RESUMO
Thoracic ultrasound is an appealing alternative to chest radiography for the diagnosis of TB. Based on research experience conducting thoracic ultrasound for adults and children in South Africa, three key considerations for potential scale-up were identified. First, thoracic ultrasound requires a comprehensive training programme for novice users; artificial intelligence may be used to simplify training and interpretation. Second, a robust ultrasound device is needed with good subpleural resolution and a probe suitable for children. Third, comprehensive scanning of the lungs is time-intensive, and shorter scanning protocols may be more feasible in clinical practice.
L'échographie thoracique est une alternative attrayante à la radiographie pulmonaire pour le diagnostic de la TB. En prenant appui sur l'expérience acquise lors d'études ayant utilisé l'échographie thoracique chez l'adulte et l'enfant en Afrique du Sud, trois considérations clés pour une éventuelle utilisation accrue de cet outil ont été identifiées. Premièrement, tout nouvel utilisateur d'un échographe thoracique doit suivre un programme de formation exhaustif. L'intelligence artificielle pourrait être utilisée pour simplifier la formation et l'interprétation des résultats. Deuxièmement, un échographe de qualité est nécessaire, avec une bonne résolution sous-pleurale et une sonde adaptée à l'enfant. Troisièmement, une scannographie exhaustive des poumons est chronophage ; des protocoles de scannographie plus courts pourraient être plus faciles en pratique clinique.
Assuntos
Acidentes por Quedas , Dor nas Costas/diagnóstico , Discite/diagnóstico , Vértebras Lombares/patologia , Idoso , Idoso de 80 Anos ou mais , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Ceftriaxona/uso terapêutico , Cefalosporinas/uso terapêutico , Diagnóstico Diferencial , Discite/tratamento farmacológico , Discite/microbiologia , Quimioterapia Combinada/uso terapêutico , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/tratamento farmacológico , Gentamicinas/uso terapêutico , Humanos , Masculino , Penicilinas/uso terapêuticoRESUMO
The chest radiographs and lung function tests of 41 patients attending the cystic fibrosis clinic at Royal Prince Alfred Hospital were reviewed. The chest radiographs were scored using three different scoring systems: the Shwachman and Kulczycki system (as modified by Doershuk), the National Institute of Health (NIH) system described by Taussig in 1973 and the Brasfield system. The scores were correlated with lung function tests. Significant correlations were found between the radiological scores and the respiratory variables; the best correlation was with the forced expiratory volume in one second (FEV1 % predicted). All three scoring systems showed a high degree of reproducibility of scores when a second radiologist was asked to score the same radiographs independently. The difference in scores between the radiologists was not significant for the NIH and the Brasfield systems. The Brasfield system is, however, the system of choice because it allows the assessment of all the major pathological features seen in cystic fibrotic chest films and consistently has the best agreement with all the lung function variables. It was also found that radiological evidence of lung hyperinflation may not be a good indicator of disease progression.
