Introduction
Lung
cancer incidence in all, the highest mortality rate, about 1.4 million people
worldwide die from lung cancer each year. Our lung cancer incidence and
mortality rates showed an increasing trend [1]. Lung cancer death in the first
place cause of death of, cancer accounted for 22.7% of total deaths, so assess
lung condition has become healthy in a very important part. Through physical
examination, a large part of the symptoms, physical signs of the early
detection of lung cancer patients. In the 20th century, chest physical
examination routine chest X-ray examination, but the misdiagnosis rate is
relatively high, mainly due to the poor resolution of the fluoroscopic image.
With the popularity of DR in the medical unit, with DR chest radiography
examination has replaced the chest X-ray. However, DR chest radiography
examination how effective is it? We need to summarize the various medical units
be verified actual data. This paper analyzes five consecutive 3 a unit in our hospital
DR chest radiography medical imaging data retrospectively, comparative analysis
3 a difference between the detection of lung nodules to demonstrate DR chest
radiography used in large quantities of healthy the value of.
Materials
and Methods
A
retrospective analysis from January 2010 to December 2012, a total of 15,595
units of five consecutive 3 a person in our hospital DR chest radiography
medical image data, the first year of 5150 the People's Bank DR chest
radiography examination, M 2 707, female 2443 people, aged 20 to 86 years, mean
age (48.35 ± 12.69) years; 2nd year 5263, of which there are 165 people in the
first year did not participate in the examination; the first three years of
5182 people, including 2 a front 57 people did not participate in the
examination. All medical staff when the body had no obvious symptoms.
Inspection
methods and image analysis
DR
equipment for the German production of digital X-ray photography system
directly. After the projection DR anterior chest films, camera films volunteers
were standing, feet apart the body to stand, chest close to the wall stand, the
face-body median projection centerline, elbows bent, two back against both
sides of the hip, both elbows forward as far as possible close to the wall
stand, so that both sides pull in order to avoid blocking the outer sides of
the scapula lung, shoulders flat into a horizontal position so that the
clavicle, the former patient is asked to take a deep breath gasped exposure
gas. Exposure parameters: 80 kV, automatic mAs (range: 25 ~ 35 mAs), more fat
people appropriately increase the value of several kV. Part of 60 years and
above line DR lateral chest examination. Projection chest after the main
console by image enhancement, transfer to DR imaging diagnostic workstation
dedicated vertical screen, make diagnoses after a mid-level titles and a senior
radiologists read the piece discussed. Patients diagnosed with lung nodules
which chest CT examination is recommended in order to further clarify the
lesion morphology, size and nature of the border.
Statistical
methods
Use
SPSS17.0 statistical software for analysis, 2010-2012 annual detection rate of
pulmonary nodules using χ2 test for pairwise comparisons, P <0.05 was
considered statistically significant.
Result
May 2010
150 DR chest radiography examination found 23 cases of pulmonary nodules, which
diagnosed with lung cancer surgery in 3 cases, 2 cases of inflammatory nodules,
tuberculoma four cases, and the remaining 14 cases regular follow observation.
2010 lung nodule detection rate of 0.447% (23/5 150). 2011 discovered two cases
of lung nodules, the two patients in 2010 did not participate in the
examination, of which 1 case diagnosed as lung cancer surgery, one patient
referral observation. 23 cases of patients with primary pulmonary nodules
discovered in 2010, only 13 cases reviewed in our hospital examination DR
chest, the rest 10 cases were followed up in hospital referral (surgical
treatment of lung cancer patients because the hospitals are referral future
examination). Surgical excision of benign lesions were reviewed DR chest shows
nodules original has disappeared, without surgery patient check DR chest
nodules pulmonary nodule unchanged. 2011 lung nodule detection rate of 0.038%
(263 2/5). 2012 new lung nodules found one case, the patient in the hospital
before 2 a chest X-ray examination showed no lesions DR, post-operative
pathology of the right lower lung invasive adenocarcinoma, violated the right
oblique fissure local pleura. 25 cases of lung nodules found in front of the
original 2 a in 17 cases to the hospital examination reviewed DR chest, no new
hair foci, and the remaining 8 exceptions hospital referral follow-up. 2012 lung
nodule detection rate of 0.020% (182 1/5).
Through to
3 a detection rate of lung nodules between two rows χ2 test, in 2010, a
comparison between the 2011, χ2 = 18.144, P = 0.000 <0.05, statistically
significant; in 2010, a comparison between the 2012, χ2 = 20.351, P = 0.000
<0.05, statistically significant; in 2011, a comparison between the 2012, χ2
= 0.318, P = 0.573> 0.05, not statistically significant.
