ABSTRACT
PURPOSE: Many underserved remote locations without specialists would benefit from the ability to quickly and easily share images of radiographs with trained radiologists using WhatsApp messenger. However, there is limited evidence on the role of WhatsApp messenger for sharing chest x-ray (CXR) images to aid diagnosis and management. The objective of the study was to determine the diagnostic accuracy and inter-observer agreement of WhatsApp messenger images of digital CXR compared to viewing on Picture Archiving and Communication System (PACS) monitor. METHODS: Two pulmonologists reported 400 WhatsApp messenger images of digital CXR each. After a wash period of two weeks, they reviewed the original CXR images on PACS and again reported their findings. Diagnostic agreement was measured using kappa value, diagnostic accuracy was evaluated by sensitivity and specificity. RESULTS: The diagnostic agreement between WhatsApp and PACS images for both the readers was high in case of normal CXR (0.84), Pneumonia (0.85) and Active Koch's (0.79) and Old Koch's (0.71). The inter-observer agreement between two readers on WhatsApp images was good in cases of normal chest x-ray (0.74), Active Koch's (0.61) and Pneumonia (0.74) and low in COPD (0.31) and Pleural Effusion (0.28) and Carcinoma Lung (0.40). In terms of radiological lesion, inter-observer agreement between two readers on WhatsApp images was good in terms of the zonal involvement, moderate in case of infiltrates, consolidation, nodules, and fibrosis, fair in cavity, effusion (0.28) and poor in hilar lymphadenopathy (0.14). The sensitivity in the diagnosis of nodules, effusion and hilar lymphadenopathy was <50% in both the readers. CONCLUSION: CXR transmission via WhatsApp is able to identify clinical findings similar to viewing the same image on a PACS monitor in cases of Pneumonia and normal subjects. Active and old Koch's has good comparability whereas; diagnostic agreement is poor in COPD, cavity, pleural effusion and hilar lymphadenopathy, requiring more caution during interpretation.
Subject(s)
Lung Neoplasms/diagnostic imaging , Mobile Applications/standards , Pulmonary Disease, Chronic Obstructive/diagnostic imaging , Radiology Information Systems/standards , Adult , Aged , Cross-Sectional Studies , Female , Humans , India , Male , Medically Underserved Area , Middle Aged , Radiography, Thoracic , Reproducibility of ResultsABSTRACT
BACKGROUND: There is no experience of point-of-care (POC) microbiological confirmation for TB in India in field settings. METHODS: Under the TB-Free Haryana project, a mobile van-mounted digital x-ray and portable GeneXpert system screened all presumptive TB patients with strong clinic-radiological suspicion for TB. RESULTS: Of 1673 x-rays, 215 (13%) had findings suggestive of TB, 109 had strong clinical suspicion and were eligible for POC GeneXpert, in whom a test was performed in 82 (75%) cases; 59 (72%) tested positive and were initiated on treatment within 24 h. CONCLUSIONS: A mobile van equipped with digital x-ray and POC GeneXpert is feasible and has a good success rate with potential for replication.
Subject(s)
Nucleic Acid Amplification Techniques , Point-of-Care Systems , Humans , India , Rural Population , X-RaysABSTRACT
This is a case report of an unusual cause of bilateral diaphragmatic palsy. A 54-year-old gentleman, presented to us with exertional dyspnea and chest heaviness for the past 6 months which had increased in the last 6 days. Dyspnea increased on lying down. He was diagnosed as pneumonia on the basis of X-ray and chest CT scan, received treatment for the same and responded to the therapy. However, breathlessness and hypercapnia persisted. He had unexplained hypercapnia for which extensive investigations were carried out. Neurological and cardiac assessments were essentially normal. On revisit clinical examination, he was found to have paradoxical diaphragmatic movement with respiration. Ultrasound of chest detected no diaphragmatic movement. Detailed history elicited that patient was fond of neck massage and neck cracking wherein his barber would bend his neck with jerk to either side after a haircut.After considering all possible etiologies; we concluded that it was a case of diaphragm palsy induced by barber neck manipulation, leading to Type-2 respiratory failure. The fact that the vital clues to the diagnosis were elicited by detailed history and thorough examination reinforces that history and clinical examination for doctors shall remain a very important tool for clinical diagnosis.
