With pneumothoraces potential for rapid clinical deterioration, timely recognition and intervention are crucial. As advancements in imaging technology continue to evolve, such as more accessible dual-energy X-ray techniques like SpectralDR, there is a growing opportunity to enhance diagnostic accuracy and patient outcomes. Keep reading to learn about the diagnostic challenges faced by radiologists, and innovative solutions that improve imaging quality for better detection and treatment.
Pneumothorax and Its Implications
Pneumothorax is a medical condition that occurs when air leaks into the space between the lungs and the chest wall, known as the pleural cavity. This accumulation of air can cause the lung on the affected side to collapse, leading to serious respiratory and cardiovascular issues. Air in the pleural space compresses the lungs and restricts venous return and cardiac blood flow. Pneumothorax has various types and causes to account for in treatment, including:
Spontaneous Pneumothorax: Spontaneous Pneumothorax occurs without any traumatic injury or external cause.
- Primary Spontaneous Pneumothorax: Frequently seen in young, healthy individuals, particularly tall males between the ages of 18 and 30. It’s caused by the rupture of small air blisters (blebs) on the lung surface.
- Secondary Spontaneous Pneumothorax: This type of spontaneous pneumothorax is shown in individuals with existing lung diseases, such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, or pneumonia.
Traumatic Pneumothorax: In contrast to the spontaneous type, traumatic pneumothorax results from physical injury to the chest. It is caused by:
- Blunt trauma, such as a car accident or sports injury.
- Penetrating trauma, such as a stab wound.
- Medical procedures, such as line insertion, thoracentesis or lung biopsy.
Tension Pneumothorax: Tension Pneumothorax is a severe and life threatening type of pneumothorax caused by air entering the pleural space without being able to escape. This is life threatening, as the accumulated air will eventually compress the lungs, heart, and other internal organs if left untreated.
Treating cases of pneumothorax requires immediate medical intervention and constitutes a medical emergency. For health professionals, not being able to identify the signs of pneumothorax is detrimental to patient outcomes. The sooner pneumothorax can be diagnosed, the better chance they have of providing effective life-saving care.
The Challenge of Pneumothorax in Radiology
Chest X-rays and CT scans are used to detect pneumothoraces. Radiology plays a crucial role in identifying a wide range of chest-related issues, including pneumonia and various cardiovascular conditions. However, pneumothoraces present unique challenges for medical x-ray imaging and diagnosis.
A chest X-ray can detect air in the pleural space and assess the degree of lung collapse. This air is visualized as a visceral pleural line that separates the lung from the chest wall. The area beyond this line will show clear space with no vascular markings, indicating the presence of air. However, there are significant challenges in pneumothorax identification, as both the air and the lungs appear dark on X-ray scans. For X-ray technologies with limited contrast, diagnosing pneumothorax can be extremely difficult. CT scans can be used for more detailed imaging, but they come with additional costs and time delays without treatment.
These challenges have resulted in frequent misdiagnosis of pneumothorax. This study by M H Kollef found that misdiagnosed patients in the ICU were more likely to see their condition escalate to tension pneumothorax than patients who were diagnosed early. These findings are concerning, as tension pneumothorax is extremely dangerous. One of the main reasons for misdiagnosis was attributed to the radiographic location of the pneumothorax.
How Radiologists Diagnose Pneumothorax
An upright (standing) X-ray provides the best view for detecting small pneumothoraces. For patients who cannot stand, a lateral decubitus view (where the patient lies on their side) is also applicable since the air will rise to the top of the pleural space. If the lung’s collapse is not yet visually apparent, diagnosis becomes complicated. In tension pneumothorax, the mediastinum may shift toward the opposite side, which can be a critical indicator of the severity of the condition.
The Historical Limitations of Dual Energy X-ray
During its inception, dual energy X-ray technology held the potential to transform the diagnosis of pneumothorax. Its ability to differentiate between materials significantly improved visualization. Studies conducted during the early adoption of dual energy showed that soft tissue images helped doctors diagnose pneumothorax more accurately. Even small cases of pneumothorax could be detected by clinicians with little experience. The results of this study stated that small cases with a pneumothorax were detected 82-92% of the time (in comparison to 70-84% with non-dual energy x-ray scans).
Despite the fact that dual energy was proposed to be more effective, not many medical institutions adopted the technology at the time. Traditional dual energy X-ray presented noticeable obstacles, making it difficult to achieve consistent results. This technology required two separate exposures, which increased the instances of motion artifacts. Additionally, two exposures meant a higher radiation dosage.
The Modern Dual-Energy Solution: Reveal 35C for Pneumothorax
Nearly 50 years since the introduction of dual energy, this technology has evolved tremendously. Researchers at KA Imaging sought to develop innovative X-ray technologies, part of which included enhancing the effectiveness of X-ray scans for diagnosis. In 2019, KA Imaging developed and clinically trialed its latest advancement in dual-energy X-ray technology, the Reveal 35C.
Reveal 35C not only enhances the image quality and power level of dual-energy X-ray but also resolves many of the challenges encountered during the early development of this technology. KA’s patented SpectralDR technology enables Reveal 35C to produce three radiographic images. Users receive a conventional radiographic image, as well as images for soft tissue and bone/calcium. All of this is accomplished with only one exposure, completely eliminating the risk of motion artifacts and the need for higher radiation dosages due to dual exposure. This advancement is significant, as clinicians can now analyze soft tissue without the interference of bones and medical devices, which often obscure important diagnostic indicators. Reveal 35C has effectively amplified the benefits of dual energy imaging while bypassing its notable drawbacks.
How Reveal35C Enables Diagnosis of Pneumothorax
The soft tissue image acquired from the Reveal 35C is particularly useful for detecting pneumothorax. By excluding the presence of ribs and other potential obstructions, indicators of pneumothorax are more clearly visualized. Clinicians can visualize pneumothorax without the distraction of obscuring shadows, such as those caused by skin folds, which further complicate diagnosis.The additional images may particularly aid the non-radiologist clinicians in making the diagnosis.
The images above show results from an X-ray using the Reveal 35C. They are arranged with the conventional X-ray image on the left, the soft tissue image in the middle, and the bone image on the right. The accumulated air (a crucial pneumothorax indicator) is highlighted on the patient’s left side. The bone image also shows a rib fracture, indicating the cause of the pneumothorax.
Conventional chest X-rays do not acquire the same level of medical information as Reveal 35C. Though CT scans, as previously mentioned, offer more detailed visualization, they are also costlier than the Reveal 35C dual energy scan and require more radiation exposure. Additionally, in ICU settings they usually require risky transport of patients to the CT imaging suite. Thus, Reveal 35C has the potential to be an effective solution in certain clinical settings.
Interested in learning more about this streamlined dual energy solution? Request a demo of the Reveal 35C today!
Pneumothorax is a serious medical condition that requires prompt and accurate diagnosis for effective treatment. Advances in radiology, particularly with the development of dual-energy X-ray technology like Reveal 35C, provide clinicians with enhanced imaging capabilities that improve the detection of pneumothorax. As this technology continues to evolve, it holds promise for better patient outcomes and streamlined diagnostic processes.
