Evaluation of a new hands-up ergonomics for chest radiography in geriatric patients.
OBJECTIVE
Pneumonia is the leading cause of death after the age of 85 years. Chest radiography (CXR) requires forced inspiration for accurate assessment, but kyphosis, denutrition, muscular weakness, and neurologic disorders limit active inspiration. The aim of this study was to evaluate a new passive expansion technique, by raising the patient's arms above the head, in the radiographic diagnosis of pneumonia.


METHODS
During a 10-month period, CXR were performed in 1452 geriatric patients for pulmonary acute disorders in our geriatric university hospital. When fewer than five anterior rib segments were visible on the conventional front view, a second CXR was performed with the patient's arms being raised above the head by a radiologist. The diagnostic questions were: Are more than five anterior rib segments present? Is pneumonia visible? The chest radiographs were independently analyzed (3-step confidence scale) by two radiologists and compared by interobserver kappa-coefficients calculation.


RESULTS
One hundred three patients (97 female, 6 male), representing 7% of the examined population, with an average age of 86.5 years (range, 70-104 years) were included. An additional anterior rib segment was visible on the front CXR when the arms were raised above the head (P < 0.001). Pneumonia was diagnosed in 59 patients with high agreement (kappa = 0.84) by the passive expansion technique, whereas the pneumonia infiltrate was visible in only 44 patients with considerably lower agreement (kappa = 0.36) when the arms were positioned along the trunk (P < 0.03).


CONCLUSIONS
Raising the arms above the head optimizes the quality of CXR and increases the detection of pneumonia in the geriatric patient. New ergonomics and adequate contention are required.
Le Blanche
Alain-Ferdinand
AF
Departments of Radiology and Medical Imaging, Charles Foix Hospital, Paris, France. alain.le-blanche@cfx.ap-hop-paris.fr
Bazot
Marc
M
Frey
Isabelle
I
Meaume
Sylvie
S
Piette
François
F
Carette
Marie-France
MF
Weill-Engerer
Sébastien
S
D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D006804:Ergonomics; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D011014:Pneumonia / Q000000981:diagnostic imaging*; D011187:Posture; D013902:Radiography, Thoracic / Q000379:methods; D018709:Statistics, Nonparametric