diagnostic quality. RESULTS: Reviewers were more likely to score Trueview higher than OEM for mediastinal structures, bones, retrocardiac region, tube visibility, and tube safety (P < 0.01). Visual grading characteristic analysis suggested a clinical preference for Trueview compared with OEM for mediastinal structures (area under the visual grading characteristic curve [AUCVGC] = 0.60, 95% confidence interval [CI] = 0.55-0.65), bones (AUCVGC = 0.61, 95% CI = 0.55-0.66), retrocardiac region (AUCVGC = 0.64, 95% CI = 0.59-0.69), tube visibility (AUCVGC = 0.65, 95% CI = 0.60-0.70), and tube safety (AUCVGC = 0.68, 95% CI = 0.64-0.73). Reviewers were indifferent to visualization of the lung fields (AUCVGC = 0.49, 95% CI = 0.44-0.55). Registrars (3/6 reviewers) were indifferent to the mediastinal structure regions (AUCVGC = 0.54, 95% CI = 0.47-0.62). CONCLUSION: Reviewers were more confident in identifying the placement and safety of tubes and lines when reviewing Trueview images than they were when reviewing OEM.

Assessment of the Subarachnoid Hemorrhage International Trialists (SAHIT) Models for Dichotomized Long-Term Functional Outcome Prediction After Aneurysmal Subarachnoid Hemorrhage in a United Kingdom Multicenter Cohort Study.

BACKGROUND: Long-term outcome after subarachnoid hemorrhage, beyond the first few months, is difficult to predict, but has critical relevance to patients, their families, and carers. OBJECTIVE: To assess the performance of the Subarachnoid Hemorrhage International Trialists (SAHIT) prediction models, which were initially designed to predict short-term (90 d) outcome, as predictors of long-term (2 yr) functional outcome after aneurysmal subarachnoid hemorrhage (aSAH). METHODS: We included 1545 patients with angiographically-proven aSAH from the Genetic and Observational Subarachnoid Haemorrhage (GOSH) study recruited at 22 hospitals between 2011 and 2014. We collected data on age, WNFS grade on admission, history of hypertension, Fisher grade, aneurysm size and location, as well as treatment modality. Functional outcome was measured by the Glasgow Outcome Scale (GOS) with GOS 1 to 3 corresponding to unfavorable and 4 to 5 to favorable functional outcome, according to the SAHIT models. The SAHIT models were assessed for long-term outcome prediction by estimating measures of calibration (calibration slope) and discrimination (area under the receiver-operating characteristic curve [AUC]) in relation to poor clinical outcome. RESULTS: Follow-up was standardized to 2 yr using imputation methods. All 3 SAHIT models demonstrated acceptable predictive performance for long-term functional outcome. The estimated AUC was 0.71 (95% CI: 0.65-0.76), 0.73 (95% CI: 0.68-0.77), and 0.74 (95% CI: 0.69-0.79) for the core, neuroimaging, and full models, respectively; the calibration slopes were 0.86, 0.84, and 0.89, indicating good calibration. CONCLUSION: The SAHIT prediction models, incorporating simple factors available on hospital admission, show good predictive performance for long-term functional outcome after aSAH.

Extra Physiotherapy in Critical Care (EPICC) Trial Protocol: a randomised controlled trial of intensive versus standard physical rehabilitation therapy in the critically ill.

INTRODUCTION: Patients discharged from Critical Care suffer from excessive longer term morbidity and mortality. Physical and mental health measures of quality of life show a marked and immediate fall after admission to Critical Care with some recovery over time. However, physical function is still significantly reduced at 6 months. The National Institute for Health and Care Excellence clinical guideline on rehabilitation after critical illness, identified the need for high-quality randomised controlled trials to determine the most effective rehabilitation strategy for critically ill patients at risk of critical illness-associated physical morbidity. In response to this, we will conduct a randomised controlled trial, comparing physiotherapy aimed at early and intensive patient mobilisation with routine care. We hypothesise that this intervention will improve physical outcomes and the mental health and functional well-being of survivors of critical illness. METHODS AND ANALYSIS: 308 adult patients who have received more than 48 h of non-invasive or invasive ventilation in Critical Care will be recruited to a patient-randomised, parallel group, controlled trial, comparing two intensities of physiotherapy. Participants will be randomised to receive either standard or intensive physiotherapy for the duration of their Critical Care admission. Outcomes will be recorded on Critical Care discharge, at 3 and 6 months following initial recruitment to the study. The primary outcome measure is physical health at 6 months, as measured by the SF-36 Physical Component Summary. Secondary outcomes include assessment of mental health, activities of daily living, delirium and ventilator-free days. We will also include a health economic analysis. ETHICS AND DISSEMINATION: The trial has ethical approval from Newcastle and North Tyneside 2 Research Ethics Committee (11/NE/0206). There is a Trial Oversight Committee including an independent chair. The results of the study will be submitted for publication in peer-reviewed journals and presented at national and international scientific meetings. TRIAL REGISTRATION NUMBER: ISRCTN20436833.