ABSTRACT
Background & objectives: Chest X-ray (CXR) is an important screening tool for pulmonary tuberculosis (TB). Accessibility to CXR facilities in difficult-to-reach and underserved populations is a challenge. This can potentially be overcome by deploying digital X-ray machines that are portable. However, these portable X-ray machines need to be validated before their deployment in the field. Here, we compare the image quality of CXR taken by a newly developed handheld X-ray machine with routinely used reference digital X-ray machine through the conduct of a feasibility study. Methods: A total of 100 participants with suspected pulmonary TB were recruited from the outpatient departments of a medical college and a community health centre in Agra. Each participant underwent CXR twice, once with each machine. Both sets of de-identified images were independently read by two radiologists, who were blinded to the type of X-ray machine used. The primary outcome was agreement between image qualities produced by these two machines. Results: The intra-observer (radiologist) agreements regarding the status of the 15 CXR parameters ranged between 74 per cent and 100 per cent, with an unweighted mean of 87.2 per cent (95% confidence interval: 71.5-100). The median Cohen’s kappa values for intra-observer agreement were 0.62 and 0.67 for radiologists 1 and 2, respectively. In addition, on comparison of the overall median score of quality of the image, the handheld machine images had a higher score for image quality. Interpretation & conclusions: The current study shows that a handheld X-ray machine, which is easy to use and can potentially be carried to any area, produces X-ray images with quality that is comparable to digital X-ray machines routinely used in health facilities.
ABSTRACT
RESUMO A representatividade da amostragem é fundamental para embasar a tomada de decisão, uma vez que a heterogeneidade da matriz é o principal fator para incerteza dos dados nos estudos de gerenciamento de áreas contaminadas. Neste estudo, coletaram-se 112 amostras de solo superficial em malha quadrada de 1 x 1 m, em uma área 15 x 6 m, no campus regional de Resende da Universidade do Estado do Rio de Janeiro. Anteriormente, no terreno funcionaram empresas de produção de filmes radiográficos e purificação de prata metálica. As amostras de solo foram analisadas por pXRF, método de screening para metais. Com base nos dados levantados, calculou-se, por meio de métodos estatísticos, a quantidade de amostras que permitiriam uma caracterização representativa da área, considerando um erro relativo de 20% para dois intervalos de confiança: 95 e 80%. As análises indicaram concentrações superiores aos valores de referência para os parâmetros prata, mercúrio, chumbo, selênio e zinco. Os resultados de mercúrio possivelmente referem-se a ruído espectral, não estando relacionados ao histórico de uso e ocupação. Os coeficientes de variação das concentrações dos elementos analisados variaram de 132 a 225%. Considerando uma distribuição lognormal, calcularam-se 76 amostras para o maior intervalo de confiança e 53 para o menor. Isso seria o equivalente a transectos com espaçamentos de 1,47 e 2,11 m. Os resultados ratificam a necessidade de investigações de alta resolução nas áreas fonte, conforme recomendado pela Decisão de Diretoria da Companhia Ambiental do Estado de São Paulo nº 038/2017/C (DD-038).
ABSTRACT The representativeness of the sampling is fundamental to support decisions, since the heterogeneity of the matrix is the main factor for data uncertainty in contaminated areas management studies. In this study, 112 surface soil samples were collected in a square mesh of 1 x 1 m, in an area of 15 x 6 m, at the Campus Regional de Resende (CRR) of Universidade do Estado do Rio de Janeiro (UERJ). Previously, companies of radiographic films production and metallic silver purification operated in this area. The soil samples were analyzed by pXRF, a screening method for metals detection. Based on the data collected, the number of samples that would allow a representative characterization of the area was calculated, using statistical methods, considering a relative error of 20% for 80 and 95% confidence intervals. The analyses indicated concentrations higher than the reference values for the parameters silver, mercury, lead, selenium, and zinc. The results of mercury possibly refer to spectral noise, not being related to the history of use and occupancy. The coefficient of variation of the soil obtained ranged from 132 to 225%. Considering a lognormal distribution, 76 samples were calculated for the highest confidence interval and 53 for the lowest. This would be the equivalent of transects with spacings of approximately 1.47 and 2.11 m. The results confirm the need for high resolution investigations in the source areas, as recommended by the Executive Board Decision of CETESB No. 038/2017/C (DD-038).
ABSTRACT
Objective: To demonstrate the use of a portable X-ray system at the scene.Patient: A 59-year-old man collapsed under a small power shovel and was discovered by his colleague. The fire department dispatched an ambulance and requested the dispatch of a doctor helicopter (DH) immediately after receiving the emergency call. When the staff of the DH used a portable X-ray system to assess the patient at the rendezvous point, he was found to have experienced a cardiac arrest with deformity of the face. Portable chest X-ray in the ambulance revealed decreased radiolucency of the lung fields without pneumothorax, and tracheal tube insertion was successful. Portable pelvic X-ray also showed no trauma. Portable cranial X-ray revealed orbital fracture. Although we urgently transported the patient to our hospital by the DH, he unfortunately died of circulatory arrest caused by his severe injuries. Based on the portable X-ray findings obtained at the scene, we suspected that the patient’s cardiac arrest had been caused by severe head and/or neck injuries.Conclusion: This portable X-ray system may be able to change and facilitate the management of patients with trauma dramatically by simplifying prehospital diagnoses even in rural areas.