Discuss
The group
of chest DR medical information: 5 units participate in the examination staff,
ranging in age from 20 years old to 80 years old, continuous 3 a medical
examination at the hospital, although a small number of staff in the first year
or second year or did not participate in the previous 2 a physical examination,
but overall there is not much impact on the findings. By χ2 test, in 2010, a
comparison between the 2011, P <0.05; a comparison between the 2010, 2012, P
<0.05, were statistically significant. But between 2011 and 2012, the
comparison, P > 0.05, no statistical significance. This shows that the first
year of DR chest radiography examination has basically been detected in
patients with lung nodules. 2-year lung nodules detected two cases of patients
is two people in 2011 for the first time to our hospital examination of 165
people, in fact, in 2011 the second parameter inspector DR radiography hospital
found no new lungs Patients with nodules, indicating lung nodules in my
hospital DR chest radiography examination for the first time has been basically
detected; the third year of the re-examination when new detection of lung
nodules although one case, but the contrast in the front 2 a hospital DR ray
examination showed no lesions, most likely due to the lower density of the
lesion was ground-glass non-solid nodules, DR chest X-ray can not tell could
not be detected. It has been reported, chest X-ray examination of pulmonary
nodules overall detection rate of 0.09% to 0.20%; and another one reported in
the literature, chest DR pulmonary nodule detection rate of 6.8% [4]; this
group Data for the first year of lung nodules detection rate of 0.447%. These
data show that,, DR chest there are some differences in different research
groups, the detection rate of pulmonary nodules, but the overall effect is
exactly detected.
Why this
group of medical staff in the hospital for the first time DR radiography
examination can find more number of pulmonary nodules and lung cancer? Analyze
the reasons, one part of the former Senate inspector did not participate in the
examination 1,2 a cause of some lesions not discover; then with other medical
units radiography and read the piece about the quality is not high. It has been
reported, DR ray screening for lung cancer nodules and film-reading ability and
experience diagnostician read the piece has a strong dependence. Therefore,
regular annual physical examination and selection of a good quality assurance
of the medical center is very important. 5 unit staff second and third years of
the new detection of pulmonary sarcoidosis rarely shows the vast majority of
lung nodules in patients in the first year have been screened out. Lei Yi et al
[4] reported chest DR sensitized to find lung nodules, is expected to become
one of the methods of screening for lung cancer. Therefore, DR radiography as a
screening lung nodules and lung cancer the most basic way higher value, the
method is simple, affordable, and radiation is very low, a single chest X-ray
radiation only DR and a single low-dose spiral CT scan radiation 1/10. There
have been reported in the literature, for lung cancer at high risk of periodic
chest radiograph did not reduce lung cancer mortality, but can improve the
early removal rate and prolong survival of patients with lung cancer. Hospital
patients with lung nodules, a large part of the DR chest radiography
examination found before symptoms, no signs, found after entering clinical
intervention, and then confirmed by the relevant examination or surgery.
However, DR radiography for pulmonary nodules (especially early lung cancer)
there is a limit of detection [9]. The first is the limitations of DR chest
itself, normal lung volume of about 26 percent in the chest radiograph was
overshadowed by the heart, mediastinum and diaphragm, others such as the clavicle,
ribs and blood vessels are also to cover up the structure of lung nodules can
not be ignored; followed by Early lung nodules small, low density, blurring the
edges with the surrounding lung tissue contrast is poor. These are likely to
lead to DR chest can not find some lung nodules.
The group
of medical information DR radiography detection of lung nodules and eventually
diagnosed with lung cancer in 5 patients, the youngest 58 years old, maximum 71
years old, belong to the category of age at high risk of lung cancer; no
symptoms and signs before the examination, and CT examination is not done;
physical examination DR radiography found lung nodules, the size of about 10
mm, did not exceed 20 mm, leaf obvious, and are in a lung field weeks; after
surgery and pathology more invasive lung adenocarcinomas cancer, partially
submerged and local pleura. According to a 2009 edition of the TNM staging of
lung cancer, more than five cases of lung adenocarcinoma stage Ia or Ib should
of, belong to the early lung cancer. DR radiography for <lung non-solid
nodule detection of 10 mm be difficult, but if nodules are more solid
components, DR radiography can be found. In this group there is a case, the
lung nodule diameter of about 5 mm, because of the substantially solid
component, it is clearly displayed on the DR chest; and if the solid component
of pulmonary nodules less, non-solid components frequently, DR radiography find
it more difficult, easily missed. We retrospectively analyzed the medical
detection of lung cancer patients the correct DR and CT data found that if
early 1 ~ 2 a low dose of their spiral CT, lung nodules more likely to be
detected early years, which can earlier clinical intervention. Such as lung cancer
is detected at the time of adenocarcinoma in situ or micro-invasive
adenocarcinoma, the effect will be better surgical resection, the 5 a survival
rate of 100 percent or close to 100% [11]. It has been reported, 10 a survival
rate of <10 mm of lung nodules after surgical resection 93%. It also shows
that early stage lung cancer at high risk of low-dose helical CT screening is
valuable.
The
possibility of checking is relatively small, one CT examination radiation and
economic costs are larger; the second is for all people, the risk of lung
cancer is a very small probability event, in which only high-risk groups is a
relatively large probability event ʱ?? It is suitable for large quantities of
DR chest chest healthy, and spiral CT for lung cancer screening for lung cancer
in high-risk groups, as well as DR ray found after further examination of lung
nodules. In 2013, the third edition of "lung cancer diagnosis and
treatment guidelines," American College of Chest Physicians (ACCP)
published stated, aged 55 to 74 years is recommended for patients at high risk
of lung cancer line of low-dose helical CT screening.
All in
all, DR chest radiography used in large quantities can effectively detect lung
nodules physical examination, chest physical examination and the results are
clearly the most common imaging equipment, but <lungs of non-solid nodule
detection of 10 mm have some difficulties.
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