title: Chest x-ray as a primary modality for preoperative imaging of pectus excavatum.
abstract: BACKGROUND
  Adolescents with a pectus excavatum mostly present with cosmetic complaints and rarely have significant physical limitations. The preoperative evaluation includes pulmonary functions tests, echocardiography, and chest computed tomography (CT) scan to measure the Haller index. In most patients, the chest CT is performed only to measure the Haller index. The purpose of this study was to evaluate whether indices measured on chest radiograph (CXR) and CT scan are comparable.
  
  
  METHODS
  Cases of pectus excavatum treated with the minimally invasive approach in the last year were prospectively collected. In patients for whom a preoperative CXR and CT scan were available, an index was measured using both imaging modalities and compared.
  
  
  RESULTS
  Both preoperative imaging studies were available in 12 patients. The mean Haller indices on CT scan and CXR were 3.97 and 4.08, respectively. The Pearson correlation score between the 2 groups was 0.984.
  
  
  CONCLUSIONS
  We propose that the Haller index measured on CT scan be replaced by CXR measurement in asymptomatic patients in whom a chest CT scan is otherwise not necessary. This will limit radiation exposure to children. When in doubt, a CT scan of the chest can be used for the preoperative evaluation.
authors.affiliation: Department of Surgery, Sainte-Justine Hospital, Montreal, PQ, Canada.
authors.forename: Claudia
authors.initials: C
authors.lastname: Mueller
authors.forename: Dickens
authors.initials: D
authors.lastname: Saint-Vil
authors.forename: Sarah
authors.initials: S
authors.lastname: Bouchard
mesh_terms: D000293:Adolescent; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000000981:diagnostic imaging* / Q000601:surgery*; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011300:Preoperative Care / Q000379:methods; D013902:Radiography, Thoracic / Q000379:methods*; D018570:Risk Assessment; D012720:Severity of Illness Index; D019616:Thoracic Surgical Procedures / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome