Emergency CT misdiagnosis in acute aortic syndrome

Objectives: This cross-sectional study assessed the accuracy of emergency CT reports at presentation in acute aortic syndrome (AAS). Methods: Retrospective identification of cases of AAS presenting within a large health board with three acute hospitals receiving adult patients between January 2013 and December 2016. CT studies and reports at presentation were reviewed for discrepancies related to diagnosis, complications and classification by two cardiovascular radiologists. The specialist interest of the original reporters, clinically suspected diagnosis at referral for CT and technical adequacy of the scans were also assessed. False-positive diagnoses were identified and evaluated separately. Results: Among 88 consecutive confirmed cases of AAS at least one discrepancy was identified in 31% (n = 27), including failure to identify or misinterpretation of the AAS itself in 15% (n = 13), haemorrhage in 13% (n = 11), branch involvement in 9% (n = 8), and misclassification in 3% (n = 3). All discrepancies occurred among the 80% (n = 70) of cases reported by radiologists without specialist cardiovascular interest. 26% (n = 23/88) of AAS cases were not clinically suspected at referral for CT and although this was associated with suboptimal protocols, only 51% of CT scans among suspected cases were technically adequate. Seven false-positive diagnoses were identified, three of which related to motion artefact. Conclusion: Significant discrepancies are common in the emergency CT assessment of positive cases AAS and this study highlights important pitfalls in CT technique and interpretation. The absence of discrepancies among radiologists with specialist cardiovascular interest suggests both suspected and confirmed cases warrant urgent specialist review. Advances in knowledge: CT angiography is central to the diagnosis of AAS; however, significant radiology discrepancies are common among non-specialists. This study highlights important pitfalls in both CT technique as well as interpretation and supports routine specialist cardiovascular imaging input in the emergency assessment of AAS.

Estimating rotation angle from asymmetric projection of chest

BACKGROUND: Manual or machine-based analysis of chest radiographs needs the images acquired with technical adequacy. Currently, the equidistance between the medial end of clavicles and the center of spinous processes serves as the only criterion to assess whether a frontal PA chest radiograph is taken with any rotation. However, this measurement is normally difficult to implement because there exists overlapping of anatomies within the region. Moreover, there is no way available to predict exact rotating angles even the distances were correctly measured from PA chest radiographs. OBJECTIVE: To quantitatively assess positioning adequacy of PA chest examination, this study proposes and investigates a new method to estimate rotation angles from asymmetric projection of thoracic cage on radiographs. METHOD: By looking into the process of radiographic projection, generalized expressions have been established to correlate rotating angles of thorax with projection difference of left and right sides of thoracic cage. A trunk phantom with different positioning angles is employed to acquire radiographs as standard reference to verify the theoretical expressions. RESULTS: The angles estimated from asymmetric projections of thoracic cage yield good agreement with those actual rotated angles, and an approximate linear relationship exists between rotation angle and asymmetric projection of thoracic cage. Under the experimental projection settings, every degree of rotation corresponds to the width difference of two sides of thoracic cage around 13–14 pixels. CONCLUSION: The proposed new method may be used to quantify rotating angles of chest and assess image quality for thoracic radiographic examination.

Validity of Automated Text Evaluation Tools for Written-Expression Curriculum-Based Measurement: A Comparison Study

Existing approaches to measuring writing performance are insufficient in terms of both technical adequacy as well as feasibility for use as a screening measure. This study examined the validity and diagnostic accuracy of several approaches to automated essay scoring as well as written expression curriculum-based measurement (WE-CBM) to determine whether an automated approach improves technical adequacy. A sample of 140 fourth grade students generated writing samples that were then scored using traditional and automated approaches and examined with the statewide measure of writing performance. Results indicated that the validity and diagnostic accuracy for the best performing WE-CBM metric, correct minus incorrect word sequences (CIWS) and the automated approaches to scoring were comparable with automated approaches offering potentially improved feasibility for use in screening. Averaging scores across three time points was necessary, however, in order to achieve improved validity and adequate levels of diagnostic accuracy across the scoring approaches. Limitations, implications, and directions for future research regarding the use of automated scoring approaches for screening are discussed.

Towards a Functional Approach to the Assessment of Daily Life Physical Activity in Children: Are the PAQ-C and Fitbit Flex-2 Technically Adequate?

Considering the need for functional physical activity (PA) measures in PA settings, this study sought to determine the technical adequacy of the Physical Activity Questionnaire for Older Children (PAQ-C) and the Fitbit Flex-2, two instruments with promising features for wide use, using the Actigraph GT3X+ accelerometer as the criterion reference. A total of 218 Greek children (94 boys, 124 girls; mean age = 10.99 ± 1.52 years) volunteered to join in. Participants wore the PA trackers for seven days and completed the PAQ-C. Moreover, a sub-group (n = 60) recompleted the PAQ-C after a week. Results revealed acceptable internal consistency and excellent test–retest reliability for the PAQ-C. Regarding concurrent validity, weak to moderate correlations with PA parameters recorded by the GT3X+ were revealed for the total PAQ-C and were excellent for the Flex-2, while a Bland–Altman plot indicated good agreement. Finally, in alignment with relevant literature, significant gender, but no age, differences were found in participants’ PA records in all the tools applied. The above results support the use of the PAQ-C and the Fitbit Flex-2 in children. Considering that they shed light into different parameters of children’s habitual PA, their combined utilisation, providing comprehensive information, is strongly recommended.

Psychometric Properties of the Assessment, Evaluation, and Programming System for Infants and Children–Third Edition (AEPS-3)

The purpose of this article is to provide evidence of the technical adequacy of the Assessment, Evaluation, and Programming System–Third Edition (AEPS-3). The AEPS has long been identified as one of the most psychometrically sound early childhood curriculum-based assessments. In this article, results of three studies of technical adequacy are reviewed. First, a utility study was conducted to examine the degree to which teachers and providers found the AEPS-3 useful for its intended purposes (i.e., goal development and programming). Second, we examined the interrater reliability of the AEPS-3 by having teachers and providers view videotapes and score AEPS-3 items. Finally, a concurrent validity study was conducted, whereby a group of children were assessed using a norm-referenced assessment and the AEPS-3. Results of all three studies show provide early evidence that the AEPS-3 is psychometrically sound.