Abstract
Introduction
Our objective was to measure the diagnostic accuracy of a novel software technology
to detect pneumothorax on Brightness (B) mode and Motion (M) mode ultrasonography.
Methods
Ultrasonography fellowship-trained emergency physicians performed thoracic ultrasonography
at baseline and after surgically creating a pneumothorax in eight intubated, spontaneously
breathing porcine subjects. Prior to pneumothorax induction, we captured sagittal
M-mode still images and B-mode videos of each intercostal space with a linear array
transducer at 4 cm of depth. After collection of baseline images, we placed a chest tube, injected
air into the pleural space in 250 mL increments, and repeated the ultrasonography for pneumothorax volumes of 250 mL, 500 mL, 750 mL, and 1000 mL. We confirmed pneumothorax with intrapleural digital manometry and ultrasound by
expert sonographers. We exported collected images for interpretation by the software.
We treated each individual scan as a single test for interpretation by the software.
Results
Excluding indeterminate results, we collected 338 M-mode images for which the software demonstrated a sensitivity of 98% (95% confidence
interval [CI] 92–99%), specificity of 95% (95% CI 86–99), positive likelihood ratio
(LR+) of 21.6 (95% CI 7.1–65), and negative likelihood ratio (LR−) of 0.02 (95% CI 0.008–0.046). Among 364 B-mode videos, the software demonstrated
a sensitivity of 86% (95% CI 81–90%), specificity of 85% (81–91%), LR+ of 5.7 (95% CI 3.2–10.2), and LR− of 0.17 (95% CI 0.12–0.22).
Conclusions
This novel technology has potential as a useful adjunct to diagnose pneumothorax on
thoracic ultrasonography.
Keywords
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis.Chest. 2011; 140: 859-866
- The accuracy of physical examination in identifying significant pathologies in penetrating thoracic trauma.Eur J Trauma Emerg Surg. 2015; 41: 647-650
- Diagnostic accuracy of chest ultrasonography versus chest radiography for identification of pneumothorax: a systematic review and meta-analysis.Tanaffos. 2014; 13: 29-40
- Automatic focused assessment with sonography for trauma exams.in: Google patents. 2016
- International evidence-based recommendations for point-of-care lung ultrasound.Intensive Care Med. 2012; 38: 577-591
- Computerized diagnostic assistant for the automatic detection of pneumothorax on ultrasound: a pilot study.West J Emerg Med. 2016; 17: 209-215
- Vented versus unvented chest seals for treatment of pneumothorax and prevention of tension pneumothorax in a swine model.J Trauma Acute Care Surg. 2013; 75: 150-156
- Adherence evaluation of vented chest seals in a swine skin model.Injury. 2016; 47: 2097-2104
- The pathophysiology of tension pneumothorax in ventilated swine.J Emerg Med. 1997; 15: 147-153
- Diagnostic accuracy studies: how to report and analyse inconclusive test results.BMJ. 2013; 346: f2778
- The jackknife estimate of variance.Ann Stat. 1981; 9: 586-596
- Evaluation of computer-aided detection and diagnosis systems.Med Phys. 2013; 40: 087001
- Anniversary paper: history and status of CAD and quantitative image analysis: the role of medical physics and AAPM.Med Phys. 2008; 35: 5799-5820
- Radiological medical device innovation: approvals via the premarket approval pathway from 2000 to 2015.J Am Coll Radiol. 2017; 14: 24-33
- Computer aided diagnosis of coronary artery disease, myocardial infarction and carotid atherosclerosis using ultrasound images: a review.Phys Med. 2016;
- Automated computer-assisted diagnosis of obstructive coronary artery disease in emergency department patients undergoing 256-slice coronary computed tomography angiography for acute chest pain.Am J Cardiol. 2015; 116: 1017-1021
- Clinical utility of ventricular repolarization dispersion for real-time detection of non-ST elevation myocardial infarction in emergency departments.J Am Heart Assoc. 2015; 4
- Automated B-line scoring on thoracic sonography.J Ultrasound Med. 2013; 32: 2185-2190
- Computer-aided quantitative ultrasonography for detection of pulmonary edema in mechanically ventilated cardiac surgery patients.Chest. 2016; 150: 640-651
- A computer aided diagnostic system for detecting diabetic retinopathy in optical coherence tomography images.Med Phys. 2016;
- Using acoustic structure quantification during B-mode sonography for evaluation of Hashimoto thyroiditis.J Ultrasound Med. 2015; 34: 2237-2243
- Histogram-based feature extraction from individual gray matter similarity-matrix for Alzheimer's disease classification.J Alzheimers Dis. 2017; 55: 1571-1582
- Enhanced characterization of solid solitary pulmonary nodules with Bayesian analysis-based computer-aided diagnosis.World J Radiol. 2016; 8: 729-734
- Automatic colorectal polyp detection in colonoscopy video frames.Asian Pac J Cancer Prev. 2016; 17: 4869-4873
- Computer-aided diagnosis of breast cancer using cytological images: a systematic review.Tissue Cell. 2016; 48: 461-474
- Computer-aided detection of prostate cancer with MRI: technology and applications.Acad Radiol. 2016; 23: 1024-1046
- Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis.Chest. 2012; 141: 703-708
- Using thoracic ultrasonography to accurately assess pneumothorax progression during positive pressure ventilation: a comparison with CT scanning.Chest. 2013; 143: 415-422
- A porcine pneumothorax model for teaching ultrasound diagnostics.Acad Emerg Med. 2012; 19: 586-592
- The intrapleural volume threshold for ultrasound detection of pneumothoraces: an experimental study on porcine models.Scand J Trauma Resusc Emerg Med. 2013; 21: 11
- Teaching chest ultrasound in an experimental porcine model.Pediatr Emerg Care. 2016; 32: 768-772
- A porcine training model for ultrasound diagnosis of pneumothoraces.J Emerg Med. 2011; 41: 176-181
Article Info
Publication History
Published online: April 01, 2017
Accepted:
March 30,
2017
Received in revised form:
March 21,
2017
Received:
March 6,
2017
Identification
Copyright
Published by Elsevier Inc.
