title: Evaluation of a new hands-up ergonomics for chest radiography in geriatric patients.
abstract: 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.
authors.affiliation: Departments of Radiology and Medical Imaging, Charles Foix Hospital, Paris, France. alain.le-blanche@cfx.ap-hop-paris.fr
authors.forename: Alain-Ferdinand
authors.initials: AF
authors.lastname: Le Blanche
authors.forename: Marc
authors.initials: M
authors.lastname: Bazot
authors.forename: Isabelle
authors.initials: I
authors.lastname: Frey
authors.forename: Sylvie
authors.initials: S
authors.lastname: Meaume
authors.forename: François
authors.initials: F
authors.lastname: Piette
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Carette
authors.forename: Sébastien
authors.initials: S
authors.lastname: Weill-Engerer
mesh_terms: 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