The Detection of Pneumothorax and How Dual-Energy Can Help

Pneumothorax, or a collapsed lung that occurs when air enters the space around the lungs, is a condition that poses diagnostic problems. Although common tests, such as lung sonography, ultrasound, CT scan and X-ray are often performed, some cases may be misdiagnosed. This could present a life-threatening situation due to the immediate treatments often needed for this medical emergency.

Several studies on patient safety look at iatrogenic (caused by medical procedure) pneumothorax in American hospitals. Healthgrades 2020 Patient Safety Excellence Award infographic reported that from 2016-2018 there were more than 44,000 Medicare patients in U.S. hospitals diagnosed with a collapsed lung due to a procedure in or around the chest alone. There are also at least 10,000 cases per year in Canada².

A recent study in France, published in 2018, calls the condition common and reports 17 out of 100,000 people are affected there, with 34.8 out of 100,000 people in England estimated to be affected by pneumothorax as well⁴.

A team of doctors studied the detection of pneumothorax and the value of using dual-energy digital radiography, as well as the impact of medical specialty. They looked at forty patients with a suspected pneumothorax and divided them into groups based on their final diagnosis – whether they were thought to have this issue or not. They were able to compare and analyze standard images, dual-energy bone subtracted images and a combination in specific sessions. Doctors with various levels of expertise were included in the study.

They found that bone subtracted dual-energy thoracic radiographs improved the detection of pneumothorax, including small pneumothoraxes, regardless of the medical specialty or reader’s level of expertise.

In fact, dual-energy bone subtraction radiographs yielded the greatest increase in detection, even when used alone. The study reported the positive result in diagnostic performance with a sensitivity and specificity for pneumothorax detection as 82% and 92%, compared to 70% and 84% in sensitivity and specificity for conventional radiographs⁴. The physicians in this case recommended the use of dual-energy bone subtraction for suspected pneumothorax without hesitation.

Dual-energy radiography is an expanding technique and has demonstrated improvement in the detection of calcified and noncalcified lung nodules, and calcified thoracic lesions, mediastinal, pleural, or pulmonary. This technique supresses bone structures of the thoracic wall, reduces superimposition and allows for finer delimitation of lung contours.

KA Imaging’s Reveal, a dual-energy X-ray detector that has received USA FDA 510 (k) clearance as well as a Health Canada Medical Device Licence, is a unique and fitting solution to help in the diagnostic process. 

Reveal is a portable detector that enables bone and soft-tissue differentiation without motion artifacts in a single X-ray exposure. It can replace existing X-ray detectors and is also retrofittable to existing X-ray systems. Reveal increases sensitivity compared to conventional X-ray to aid in the early diagnosis and monitoring of pulmonary conditions. It is much more affordable than other fixed dual-energy systems, at less than a quarter of the price, and can be taken right to a patient’s bedside in an emergency room setting.

Reveal uses significantly less radiation than a CT and provides clearer images than a conventional X-ray. In one shot, the detector simultaneously delivers DR, bone, and tissue images.

References

1. Right Diagnosis from Healthgrades. Statistics about Pneumothorax. https://www.rightdiagnosis.com/p/pneumothorax/stats.htm
2. Healthgrades. Patient Safety 2020 Infographic. https://www.healthgrades.com/quality/patient-safety-2020-infographic
3. Reed, K. May, R., et al. (2011) Healthgrades Patient Safety in American Hospitals Study. HealthGrades, Guiding America to Better Healthcare. https://patientsafetymovement.org/wp-content/uploads/2016/02/Resources_Reports_Patient_Safety_in_American_Hospitals_Study.pdf
4. Urbaneja, A., Dodin, G., Hoosu, G., et al. (2018) Added Value of Bone Subtraction in Dual-energy Digital Radiography in the Detection of Pneuomothorax: Impact of Reader Expertise and Medical Specialty. The Association of University Radiologists. Elsevier Inc.