ABSTRACT
Computer-assisted diagnosis (CAD) algorithms have shown its usefulness for the identification of pulmonary nodules in chest x-rays, but its capability to diagnose lung cancer (LC) is unknown. A CAD algorithm for the identification of pulmonary nodules was created and used on a retrospective cohort of patients with x-rays performed in 2008 and not examined by a radiologist when obtained. X-rays were sorted according to the probability of pulmonary nodule, read by a radiologist and the evolution for the following three years was assessed. The CAD algorithm sorted 20,303 x-rays and defined four subgroups with 250 images each (percentiles ≥ 98, 66, 33 and 0). Fifty-eight pulmonary nodules were identified in the ≥ 98 percentile (23,2%), while only 64 were found in lower percentiles (8,5%) (p < 0.001). A pulmonary nodule was confirmed by the radiologist in 39 out of 173 patients in the high-probability group who had follow-up information (22.5%), and in 5 of them a LC was diagnosed with a delay of 11 months (12.8%). In one quarter of the chest x-rays considered as high-probability for pulmonary nodule by a CAD algorithm, the finding is confirmed and corresponds to an undiagnosed LC in one tenth of the cases.
Subject(s)
Lung Neoplasms , Multiple Pulmonary Nodules , Solitary Pulmonary Nodule , Humans , X-Rays , Tomography, X-Ray Computed/methods , Retrospective Studies , Solitary Pulmonary Nodule/diagnostic imaging , Radiographic Image Interpretation, Computer-Assisted/methods , Sensitivity and Specificity , Lung Neoplasms/diagnostic imaging , Diagnosis, Computer-Assisted/methods , Multiple Pulmonary Nodules/diagnostic imagingABSTRACT
El acceso a una espirometría de calidad es un objetivo imprescindible para poder minimizar el infradiagnósticode las enfermedades respiratorias, especialmente en las más frecuentes, como la EPOC y el asma.Este objetivo es alcanzable a corto plazo pero requiere la integración simultánea de estrategias diversas:formación de los profesionales que deben realizar la espirometría, definición de estándares para la transmisiónde la información, programa de control de calidad requerimientos técnicos en las adquisicionesde aparatos y la correcta interpretación de los resultados.El presente trabajo muestra la utilización de estándares para el intercambio electrónico de informaciónclínica. Para normalizar el tratamiento de los datos relacionados con la espirometría y permitir elintercambio de información se ha utilizado el estándar CDA R2 (Clinical Document Architecture, Release2) de HL7 (Health Level Seven) versión 3. HL7 es un producto de HL7 International, una organizaciónno lucrativa que se dedica a la producción de estándares en el ámbito de la salud para facilitar lainteroperabilidad.La definición de este estándar, además, es imprescindible para asegurar la adopción del mismo porparte de los fabricantes de espirómetros. Mediante este proceso se ponen las bases para facilitar el accesoa la espirometría desde todos los ámbitos asistenciales y, a su vez, es un elemento técnico fundamentalpara disenar los programas de control de calidad de las exploraciones (AU)
Access to quality spirometry is an essential objective in order to be able to minimize the underdiagnosisof respiratory diseases, especially in those that are most frequent, such as COPD and asthma. Thisobjective can be reached in the short term, but it requires the simultaneous integration of differentstrategies: training of the health-care professionals who perform spirometry, definition of standards forthe transmission of the information, technical requirements for acquiring apparatuses and the correctinterpretation of the results.This present study shows the use of standards for the electronic exchange of clinical information.In order to normalize the treatment of the data related with spirometry and to enable the exchangeof information, we have used the standard CDA R2 (Clinical Document Architecture, Release 2) of HL7(Health Level Seven), version 3. HL7 is a product by HL7 International, a non-profit organization thatdeals in the production of standards in the health-care setting in order to facilitate interoperability.Furthermore, defining these standards is essential for ensuring that they are adopted by spirometermanufacturers. Be means of this process, the base is set for facilitating access to spirometry at the healthcarelevel, while at the same time it is a fundamental technical element for designing quality controlprograms of the explorations (AU)
Subject(s)
Spirometry/standards , Spirometry/instrumentation , Spirometry/trends , Quality Control , Reference StandardsABSTRACT
Access to quality spirometry is an essential objective in order to be able to minimize the underdiagnosis of respiratory diseases, especially in those that are most frequent, such as COPD and asthma. This objective can be reached in the short term, but it requires the simultaneous integration of different strategies: training of the health-care professionals who perform spirometry, definition of standards for the transmission of the information, technical requirements for acquiring apparatuses and the correct interpretation of the results. This present study shows the use of standards for the electronic exchange of clinical information. In order to normalize the treatment of the data related with spirometry and to enable the exchange of information, we have used the standard CDA R2 (Clinical Document Architecture, Release 2) of HL7 (Health Level Seven), version 3. HL7 is a product by HL7 International, a non-profit organization that deals in the production of standards in the health-care setting in order to facilitate interoperability. Furthermore, defining these standards is essential for ensuring that they are adopted by spirometer manufacturers. Be means of this process, the base is set for facilitating access to spirometry at the health-care level, while at the same time it is a fundamental technical element for designing quality control programs of the explorations.
